Chapter 28: Antidepressants and Mood Stabilizers Nursing School Test Banks

Kee: Pharmacology, 7th Edition

Chapter 28: Antidepressants and Mood Stabilizers

Test Bank

MULTIPLE CHOICE

1. A nurse is scheduling a clients medications. The client is ordered to receive a daily dose of fluoxetine (Prozac). Because of the major side effects of this medication, the nurse correctly scheduled this medication at:

a.

0800.

b.

1200.

c.

1700.

d.

2200.

ANS: A

This medication, an SSRI, may cause insomnia, so it should be given early in the day.

DIF: Cognitive Level: Application REF: p. 400

TOP: Nursing Process: Planning

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

2. A client is ordered a tricyclic antidepressant. In monitoring this client, the nurse would assess for:

a.

orthostatic hypotension.

b.

secondary hypertension.

c.

gastrointestinal upset.

d.

bradycardia.

ANS: A

Tricyclic antidepressants are known to cause orthostatic hypotension, hypotension, and sedation.

DIF: Cognitive Level: Application REF: p. 399

TOP: Nursing Process: Assessment

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

3. A client is ordered fluoxetine (Prozac) for mild depression. The nurse would monitor for which side effect(s)?

a.

Dry mouth and eyes

b.

Extrapyramidal syndrome

c.

Leukopenia (decrease in WBCs)

d.

Nervousness, restlessness, and insomnia

ANS: D

Side effects of fluoxetine (Prozac) include nervousness, restlessness, and insomnia.

DIF: Cognitive Level: Application REF: p. 400

TOP: Nursing Process: Assessment

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

4. A nurse works in an assisted living setting. The nurse is administering a selective serotonin reuptake inhibitor to an 84-year-old client. The nurse is aware that the daily dose of this medication for the older adult client would be _____ the adult dose.

a.

the same as

b.

higher than

c.

about half

d.

about one-fourth

ANS: C

Older adults require half the adult dose related to physiologic differences in absorption, distribution, metabolism, and excretion.

DIF: Cognitive Level: Application REF: p. 399

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

5. Which beverage will the nurse instruct a client taking lithium (Eskalith) for treatment of bipolar disorder to avoid?

a.

Cola

b.

Grape juice

c.

Milk

d.

Orange juice

ANS: A

The client should avoid caffeine products such as cola, because they can aggravate the manic phase of bipolar disorder.

DIF: Cognitive Level: Comprehension REF: p. 406

TOP: Nursing Process: Intervention/Teaching

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

6. Serum lithium level is important to monitor because it has a narrow therapeutic range. What is the reference (therapeutic) range?

a.

0.5 to 1 mEq/L

b.

0.5 to 1.5 mEq/L

c.

1.5 to 3 mEq/L

d.

2 to 2.5 mEq/L

ANS: B

The normal maintenance serum level for lithium is 0.5 to 1.5 mEq/L.

DIF: Cognitive Level: Comprehension REF: p. 404

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

7. A client is receiving lithium (Eskalith). Which serum electrolyte level is of greatest concern to the nurse?

a.

Calcium level of 4.5 mEq/L

b.

Potassium level of 3 mEq/L

c.

Sodium level of 130 mEq/L

d.

Potassium level of 5.7 mEq/L

ANS: C

Hyponatremia can occur with diuresis, and sodium loss that may occur with lithium therapy.

DIF: Cognitive Level: Analysis REF: p. 405

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

8. A nurse is scheduling a clients medications. The client is ordered to receive a daily dose of amitriptyline (Elavil). Because of the major side effects of this medication, the nurse correctly schedules this medication at:

a.

8:00 AM.

b.

12:00 PM.

c.

5:00 PM.

d.

10:00 PM.

ANS: D

This medication, a tricyclic antidepressant, may cause sedation, so it should be given at bedtime.

DIF: Cognitive Level: Application REF: p. 398

TOP: Nursing Process: Planning

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

9. A client is on maintenance lithium therapy for bipolar disorder. The client enters the emergency department complaining of tremors. The client appears to be giddy and confused. A serum lithium level is drawn and is found to be 2 mEq/L. The nurse would anticipate:

a.

holding the next dose of lithium.

b.

administering the next dose of lithium at the next scheduled time.

c.

administering the next dose of lithium STAT.

d.

administering a dose of lithium double the normal dose.

ANS: A

This serum lithium level is above therapeutic range and the client is demonstrating symptoms of early lithium toxicity. The next dose would be held.

DIF: Cognitive Level: Application REF: p. 405

TOP: Nursing Process: Planning

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

10. A client begins taking paroxetine (Paxil) for obsessive-compulsive disorder. Which client statement would indicate that the medication is effective?

a.

I have so much energy now, I dont need sleep.

b.

I stayed up all last night cleaning my house.

c.

I am learning to set priorities for what has to be done.

d.

I do not go out much because of the germs.

ANS: C

This option demonstrates that the client is less compulsive. The other options do not.

DIF: Cognitive Level: Application REF: p. 399

TOP: Nursing Process: Evaluation

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

11. The client has been treated with antidepressants for mild depression for 3 years. The client says her medication is no longer working, and she states that she has heard that MAO inhibitors are effective medications in treating depression. The nurse would respond based on the knowledge that:

a.

there are few side effects with this medication.

b.

this medication requires significant dietary restrictions.

c.

this medication is relatively ineffective for depression.

d.

this medication causes hypertensive crisis.

ANS: B

MAO inhibitors, when eaten with aged foods (such as some cheeses and wines) and foods with tyramine, can cause hypertensive crises.

DIF: Cognitive Level: Application REF: p. 403

TOP: Nursing Process: Planning

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

12. Which intervention is highest priority for the care plan of a client on lithium therapy?

a.

Drink 1 to 2 L of water per day.

b.

Limit caffeinated beverages.

c.

Eat three meals daily.

d.

Suck on ice chips for dry mouth.

ANS: A

Drinking water and staying hydrated are of highest priority. Lithium may cause polyuria and lead to dehydration.

DIF: Cognitive Level: Application REF: p. 404

TOP: Nursing Process: Planning

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

13. A client is taking an antidepressant. What would indicate a side effect of anticholinergic origin?

a.

Diarrhea

b.

Increased salivation and drooling

c.

Urinary retention

d.

Bradycardia

ANS: C

Urinary retention, constipation, tachycardia, and dry mouth are anticholinergic symptoms.

DIF: Cognitive Level: Application REF: p. 399

TOP: Nursing Process: Assessment

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

14. A client is taking fluoxetine (Prozac) for mild depressive disorder. The nurse is providing teaching and counseling. The client complains of lack of sexual desire and diminished sexual arousal. The nurses response is based on the fact that:

a.

this is a known side effect and may require intervention.

b.

this side effect will go away in 1 to 2 weeks.

c.

this is a side effect of depression, not of medication.

d.

clients may stop the medication on days they want to have sex.

ANS: A

This side effect is expected of the SSRIs and may require specific interventions and counseling.

DIF: Cognitive Level: Application REF: p. 400

TOP: Nursing Process: Intervention/Teaching

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

15. The client is on medication for hypertension as well as a monamine oxidase inhibitor. The highest priority instruction that the nurse should give to the client regarding supplements or herbal preparations is to avoid:

a.

food with brewers yeast.

b.

food containing garlic.

c.

ginger supplements.

d.

feverfew supplements.

ANS: A

An increased use of brewers yeast with MAOIs can increase blood pressure.

DIF: Cognitive Level: Application REF: p. 403

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

16. The client is a 10 year old who is being considered for lithium therapy. What should the nurse recognize as a priority in this decision?

a.

The normal adult dosage should be halved for this client.

b.

Lithium is contraindicated for a client this age.

c.

The standard dosage of lithium can be administered.

d.

The pediatric dosage must be clarified with the pharmacist.

ANS: B

Lithium should not be given to a client younger than 12 years.

DIF: Cognitive Level: Application REF: p. 405

TOP: Nursing Process: Intervention/Teaching

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

17. The client is due to be started on Prozac. What changes in the clients bodily functioning should the nurse anticipate?

a.

Daytime drowsiness

b.

Increased sodium level

c.

ECG changes

d.

Thyroid dysfunction

ANS: C

ECG changes can occur when the client is treated with Prozac.

DIF: Cognitive Level: Application REF: p. 400

TOP: Nursing Process: Planning

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

18. The client has been started on Elavil. He tells the nurse that he does not take any other medication except for St. Johns wort, which he has found to be mildly therapeutic. What should be the nurses highest priority response to this information?

a.

The combination of Elavil and St. Johns wort can be particularly therapeutic.

b.

Use of St. Johns wort can cause the dosage of Elavil to require increase.

c.

Use of St. Johns wort can cause the Elavil to be completely ineffective.

d.

The combination of St. Johns wort and Elavil can produce serotonin syndrome.

ANS: D

When Elavil is combined with St. Johns wort, serotonin syndrome can result.

DIF: Cognitive Level: Application REF: p. 398

TOP: Nursing Process: Intervention/Teaching

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

19. The client is being treated with lithium regularly. The best time for blood to be drawn from the client to check her lithium level is _____ hours after the previous dose.

a.

4 to 8

b.

6 to 10

c.

8 to 12

d.

10 to 14

ANS: C

When attempting to assess the clients lithium level, draw the blood sample 8 to 12 hours after the previous dose.

DIF: Cognitive Level: Application REF: p. 406

TOP: Nursing Process: Planning

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

MULTIPLE RESPONSE

1. A client is ordered to receive an MAO inhibitor in the treatment of major depression. Which foods and beverages will be restricted while the client is on this medication? (Select all that apply.)

a.

Bread

b.

Wine

c.

Aged cheese

d.

Meat

e.

Citrus fruit

f.

Coffee

ANS: B, C, F

Aged cheeses and wines are the chief foods that are prohibited. Caffeine-containing beverages, such as coffee, are contraindicated because of tachycardia. The other foods are allowed.

DIF: Cognitive Level: Application REF: p. 403

TOP: Nursing Process: Planning

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

Copyright 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc.

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