Chapter 15: Antidepressant Drugs Practice questions

What is the nurse's highest priority when caring for a patient after a TCA overdose? a. Frequently monitor blood pressure and heart rate/rhythm. b. Monitor for skin rashes, particularly on the torso. c. Measure and record intake and output every 12 hours. d. Institute cooling blankets for hyperthermia.

a. Frequently monitor blood pressure and heart rate/rhythm. It is necessary to assess cardiovascular function, because cardiovascular reactions can occur suddenly, even several days after the TCA overdose, and can result in acute heart failure. The other options are not as closely aligned with cardiovascular problems.

A 75-year-old patient with a long history of depression begins amitriptyline (Elavil) 100 mg/day. The patient also takes a diuretic daily for hypertension. The highest priority nursing diagnosis is risk for: a. falls related to dizziness and orthostatic hypotension. b. ineffective thermoregulation related to anhidrosis. c. infection related to suppressed white blood cell count. d. constipation related to slowed peristalsis.

a. falls related to dizziness and orthostatic hypotension. Amitriptyline is a TCA that has a high risk of producing orthostatic hypotension. The patient is placed at even greater risk because of older age and diuretic therapy, which reduces fluid volume. The other options are either unassociated or are remote possibilities.

Patients taking TCAs exhibit more side effects than patients taking SSRIs, because TCAs: a. inhibit reuptake of norepinephrine and serotonin. b. selectively inhibit dopamine reuptake. c. selectively block serotonin uptake. d. block enzymatic breakdown.

a. inhibit reuptake of norepinephrine and serotonin. TCAs inhibit the reuptake of both norepinephrine and serotonin and because of their nonselectivity produce many side effects. The other options are incorrect statements about the action of TCAs.

When teaching about the MAOI tranylcypromine (Parnate), the nurse should consider it a priority to: a. provide a list of tyramine-rich foods. b. instruct the patient to avoid direct sunlight. c. advise the patient to manage fever with acetaminophen. d. direct the patient to report dry mouth and blurred vision.

a. provide a list of tyramine-rich foods. MAOIs and ingested tyramine interact to produce hypertensive crisis, a life-threatening medical emergency, so it is necessary to teach the patient foods to avoid. The other options are unrelated to tranylcypromine therapy.

The nurse's priority assessment for a patient taking an antidepressant medication is for the presence of: a. suicidal ideation. b. antiadrenergic side effects. c. anticholinergic side effects. d. symptoms of sexual dysfunction.

a. suicidal ideation. Antidepressant medication tends to energize depressed patients, possibly giving them the impetus to act on suicidal ideation that has been present related to the depression. This complication is particularly applicable to adolescents. Some suggest that suicidal ideation might be the actual result of antidepressant therapy. In either case the implication for nursing is clear: patients should be carefully assessed for the presence of suicidal ideation, suicidal plans, and means for carrying out the plans. This option is related to patient safety and takes priority over the other options.

A patient with depression has taken an SSRI for 1 month. The nurse should use direct questions to evaluate which potential side effect? a. Aggressive impulses b. Sexual dysfunction c. Paranoid delusions d. Weight gain

b. Sexual dysfunction SSRIs often produce sexual dysfunction, such as decreased libido. Patients readily tell nurses about anticholinergic, gastrointestinal, and other side effects, but are not as forthcoming in reporting sexual problems. The nurse might need to ask directly to elicit this information. Patients are more willing to discuss the other options.

Nortriptyline (Aventyl) was prescribed for a 68-year-old patient diagnosed with depression and insomnia. Benefits specific to use of nortriptyline would include: a. regular bowel movements. b. improved sleep pattern. c. weight loss. d. anhedonia.

b. improved sleep pattern. Nortriptyline is a secondary amine with a good side effect profile. It has a minimal tendency to cause orthostatic hypotension, meaning the risk of falls is low. It is somewhat sedating, which is helpful to patients with insomnia. The other options are either undesirable or nonspecific outcomes.

Evaluation of a patient's response after 1 week of tricyclic antidepressant therapy would be expected to show: a. no change in objective or subjective symptoms. b. increased appetite and weight gain. c. decreased suicidal ideation. d. improved mood and affect.

b. increased appetite and weight gain. Improved appetite might be caused by the antihistaminic effect of the drug. Improvement in mood might not occur for 2 to 4 weeks. Suicidal ideation might not improve for 2 to 4 weeks.

A pregnant patient took SSRI antidepressants during the third trimester of pregnancy. The newborn will be carefully assessed for neonatal: a. temperature dysregulation. b. serotonin syndrome. c. seizure disorder. d. diabetes.

b. serotonin syndrome. The neonate whose mother has received SSRIs might experience respiratory depression, hypoglycemia, tremor, and low birth weight as part of neonatal serotonin syndrome. The disorder normally is resolved within 2 weeks of birth. The other options are not usually seen as a result of in utero exposure to SSRIs.

A patient tells the nurse that he stopped taking sertraline (Zoloft) because the drug made him impotent. The nurse can be most helpful by saying: a. "Your doctor wants you to continue taking your medication." b. "Have you talked with your therapist regarding your feelings about sex?" c. "Let's talk with your doctor. Changing your medication might be a possibility." d. "Our priority is to treat your depression. Impotence can be addressed in a few weeks."

c. "Let's talk with your doctor. Changing your medication might be a possibility." SSRIs commonly cause sexual dysfunction. Sertraline is a widely marketed SSRI and was the second drug of this class to be used in the United States. Sertraline can also be given once daily (morning or evening) with or without food. Sertraline causes sexual dysfunction in men and women. Sexual function typically returns to normal 2 to 3 days after drug cessation. Changing to another type of antidepressant or adding bupropion in small doses can be helpful. The other options are not compassionate or therapeutic.

The nurse cares for four patients receiving SSRIs. Which assessment finding warrants the nurse's priority attention? a. Dry mouth and stuffy nose b. Malaise and frontal headache c. Confusion, agitation, and hyperthermia d. Constipation, photophobia, and anhidrosis

c. Confusion, agitation, and hyperthermia The correct response suggests serotonin syndrome, an acute medical problem requiring immediate medical and nursing attention. The distracters are examples of anticholinergic effects and are not considered emergencies.

A nurse teaches a patient taking an MAOI antidepressant about important dietary guidelines. Which nutritional choices by the patient indicate that the teaching was effective? Select all that apply. a. Sausage b. Avocados c. Pork chops d. Strawberries e. Chocolate chip cookies

c. Pork chops d. Strawberries The patient must avoid foods high in tyramine so as to prevent a hypertensive crisis. Sausage, avocados, and chocolate contain significant amounts of tyramine.

A patient diagnosed with depression who has reported vague suicidal ideation will stay at home, have close family supervision, and make weekly visits to the health care provider. Bupropion (Wellbutrin) is prescribed. What is the benefit of bupropion in this scenario? a. It has antianxiety properties as well as antidepressant effects. b. It lowers the seizure threshold to a lesser extent than TCAs. c. There is reduced potential for lethal overdose. d. It stimulates appetite and weight gain.

c. There is reduced potential for lethal overdose. Bupropion has no lethal-overdose potential, making it well suited for use in outpatient treatment of depression. Bupropion has a narrow therapeutic index but is far less lethal than TCAs or monoamine oxidase inhibitors (MAOIs). However, it might cause agitation, anxiety, seizures, anorexia, and weight loss.

A patient for whom phenelzine (Nardil) is prescribed complains of a sudden headache and palpitations. The nurse observes dilated pupils and diaphoresis. The nurse's first action should be: a. assess for cogwheel rigidity. b. notify the health care provider. c. assess the patient's blood pressure. d. withhold the morning dose of phenelzine.

c. assess the patient's blood pressure. The patient's symptoms are suggestive of hypertensive crisis. It is vital to know whether or not the blood pressure is elevated, so obtaining the blood pressure is the necessary first action. The most probable reason for the reaction would be drug-food interaction. The nurse may notify the health care provider and withhold the morning dose as subsequent actions. Cogwheel rigidity is associated with antipsychotic medications.

A patient tells the nurse that he stopped taking sertraline (Zoloft) because the drug made him impotent. The nurse can be most helpful by saying: A TCA is prescribed for a patient newly diagnosed with depression. What information should be included in patient teaching? a. "Take this medication on an empty stomach." b. "Do not eat aged cheese while using this medication." c. "You might experience sweating, tremors, and excessive urination." d. "It might be 2 weeks or more before you notice the effects of this medicine."

d. "It might be 2 weeks or more before you notice the effects of this medicine." Antidepressant effects might take several weeks to be noticeable. Avoidance of tyramine (as is present in aged cheeses) is necessary for MAOI therapy but not for TCAs. It is not necessary to take TCAs on an empty stomach. Sweating, tremors, and urination problems are not commonly experienced with TCA therapy.

A depressed patient prepares for discharge. The patient is prescribed desipramine (Norpramin) and will have outpatient visits. The patient reports, "They gave me only a 1-week supply of my medicine." Select the nurse's best reply. a. "Federal law limits the amount you may be given at any one time." b. "It will save you money if the drug doesn't work well for your symptoms." c. "This is a way of ensuring that you will come in for your follow-up appointment." d. "Prescribing a small amount of drug addresses our concerns for your continuing safety."

d. "Prescribing a small amount of drug addresses our concerns for your continuing safety." Desipramine is an activating antidepressant, and it might provide a patient who has suicidal ideation with the energy to make an attempt. Because the therapeutic dose and lethal dose are not widely separated, TCA overdose is an often-used suicide plan. Because desipramine appears to be the most toxic TCA, prescribing only a 7-day supply limits the possibility of using the drug in a suicide attempt. The other options are either less relevant or incorrect.

A patient prescribed fluoxetine (Prozac) is being changed to tranylcypromine (Parnate). The nurse schedules a time lapse between the last dose of fluoxetine and the first dose of tranylcypromine of at least: a. 7 days. b. 14 days. c. 3 weeks. d. 6 weeks.

d. 6 weeks. Drugs that have a high probability for serious interactions (e.g., MAOIs) will need to be withheld for up to 6 weeks or more as fluoxetine is washing out of the system. The remaining options are too short an interval.

A secondary amine tricyclic antidepressant is prescribed for a patient. The medication will significantly increase the availability of which neurotransmitter? a. GABA b. Glutamate c. Serotonin d. Norepinephrine

d. Norepinephrine Secondary amines increase the availability and enhance the action of norepinephrine.

Priority assessments for a patient beginning amitriptyline (Elavil) include: a. nausea, diarrhea, and irritability. b. seizures, agranulocytosis, and insomnia. c. headache, sexual dysfunction, and weight loss. d. history of falls, arrhythmias, and blurred vision.

d. history of falls, arrhythmias, and blurred vision. Tricyclic antidepressants (TCAs) produce anticholinergic (blurred vision) and antiadrenergic (orthostatic hypotension leading to falls and arrhythmias) side effects. Gastrointestinal symptoms, sexual dysfunction, and weight variations are related to selective serotonin reuptake inhibitor (SSRI) therapy. Seizures are seen with bupropion therapy. Agranulocytosis is not considered a major problem with any of the groups of antidepressants.