Question 1

A patient prescribed fluoxetine is being changed to tranylcypromine. The nurse provides education on this change that will include a time lapse between the last dose of fluoxetine and the first dose of tranylcypromine of at least how long?

Accepted Answer

Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) with a long half-life, and tranylcypromine is a monoamine oxidase inhibitor (MAOI). Due to the risk of serotonin syndrome, a washout period of at least 5 weeks is recommended when switching from fluoxetine to an MAOI like tranylcypromine. The closest option provided is 6 weeks.

Question 2

What is the nurse's priority assessment for a patient taking an antidepressant medication?

Accepted Answer

The nurse's priority assessment for a patient taking an antidepressant medication should be the presence of suicidal ideations, as these medications can increase the risk of suicidal thoughts and behaviors. This is a potentially life-threatening side effect that requires immediate intervention. While assessing for other side effects of antidepressant medications is important, it is not as urgent as assessing for suicidality.

Question 3

A patient tells the nurse, "I've stopped taking sertraline because the drug made me impotent. Which statement by the nurse will provide the best patient support?

Accepted Answer

The nurse should explore the possibility of changing the medication if the patient is experiencing side effects that are affecting the quality of life. In this case, the patient is experiencing impotence from taking sertraline. Therefore, talking to the doctor about changing the medication is the best way to support the patient.

Question 4

A patient diagnosed with depression is prescribed the tricyclic antidepressant (TCA) bupropion. What is the benefit of this medication for nonhospitalized patients?

Accepted Answer

The answer of A patient diagnosed with depression is prescribed...

Question 5

What is the nurse's highest priority when caring for a patient after a tricyclic antidepressant (TCA) overdose?

Accepted Answer

The nurse's highest priority should be to frequently monitor the patient's blood pressure and heart rate/rhythm as TCAs can cause cardiac toxicity and arrhythmias. Skin rashes may occur but are not typically a priority. Measuring intake and output is important for overall fluid balance but not the highest priority in this situation. Cooling blankets may be used for hyperthermia, but the priority is to address the cardiac effects of the overdose.

Question 6

Evaluation of a patient's response after 1 week of tricyclic antidepressant (TCA) therapy would be expected to focus on what assessment question? (Select all that apply.)

Accepted Answer

The answer of Evaluation of a patient's response after 1...

Question 7

Which assessment finding warrants the nurse's priority attention when caring for a patient prescribed a selective serotonin reuptake inhibitor (SSRI)? (Select all that apply.)

Accepted Answer

hyperthermia, confusion, and agitation are potential signs of serotonin syndrome, a potentially life-threatening adverse reaction to SSRIs. Therefore, the nurse should prioritize attention to these findings and notify the healthcare provider immediately. Frontal headache and photophobia are not typically associated with serotonin syndrome but should still be assessed and documented.

Question 8

When teaching about the monoamine oxidase inhibitor (MAOI) tranylcypromine, the nurse should consider it a priority to provide what information?

Accepted Answer

A key concern when taking an MAOI like tranylcypromine is the risk of a hypertensive crisis when consuming foods high in tyramine. Therefore, providing a list of tyramine-rich foods is a priority for patient education. The other options listed are not specific to the side effects or interactions of tranylcypromine.

Question 9

A secondary amine tricyclic antidepressant is prescribed for a patient. The medication will significantly increase the availability of which neurotransmitter?

Accepted Answer

Secondary amine tricyclic antidepressants increase the availability of norepinephrine by blocking its reuptake into the presynaptic neuron.

Question 10

What are the priority history assessments for a patient beginning amitriptyline therapy? (Select all that apply.)

Accepted Answer

D) Orthostatic hypotension: Amitriptyline can cause a significant drop in blood pressure upon standing, which can lead to falls, syncope, and injury. Monitoring the patient's blood pressure while supine and standing is essential.
E) Blurred vision: Amitriptyline is known to cause visual disturbances, including blurred vision and dry eyes. Patients should have a thorough ophthalmic examination before starting therapy and should be advised to report any changes in vision.

Question 11

A tricyclic antidepressant (TCA) is prescribed for a patient newly diagnosed with depression. What information should be included in patient teaching?

Accepted Answer

It is important to inform the patient that TCAs can take up to 2 weeks, sometimes longer, for their therapeutic effects to become noticeable. This can help the patient manage their expectations and continue taking the medication as prescribed. Option A is incorrect because TCAs should be taken with food to minimize gastrointestinal side effects. Option B is incorrect because TCAs can have interactions with tyramine-rich foods such as aged cheese, but it is not a necessary precaution for all patients. Option C is incorrect because the side effects listed are typically associated with selective serotonin reuptake inhibitors (SSRIs) rather than TCAs.

Question 12

A 75-year-old patient with a long history of depression begins amitriptyline 100 mg/day. The patient also takes a diuretic daily for hypertension. What is the highest priority nursing diagnosis this patient is at risk for?

Accepted Answer

Amitriptyline, a tricyclic antidepressant, can cause orthostatic hypotension and dizziness, which increases the risk for falls, especially in older adults. The diuretic can exacerbate these side effects by lowering blood pressure further. Anhidrosis, suppressed white blood cell count, and slowed gastrointestinal peristalsis may be potential side effects, but they are not linked to the highest priority nursing diagnosis of fall risk.

Question 13

A patient prescribed phenelzine reports a sudden headache and palpitations. What is the nurse's initial intervention when observing the patient demonstrating dilated pupils and diaphoresis?

Accepted Answer

The answer of A patient prescribed phenelzine reports a sudden...

Question 14

A nurse teaches a patient taking a monoamine oxidase inhibitor (MAOI) about important dietary guidelines. Which nutritional choices by the patient indicate that the teaching was effective? (Select all that apply.)

Accepted Answer

The answer of A nurse teaches a patient taking a...

Question 15

A pregnant patient took selective serotonin reuptake inhibitors (SSRIs) during the third trimester of pregnancy. The newborn will be carefully assessed for which neonatal complication?

Accepted Answer

The answer of A pregnant patient took selective serotonin reuptake...

Question 16

A depressed patient preparing for discharge is prescribed desipramine and will have follow-up outpatient visits. The patient reports, "Why did they gave me only a 1-week supply of my medicine?" Select the nurse's best reply.

Accepted Answer

Prescribing a small amount of medication, especially in the case of antidepressants like desipramine, is a safety measure to minimize the risk of overdose in patients who are at risk of suicide, which is a concern in individuals with depression.

Question 17

Why do patients taking tricyclic antidepressants (TCAs) exhibit more side effects than patients taking selective serotonin reuptake inhibitors (SSRIs)?

Accepted Answer

TCAs inhibit the reuptake of both norepinephrine and serotonin, leading to a broader range of side effects. SSRIs, on the other hand, only inhibit the reuptake of serotonin.

Question 18

A patient diagnosed with depression has taken a selective serotonin reuptake inhibitor (SSRI) for 1 month. The nurse should use direct questions to evaluate which potential side effect?

Accepted Answer

Sexual dysfunction is a potential side effect of SSRIs, therefore the nurse should use direct questioning to evaluate for this specific side effect. Aggressive impulses and paranoid delusions are not commonly associated with SSRIs, while weight gain may be a potential side effect, it is not specific enough to warrant direct questioning.

Question 19

Nortriptyline was prescribed for a 68-year-old patient diagnosed with depression and insomnia. What assessment question should the nurse ask to determine the effectiveness of nortriptyline?

Accepted Answer

Nortriptyline is prescribed for depression and insomnia, so the most appropriate question to determine its effectiveness would be whether the patient is still experiencing insomnia or not. Questions about bowel movements, weight loss, or concentration are not directly related to the medication's effectiveness in treating depression and insomnia.

Quiz 15: Antidepressant Drugs