Ch 21: Antidepressants

After teaching a client who is to receive transdermal selegiline, which client statement would indicate to the nurse that the client has understood the instructions?

"I can apply a new patch to my upper arm, thigh, or torso."

The nurse is interviewing the client who is to receive a tricyclic antidepressant. Which client statement should alert the nurse to a likely contraindication?

"I had a myelogram yesterday."

A client has been taking fluoxetine (Prozac) for the last ten days and calls the clinic reporting not feeling any better. What is the nurse's best response to this client?

"It may take another two to three weeks before the medication is completely effective."

A new mother asks her nurse about the safety of taking St. John's wort for postpartum depression. What would be the nurse's best response?

"There is insufficient evidence to support the use of St. John's wort, and drug interactions may be extensive."

What instructions should a nurse include when teaching a client who has depression about the use of amitriptyline?

"Use sugarless hard candies and gum to deal with dry mouth."

A nurse educating a client starting phenelzine (Nardil) should educate the client to avoid which foods? (Select all that apply.)

-Blue cheese -Pepperoni -Chocolate

A client taking phenelzine (Nardil) is at a dinner party and has several glasses of red wine. The client begins to feel nauseated and develops a terrible headache. The client is taken to the nearest emergency department. This client might be experiencing a hypertensive crisis. As the nurse in the ED, what other symptoms might the client experience if they are having a hypertensive crisis? (Select all that apply.)

-Chest pain -Tachycardia -Stiff neck

A nurse should be cautious when administering amitriptyline (Elavil) to which clients? (Select all that apply.)

-Clients with cardiac disease -Elderly clients

Which class of antidepressants exerts their effects by inhibiting reuptake serotonin? (Select all that apply.)

-Escitalopram (Lexapro) -Fluoxetine (Prozac)

Which medications should not be administered to clients receiving monoamine oxidase inhibitors (MAOIs) because of the increased risk of hypertensive episodes? (Select all that apply.)

-Meperidine (Demerol) -Sertraline (Zoloft) -Amitriptyline (Elavil)

A nurse is reviewing a client's serum lithium level. Which finding would indicate that the client is experiencing lithium toxicity?

1.8 mEq/L

How long does a patient need to wait after stopping a phenelzine (Nardil) before starting paroxetine (Paxil)?

14 days

A client is receiving an SSRI. The nurse would inform the client that the full benefits of the drug may not occur for which time period?

4 weeks

In patients requiring sertraline therapy, which patient would require the closest monitoring by the nurse?

A 45-year-old man with liver impairment

The nurse provides care for several clients who are taking antidepressants. Which client should the nurse assess most closely for signs of addiction and anxiety?

A client who was recently prescribed venlafaxine (Effexor)

A client tells the nurse that the client recently started on SSRIs for the treatment of depression. The client asks if there are any side effects to the SSRIs. The nurse should inform the client to watch for the following adverse effects:

A high incidence of nausea, diarrhea, and weight loss, as well as anxiety, nervousness, and insomnia.

A male client has a history of hepatic dysfunction secondary to alcoholism. Based on the client's diagnostic history, what would the nurse expect his physician to order?

A lower dose of the antidepressant

When taking MAO inhibitors, clients should avoid which foods?

Aged cheeses and meats, concentrated yeast extracts, sauerkraut, and fava beans

A nurse is working with a Chinese immigrant who is taking an MAOI. The most important instruction to the patient by the nurse will be to

Avoid use of soy sauce in the diet.

A patient has been prescribed phenelzine sulfate (Nardil), which is an MAO inhibitor. Which food should the patient avoid eating?

Cheddar cheese and bratwurst

A client is receiving a tricyclic antidepressant for treatment of obsessive-compulsive disorder. Which agent most likely would be prescribed?

Clomipramine

A group of students are reviewing information about tricyclic antidepressants and demonstrate understanding of the material when they identify which drug as also being indicated for the treatment of obsessive-compulsive disorder.

Clomipramine

A nurse is caring for a patient with depression. Which symptom should the nurse closely monitor for in the patient?

Extreme sadness

Tricyclic antidepressants are lipid insoluble.

False

Which agent would a nurse identify as a selective serotonin reuptake inhibitor?

Fluvoxamine

A nurse is caring for a patient who is taking a monoamine oxidase (MAO) inhibitor for treatment of a depressive disorder. What is a potentially serious side effect of MAO inhibitors?

Hypertension

A patient has been prescribed a monoamine oxidase inhibitor (MAOI) by the physician. Before administration of the drug, the patient wants to know the adverse reactions of the drug. What is an adverse reaction to the drug?

Hypertensive crisis

A client who was previously taking paroxetine is being switched to phenelzine due to a lack of response. The nurse would expect that the phenelzine will be started at which time?

In 4 to 6 weeks after stopping the paroxetine

A client has been taking citalopram for 2 weeks and has expressed a desire to discontinue it, stating, "I don't feel any better than I did before I started these pills." What should the nurse teach the client?

It may take up to two more weeks before the client feels better

A nurse is required to administer selective serotonin reuptake inhibitors (SSRIs) to a group of patients. Which patients should the nurse take precautions for while administering SSRIs?

Patients with diabetes mellitus

The nurse is aware that which medication taken by a client for treatment of mood disorder requires a diet that restricts the amount of tyramine eaten?

Phenelzine (Nardil)

Which class of antidepressants exerts its effects by inhibiting reuptake serotonin?

Selective serotonin reuptake inhibitors

A patient suffers from depression and states feelings of gloom and inability to perform the activities of daily living. What neurotransmission is decreased?

Serotonin

Which herbal product should a nurse specifically question patients about due to the potential for adverse reactions when taken with antidepressants?

St. John's wort

A female client has been diagnosed with depression. She also has a history of alcoholism. She has been sober now for 4 months, but at her last physical examination, the physician noted right-upper-quadrant tenderness and elevated liver enzyme levels. The physician has prescribed sertraline to treat Ms. Tooka's depression. Which factor would need to be considered prior to administering this medication to her?

The medication should be started at a lower dose due to liver dysfunction, and the patient should be monitored for side effects.

Why are selective serotonin reuptake inhibitors considered the first line of drug therapy for patients with depression?

The medications have fewer anticholinergic effects than alternatives.

A deficiency of a biogenic amine in key brain areas is believed to result in depression.

True

The adverse effects of selective serotonin reuptake inhibitors are less than other antidepressants.

True

Tricyclic antidepressants reduce the reuptake of serotonin and norepinephrine.

True

A nurse is caring for a patient who has been prescribed a monoamine oxidase inhibitor (MAOI). What should the nurse ask the patient to avoid?

Yogurt

A 30-year-old woman is taking phenelzine (Nardil) 30mg PO tid. The nurse knows that at that dosage, the patient will need to be carefully monitored for

dizziness.

A 12-year-old child who has been taking sertraline for the past 2 weeks has returned to the clinic to be seen. It will be critical for the nurse to assess for

onset of suicidal ideation.