Chapter 28: Antidepressants and Mood Stabilizers Nursing School Test Banks

Chapter 28: Antidepressants and Mood Stabilizers
Test Bank

MULTIPLE CHOICE

1. 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 depressed mood. The nurse will contact the provider to discuss which intervention?
a. Beginning to taper the amitriptyline
b. Changing to a morning dose schedule
c. Giving the amitriptyline twice daily
d. Increasing the dose of amitriptyline
ANS: A
The response to tricyclic antidepressants (TCAs) should occur after 2 to 4 weeks of therapy. If there is no improvement at this time, the TCA should be gradually withdrawn and an SSRI prescribed. TCAs should never be stopped abruptly. TCAs cause fatigue and drowsiness, so they should be given at bedtime. Changing the dose or the dosing schedule are not indicated.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 387
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

2. 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?
a. I should expect results within 2 to 4 weeks.
b. I should increase fluids and fiber while taking this medication.
c. I should take care when rising from a sitting to standing position.
d. I will take the medication in the morning before breakfast.
ANS: D
Tricyclic antidepressants (TCAs) should begin to show effects within 1 to 4 weeks. Tricyclic antidepressants are known to cause orthostatic hypotension and constipation, so patients should be counseled on how to minimize these effects. TCAs should be taken at bedtime because of their tendency to cause drowsiness.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 392
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

3. A patient who is taking amitriptyline (Elavil) reports constipation and dry mouth. 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.
ANS: A
Constipation and dry mouth are common side effects of tricyclic antidepressants (TCAs), and patients should be taught to manage these symptoms. There is no need to notify the provider or to switch medications unless the side effects become too uncomfortable. Patients should not stop taking TCAs abruptly.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 397
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

4. A patient who has had a loss of interest in most activities, weight loss, and insomnia is diagnosed with a 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.
ANS: A
Before weekly dosing is begun, the patient should respond to a daily maintenance dose of 20 mg/day without serious effects. It is not necessary to undergo a trial of tricyclic antidepressants (TCAs). Weekly dosing is used for this type of depression, and although it may have some adverse effects, these are not more common than with daily dosing.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 388
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

5. 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. 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.
ANS: A
Selective serotonin reuptake inhibitors (SSRIs) cause nervousness and insomnia. Patients can minimize these effects by taking the drug in the morning. The nurse should assess this with this patient. Taking the medication at bedtime will only increase the insomnia. Requesting a lower dose or changing to weekly dosing are not recommended.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 392
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

6. A patient has been taking paroxetine (Paxil) 20 mg per day for 2 weeks and reports headaches, nervousness, and poor appetite. Which action will the nurse take?
a. Counsel the patient to take the medication with food.
b. Reassure the patient that these side effects will decrease over time.
c. Suggest that the patient discuss a lower dose with the provider.
d. Tell the patient to stop taking the drug and contact the provider.
ANS: B
These are common side effects of SSRIs and will subside over time. Taking the medication with food will not affect these side effects. Lowering the dose is not indicated. Patients should not abruptly stop taking SSRIs.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 388
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

7. 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. Johns wort
ANS: D
The concurrent interaction of venlafaxine and St. Johns wort may increase the risk of serotonin syndrome and neuroleptic malignant syndrome. Oral hypoglycemic drugs are concerning for patients who take lithium. Coffee and grapefruit juice is to be avoided by patients who take monoamine oxidase inhibitors

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 388
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

8. A male patient has been taking venlafaxine (Effexor) 37.5 mg daily for 2 weeks and reports ejaculation dysfunction and urinary retention. What action will the nurse take?
a. Contact the provider to discuss decreasing the dose.
b. Reassure the patient that these are common side effects.
c. Report potential serious adverse effects to the provider.
d. Withhold the dose until the provider is notified.
ANS: B
Venlafaxine can cause ejaculation dysfunction and urinary retention, and these side effects tend to be transient and treatable. Decreasing the dose is not indicated, and these are not serious adverse effects. Withholding the dose is not indicated.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 389
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

9. 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.
ANS: B
Amoxapine is an atypical antidepressant that should not be taken with MAO inhibitors and should not be used within 14 days of taking an MAO inhibitor.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 389
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

10. 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.
ANS: D
MAO inhibitors have many food and drug interactions that can be fatal, and patients must adhere to strict dietary restrictions while taking these drugs. They are not more expensive than the newer antidepressants. They remain approved for treating depression. MAO inhibitors cause profound hypertension.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 389
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

11. 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 an MAO inhibitor?
a. Diphenhydramine
b. Guaifenesin
c. Pseudoephedrine
d. Saline nasal spray
ANS: C
MAO inhibitors can cause hypertensive crises, which can be fatal when taken with sympathomimetic drugs such as pseudoephedrine.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 391
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

12. A patient who has a 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 patients side effects have diminished. 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
ANS: A
Once patients have demonstrated control of symptoms with decreased side effects on the maintenance dose of 20 mg daily, patients may begin once-weekly dosing. The 20-mg dose is maintenance dosing, so decreasing or increasing the dose is not indicated. Patients should not stop taking the medication abruptly.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 388
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

13. A patient who has been diagnosed with a major depression disorder has been ordered to take doxepin (Sinequan). The nurse will contact the provider if the patients medical history reveals a history of which condition?
a. Asthma
b. Glaucoma
c. Hypertension
d. Hypoglycemia
ANS: B
Antidepressants, such as doxepin, that cause anticholinergic-like symptoms are contraindicated if the patient has glaucoma.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 394
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

14. The nurse is preparing to administer a dose of lithium (Lithibid) 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 patients 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.
ANS: B
The patient has symptoms of lithium toxicity, and the serum drug level is in toxic range. The nurse should hold the dose and notify the provider.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 396
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

15. The nurse assesses a patient who is taking lithium (Lithibid) and notes a large output of clear, dilute urine. The nurse suspects which cause for this finding?
a. Cardiovascular complications
b. Expected lithium side effects
c. Increased mania
d. Lithium toxicity
ANS: D
An increased output of dilute urine is a sign of lithium toxicity.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 397
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

16. The nurse provides teaching for a patient who will begin taking lithium (Lithibid). Which statement by the patient indicates understanding of the teaching?
a. I may drink tea or cola but not coffee.
b. I may stop taking the drug when mania symptoms subside.
c. I should consume a sodium-restricted diet.
d. I should drink 2 to 3 liters of fluid each day.
ANS: D
Patients taking lithium should be encouraged to maintain adequate fluid intake of 2 to 3 L/day initially and then 1 to 2 L/day as maintenance. Patients should not drink any caffeine-containing drinks, including tea and cola. Patients must continue taking lithium even when symptoms subside, or else symptoms will recur. It is not necessary to consume a sodium-restricted diet.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 397
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

17. A patient who has recently begun taking lithium (Lithibid) calls the clinic to report nausea, vomiting, anorexia, and drowsiness. What will the nurse do next?
a. Contact the provider to obtain an order for a serum lithium level.
b. Reassure the patient that these symptoms are common and transient.
c. Tell the patient that the lithium dose is probably too low.
d. Tell the patient to stop taking the medication immediately.
ANS: A
Early symptoms of lithium toxicity include nausea and vomiting, anorexia, and drowsiness. The nurse should obtain an order for a lithium level to evaluate this. Patients should be encouraged to report these symptoms if they occur. Patients should never be counseled to stop the medication abruptly.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 397
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

18. The nurse is preparing to administer paroxetine HCl (Paxil) to a 70-year-old patient. The nurse understands that this patient may require
a. a decreased dose.
b. an increased dose.
c. every other day dosing.
d. more frequent dosing.
ANS: A
Older adults usually need a lower dose of antidepressants.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 392
TOP: NURSING PROCESS: Assessment/Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

19. 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?
a. Carbamazapine (Tegretol)
b. Divalproex (Valproate)
c. Lamotrigine (Lamictal)
d. Lithium citrate (Eskalith)
ANS: B
All of these medications may be used to treat bipolar disorder, but divalproex is also indicated for migraine prophylaxis.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 394
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

MULTIPLE RESPONSE

1. The nurse is teaching a patient about foods to avoid when taking isocarboxazid (Marplan). Which foods will the nurse instruct the patient to avoid? (Select all that apply.)
a. Bananas
b. Bread
c. Eggs
d. Red wine
e. Sausage
f. Yogurt
ANS: A, D, E, F
Aged cheeses and wines are the chief foods that are prohibited. Any food containing tyramine, which has sympathomimetic effects, can cause a hypertensive crisis. This includes bananas, sausage, and yogurt.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 393
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

Leave a Reply