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31. A client is receiving lithium therapy at a health care facility. The client informs the nurse that he is taking antacids for heartburn. The nurse would be alert for which of the following due to the interaction of the two drugs? A) Decreased effectiveness of lithium B) Increased risk of lithium toxicity C) Increased risk for bipolar disorder D) Increased psychotic symptoms

Ans: A Feedback: Combining lithium with antacids may result in decreased effectiveness of lithium. This combination will not increase the risk for lithium toxicity, bipolar disorder, or psychotic symptoms.

22. A nurse is caring for a client with suicidal tendencies. Which of the following would be most important for the nurse to do after administering the drug orally? A) Inspect the oral cavity to ensure that the drug is swallowed. B) Monitor body temperature for changes. C) Monitor blood pressure for unusual changes. D) Inspect pulse rate for unusual changes.

Ans: A Feedback: The immediate nursing intervention is to inspect the oral cavity to ensure that the client swallowed the drug. Assessment for changes in body temperature, blood pressure, and pulse rate should be completed once the nurse ensures that the client has swallowed the drug.

19. A nurse is caring for a client with depression. The client has been prescribed amitriptyline. Which of the following would the nurse integrate into the teaching for the client about how the drug works? A) Decreased reuptake of norepinephrine B) Increased serotonin in the nervous system C) Increased endogenous norepinephrine D) Increased endogenous epinephrine

Ans: A Feedback: The nurse should identify decreased reuptake of norepinephrine as the effect of the tricyclic antidepressant on the patient's body. Increased serotonin in the nervous system, increased endogenous norepinephrine, and increased endogenous epinephrine are effects of monoamine oxidase inhibitors.

13. A client receiving clomipramine is given a prescription for zolpidem for sleep. The primary health care provider was unaware the client was taking clomipramine. Which of the following reactions might the nurse observe in this client? Select all that apply. A) Respiratory depression B) CNS depression C) Hypertensive crisis D) Easy bruising E) Hyperglycemia

Ans: A, B Feedback: The concomitant administration of tricyclic antidepressants like clomipramine with hypnotics like zolpidem can result in the increased risk of respiratory depression and CNS depression.

28. After teaching a group of students about antidepressant therapy, the instructor determines that the teaching was successful when the students identify which of the following as a class of antidepressants? Select all that apply. A) Selective serotonin reuptake inhibitors B) Tricyclics C) Monoamine oxidase inhibitors D) Benzodiazepines E) Barbiturates

Ans: A, B, C Feedback: Antidepressants include selective serotonin reuptake inhibitors, tricyclic antidepressants, and monoamine oxidase inhibitors. Benzodiazepines and barbiturates are sedative and hypnotics.

15. A client is prescribed paroxetine. When teaching the client about this drug, which of the following would the nurse include as a possible adverse reaction? Select all that apply. A) Sexual dysfunction B) Insomnia C) Somnolence D) Diarrhea E) Constipation

Ans: A, B, C, D, E Feedback: The following are possible adverse reactions that may occur with paroxetine: headache, tremors, somnolence, nervousness, dizziness, insomnia, nausea, diarrhea, constipation, dry mouth, sweating, weakness, and sexual dysfunction.

8. Before administering an antidepressant to a client, which of the following would the nurse assess? Select all that apply. A) Vital signs B) Presence of suicidal ideation C) Complete medical history D) Weight E) Mental status

Ans: A, B, C, D, E Feedback: The nurse's preadministration assessment for a client receiving an antidepressant should include vital signs, presence of suicidal ideation, complete medical history, weight, and mental status.

32. The nurse is reviewing the medical records of several clients who are receiving lithium. Which of the following would the nurse identify as being at increased risk for the development of lithium toxicity? Select all that apply. A) Clients receiving furosemide (Lasix) B) Clients experiencing diarrhea C) Clients with renal insufficiency D) Clients with liver cirrhosis E) Clients experiencing vomiting

Ans: A, B, C, E Feedback: Clients with dehydration, diarrhea, vomiting, renal or cardiovascular disease, or sodium depletion and those receiving diuretics (i.e., furosemide) are at an increased risk for developing lithium toxicity.

7. A client is prescribed phenelzine. Which of the following would the nurse instruct the client to avoid? Select all that apply. A) Blue cheese B) Pepperoni C) Apples D) Chocolate E) Celery

Ans: A, B, D Feedback: A nurse educating a client starting phenelzine (Nardil) should educate the client to avoid foods containing tyramine (aged cheese, sour cream, yogurt, beef, chicken livers, pickled herring, fermented meat, undistilled alcoholic beverages, caffeinated beverages, chocolate, certain fruits and vegetables, yeast extract, and soy sauce) because the combination can result in a life-threatening hypertensive crisis.

3. After teaching a group of nursing students about the action of antidepressants, the instructor determines that the teaching was successful when the students identify which of the following classes as exerting their effects by inhibiting reuptake of norepinephrine and serotonin? Select all that apply. A) Amitriptyline B) Bupropion C) Clomipramine D) Duloxetine E) Venlafaxine

Ans: A, C Feedback: Tricyclic antidepressants like amitriptyline and clomipramine exert their effects by inhibiting reuptake of norepinephrine and serotonin. Bupropion, duloxetine, and venlafaxine are believed to affect serotonin, norepinephrine, and dopamine receptors.

10. Antidepressants can often have GI adverse reactions that can result in a nursing diagnosis of Imbalanced Nutrition: Less Than Body Requirements. Which of the following would be appropriate for the nurse to suggest to minimize these effects? Select all that apply. A) Increase fiber intake. B) Decrease fiber intake. C) Increase fluid intake. D) Decrease fluid intake. E) Chew sugarless gum.

Ans: A, C, E Feedback: To help with antidepressant-induced constipation, the nurse can recommend increased fluid and fiber intake, and for antidepressant-induced dry mouth the nurse can recommend good oral hygiene, frequent sips of water, sugarless gum, and hard candy.

5. A nurse administers amitriptyline cautiously to which clients? Select all that apply. A) Clients with cardiac disease B) Clients with hypothyroidism C) Clients with diabetes D) Elderly clients E) Adolescent clients

Ans: A, D Feedback: Tricyclic antidepressants (TCAs) like amitriptyline can cause cardiac-related adverse reactions, so the nurse should give TCAs with caution to clients with pre-existing cardiac disease and elderly clients.

25. The nurse suspects that a client is experiencing major depression based on assessment of which of the following? Select all that apply. A) Feelings of hopelessness B) Minimal changes in weight C) Focused concentration D) Loss of energy E) Excessive guilt

Ans: A, D, E Feedback: Manifestations of depression include feelings of hopelessness or helplessness, significant weight loss or gain, inability to concentrate, and excessive guilt.

1. A nurse caring for a client taking amitriptyline for depression should monitor the client for which of the following adverse events? Select all that apply. A) Sedation B) Diarrhea C) Incontinence D) Dry mouth E) Photosensitivity

Ans: A, D, E Feedback: The use of tricyclic antidepressants like amitriptyline can cause the following side effects: sedation, dry mouth, visual disturbances, urinary retention, constipation, and photosensitivity.

21. A nurse is caring for an individual who is to receive antidepressant therapy on an outpatient basis. What precaution should the nurse suggest to prevent risk of injury if the client experiences dizziness when getting out of bed? A) Strictly avoid movements if dizziness occurs. B) Rise slowly when getting out of bed. C) Have breakfast before getting out of bed. D) Have a glass of water to overcome dizziness.

Ans: B Feedback: The nurse should instruct the client to rise slowly when getting out of bed. Strictly avoiding movements will restrict the patient's mobility, which is unadvisable. Having breakfast or a glass of water before getting out of bed will not help the client to overcome dizziness because the dizziness is not due to lack of nourishment.

18. When assessing a client for depression, which of the following would the nurse most likely find? A) Drowsiness B) Extreme sadness C) Severe headache D) Dilated pupils

Ans: B Feedback: The nurse should monitor the client for extreme sadness because this is a symptom of depression. Drowsiness is an adverse effect of most antidepressants. Severe headache and dilated pupils are symptoms of hypertensive crisis.

29. A group of nursing students are reviewing information about antidepressants. The students demonstrate understanding of the information when they identify which of the following as an example of a serotonin/norepinephrine and dopamine/norepinephrine reuptake inhibitor? Select all that apply. A) Doxepin B) Venlafaxine C) Bupropion D) Sertraline E) Escitalopram

Ans: B, C Feedback: Bupropion and venlafaxine are examples of serotonin/norepinephrine and dopamine/norepinephrine reuptake inhibitors. Doxepin is a tricyclic antidepressant; sertraline and escitalopram are selective serotonin reuptake inhibitors.

17. A nurse understands that duloxetine may be used to treat which of the following? Select all that apply. A) Obsessive-compulsive disorder B) Depression C) Fibromyalgia D) Diabetic neuropathy E) Stress incontinence

Ans: B, C, D, E Feedback: Duloxetine can be used to treat clients with depression, fibromyalgia, diabetic neuropathy, and stress incontinence.

14. A nurse would assess the client for an increase in anticholinergic symptoms if the client is prescribed cimetidine with which antidepressant? Select all that apply. A) Phenelzine B) Sertraline C) Venlafaxine D) Clomipramine E) Escitalopram

Ans: B, C, D, E Feedback: The concomitant use of cimetidine and tricyclic antidepressants (clomipramine), serotonin reuptake inhibitors (escitalopram and sertraline), and atypical antidepressants (venlafaxine) results in increased anticholinergic symptoms.

11. Which of the following would the nurse report to the primary health care provider if assessed in a client receiving an antidepressant? Select all that apply. A) Weight gain B) Expressions of guilt C) Indirect threats of suicide D) Somnolence E) Insomnia

Ans: B, C, E Feedback: The nurse should report any of the following to the client's primary health care provider if observed: expressions of guilt, hopelessness, or helplessness; insomnia; weight loss; and direct or indirect threats of suicide.

6. A nurse understands that the antidepressant drug paroxetine (Paxil) can be used to treat which of the following medical conditions? Select all that apply. A) Enuresis B) Depressive episodes C) Anorexia D) Obsessive-compulsive disorders E) Bulimia nervosa

Ans: B, D, E Feedback: Serotonin reuptake inhibitors like paroxetine (Paxil) are used in the treatment of depressive episodes, obsessive-compulsive disorders, and bulimia nervosa.

27. After teaching a client who is prescribed lithium about the drug, the nurse determines that the teaching was successful when the client states which of the following? A) "I need to limit how much I drink." B) "Salt is something that I need to avoid." C) "I should take the drug with food." D) "I need to call the doctor if I have a painful erection."

Ans: C Feedback: With lithium, the client should take the drug with food or immediately after meals, drink at least 10 large glasses of fluid each day, and add extra salt to food. Painful erections are not associated with lithium use.

2. When describing the action of antidepressants, the nursing instructor would include the belief that they exert their effect by causing slow adaptive changes to which of the following receptor systems? Select all that apply. A) Beta-adrenergic B) Baroreceptors C) Norepinephrine D) Serotonin E) Nicotinic

Ans: C, D Feedback: New research indicates that the effects of antidepressants are related to slow adaptive changes in norepinephrine and serotonin receptor systems.

12. 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 (ED). This client might be experiencing a hypertensive crisis. What other symptoms might the nurse in the ED assess if the client is experiencing a hypertensive crisis? Select all that apply. A) Constricted pupils B) Chills C) Chest pain D) Tachycardia E) Stiff neck

Ans: C, D, E Feedback: A client experiencing a hypertensive crisis can exhibit the following symptoms: stiff or sore neck, nausea, vomiting, headache, sweating, fever, chest pain, dilated pupils, and bradycardia or tachycardia.

9. A nurse determines the need to administer a prescribed antidepressant in the morning because of the increased likelihood of insomnia. Which drug would this most likely be? Select all that apply. A) Amitriptyline B) Bupropion C) Citalopram D) Paroxetine E) Sertraline

Ans: C, D, E Feedback: It is best to administer serotonin reuptake inhibitors, such as citalopram, paroxetine, and sertraline, in the morning as they have a greater likelihood to cause insomnia.

16. After teaching a group of nursing students about possible adverse reactions associated with trazodone, the instructor determines that the teaching was successful when the students identify which of the following? Select all that apply. A) Sexual dysfunction B) Insomnia C) Priapism D) Diarrhea E) Dry mouth

Ans: C, E Feedback: The following are possible adverse reactions that may occur with trazodone: priapism, drowsiness, dizziness, dry mouth, nausea, vomiting, constipation, fatigue, and nervousness.

30. When developing the plan of care for a client who is receiving lithium therapy, which nursing diagnosis would the nurse most likely identify as a priority? A) Self-Care Deficit B) Disturbed Sleep Pattern C) Imbalanced Nutrition: Less Than Body Requirements D) Imbalanced Fluid Volume

Ans: D Feedback: Fluid balance determines the concentration of lithium in the blood and thus the client's risk for toxicity. Therefore, imbalanced fluid volume is a priority. Self-care deficit, disturbed sleep pattern, and imbalanced nutrition also may apply, but imbalanced fluid volume would be the priority.

23. A nurse is caring for a client who has been prescribed a monoamine oxidase inhibitor (MAOI). Which of the following should the nurse instruct the client to avoid? A) Milk B) Butter C) Rice D) Yogurt

Ans: D Feedback: The nurse should ask the client to avoid yogurt because yogurt contains tyramine, which interacts with MAOIs and causes hypertensive crisis. Milk, butter, and rice do not contain tyramine and hence can be consumed when the client is undergoing treatment with MAOIs.

20. A nurse is caring for an older adult client who has been prescribed amoxapine for depression accompanied by anxiety. After administration of the drug, the nurse observes muscle rigidity and sweating. The nurse identifies these as the symptoms of neuroleptic malignant syndrome. Which of the following would the nurse do next? A) Suggest the client engage in exercise. B) Get the client to drink a glass of cold water. C) Encourage the client to breathe deeply. D) Stop the drug and contact the physician.

Ans: D Feedback: The nurse should discontinue the drug administration and contact the physician. Exercising, drinking cold water, and encouraging deep breaths will not help the client with symptoms of neuroleptic malignant syndrome.

24. A client is prescribed a monoamine oxidase inhibitor (MAOI) for depression. During the initial interview with the client, the nurse understands that the client is also receiving an adrenergic agent. The nurse would be alert for which of the following? A) Increased risk for hypertensive episodes B) Increased risk for severe convulsions C) Increased risk for hyperpyretic episodes D) Increased risk for cardiac arrhythmias

Ans: D Feedback: The nurse should identify increased risk for cardiac arrhythmias because of the effects of interaction between MAOIs and adrenergic agents. Increased risk for hypertensive episodes, severe convulsions, and hyperpyretic episodes occur when an MAOI and meperidine are used together.

26. A client is prescribed lithium. The nurse suspects lithium toxicity based on which lithium drug level? A) 0.8 mEq/L B) 1.0 mEq/L C) 1.3 mEq/L D) 1.6 mEq/L

Ans: D Feedback: Toxicity may occur when serum lithium levels are greater than 1.5 mEq/L.

4. Which of the following antidepressants exert their effects by inhibiting the reuptake of serotonin? Select all that apply. A) Amitriptyline B) Bupropion C) Clomipramine D) Fluoxetine E) Escitalopram

Ans: D, E Feedback: Selective serotonin reuptake inhibitors like fluoxetine and escitalopram exert their effects by inhibiting the reuptake of serotonin. Tricyclic antidepressants like amitriptyline and clomipramine exert their effects by inhibiting the reuptake of norepinephrine and serotonin. Bupropion is believed to affect serotonin, norepinephrine, and dopamine receptors.