NUR316 prepu Ch. 21 antidepressant agents
A client has been prescribed phenelzine sulfate. When providing teaching, which food should the nurse instruct the client to avoid eating?
Salami
After teaching a group of nursing students about antidepressants, the instructor determines that the teaching was successful when the students identify which as inhibiting the reuptake of serotonin?
Selective serotonin reuptake inhibitors
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?
Several weeks after stopping the paroxetine
A client prescribed a selective serotonin reuptake inhibitor has begun taking St. John's wort daily. The nurse should teach the client that this combination may result in what adverse reaction?
dangerous drug interactions Explanation: Combining St. John's wort with antidepressants can cause serious drug-to-drug interactions. These effects do not typically include worsened depression, alterations in coagulation, or dyscrasias.
A 30-year-old client is taking phenelzine 30mg PO tid. The nurse knows that at that dosage, the client will need to be carefully monitored for which?
dizziness
A 12-year-old client 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 which?
onset of suicidal ideation.
A client being treated for schizophrenia with a traditional antipsychotic medication is taking an herbal preparation for arthritis. The client buys the herbal remedy at the local retail store. Which herbal medication should the nurse caution the client about taking for arthritic pain?
evening primrose
A client has been prescribed a tricyclic antidepressant. What subsequent adverse effects of this drug should the nurse discuss with the client? Select all that apply.
urinary retention blurred vision dry mouth
A nurse is working with a client who is taking an MAOI. What would be the most important instruction to the client?
avoid use of soy sauce in the diet.
How long does a patient need to wait after stopping a phenelzine before starting paroxetine?
14 days
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 client has been taking a selective serotonin reuptake inhibitor (SSRI) for the treatment of depression. Which represents the action of the medication?
SSRIs prevent serotonin from being reabsorbed.
To best assure client safety, what information should the nurse provide to a client whose fluoxetine therapy has been discontinued?
The dosage of the medication will be gradually reduced over a period of 6 to 8 weeks.Explanation:To avoid antidepressant discontinuation syndrome, it is essential to taper the dosage of the antidepressant and discontinue it gradually, over 6 to 8 weeks, unless severe drug toxicity, anaphylactic reaction, or another life-threatening condition is present. ECT will not avoid this syndrome. Concurrent use of an MAO inhibitor is dangerous. Avoiding stress is advisable but will not minimize the risk of injury in this situation
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) Amitriptyline (Elavil) Sertraline (Zoloft)
A client comes to the clinic with a possible mood disorder diagnosis of unipolar depression. What question by the nurse will best help in assessing this client's mental status?
"Have you felt hopeless anytime lately?" A quick depression assessment involves asking the client if he/she has felt helpless or hopeless over the last two weeks. The other questions will not be helpful in assessing the client's current mental status.
A patient is receiving an antidepressant that helps to decrease addictive behavior. Which drug most likely would be prescribed?
Venlafaxine
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 nurse is caring for a patient with depression. The patient has been prescribed amitriptyline, a tricyclic antidepressant. What should the nurse identify as the effect of this antidepressant on the patient's body?
Decreased reuptake of norepinephrine
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."
A physician has prescribed an antidepressant medication for a 15-year-old client. Which statement would be appropriate for inclusion in medication teaching?
"There may be an increased risk of suicide while taking this drug."
A client is prescribed transdermal selegiline. What health education should the nurse provide?
"Place the patch on dry skin on your torso that has no cuts or openings."
A client with depression has been taking citalopram for several months and has presented for a follow-up assessment. The client tells the nurse, "I've been reading a lot online about the benefits of St. John's wort for depression, so I've started taking it once per day." In addition to referring the client to the provider, what is the nurse's best response?
"There can be an unsafe reaction between your antidepressant and St. John's wort, which is why taking them both is discouraged."
The client is experiencing some slurred speech and the nurse notices tremors. In reviewing the client's am lab results she focuses on the serum lithium level. Which finding would indicate that the client is experiencing lithium toxicity?
1.8 mEq/L
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
The following patients are receiving nortriptyline therapy. Which patient would the nurse most closely monitor for cardiotoxicity?
A 45-year-old man with angina pectoris
A community health nurse follows many clients, several of whom have depression and who are taking antidepressants. What assessment finding should the nurse prioritize for reporting to the care provider?
A client who began taking escitalopram two weeks ago says her mood has worsened since starting the drug
A nurse is providing care on a psychiatric unit with many clients that take antidepressants. What client factor would the nurse have to consider when administering these medications?
A client has dysphagia
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 health care provider to order?
A lower dose of the antidepressant
Venlafaxine is an antidepressant that has become more popular with adults in treating their depression. Why has it become more popular?
An extended release form is available.
A client has been diagnosed with depression and prescribed fluoxetine 200 mg PO daily to be taken in the morning. What is the nurse's best action upon receiving the client's prescription?
Question the prescriber about the dose
A client with a longstanding diagnosis of depression is being treated with phenelzine. The client reports the recent use of some over-the-counter flu and cold remedies and has consequently been admitted for observation and client teaching. What assessment should the nurse prioritize?
Blood pressure monitoring The drug-drug interactions that exist with the use of monoamine oxidase inhibitors create a high risk for hypertensive crisis. Blood pressure monitoring is thus among the priority assessments. Tardive dyskinesia is not among the varied signs and symptoms that can result from drug-drug interactions with MAOIs. The nurse should certainly monitor the client's pain and oxygenation, but blood pressure monitoring is the highest priority due to the likelihood and safety risks associated with hypertensive crisis.
A client with a severe depression has been hospitalized, and the health care provider has ordered amitriptyline. What common adverse effect might this client have?
Dry mouth
A nurse is caring for a patient with depression. Which symptom should the nurse closely monitor for in the patient?
Extreme sadness
Which agent would a nurse identify as a selective serotonin reuptake inhibitor?
Fluvoxamine
A nurse is caring for a client 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 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 tricyclic antidepressant has been prescribed to a 77-year-old client whose current medication regimen includes omeprazole, captopril, calcium carbonate, alendronate, and warfarin. What assessment should the nurse prioritize when monitoring the client for drug-drug interactions?
Monitor the client closely for bleeding and review coagulation indices when available.
While reviewing the medication history of an older adult client, the nurse learns that the client is taking amitriptyline 25 mg three times per day. What adverse effect should the nurse prioritize when incorporating safety measures into the care plan?
Orthostatic hypotension
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
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 health care provider noted right-upper-quadrant tenderness and elevated liver enzyme levels. The provider has prescribed sertraline to treat the client's depression. Which factor would need to be considered prior to administering this medication?
The medication should be started at a lower dose due to liver dysfunction, and the client should be monitored for side effects.
A patient is starting on a selective serotonin reuptake inhibitor for depression. What will the nurse instruct the patient about taking the medication?
The medication should be taken once a day in the morning.
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.
What adverse effect could be related to a fall experienced by an older client prescribed amitriptyline?
orthostatic hypotension
A client prescribed fluoxetine 1 week ago presents for a scheduled follow-up appointment. What should be the focus of the client's nursing assessment to best assure client safety?
presence of suicidal ideationExplanation:It is essential to assess for suicidal thoughts or plans, especially at the beginning of selective serotonin reuptake inhibitor (SSRI) therapy or when dosages are increased or decreased. This supersedes the need to assess for concentration, cardiac function, or hypersensitivity.
