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A patient who has been taking a selective serotonin reuptake inhibitor (SSRI) states that he -felt awful when he started taking an over-the-counter St. John's wort herbal product at home. The nurse suspects that he is experiencing serotonin syndrome. Which of these are symptoms of serotonin syndrome?
- A. Agitation
- B. Drowsiness
- C. Tremors
- D. Bradycardia
- E. Sweating
Correct Answer: A,C,E
Rationale: Common symptoms of serotonin syndrome include delirium, agitation, tachycardia, sweating, hyperreflexia, shivering, coarse tremors, and others.
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The wife of a patient who has been diagnosed with depression calls the office and says, -It's been an entire week since he started that new medicine for his depression, and there's no change! The medicine is not working! What is the nurse's best response?
- A. The medication may not be effective for him. He may need to try another type.
- B. It may take 4 to 6 weeks to notice any therapeutic effects. Let's wait a little longer to see how he does.
- C. It sounds like the dose is not high enough. I'll check about increasing the dosage.
- D. Some patients never recover from depression. He may not respond to this therapy.
Correct Answer: B
Rationale: Patients and family members need to be told that antidepressant drugs commonly require several weeks before full therapeutic effects are noted. The other answers are incorrect.
A patient has been taking lithium for 1 year, and the most recent lithium level is 0.5 mEq/L. What concern will the nurse have, if any?
- A. The level is too low, indicating a subtherapeutic dose.
- B. The level is within the therapeutic range.
- C. The level is too high, indicating a toxic dose.
- D. No concerns, as lithium levels do not need monitoring.
Correct Answer: A
Rationale: Therapeutic lithium levels are typically between 0.6 and 1.2 mEq/L for maintenance therapy. A level of 0.5 mEq/L is subtherapeutic, which may reduce the effectiveness of the treatment. Monitoring lithium levels is critical due to its narrow therapeutic index.
The nurse is reviewing medications used for depression. Which of these statements is a reason that selective serotonin reuptake inhibitors (SSRIs) are more widely prescribed today than tricyclic antidepressants?
- A. SSRIs have fewer sexual side effects.
- B. Unlike tricyclic antidepressants, SSRIs do not have drug-food interactions.
- C. Tricyclic antidepressants cause serious cardiac dysrhythmias if an overdose occurs.
- D. SSRIs cause a therapeutic response faster than tricyclic antidepressants.
Correct Answer: C
Rationale: Death from overdose of tricyclic antidepressants usually results from either seizures or dysrhythmias. SSRIs are associated with significantly fewer and less severe systemic adverse effects, especially anticholinergic and cardiovascular adverse effects. The other options are incorrect.
A patient has been admitted to the emergency department with a suspected overdose of a tricyclic antidepressant. The nurse will prepare for what immediate concern?
- A. Hypertension
- B. Renal failure
- C. Cardiac dysrhythmias
- D. Gastrointestinal bleeding
Correct Answer: C
Rationale: Tricyclic antidepressant overdoses are notoriously lethal. The primary organ systems affected are the central nervous system and the cardiovascular system, and death usually results from either seizures or dysrhythmias.
The nurse is reviewing the food choices of a patient who is taking a monoamine oxidase inhibitor (MAOI). Which food choice would indicate the need for additional teaching?
- A. Grapefruit juice
- B. Salami sandwich
- C. Scrambled eggs
- D. Pancakes and maple syrup
Correct Answer: B
Rationale: Cured meats such as salami contain tyramine. Patients who are taking MAOIs need to avoid tyramine-containing foods because of a severe hypertensive reaction that may occur. The other foods listed do not contain tyramine.