Ch. 21 - Antidepressant Agents
A patient diagnose with type 1 diabetes mellitus is receiving insulin. The physician has prescribed a monoamine oxidase inhibitor (MAOI) to treat this patient's depression. What interaction will the nurse know to observe for with this drug combination? A) Increased risk of hypoglycemia B) Increased risk of hyperglycemia C) Bradycardia D) Hypotension
A
A patient explains to a nurse that he had been taking amitriptyline (Elavil) for depression and that his physician changed his medication to paroxetine (Paxil). The patient is confused and doesn't understand why the medication was changed. The nurse's best response to the patient would be what? A) "Would you like to talk with your physician about this?" B) "Did you take the amitriptyline like you should have?" C) "Maybe the old medicine wasn't working anymore." D) "Paroxetine is newer and will be much better for you."
A
A patient has been taking Prozac for the past 3 years for depression. She is seeing her gynecologist for pre-menopausal symptoms and during the interview with the nurse she says that "she would like to try sarafem because her friend is taking it and she says it works great." The nurse's best response is what? A) "These two drugs are the same class and should not be taken together." B) "This is a good idea. We will talk to your physician about this." C) "The doctor will probably decrease the dosage of Prozac if you take sarafem." D) "If you do take both of these drugs, take one in the morning and one at night."
A
A patient is admitted to your unit with OCD. What drug has been found to be effective for treating OCD? A) Fluvoxamine B) Phenelzine C) Desipramine D) Amitriptyline
A
An 18-year-old leaves the clinic with a prescription for imipramine. Imipramine is used to relieve symptoms of depression and what else? A) Enuresis B) Encopresis C) Ecthyma D) Empyema
A
Obsessive-compulsive disorder (OCD) is a disorder that remains under investigation as to its actual neurophysiology. What TCA is now approved by the FDA to treat OCD? A) Clomipramine B) Imipramine C) Nortriptyline D) Amitriptyline
A
You are caring for a 75-year-old male brought to the Emergency Department by his family because he is "talking to people who aren't there." During the initial admission assessment the daughter mentions that her mother died 4 months ago and "Dad just hasn't been the same. The doctor has even put him on antidepressant medication. I go by the house every day to make sure he takes his medication." What would the nurse suspect is happening to this patient? A) The patient is having hallucinations as an adverse effect of his antidepressant medication. B) The mental status change is due to the patient's age. C) The patient probably has a urinary tract infection. D) The patient is having delusions because of his antidepressant.
A
The nurse interviews the family of a patient hospitalized with severe depression and suicidal ideations. What assessment data is important in planning this family's plan of care? (Mark all that apply.) A) Recent suicide attempts B) GI obstruction C) Affect D) Physical pain E) Personal responsibilities
A, B, C
A patient is prescribed sertraline (Zoloft). What adverse effects should the nurse include for this patient when developing a medication teaching plan? (Mark all that apply.) A) Agitation B) Agglutination C) Sleep disturbance D) Intermittent tachycardia E) Dry mouth
A, C, E
It has been postulated that depression may be a syndrome that reflects either activity or lack of activity in what areas of the brain? (Mark all that apply.) A) Limbic system B) Corpus callosum C) RAS D) Substantia Nigra E) Basal ganglia
A, C, E
A 10-year-old is being seen by a physician for severe depression. The physician prescribes an antidepressant. What antidepressant would the nurse expect to receive orders for? A) Trazodone B) Nortriptyline C) Luvox D) Phenelzine
B
A patient comes to the clinic because they are feeling depressed and have had some weight gain. The physician prescribes tranylcypromine (Parnate) 10 mg PO bid for an atypical depression. When prescribed in this manner when would you expect the drug to reach peak levels in the body? A) 1-2 hours B) 2-3 hours C) 3-4 hours D) 4-5 hours
B
Antidepressants carry a "Black Box" warning about the increased risk of suicide in what age group? A) Infants and children B) Children and adolescents C) Adolescents and adults D) Adults and older adults
B
The mental health nursing instructor is talking with her class about depression. She should tell the students that a deficiency in what will result in depression? A) Epinephrine B) Norepinephrine C) Acetylcholine D) Gamma-aminobutyric acid
B
While studying for an upcoming pharmacology test a student asks his peers what drug would be more effective against depression characterized by anxiety and sleep disturbances. What one of the choices below would apply? A) Buproprion (Wellbutrin) B) Imipramine (Tofranil) C) Fluvoxamine (Luvox) D) Tranylcypromine (Parnate)
B
Your patient has been severely depressed since her father died 6 months ago. The physician has prescribed amitriptyline. The nurse reviews the patient's chart prior to administering the medication. What pre-existing condition would require cautious use of this drug? A) Osteosarcoma B) Hepatic disease C) Closed head injury D) Bleeding ulcer
B
A nurse is working with a 9-year-old child who exhibits signs and symptoms of obsessive-compulsive disorder. Which of the following drugs will be prescribed for the child? A) Phenelzine (Nardil) B) Amitriptyline (Elavil) C) Fluvoxamine (Prozac) D) Isocarboxazid (Marplan)
C
The biogenic amine theory of depression states that there are 3 reasons for depression. One of those reasons is what? A) A slowing of the action of the neurons may lead to their depletion B) Monoamine oxidase (MAO) strengthen biogenic amine down to be recycled or restored in the neuron C) The number or sensitivity of postsynaptic receptors may increase D) NE may be depleted because biogenic amines feed off of loose particle of the neurotransmitter
C
The nurse is caring for a patient who is taking amitriptyline for depression. What nursing intervention would be most appropriate if this patient developed orthostatic hypotension? A) Instructing the client to double the dosage until the adverse effect goes away B) Consulting with the physician to change the medication C) Ask the patient to sit on the side of the bed for 1 minute before getting up D) Informing the patient this adverse reaction should be gone in a week
C
When teaching a patient on an MAO inhibitor, what would be important to include in the teaching? A) Take at bedtime B) Drink lots of fluid C) Do not take OTC drugs D) Report double vision right away
C
You are writing a care plan for a patient on an SSRI. What would be an appropriate nursing diagnosis for this patient? A) Monitor patient for up to 4 weeks B) Establish suicide precautions C) Disturbed thought processes and disturbed sensory perception (kinesthetic, tactile) related to CNS effects D) Imbalanced nutrition: More than required related to GI effects
C
A 12-year-old patient is hospitalized with severe depression. The patient has been taking a selective serotonin reuptake inhibitor (SSRI). Which of the following is a priority nursing action for the patient? A) Monitor food intake for levels of tyramine B) Assess for increased bleeding C) Monitor the patient for severe headaches D) Implement suicide precautions
D
A patient comes to the mental health clinic for a regular appointment. The patient tells the nurse they have been taking fluoxetine (Prozac) 20 mg PO daily for the past 3 weeks and that they have lost 3 pounds during that time due to a loss of appetite. What action should the nurse take? A) The physician should increase the dosage of the medication. B) The physician should change the medication. C) She will inform the patient that they need to increase their fluid intake. D) She will inform the patient that a decrease in weight is normal with this medication.
D
A patient is starting on a selective serotonin reuptake inhibitor for depression. What will the nurse instruct the patient about taking the medication? A) The dosage cannot be divided B) It needs to be taken with 8 ounces of liquid C) The dosage may need to be increased if they are not feeling better in 2 weeks D) The medication should be taken once a day in the morning
D
A patient with a diagnosis of depression is taking an MAO inhibitor. The patient is admitted to your unit with a presumed diagnosis of colon cancer. As the nurse caring for the patient you know that you should have what drug on standby in case of an adverse reaction? A) Pseudotension B) Prebiced C) Phynelalanine D) Phentolamine
D
A patient with a severe depression has been hospitalized and the physician has ordered amitriptyline. What common adverse effect might this patient have? A) Fever B) Hypertension C) Decreased B/P D) Dry mouth
D
Antidepressants work in more than one way. What is the physiological action of tricyclic antidepressants? A) Inhibits monoamine oxidase inhibitors that break down norepinephrine and serotonin B) Inhibits nerve activity, which prevents over excitability or stimulation C) Blocks the reuptake of serotonin, which increases the levels of serotonin in the synaptic cleft D) Inhibits presynaptic reuptake of norepinephrine and 5HT, which causes an accumulation of these neurotransmitters in the synaptic cleft and increases stimulation of the postsynaptic receptors
D
The emergence of psychotropic medications has given us the ability to target specific actions in the brain as treatment for mental illness. What psychotropic medication is an MAO inhibitor? A) Valium B) Halcion C) Paxil D) Nardine
D
The nurse refers a patient to a psychiatrist for medication to treat a severe anxiety disorder. What medication does the nurse expect the patient to be given? A) Chlorpromazine (Thorazine) 25 mg PO tid B) Benztropine (Cogentin) 2 mg PO bid C) Clozapine (Clozaril) 200 mg PO bid D) Paroxetine (Paxil) 10 mg po qd
D
Venlafaxine (Effexor) is an antidepressant that has become more popular with adults in treating their depression. Why has it become more popular? A) It is an oral drug. B) It doesn't have side effects. C) It can be taken during pregnancy. D) An extended release form is available.
D