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?

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:

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?

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?

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?

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?

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?

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?

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?

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?

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:

Accepted Answer

MAO inhibitors necessitate strict dietary restrictions to avoid potentially dangerous interactions with certain foods that contain high levels of tyramine, which can lead to hypertensive crises.

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?

Accepted Answer

These symptoms can be signs of lithium toxicity, so the nurse should contact the provider to obtain an order for a serum lithium level to assess the patient's lithium level and make dose adjustments as needed. It is not appropriate to reassure the patient that these symptoms are common and transient or tell the patient that the lithium dose is probably too low. It is also not appropriate to tell the patient to stop taking the medication immediately without consulting the provider.

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?

Accepted Answer

Lithium toxicity can lead to nephrogenic diabetes insipidus, which causes the kidneys to produce a large amount of dilute urine.

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?

Accepted Answer

Divalproex (Valproate) is a medication used to treat both bipolar disorder and migraine headaches, making it a good choice for a patient with a history of both conditions. Carbamazepine (Tegretol) is also used to treat bipolar disorder, but it is not typically used for migraine headaches. Lamotrigine (Lamictal) is primarily used to treat bipolar disorder and seizures, but may not be as effective for migraine headaches. Lithium citrate (Eskalith) is typically used solely for bipolar disorder and would not be effective for treating migraine headaches.

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?

Accepted Answer

Lithium can cause dehydration and increase the risk of toxicity. Drinking 2 to 3 liters of fluid each day helps to prevent dehydration and toxicity. Coffee intake is not recommended while taking lithium as it can increase the risk of toxicity. Lithium should not be stopped abruptly even when symptoms subside. Sodium restriction may be recommended in some patients, but not always.

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?

Accepted Answer

The patient's symptoms of tremors and confusion, along with a serum lithium level of 2 mEq/L, indicate that the patient may be experiencing toxicity from the medication. The nurse should hold the dose and notify the provider to assess the patient's condition and adjust the medication if necessary. Administering the dose or requesting a higher dose could exacerbate the symptoms of toxicity and put the patient at risk for further complications. Requesting a lower dose may be appropriate, but the healthcare provider should make this decision after assessing the patient's condition.

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?

Accepted Answer

Pseudoephedrine is a nasal decongestant that should be avoided when taking MAO inhibitors due to the risk of increased blood pressure and potential hypertensive crisis. Diphenhydramine is an antihistamine, guaifenesin is an expectorant, and saline nasal spray is a non-medicated option for relieving congestion that do not pose a significant risk when taken with MAO inhibitors.

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?

Accepted Answer

Venlafaxine is a serotonin-norepinephrine reuptake inhibitor (SNRI), which means it increases levels of both of these neurotransmitters in the brain. Norepinephrine is also known to increase blood pressure, so an increase in norepinephrine levels could lead to elevated blood pressure in some patients taking this medication.

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

Accepted Answer

Older adults tend to have a slower metabolism and decreased liver and kidney function, which may require a decreased dose of medications like paroxetine HCl.

Quiz 23: Antidepressants and Mood Stabilizers