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A patient being treated with paroxetine 50 mg/day orally for major depressive disorder reports to the clinic nurse, 'I took a few extra tablets earlier in the day and now I feel bad.' Which aspects of the nursing assessment are most critical?
- A. Vital signs
- B. Urinary frequency
- C. Increased suicidal ideation
- D. Presence of abdominal pain and diarrhea
- E. Hyperactivity or feelings of restlessness
Correct Answer: A,D,E
Rationale: The patient is taking the maximum dose of this SSRI and has ingested an additional unknown amount of the drug. Central serotonin syndrome must be considered. Symptoms include abdominal pain, diarrhea, tachycardia, elevated blood pressure, hyperpyrexia, increased motor activity, and muscle spasms. Central serotonin syndrome may progress to a full medical emergency if not treated early. Although assessing for suicidal ideation is never inappropriate, in this situation physiological symptoms should be the initial focus. The patient may have urinary retention, but frequency would not be expected.
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A nurse teaching a patient about a tyramine-restricted diet would approve which meal?
- A. Mashed potatoes, ground beef patty, corn, green beans, apple pie
- B. Avocado salad, ham, creamed potatoes, asparagus, chocolate cake
- C. Macaroni and cheese, hot dogs, banana bread, caffeinated coffee
- D. Noodles with cheddar cheese sauce, smoked sausage, lettuce salad, yeast rolls
Correct Answer: A
Rationale: The correct answer describes a meal that contains little tyramine. Vegetables and fruits contain little or no tyramine, and fresh ground beef and apple pie should be safe. The other meals contain various amounts of tyramine-rich foods or foods that contain vasopressors: avocados, ripe bananas (banana bread), sausages and hot dogs, smoked meat (ham), cheddar cheese, yeast, caffeine drinks, and chocolate.
A patient was started on escitalopram 5 days ago and now says, 'This medicine isn't working.' What is the nurse's best intervention?
- A. Discussing with the health care provider the need to change medications
- B. Reassuring the patient that the medication will be effective soon
- C. Explaining the time lag before antidepressants relieve symptoms
- D. Critically assessing the patient for symptom relief
Correct Answer: C
Rationale: Escitalopram is an SSRI antidepressant. Between 1 and 3 weeks of treatment are usually necessary before a relief of symptoms occurs. This information is important to share with patients.
A patient diagnosed with major depressive disorder does not interact with others except when addressed and then only in monosyllables. The nurse wants to show nonjudgmental acceptance and support for the patient. Select the nurse's most effective approach to communication.
- A. Make observations on neutral topics.
- B. Ask the patient direct questions.
- C. Phrase questions to require 'yes' or 'no' answers.
- D. Frequently reassure the patient to reduce guilt feelings.
Correct Answer: A
Rationale: Making observations about neutral topics such as the environment draws the patient into the reality around him or her but places no burdensome expectations on the patient for answers. Acceptance and support are shown by the nurse's presence. Direct questions may make the patient feel that the encounter is an interrogation. Open-ended questions are preferable if the patient is able to participate in dialog. Platitudes are never acceptable; they minimize patient feelings and can increase feelings of worthlessness.
A patient diagnosed with major depressive disorder begins selective serotonin reuptake inhibitor (SSRI) antidepressant therapy. Priority information given to the patient and family should include a directive to do what?
- A. Avoid exposure to bright sunlight.
- B. Report increased suicidal thoughts.
- C. Restrict sodium intake to 1 g daily.
- D. Maintain a tyramine-free diet.
Correct Answer: B
Rationale: Some evidence indicates that suicidal ideation may worsen at the beginning of antidepressant therapy; thus, close monitoring is necessary. Avoiding exposure to bright sunlight and restricting sodium intake are unnecessary. Tyramine restriction is associated with monoamine oxidase inhibitor (MAOI) therapy.
What is the focus of priority nursing care for the period immediately after a patient has an electroconvulsive therapy (ECT) treatment?
- A. Supporting physiological stability
- B. Reducing disorientation and confusion
- C. Monitoring pupillary responses
- D. Assisting the patient to plan for the future
Correct Answer: A
Rationale: During the immediate post-treatment period, the patient is recovering from general anesthesia, hence the need to establish and support physiological stability. Monitoring pupillary responses is not a priority. Reducing disorientation and confusion is an acceptable intervention but not the priority. Assisting the patient to plan for the future is inappropriate in the immediate post-treatment period because the patient may be confused.