Unit 5 Pharm Chapter 21 Flashcards
A client has been taking a tricyclic antidepressant for several weeks and has presented to the clinic feeling “unwell.” What sign or symptom should the nurse most likely attribute to adverse drug effects?
A) Vivid and disturbing dreams
B) Blood-streaked stool
C) Headaches
D) Urinary hesitancy
D) Urinary hesitancy
Rationale:The anticholinergic effects of TCAs include urinary hesitancy. Each of the other listed signs and symptoms warrants follow-up, but none is as likely to result from the client’s medication regimen.
The nurse teaches a class on use of antidepressants in children at a local parent–teacher association meeting. What should the nurse teach these parents about the safe use of antidepressants in children? Select all that apply.
A) A black box warning was added to all antidepressants, bringing attention to the increase in suicidality in children and adolescents.
B) The data from the FDA study clearly established a link between increased suicidal ideation and the use of antidepressants.
C) Research does not indicate a high risk for suicide among pediatric clients taking antidepressants.
D) Antidepressants are not particularly effective in major depressive disorders in children, except fluoxetine.
A) A black box warning was added to all antidepressants, bringing attention to the increase in suicidality in children and adolescents.
C) Research does not indicate a high risk for suicide among pediatric clients taking antidepressants.
D) Antidepressants are not particularly effective in major depressive disorders in children, except fluoxetine.
Rationale:FDA data did not establish effectiveness in major depressive disorder in children for any antidepressants, except fluoxetine. In 20 placebo-controlled studies involving these eight drugs and more than 4,100 pediatric clients, there were no reports of completed suicides. In 2006, a black box warning was added to all antidepressants to bring attention to the increase in suicidality, especially in children and adolescents, when these drugs were used. The data from these studies did not clearly establish a link between increased suicidal ideation and the use of these antidepressants.
The nurse at an outpatient mental health unit is reviewing the black box warning that applies to clients who are taking antidepressants. To which of the nurse’s clients would the black box warning apply?
A) A 14-year-old client who has been diagnosed with major depression
B) A 33-year-old female client who has been diagnosed with postpartum depression
C) A client who once experienced an anaphylactic reaction to a blood transfusion
D) A depressed client who is in the second trimester of pregnancy
A) A 14-year-old client who has been diagnosed with major depression
Rationale:In 2006, a black box warning was added to all antidepressants bringing attention to the increase in suicidality, especially in children and adolescents, when these drugs were used. This warning does not apply to adults.
A client has been diagnosed with depression and has been prescribed amitriptyline. What should the nurse teach the client about expected adverse effects?
A) “If you get a nosebleed, go to the emergency department.”
B) “Your feelings of depression might get worse for a few days before they get better.”
C) “This drug is very likely to make you drowsy.”
D) “Some clients get high blood pressure from this, so check it often.”
C) “This drug is very likely to make you drowsy.”
Rationale:Amitriptyline is associated with significant drowsiness. It does not present a particular risk for bleeding, and epistaxis would not be an emergency. The client’s symptoms of depression are not expected to worsen in the short term. Hypotension is more likely than hypertension.
A client with depression began taking fluoxetine 10 days ago. The nurse should monitor the client for what adverse effect?
A) Epistaxis (nosebleed)
B) Urinary incontinence
C) Priapism (prolonged erection)
D) Anorexia
D) Anorexia
Rationale:Fluoxetine and the other SSRIs are associated with anorexia and weight loss in some clients. Some clients experience urgency, but incontinence is not expected. Epistaxis is not expected. Priapism is associated with trazodone, not SSRIs.
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?
A) Question the prescriber about the dose.
B) Question the prescriber about the timing.
C) Question the prescriber about the frequency.
D) Teach the client about possible anticholinergic effects.
A) Question the prescriber about the dose.
Rationale:Prozac is usually prescribed at 20 mg/d in the morning, with a ceiling of 60 mg/d. Consequently, the nurse should clarify the dose with the prescriber. Anticholinergic effects are not expected with SSRIs such as fluoxetine.
What instructions should a nurse include when teaching a client who has depression about the use of amitriptyline?
A) “Be sure to eat a low-fiber diet to prevent diarrhea.”
B) “Use sugarless hard candies and gum to deal with dry mouth.”
C) “Limit your fluid intake, so you don’t have to urinate during the night.”
D) “Take the drug daily in the morning for maximum benefit.”
B) “Use sugarless hard candies and gum to deal with dry mouth.”
Rationale:Sugar-free hard candies and gums would help to alleviate dry mouth that may occur due to anticholinergic effects. The client should take a major portion of the dose at bedtime if drowsiness and anticholinergic effects are severe. Fluid restriction should not be encouraged and would have no benefit. Similarly, a higher-fiber diet would be beneficial for maintaining normal bowel function.
A deficiency of a biogenic amine in key brain areas is believed to result in depression.
A) TRUE
B) FALSE
A) TRUE
Rationale:Scientists have theorized that depression results from a deficiency of biogenic amines in key areas of the brain; these biogenic amines include norepinephrine (NE), dopamine, and serotonin (5HT).
A nurse provides care on a psychiatric unit, and many of the clients on the unit take antidepressants. What client factor would the nurse have to consider when administering these medications?
A) A client who has a history of pulling out their IV cannula
B) A client who has dysphagia
C) A client who actively resists IM injections
D) A client who has an intense fear of injections
B) A client who has dysphagia
Rationale:Antidepressants are almost exclusively administered in oral form.
A nurse is reviewing the indications for the use of fluoxetine. For what client would this drug be appropriate?
A) An adult client who has bipolar disorder
B) A young adult client with bulimia
C) A client who has trichotillomania
D) A client with generalized anxiety disorder
B) A young adult client with bulimia
Rationale:Fluoxetine is indicated for the treatment of bulimia. Escitalopram is indicated for the treatment of generalized anxiety disorder. Duloxetine is indicated for the treatment of diabetic neuropathic pain. Citalopram is indicated for the treatment of trichotillomania.
