Pharm ch21
A 75-year-old male patient is brought to the emergency department by his family because he is "talking to people who aren't there." During the initial admission assessment, his 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 depression over the loss of his wife.
A
A patient diagnosed 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 assess for with this drug combination? A) Increased risk of hypoglycemia B) Increased risk of hyperglycemia C) Increase in appetite D) Increased total cholesterol
A
A patient explains to a nurse that he had been taking amitriptyline (Elavil) for depression and that his physician changed his medication to clomipramine (Anafranil). The patient is confused and does not understand why his medication was changed. The nurse's best response to the patient would be what? A) "These drugs are similar but some patients respond better to one drug than another." B) "Did you take the amitriptyline like you should have?" C) "Maybe the old medicine wasn't working anymore." D) "Clomipramine is newer and will be much better for you."
A
A patient has been taking Prozac (fluoxetine) for the past 3 years for depression. She is seeing her gynecologist for premenopausal 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) "Sarafem and Prozac are different brand names for the same generic medication." B) "Before changing drugs it is important to consider how well you responded to Prozac." C) "You cannot take both drugs at the same time so it will be important to decide which is best." D) "When taking both of these drugs, it is best to take one in the morning and one at night."
A
A patient is admitted to the unit with obsessive-compulsive disorder (OCD). What drug might the nurse administer that has been found to be effective for treating OCD? A) Fluvoxamine B) Phenelzine C) Desipramine D) Amitriptyline
A
Obsessive-compulsive disorder (OCD) is a disorder that remains under investigation as to its actual neurophysiology. What tricyclic antidepressant is now approved by the Food and Drug Administration to treat OCD? A) Clomipramine B) Imipramine C) Nortriptyline D) Amitriptyline
A
The nurse is caring for a young female patient who is 5 weeks pregnant. What statement made by the nurse about the use of antidepressants during pregnancy is most accurate? A) "Antidepressants are used very cautiously during pregnancy and only when benefit outweighs risk." B) "Antidepressants are contraindicated and must be discontinued if pregnancy occurs." C) "Antidepressants must be chosen carefully because only a few are safe during pregnancy." D) "Most antidepressants are safe during pregnancy but those that are contraindicated should be avoided."
A
The nurse is caring for an 8-year-old clinic patient who takes imipramine. The nurse assesses the patient who does not have a history for or signs of depression, so the nurse suspects this drug was prescribed as treatment for what? A) Enuresis B) Obsessive compulsive disorder (OCD) C) Peripheral neuropathy D) Panic disorder
A
The nurse is working on the telemetry unit and has noted that many post-myocardial-infarction (MI) patients experience depression. What medication would the nurse question if ordered for one of these patients? A) Amitriptyline B) Escitalopram C) Fluoxetine D) Fluvoxamine
A
The patient presents to the emergency department with a headache in the back of the head, palpitations, neck stiffness, nausea, vomiting, sweating, dilated pupils, tachycardia, and chest pain. Blood pressure measures 180/124 and heart rate is 168 beats per minute. The spouse says the only medication he takes is something for depression but she does not know the name of the drug and the patient is also unable to supply the name. What classification of antidepressant does the nurse suspect this patient is taking? A) Monoamine oxidase inhibitors (MAOIs) B) Selective serotonin reuptake inhibitors (SSRIs) C) Tricyclic antidepressants (TCAs) D) Antianxiety antidepressants
A
What drugs would the nurse consider contraindicated for the patient taking a monoamine oxidase inhibitor (MAOI)? A) Selective serotonin reuptake inhibitor (SSRI) B) Insulin C) Acetaminophen D) Docusate (Colace)
A
The nurse interviews the family of a patient hospitalized with severe depression who is prescribed a tricyclic antidepressant. What assessment data are important in planning this patient's plan of care? (Select all that apply.) A) Recent suicide attempts B) Gastrointestinal (GI) obstruction C) Affect D) Physical pain E) Personal responsibilities
A,B,C
The nurse works in a mental health clinic. When a new patient arrives reporting feelings of depression, what conditions are screened for before prescribing antidepressants? (Select all that apply.) A) Thyroid disease B) Hormonal imbalance C) Cardiovascular disorders D) Parkinson's disease E) Diabetes mellitus
A,B,C
A patient is prescribed sertraline (Zoloft). What adverse effects should the nurse warn of when developing a medication teaching plan? (Select all that apply.) A) Agitation B) Agglutination C) Insomnia 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? (Select all that apply.) A) Limbic system B) Corpus callosum C) Reticular activating system (RAS) D) Substantia nigra E) Basal ganglia
A,C,E
A patient comes to the clinic because she is feeling depressed and has gained some weight. The physician prescribes oral tranylcypromine (Parnate) 10 mg twice daily for an atypical depression. When prescribed in this manner, when would the nurse tell the patient to expect the drug to reach peak levels in the body? A) 1 to 2 hours B) 2 to 3 hours C) 3 to 4 days D) 4 to 5 weeks
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 the class about depression. What deficiency does the instructor explain will result in depression? A) Epinephrine, norepinephrine, and acetylcholine B) Norepinephrine, dopamine, and serotonin C) Acetylcholine, gamma-aminobutyric acid, and serotonin D) Gamma-aminobutyric acid, dopamine, and epinephrine
B
The patient has been severely depressed since her father died 6 months ago. The physician has prescribed amitriptyline. The nurse reviews the patient's chart before administering the medication. What preexisting condition would require cautious use of this drug? A) Osteosarcoma B) Cardiovascular disorders C) Closed head injury D) Bleeding ulcer
B
What drug, if prescribed for the patient, would indicate the need to assess the patient for depression characterized by anxiety and addictive behaviors? A) Imipramine (Tofranil) B) Venlafaxine (Effexor) C) Fluvoxamine (Luvox) D) Tranylcypromine (Parnate)
B
The biogenic amine theory of depression states that depression results from a deficiency of biogenic amines in key areas of the brain. Why might a deficiency of these biogenic amines exist? A) A slowing of the action of the neurons may lead to their depletion. B) Monoamine oxidase (MAO) strengthens the impact of biogenic amines. C) The number or sensitivity of postsynaptic receptors may increase. D) Norepinephrine may be depleted because biogenic amines feed off of loose particles of the neurotransmitter.
C
The nurse is caring for a patient who is taking amitriptyline for depression. What teaching will the nurse include in the teaching plan to help the patient monitor for adverse effects? A) "If chest pain occurs an over-the-counter pain reliever will help." B) "Nasal congestion indicates a respiratory virus is beginning." C) "Measure and record your blood pressure daily." D) "Adverse effects will subside as you adjust to the medication."
C
The nurse is creating a care plan for a patient taking a selective serotonin reuptake inhibitor (SSRI). What would be an appropriate nursing diagnosis for this patient? A) Risk for infection B) Establish suicide precautions C) Disturbed thought processes related to central nervous system (CNS) effects of medication D) Dysfunctional Family Processes
C
A 12-year-old patient is hospitalized with severe depression. The patient has been taking a selective serotonin reuptake inhibitor (SSRI). What is the priority nursing action for the patient? A) Monitor food intake for levels of tyramine. B) Assess for weight loss and difficulty sleeping. 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 he has been taking oral fluoxetine (Prozac) 20 mg daily for the past 3 weeks and that he has lost 3 pounds during that time due to a loss of appetite. What action should the nurse take? A) Teaching the patient about healthy eating to maintain weight B) Congratulating the patient on his weight loss and commenting how well he looks C) Encouraging the patient to increase fluid intake to avoid further weight loss D) Reassuring the patient that a decrease in weight is a common adverse effect with this medication
D
A patient is admitted with a presumed diagnosis of colon cancer who takes a monoamine oxidase inhibitor for depression. What drug will the nurse keep on hand for this patient in case of the onset of an adverse reaction? A) Epinephrine B) Injectable naloxone (Narcan) C) Phenylalanine D) Phentolamine
D
A patient receives a new prescription for fluvoxamine (Luvox). What will the nurse instruct the patient about taking the medication? A) Take medication after eating breakfast. B) Take medication with at least 8 ounces of liquid. C) The dosage may need to be increased if the patient is not feeling better in 2 weeks. D) The medication should be taken once a day before bedtime.
D
The nurse is teaching a patient taking a monoamine oxidase inhibitor (MAOI) about dietary changes required to minimize adverse effects of the drug. The nurse determines the patient understands a low tyramine diet when what meal is chosen? A) A chop salad with blue cheese, sardines, and pepperoni B) A sandwich with turkey, avocado, and Swiss cheese C) Corned beef hash, eggs, and hash browns D) A hamburger, French fries, and a strawberry milkshake
D
What is the physiological action of tricyclic antidepressants (TCAs)? A) Inhibiting monoamine oxidase inhibitors that break down norepinephrine B) Inhibiting nerve activity, which prevents over excitability or stimulation C) Blocking the reuptake of serotonin, which increases the levels of norepinephrine D) Inhibiting reuptake of norepinephrine and serotonin
D
What reason might the nurse give for why venlafaxine (Effexor) has become more popular with adults in treating their depression? A) It is taken orally. B) It does not have adverse effects. C) It can be taken during pregnancy. D) An extended release form is available.
D
A 10-year-old patient is being seen by a physician for severe depression. The physician prescribes an antidepressant. What antidepressant could the nurse safely administer to a child? A) Trazodone B) Nortriptyline C) Fluvoxamine D) Phenelzine
B
A patient with severe depression has been hospitalized and the physician has ordered amitriptyline. What common adverse effect will the nurse monitor and assess the patient for? (Select all that apply.) A) Fever B) Myocardial Infarction C) Stroke D) Dry mouth E) Gynecomastia
B,C,D
What priority teaching point does the nurse include in the teaching plan for a patient on a monoamine oxidase inhibitor (MAOI)? (Select all that apply.) A) Take medication at bedtime. B) Monitor blood pressure. C) Do not take over-the-counter (OTC) drugs without talking to physician. D) Report double vision right away E) Reduce tyramine intake
B,C,E
A nurse is working with a 9-year-old child who exhibits signs and symptoms of obsessive-compulsive disorder (OCD). What drug will the nurse anticipate may be prescribed for the child? A) Phenelzine (Nardil) B) Amitriptyline (Elavil) C) Fluvoxamine (Prozac) D) Isocarboxazid (Marplan)
C
The nurse is caring for a patient who was referred to a psychiatrist for treatment of a severe anxiety disorder. What medication does the nurse consider appropriate for this patient? A) Chlorpromazine (Thorazine) 25 mg three times daily orally B) Benztropine (Cogentin) 2 mg twice daily orally C) Clozapine (Clozaril) 200 mg twice daily orally D) Paroxetine (Paxil) 10 mg once daily orally
D
