Question 1

A patient who is taking amitriptyline (Elavil) reports constipation and dry mouth. The patient notes that these side effects are a nuisance, but not severe. The nurse will give the patient which instruction?

A) Increase fluid intake.
B) Notify the provider.
C) Request another antidepressant.
D) Stop taking the medication immediately.

Increase fluid intake.

Accepted Answer

Constipation and dry mouth are common side effects of amitriptyline. Increasing fluid intake can help alleviate these symptoms. The patient should not stop taking the medication without consulting their provider, and it is not necessary to request another antidepressant unless these side effects become severe or intolerable.

Question 2

A patient who has been taking a monoamine oxidase (MAO) inhibitor for several months will begin taking amoxapine (Asendin) instead of the MAO inhibitor. The nurse will counsel the patient to begin taking the amoxapine:

A) along with the MAO inhibitor for several months.
B) at least 14 days after discontinuing the MAO inhibitor.
C) the day after the last dose of the MAO inhibitor.
D) while withdrawing the MAO inhibitor over several weeks.

Accepted Answer

Due to the risk of a potentially fatal interaction between MAO inhibitors and certain antidepressants, including amoxapine, the patient must wait at least 14 days after discontinuing the MAO inhibitor before starting amoxapine. This is to allow sufficient time for the MAO inhibitor to be cleared from the body and reduce the risk of adverse effects such as serotonin syndrome or hypertensive crisis.

Question 3

The nurse is teaching a patient who will begin taking doxepin (Sinequan) to treat depression. Which statement by the patient indicates a need for further teaching?&#10;A) &#34;I should expect results within 2 to 4 weeks.&#34;&#10;B) &#34;I should increase fluids and fiber while taking this medication to avoid constipation.&#34;&#10;C) &#34;I should take care when rising from a sitting to standing position.&#34;&#10;D) &#34;I will take the medication in the morning before breakfast.&#34;

Accepted Answer

Doxepin (Sinequan) is a tricyclic antidepressant and should be taken at bedtime, not in the morning. This medication can cause drowsiness and should not be taken during the day. The other statements are correct and do not require further teaching.

Question 4

A patient who has major depressive disorder has been taking fluoxetine (Prozac) 20 mg daily for 3 months and reports improved mood, less fatigue, and an increased ability to concentrate. The patient's side effects have diminished. The only complaint from the patient is regarding the number of medications she has to take daily. What will the nurse counsel this patient to discuss with the provider?

A) Changing to once-weekly dosing
B) Decreasing the dose to 10 mg daily
C) Discontinuing the medication
D) Increasing the dose to 30 mg daily

Accepted Answer

The nurse should counsel the patient to discuss once-weekly dosing with their provider as a possible option to decrease the daily medication burden. However, this should only be considered if the patient is stable on their current dose and has been taking medication consistently for at least 6 months. It is not appropriate to decrease or discontinue medication without provider guidance, and increasing the dose should only be done if the patient is experiencing inadequate response and has not reached the maximum therapeutic dose.

Question 5

A patient who has been diagnosed with major depression disorder has been ordered to take doxepin (Sinequan). The nurse will contact the provider if the patient's medical history reveals a history of which condition?

A) Asthma
B) Glaucoma
C) Hypertension
D) Hypoglycemia

Accepted Answer

Doxepin can increase intraocular pressure and can be harmful in patients with glaucoma. Therefore, the nurse needs to contact the provider if the patient has a history of glaucoma. Asthma, hypertension, and hypoglycemia are not contraindications for doxepin.

Question 6

A patient who has had a loss of interest in most activities, weight loss, and insomnia is diagnosed with major depressive disorder and will begin taking fluoxetine (Prozac) daily. The patient asks about the weekly dosing that a family member follows. What will the nurse tell the patient about a weekly dosing regimen?

A) It can be used after daily maintenance dosing proves effective and safe.
B) It is used after a trial of tricyclic antidepressant medication fails.
C) It is not effective for this type of depression and its symptoms.
D) It will cause more adverse effects than daily dosing regimens.

Accepted Answer

Weekly dosing is an option for fluoxetine after the patient has been stabilized on a daily maintenance dose and can improve adherence. However, it is not used after a trial of tricyclic antidepressants fails, and it is not necessarily less effective than daily dosing. Adverse effects may be similar between the two dosing regimens.

Question 7

A nurse performs a medication history on a newly admitted patient. The patient reports taking amitriptyline (Elavil) 75 mg at bedtime for 6 weeks to treat depression. The patient reports having continued fatigue, lack of energy, and no improvement in mood. The nurse will contact the provider to discuss which intervention?

A) Beginning to down-taper the amitriptyline
B) Changing to a morning dose schedule
C) Giving the amitriptyline twice daily
D) Increasing the dose of amitriptyline

Accepted Answer

The answer of A nurse performs a medication history on...

Question 8

A patient has been taking paroxetine (Paxil) 20 mg per day for 2 weeks and reports a decrease in libido. Which action will the nurse take?&#10;A) Counsel the patient to take the medication with food.&#10;B) Reassure the patient that this side effect can decrease over time.&#10;C) Suggest that the patient discuss a lower dose with the provider.&#10;D) Tell the patient to stop taking the drug and contact the provider.

Accepted Answer

Sexual side effects, such as decreased libido, are common with SSRIs like paroxetine. These side effects can decrease over time, so reassurance is appropriate.

Question 9

A patient who has been diagnosed with social anxiety disorder will begin taking venlafaxine (Effexor). The nurse who performs a medication and dietary history will be concerned about ingestion of which substance or drug?

A) Coffee
B) Grapefruit juice
C) Oral hypoglycemic drug
D) St. John's wort

Accepted Answer

St. John's wort can interact with venlafaxine (Effexor) by increasing the risk of serotonin syndrome, a potentially life-threatening condition. This is due to both substances potentially increasing serotonin levels.

Question 10

A patient has been taking sertraline (Zoloft) 20 mg/mL oral concentrate, 1 mL daily for several weeks and reports being unable to sleep well. The patient's depressive symptoms are well managed on the current dose. What will the nurse do next?

A) Ask the patient what time of day the medication is taken.
B) Counsel the patient to take the medication at bedtime.
C) Recommend asking the provider about weekly dosing.
D) Suggest that the patient request a lower dose.

Accepted Answer

The nurse should first ask the patient what time of day they are taking the medication to see if it is possible that the medication is causing insomnia. If the patient is taking the medication in the morning or afternoon, the nurse can counsel the patient to take it at bedtime. However, if the patient is already taking it at bedtime, the nurse will need more information before making any further recommendations. Recommending a lower dose or weekly dosing is not appropriate unless further assessment is done.

Question 11

A patient who has been diagnosed with depression asks why the provider has not ordered a monoamine oxidase (MAO) inhibitor to treat the disorder. The nurse will explain to the patient that MAO inhibitors:

A) are more expensive than other antidepressants.
B) are no longer approved for treating depression.
C) can cause profound hypotension.
D) require strict dietary restrictions.

Accepted Answer

The answer of A patient who has been diagnosed with...

Question 12

A patient who has recently begun taking lithium (Lithobid) calls the clinic to report nausea, vomiting, anorexia, and hand tremor. What will the nurse do next?&#10;A) Contact the provider to obtain an order for a serum lithium level.&#10;B) Reassure the patient that these symptoms are common and transient.&#10;C) Tell the patient that the lithium dose is probably too low.&#10;D) Tell the patient to stop taking the medication immediately.

Accepted Answer

The answer of A patient who has recently begun taking...

Question 13

The nurse assesses a patient who is taking lithium (Lithobid) and notes a large output of clear, dilute urine. The nurse suspects which cause for this finding?&#10;A) Cardiovascular complications&#10;B) Expected lithium side effects&#10;C) Increased mania&#10;D) Lithium toxicity

Accepted Answer

The answer of The nurse assesses a patient who is...

Question 14

A patient who has a history of migraine headaches is diagnosed with bipolar disorder. The nurse might expect the provider to order which medication for this patient?&#10;A) Carbamazepine (Tegretol)&#10;B) Divalproex (Valproate)&#10;C) Lamotrigine (Lamictal)&#10;D) Lithium citrate (Eskalith)

Accepted Answer

The answer of A patient who has a history of...

Question 15

The nurse provides teaching for a patient who will begin taking lithium (Lithobid). Which statement by the patient indicates understanding of the teaching?&#10;A) &#34;I may drink tea or cola but not coffee.&#34;&#10;B) &#34;I may stop taking the drug when mania symptoms subside.&#34;&#10;C) &#34;I should consume a sodium-restricted diet.&#34;&#10;D) &#34;I should drink 2 to 3 liters of fluid each day.&#34;

Accepted Answer

The answer of The nurse provides teaching for a patient...

Question 16

The nurse is preparing to administer a dose of lithium (Lithobid) to a patient who has been taking the drug as maintenance therapy to treat bipolar disorder. The nurse assesses the patient and notes tremors and confusion. The patient's latest serum lithium level was 2 mEq/L. Which action will the nurse take?

A) Administer the dose.
B) Hold the dose and notify the provider.
C) Request an order for a higher dose.
D) Request an order for a lower dose.

Accepted Answer

The answer of The nurse is preparing to administer a...

Question 17

A patient who takes a monoamine oxidase (MAO) inhibitor asks the nurse about taking over-the-counter medications to treat cold symptoms. Which medication will the nurse counsel the patient to avoid while taking a MAO inhibitor?

A) Diphenhydramine
B) Guaifenesin
C) Pseudoephedrine
D) Saline nasal spray

Accepted Answer

The answer of A patient who takes a monoamine oxidase...

Question 18

A male patient has been taking venlafaxine (Effexor) 37.5 mg daily for 2 weeks and reports an increase in blood pressure. The nurse understands that this is due to which of the following?&#10;A) Increased serotonin levels.&#10;B) Increased norepinephrine levels.&#10;C) Increased dopamine levels.&#10;D) Increased acetylcholine levels.

Accepted Answer

The answer of A male patient has been taking venlafaxine...

Question 19

The nurse is preparing to administer paroxetine HCl (Paxil) to a 70-year-old patient. The nurse understands that this patient may require&#10;A) a decreased dose.&#10;B) an increased dose.&#10;C) every other day dosing.&#10;D) more frequent dosing.

Accepted Answer

The answer of The nurse is preparing to administer paroxetine...

Deck 23: Antidepressants and Mood Stabilizers