Chapter 23: Antidepressants and Mood Stabilizers

Chapter 23: Antidepressants and Mood Stabilizers

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. A nurse performs a medication history on a newly admitted patient. The patient reports taking amitriptyline (Elavil) 75 mg at bedtime for 6 weeks to treat depression. The patient reports having continued fatigue, lack of energy, and depressed mood. The nurse will contact the provider to discuss which intervention?

a.	Beginning to taper the amitriptyline
b.	Changing to a morning dose schedule
c.	Giving the amitriptyline twice daily
d.	Increasing the dose of amitriptyline

 

 

ANS:   A

The response to tricyclic antidepressants (TCAs) should occur after 2 to 4 weeks of therapy. If there is no improvement at that time, the TCA should be gradually withdrawn and an SSRI prescribed. TCAs should never be stopped abruptly. TCAs cause fatigue and drowsiness, so they should be given at bedtime. Changing the dose or the dosing schedule is not indicated.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 295

TOP:    Nursing Process: Evaluation

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

2. The nurse is teaching a patient who will begin taking doxepin (Sinequan) to treat depression. Which statement by the patient indicates a need for further teaching?

a.	“I should expect results within 2 to 4 weeks.”
b.	“I should increase fluids and fiber while taking this medication.”
c.	“I should take care when rising from a sitting to standing position.”
d.	“I will take the medication in the morning before breakfast.”

 

 

ANS:   D

Tricyclic antidepressants (TCAs) should begin to show effects within 1 to 4 weeks. Tricyclic antidepressants are known to cause orthostatic hypotension and constipation, so patients should be counseled on how to minimize these effects. TCAs should be taken at bedtime because of their tendency to cause drowsiness.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 295

TOP:    Nursing Process: Nursing Intervention: Patient Teaching

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

3. A patient who is taking amitriptyline (Elavil) reports constipation and dry mouth. The nurse will give the patient which instruction?

a.	Increase fluid intake.
b.	Notify the provider.
c.	Request another antidepressant.
d.	Stop taking the medication immediately.

 

 

ANS:   A

Constipation and dry mouth are common side effects of tricyclic antidepressants (TCAs), and patients should be taught to manage these symptoms. There is no need to notify the provider or to switch medications unless the side effects become too uncomfortable. Patients should not stop taking TCAs abruptly.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 295

TOP:    Nursing Process: Nursing Intervention

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

4. A patient who has had a loss of interest in most activities, weight loss, and insomnia is diagnosed with a major depressive disorder and will begin taking fluoxetine (Prozac) daily. The patient asks about the weekly dosing that a family member follows. What will the nurse tell the patient about a weekly dosing regimen?

a.	It can be used after daily maintenance dosing proves effective and safe.
b.	It is used after a trial of tricyclic antidepressant medication fails.
c.	It is not effective for this type of depression and its symptoms.
d.	It will cause more adverse effects than daily dosing regimens.

 

 

ANS:   A

Before weekly dosing is begun, the patient should respond to a daily maintenance dose of 20 mg/day without serious effects. It is not necessary to undergo a trial of tricyclic antidepressants (TCAs). Weekly dosing is used for this type of depression, and although it may have some adverse effects, these are not more common than with daily dosing.

 

DIF:    Cognitive Level: Applying (Application)                              REF:    p. 296

TOP:    Nursing Process: Nursing Intervention

MSC:   NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies