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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.
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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.
A patient became severely depressed when the last of six children moved out of the home 4 months ago. The patient repeatedly says, 'No one cares about me. I'm not worth anything.' Which response by the nurse would be the most helpful?
- A. Things will look brighter soon. Everyone feels down once in a while.
- B. The staff here cares about you and wants to try to help you get better.
- C. It is difficult for others to care about you when you repeatedly say negative things about yourself.
- D. I'll sit with you for 10 minutes now and return for 10 minutes at lunchtime and again at 2:30 this afternoon.
Correct Answer: D
Rationale: Spending time with the patient at intervals throughout the day shows acceptance by the nurse and helps the patient establish a relationship with the nurse. The therapeutic technique is called offering self. Setting definite times for the therapeutic contacts and keeping the appointments show predictability on the part of the nurse, an element that fosters the building of trust. The incorrect responses would be difficult for a person with profound depression to believe, provide trite reassurance, and are counterproductive. The patient is unable to say positive things at this point.
A patient being treated for major depressive disorder has taken 300 mg amitriptyline daily for a year. The patient calls the case manager at the clinic and says, 'I stopped taking my antidepressant 2 days ago. Now I am having cold sweats, nausea, a rapid heartbeat, and nightmares.' How should the nurse advise the patient?
- A. Go to the nearest emergency department immediately.
- B. Do not to be alarmed. Take two aspirin and drink plenty of fluids.
- C. Take one dose of the antidepressant, and then come to the clinic to see the health care provider.
- D. Resume taking the antidepressant for 2 more weeks, and then discontinue it again.
Correct Answer: C
Rationale: The patient has symptoms associated with abrupt withdrawal of the tricyclic antidepressant. Taking a dose of the drug will ameliorate the symptoms. Seeing the health care provider will allow the patient to discuss the advisability of going off the medication and to be given a gradual withdrawal schedule if discontinuation is the decision. This situation is not a medical emergency, although it calls for medical advice. Resuming taking the antidepressant for 2 more weeks and then discontinuing again would produce the same symptoms the patient is experiencing.
A patient diagnosed with major depressive disorder will begin electroconvulsive therapy tomorrow. Which interventions are routinely implemented before the treatment?
- A. Administer pretreatment medication 30 to 45 minutes before treatment.
- B. Withhold food and fluids for a minimum of 6 hours before treatment.
- C. Remove dentures, glasses, contact lenses, and hearing aids.
- D. Restrain the patient in bed with padded limb restraints.
- E. Assist the patient to prepare an advance directive.
Correct Answer: A,B,C
Rationale: The correct interventions reflect routine electroconvulsive therapy preparation, which is similar to preoperative preparation: sedation and anticholinergic medication before anesthesia, maintaining nothing-by-mouth status to prevent aspiration during and after treatment, airway maintenance, and general safety by removing prosthetic devices. Restraint is not part of the pretreatment protocol. An advance directive is prepared independent of this treatment.
Which beverage should the nurse offer to a patient diagnosed with major depressive disorder who refuses solid food?
- A. Tomato juice
- B. Orange juice
- C. Hot tea
- D. Milk
Correct Answer: D
Rationale: Milk is the only beverage listed that provides protein, fat, and carbohydrates. In addition, milk is fortified with vitamins.