Mod 15- Antidepressant Agents

Question 1

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?

Answer 1

Yogurt
Explanation:
The nurse should ask the patient to avoid yogurt because yogurt contains tyramine, which interacts with MAOIs and causes hypertensive crisis.

Question 2

Several clients are prescribed sertraline therapy on the unit. Which client would require the closest monitoring by the nurse?

Answer 2

A 45-year-old man with liver impairment
Explanation:
Caution must be used when administering sertraline in clients with compromised liver function; therefore, the client with the liver impairment would require the closest monitoring. Adjustments such as a lower dosage or less-frequent dosing schedule may need to be made for these clients because the drug is extensively metabolized by the liver.

Question 3

A client has recently received a diagnosis of depression and has been prescribed citalopram. The nurse is providing health education and the client states, “I’m relieved to have some medication to help with my mood, because it’s my daughter’s wedding next weekend and I’ll be feeling better.” What is the nurse’s best response?

Answer 3

“Antidepressants will help your mood but it usually takes a few weeks to experience the benefits.”

Question 4

A black box warning alerts health care providers to risks in young adults 18 to 24 years of age when taking antidepressant medications. Which symptoms of concern should be included?

Answer 4

statements or resignation and futility and a desire to die

Question 5

The psychiatric-mental health nurse is providing care for several clients. Which client should the nurse monitor most closely for adverse medication effects?

Answer 5

a client who has depression and who began taking phenelzine 15 mg PO t.i.d. last month
Explanation:
The potential adverse effects of monoamine oxidase inhibitors far exceed those of SSRIs or tricyclic antidepressants, even when the latter are combined with ECT. For this reason, a client taking phenelzine requires exceptionally close monitoring.

Question 6

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?

Answer 6

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

Question 7

A client reports feelings of gloom and the inability to perform activities of daily living. The normal function of which neurotransmitter is most likely impaired?

Answer 7

Serotonin

Question 8

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?

Answer 8

onset of suicidal ideation

Question 9

What adverse effect could be related to a fall experienced by an older client prescribed amitriptyline?

Answer 9

orthostatic hypotension
Explanation:
Orthostatic hypotension, a common cause for falls, is an adverse effect related to tricyclic antidepressants like amitriptyline.

Question 10

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?

Answer 10

Orthostatic hypotension

Question 11

The nurse is caring for a 32-year-old client who is taking amitriptyline for depression. What nursing intervention would be appropriate if this client developed orthostatic hypotension?

Answer 11

Asking the client to sit on the side of the bed for 1 minute before getting up

Question 12

The client has been prescribed an MAO inhibitor. As the nurse teaches the client about this medication, what foods will the client be instructed to avoid?

Answer 12

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

Question 13

What should the nurse’s pre-administration assessment for a client receiving an antidepressant include? (Select all that apply.)

Answer 13

Vital signs assessment
 Presence of suicidal ideation
 Complete medical history
 Weight
 Mental status assessment

Question 14

The nurse is caring for a client taking fluoxetine for depression. Which assessment findings indicate that the medication is effective? Select all that apply.

Answer 14

Correct response:
improved sleep

decreased anxiety

interest in physical activity

Explanation:
Selective serotonin reuptake inhibitors such as fluoxetine are the drugs of first choice in the treatment of depression. Assessment findings that indicate therapeutic effects include improved sleep, decreased anxiety, improved appetite, and interest in physical activity.

Question 15

A client has been prescribed phenelzine sulfate. When providing teaching, which food should the nurse instruct the client to avoid eating?

Answer 15

Salami

Question 16

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?

Answer 16

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

Question 17

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?

Answer 17

A client who began taking escitalopram two weeks ago says her mood has worsened since starting the drug

Question 18

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

Answer 18

Extreme sadness

Question 19

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?

Answer 19

A lower dose of the antidepressant

Question 20

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?

Answer 20

Correct response:
Dangerous drug interactions
Explanation:
Combining St. John’s wort with antidepressants can cause serious drug-to-drug interactions.

Question 21

A patient is receiving an antidepressant that helps to decrease addictive behavior. Which drug most likely would be prescribed?

Answer 21

Venlafaxine
Explanation:
Venlafaxine is used to treat and prevent depression in generalized anxiety disorder, as treatment for social anxiety disorder, and to help decrease addictive behaviors. Nefazodone is used to treat depression. Mirtazapine is used to treat depression. Selegiline is used to treat depression.

Question 22

An adult resident of a long-term care facility has been diagnosed with depression and the provider has prescribed selegiline. When preparing to administer the medication, what is the nurse’s best action?

Answer 22

Assess the integrity of the client’s skin.
Explanation:
Selegiline is administered by a transdermal patch, which requires dry, intact skin. It cannot be administered orally so there is no need for the client to sit upright.

Question 23

A client has been taking a selective serotonin reuptake inhibitor (SSRI) for the treatment of depression. Which represents the action of the medication?

Answer 23

SSRIs prevent serotonin from being reabsorbed

Question 24

A client is prescribed transdermal selegiline. What health education should the nurse provide?

Answer 24

“Place the patch on dry skin on your torso that has no cuts or openings.”

Question 25

A client taking phenelzine 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.)

Answer 25

Chest pain
 Tachycardia
 Stiff neck
  Explanation:
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.

Question 26

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?

Answer 26

Correct response:
dizziness.
Explanation:
The nurse will closely monitor for the adverse effects of phenelzine related to the anticholinergic effect of the drug, such as dizziness that tends to be more pronounced at dosages above 45 mg/day. Dizziness is also a sign of a phenelzine drug overdose. Constipation and dry mouth are also adverse effect

Question 27

How long does a patient need to wait after stopping a phenelzine before starting paroxetine?

Answer 27

14 days
Explanation:
Patients should not start a serotonin reuptake inhibitor like paroxetine (Paxil) until they have been off phenelzine (Nardil) for 14 days.

Question 28

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?

Answer 28

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

Question 29

To best assure client safety, what information should the nurse provide to a client whose fluoxetine therapy has been discontinued?

Answer 29

The dosage of the medication will be gradually reduced over a period of 6 to 8 weeks.

Question 30

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?

Answer 30

4 weeks

Question 31

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?

Answer 31

Use of TCAs may lead to GI anticholinergic effects, such as dry mouth, constipation, nausea, vomiting, anorexia, increased salivation, cramps, and diarrhea.

Question 32

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.

Answer 32

Clomipramine
Explanation:
Only clomipramine is indicated for the treatment of obsessive-compulsive disorder.