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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.
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A patient is to receive an intravenous dose of lorazepam. The order reads, -Give lorazepam, 1 mg, IV push, now. Identify how many milliliters the nurse will administer for this dose. The medication vial contains 2 mg/mL.
Correct Answer: 0.5 mL
Rationale: 2 mg : 1 mL :: 1 mg : x mL; (2 * x) = (1 * 1); 2x = 1; x = 0.5 mL.
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 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.
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.
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.