Question 1

The nurse is caring for a patient who is taking a newly prescribed drug,nefazodone,for treatment of depression.Which physical assessment finding is most important for the nurse to report to the health care provider immediately?

Accepted Answer

Bradycardia with a drop in 15 beats/min is to be reported to the health care provider immediately; withholding the dose is warranted until approved.Dizziness,drowsiness,and urinary retention are common adverse effects that would not need to be reported to the health care provider.

Question 2

What occurs with mania associated with bipolar disorder?

Accepted Answer

Mania is characterized by distinct episodes of euphoria and elation.Sadness is characteristic of depression.Suicide is not generally associated with mania; it is more commonly associated with depression.Psychomotor retardation is not associated with mania.

Question 3

The nurse is teaching a patient about medication treatment for depression.The patient asks how long it will take before sleep and appetite will begin to improve.Which response by the nurse is most accurate?

Accepted Answer

The physiological manifestations of depression (sleep disturbance,change in appetite,loss of energy,fatigue,palpitations)begin to be alleviated within the first week of therapy.It takes longer than 3 days for the symptoms to improve.Four weeks and 2 months are longer than it takes for the symptoms to improve.

Question 4

Which area(s)should be addressed by the nurse when obtaining a history of a patient admitted with depression?(Select all that apply.)

Accepted Answer

It is important to obtain a thorough history when assessing the patient with depression,including current medical status and medications,recent stressors,support system,family history of mood disorders,and nutritional patterns.Financial matters should not be part of the nursing assessment.

Question 5

Which assessment would the nurse expect to observe in a patient who has been prescribed trazodone for treatment anxiety?

Accepted Answer

Drowsiness is a common adverse effect,and people who work with machinery,drive a car,administer medicines,or perform other duties in which they must remain mentally alert should not take trazodone while working.Excessive thirst,hand tremors,and diarrhea are not adverse effects associated with trazodone.

Question 6

Which psychological manifestation of depression will improve in response to antidepressant therapy?

Accepted Answer

Social withdrawal and lack of interest in surroundings are psychological responses that will improve within 2 to 4 weeks of the patient receiving an effective dosage of antidepressant therapy.An increase in energy,decreased palpitations,and improvement in sleep patterns are physiological responses.

Question 7

A patient who is taking an MAOI to treat depression admits to eating pickled herring and cheese and drinking red wine.Which assessment finding alerts the nurse to a potential complication?

Accepted Answer

Hypertensive crisis is a major potential complication.Common prodromal symptoms of hypertensive crisis include severe occipital headache,stiff neck,sweating,nausea,vomiting,and sharply elevated blood pressure.Constipation,hypotension,and urinary retention are not indicative of a major potential complication when patients consume foods high in tyramine.

Question 8

A patient taking vilazodone has been vomiting persistently for 12 hours.The priority nursing diagnosis for this patient is

Accepted Answer

Nausea and vomiting are common adverse effects of vilazodone.Persistent vomiting should be evaluated for other causes,as well as for the development of electrolyte imbalance.Fluid volume deficit can lead to life-threatening cardiac arrhythmias and therefore is the priority nursing diagnosis.The nursing diagnosis nausea is appropriate but is not the priority.Imbalanced nutrition is an appropriate nursing diagnosis but is not the priority at this time.Altered peripheral tissue perfusion does not apply to this scenario.

Question 9

Lithium (Eskalith)is the drug of choice for which of the following disorders?(Select all that apply.)

Accepted Answer

Lithium is used to treat acute mania and for prophylactic treatment of recurrent manic and depressive episodes in bipolar disorders.Psychotic episodes are treated with major tranquilizers that have an antipsychotic effect.The drugs of choice for treating OCD are SSRIs.Depressive disorders are not primarily treated with lithium.

Question 10

Which postoperative narcotic analgesic will most likely be prescribed to a patient whose current medications include a monoamine oxidase inhibitor (MAOI),a thyroid hormone,and a multivitamin?

Accepted Answer

Morphine is the narcotic analgesic of choice because it will not interact with the patient's MAOI.Meperidine will interact with the patient's medication.Ibuprofen and acetaminophen are not narcotic analgesics.

Question 11

Which nursing action is most important when providing care to a patient diagnosed with a mood disorder?

Accepted Answer

Determining if there is a risk for suicide,monitoring at specified intervals,and providing patient safety and supervision are the highest priorities with severe mood disorders.Providing supplemental feedings,assisting with activities of daily living,and offering opportunities for interaction with other patients are not priorities of care.

Question 12

Which food(s)containing significant amounts of tyramine will be contraindicated when a patient is on MAOI therapy?(Select all that apply.)

Accepted Answer

Beer,red wines,well-ripened cheeses (such as camembert,edam,roquefort,parmesan,mozzarella,and cheddar),and overripe bananas contain tyramine.Red meat and green vegetables do not contain tyramine.

Question 13

On what is the choice of tricyclic antidepressants based?

Accepted Answer

The choice of tricyclic antidepressants is based on their individual therapeutic characteristics.Tricyclics prolong the action of norepinephrine,dopamine,and serotonin.All tricyclics produce orthostatic hypotension to some degree.All tricyclics produce sedation,not stimulation.

Question 14

What is the action of MAOIs on neurotransmitters?

Accepted Answer

MAOIs act by blocking the metabolic destruction of epinephrine,norepinephrine,dopamine,and serotonin neurotransmitters by the enzyme monoamine oxidase in the presynaptic neurons of the brain.They prevent the degradation of these central nervous system (CNS)neurotransmitters so that their concentration is increased.MAOIs do not block or increase the reuptake of neurotransmitters.MAOIs do not increase production of neurotransmitters.

Question 15

What will the nurse include in a teaching plan for a patient with depression being treated with amitriptyline (Elavil)?(Select all that apply.)

Accepted Answer

Common adverse effects associated with tricyclic antidepressants are dry mouth and orthostatic hypotension.Alcohol and barbiturates should be avoided while taking tricyclic antidepressants because they enhance sedation.Adverse effects are likely to occur,and the medication should not be discontinued without the direction of the health care provider.Tricyclic antidepressants typically take several weeks to produce a therapeutic effect.

Question 16

A patient is admitted to a long-term psychiatric setting.The MAOI medication previously prescribed is discontinued by the physician.New orders are obtained to initiate imipramine therapy.The nurse will provide the first dose of imipramine to the patient _____ the MAOI drug.

Accepted Answer

MAOIs and TCAs,especially imipramine and desipramine,should not be administered concurrently.It is recommended that at least 14 days lapse between discontinuing an MAOI and starting SSRI/SNRI therapy.

Question 17

Which nursing assessment(s)is/are important before the initiation of antidepressant therapy?(Select all that apply.)

Accepted Answer

Compliancy with prescribed medications over the last 2 months provides the health care provider with information regarding the patient's state of mind and ability to follow through with medication administration independently.Patients with altered thought processes often display inconsistencies between statements of feelings and behavior norms in social settings.Coherency,relevancy,and organization of thoughts are often affected by thought disorders.This assessment also provides information regarding the accuracy of other information that the patient has offered.Note general appearance and appropriateness of attire and posture because these are often affected by mood disorders.Elimination pattern is not a priority premedication assessment.

Question 18

The nurse is providing education to a patient who has been prescribed bupropion (Wellbutrin)for smoking cessation.Which statement by the patient would indicate the need for further teaching?

Accepted Answer

Dosage will begin at 150 mg/day for the first 3 days and then,for most patients,be increased to 300 mg/day.The patient is maintained on doses of 300 mg/day for 7 to 12 weeks and dosage is not based on a desire to smoke.Bupropion should be swallowed whole,not crushed,divided,or chewed.Dose tapering is not required when discontinuing bupropion.

Question 19

Which instruction(s)is/are most pertinent to include in the discharge teaching of a patient on lithium (Eskalith)who is being discharged?(Select all that apply.)

Accepted Answer

Patients should be informed of the importance of toxic symptoms to report and monitoring therapeutic lithium levels.Nausea,vomiting,and abdominal cramps are common adverse effects and tend to resolve.Lithium should be administered with food or milk.Chianti wine and aged cheeses are to be avoided during MAOI therapy.The bipolar patient may be on lithium treatment for the rest of his or her life and will not be weaned from the medication.

Question 20

What is the major advantage of selective serotonin reuptake inhibitors (SSRIs)over other types of antidepressant therapy?(Select all that apply.)

Accepted Answer

SSRIs are the most widely used class of antidepressants.Although they are as effective in treating depression as the tricyclic antidepressants,they do not cause the anticholinergic and cardiovascular adverse effects that often limit the use of tricyclic antidepressants.SSRIs tend to be more expensive than other available antidepressants.SSRIs do not cure major depressive illnesses.As with other antidepressants,it takes 2 to 4 weeks to obtain the full therapeutic benefit when taking SSRIs.

Quiz 16: Drugs Used for Depressive and Bipolar Disorders

The nurse is caring for a patient who is taking a newly prescribed drug,nefazodone,for treatment of depression.Which physical assessment finding is most important for the nurse to report to the health care provider immediately?

What occurs with mania associated with bipolar disorder?

The nurse is teaching a patient about medication treatment for depression.The patient asks how long it will take before sleep and appetite will begin to improve.Which response by the nurse is most accurate?

Which area(s) should be addressed by the nurse when obtaining a history of a patient admitted with depression?(Select all that apply.)

Which assessment would the nurse expect to observe in a patient who has been prescribed trazodone for treatment anxiety?

Which psychological manifestation of depression will improve in response to antidepressant therapy?

A patient who is taking an MAOI to treat depression admits to eating pickled herring and cheese and drinking red wine.Which assessment finding alerts the nurse to a potential complication?

A patient taking vilazodone has been vomiting persistently for 12 hours.The priority nursing diagnosis for this patient is

Lithium (Eskalith) is the drug of choice for which of the following disorders?(Select all that apply.)

Which postoperative narcotic analgesic will most likely be prescribed to a patient whose current medications include a monoamine oxidase inhibitor (MAOI) ,a thyroid hormone,and a multivitamin?

Which nursing action is most important when providing care to a patient diagnosed with a mood disorder?

Which food(s) containing significant amounts of tyramine will be contraindicated when a patient is on MAOI therapy?(Select all that apply.)

On what is the choice of tricyclic antidepressants based?

What is the action of MAOIs on neurotransmitters?

What will the nurse include in a teaching plan for a patient with depression being treated with amitriptyline (Elavil) ?(Select all that apply.)

A patient is admitted to a long-term psychiatric setting.The MAOI medication previously prescribed is discontinued by the physician.New orders are obtained to initiate imipramine therapy.The nurse will provide the first dose of imipramine to the patient _____ the MAOI drug.

Which nursing assessment(s) is/are important before the initiation of antidepressant therapy?(Select all that apply.)

The nurse is providing education to a patient who has been prescribed bupropion (Wellbutrin) for smoking cessation.Which statement by the patient would indicate the need for further teaching?

Which instruction(s) is/are most pertinent to include in the discharge teaching of a patient on lithium (Eskalith) who is being discharged?(Select all that apply.)

What is the major advantage of selective serotonin reuptake inhibitors (SSRIs) over other types of antidepressant therapy?(Select all that apply.)