Chapter 32-Antidepressants

Question 1

1. A patient taking fluoxetine [Prozac] complains of decreased sexual interest. A prescriber orders a “drug holiday.” What teaching by the nurse would best describe a drug holiday?
   a.
   “Cut the tablet in half anytime to reduce the dosage.”
   b.
   “Discontinue the drug for 1 week.”
   c.
   “Don’t take the medication on Friday and Saturday.”
   d.
   “Take the drug every other day.”

Answer 1

C

Question 2

2.	A patient whose spouse has died recently reports feeling down most of each day for the past 2 months. On further questioning, the nurse learns that the patient has quit participating in church and social activities, has difficulty falling asleep, and has lost 5 pounds. The patient reports feeling tired and confused all the time but does not have suicidal thoughts. What does the nurse suspect?
a.
Grief and sadness
b.
Hypomania
c.
Major depression
d.
Situational depression

Answer 2

C

Question 3

3. A patient is diagnosed with major depression with severe symptoms and begins taking an antidepressant medication. Three weeks after beginning therapy, the patient tells the nurse that the drug is not working. The nurse will counsel this patient to ask the provider about:
   a.
   adding a second medication to complement this drug.
   b.
   changing the medication to one in a different drug class.
   c.
   increasing the dose of this medication.
   d.
   using nondrug therapies to augment the medication.

Answer 3

D

Question 4

4. A young adult patient has been taking an antidepressant medication for several weeks and reports having increased thoughts of suicide. The nurse questions further and learns that the patient has attempted suicide more than once in the past. The patient identifies a concrete plan for committing suicide. The nurse will contact the provider to discuss:
   a.
   changing the medication to another drug class.
   b.
   discontinuing the medication immediately.
   c.
   hospitalizing the patient for closer monitoring.
   d.
   requiring more frequent clinic visits for this patient.

Answer 4

C

Question 5

5. A patient has been taking fluoxetine [Prozac] for 2 years and reports feeling cured of depression. The nurse learns that the patient is sleeping well, participates in usual activities, and feels upbeat and energetic most of the time. The patient’s weight has returned to normal. The patient reports last having symptoms of depression at least 9 months ago. What will the nurse tell this patient?
   a.
   Indefinite drug therapy is necessary to maintain remission.
   b.
   Discuss gradual withdrawal of the medication with the provider.
   c.
   Stop the drug while remaining alert for the return of symptoms.
   d.
   Take a drug holiday to see whether symptoms recur.

Answer 5

B

Question 6

6. A patient has been taking an SSRI antidepressant for major depression and reports having headaches and jaw pain. What will the nurse tell the patient?
   a.
   This represents an irreversible extrapyramidal side effect.
   b.
   Discuss discontinuing the antidepressant with the provider.
   c.
   Discuss these symptoms with a dentist.
   d.
   Try stress-relieving methods and relaxation techniques.

Answer 6

C

Question 7

7. A patient who has been taking a monoamine oxidase inhibitor (MAOI) for depression for several months tells the provider that the medication has not helped with symptoms. The provider plans to switch the patient to an SSRI. The nurse will teach this patient to:
   a.
   start taking the SSRI and stop the MAOI when symptoms improve.
   b.
   start taking the SSRI and then gradually withdraw the MAOI.
   c.
   stop taking the MAOI and wait 5 weeks before starting the SSRI.
   d.
   stop taking the MAOI 2 weeks before starting the SSRI.

Answer 7

D

Question 8

8. A neonate is born to a patient who reports taking venlafaxine [Effexor XR]. The nurse caring for the infant will observe the infant for:
   a.
   irritability, tremor, and respiratory distress.
   b.
   poor appetite and disturbed sleeping patterns.
   c.
   serotonin syndrome.
   d.
   sustained mydriasis.

Answer 8

A

Question 9

9.	A provider has indicated that a serotonin/norepinephrine reuptake inhibitor (SNRI) will be prescribed for a patient who is experiencing major depression. When conducting a pretreatment health history, the nurse learns that the patient has a recent history of alcohol abuse. Which SNRI would be contraindicated for this patient?
a.
Desvenlafaxine [Pristiq]
b.
Duloxetine [Cymbalta]
c.
Escitalopram [Lexapro]
d.
Venlafaxine [Effexor SR]

Answer 9

B

Question 10

10. A nurse is teaching a group of nursing students about tricyclic antidepressants (TCAs). Which statement by a student indicates a need for further teaching?
    a.
    “TCAs block receptors for histamine, acetylcholine, and norepinephrine.”
    b.
    “TCAs block the uptake of norepinephrine and 5-HT.”
    c.
    “TCAs have many side effects, but none of them are serious.”
    d.
    “TCAs have other uses than for depression.”

Answer 10

C

Question 11

11. An older adult patient who is to begin taking imipramine [Tofranil] asks the nurse when the drug should be taken. The nurse will instruct the patient to:
    a.
    divide the daily dose into two equal doses 12 hours apart.
    b.
    take the entire dose at bedtime to minimize sedative effects.
    c.
    take the medication once daily in the late afternoon.
    d.
    take the medication once daily in the morning.

Answer 11

A

Question 12

12.	A patient who has fibromyalgia is diagnosed with major depression. The provider orders a TCA. The nurse will teach this patient to:
a.
avoid foods containing tyrosine.
b.
consume alcohol in moderation.
c.
sit or lie down when feeling lightheaded.
d.
take the medication in the morning.

Answer 12

C

Question 13

13. A patient taking an MAOI is seen in the clinic with a blood pressure of 170/96 mm Hg. What will the nurse ask this patient?
    a.
    Whether any antihypertensive medications are used
    b.
    Whether the patient drinks grapefruit juice
    c.
    To list all foods eaten that day
    d.
    Whether SSRIs are taken in addition to the MAOI

Answer 13

C

Question 14

14.	A patient who has been taking an SSRI tells the nurse that the drug has caused reduced sexual performance, weight gain, and sedation. The nurse will suggest that the patient ask the provider about using which drug?
a.
Bupropion [Wellbutrin]
b.
Imipramine [Tofranil]
c.
Isocarboxazid [Marplan]
d.
Trazodone [Oleptro]

Answer 14

A

Question 15

15. A first-time parent of a 6-week-old infant tells the nurse that she feels anxious and sad, cries a lot, and has difficulty sleeping. What will the nurse do?
    a.
    Ask her to complete the Edinburgh Postnatal Depression Scale.
    b.
    Reassure her that the “baby blues” are normal after childbirth.
    c.
    Suggest that she get more sleep and try to increase her activity.
    d.
    Suggest that she talk to her provider about using an SSRI.

Answer 15

A

Question 16

16. A woman who is nursing a newborn develops postpartum depression and her provider orders sertraline [Zoloft] to treat her symptoms. The patient is concerned about the safety of this medication for her infant. What will the nurse tell her about this medication?
    a.
    To stop nursing while taking the medication
    b.
    To expect symptoms of colic and poor weight gain in the baby
    c.
    That sertraline is safer than other antidepressants for nursing mothers
    d.
    To ask her provider about switching to fluoxetine [Prozac] instead

Answer 16

C

Question 17

1.	A patient is brought to the emergency department after taking a handful of TCA pills. The nurse will expect to provide what when caring for this patient? (Select all that apply.)
a.
Cardiac monitoring
b.
Cholinesterase inhibitors
c.
Gastric lavage and activated charcoal
d.
Sedative medications
e.
Procainamide

Answer 17

A. B. C

Question 18

2.	Which patients are candidates for MAOIs? (Select all that apply.)
a.
Patients who have not responded to SSRIs and TCAs
b.
Patients with atypical depression
c.
Patients with bulimia nervosa
d.
Patients with hypotension
e.
Patients with postpartum depression

Answer 18

A. B. C