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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.
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While monitoring a depressed patient who has just started SSRI antidepressant therapy, the nurse will observe for which problem during the early time frame of this therapy?
- A. Hypertensive crisis
- B. Self-injury or suicidal tendencies
- C. Extrapyramidal symptoms
- D. Loss of appetite
Correct Answer: B
Rationale: The U.S. Food and Drug Administration (FDA) has issued black box warnings regarding the use of all classes of antidepressants in both adult and pediatric patient populations. Data from the FDA indicated a higher risk for suicide in patients receiving these medications. As a result, current recommendations for all patients receiving antidepressants include regular monitoring for signs of worsening depressive symptoms, especially when the medication is started or the dosage is changed. The other options are incorrect.
A patient has been taking haloperidol for 3 months for a psychotic disorder, and the nurse is concerned about the development of extrapyramidal symptoms. The nurse will monitor the patient closely for which effects?
- A. Increased paranoia
- B. Drowsiness and dizziness
- C. Involuntary motor symptoms
- D. Dry mouth and constipation
Correct Answer: C
Rationale: Extrapyramidal symptoms are manifested by involuntary motor symptoms, and the incidence of such symptoms is high during haloperidol therapy. The other options are incorrect.
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.
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 reads in the patient's medication history that the patient is taking buspirone. The nurse interprets that the patient may have which disorder?
- A. Anxiety disorder
- B. Depression
- C. Schizophrenia
- D. Bipolar disorder
Correct Answer: A
Rationale: Buspirone is indicated for the treatment of anxiety disorders, not depression, schizophrenia, or bipolar disorder.