Chapter 47: Antidepressants

Chapter 47: Antidepressants

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

1. A patient reports having feelings of hopelessness and anxiety for the past few months. The primary care nurse practitioner (NP) performs a history and learns that these feelings occur almost daily. The patient also reports having headaches and difficulty concentrating at work along with wanting to sleep all the time. The patient has gained 5 lb in the past 6 months. The NP should:

ANS:  D

The patient is having symptoms of major depression, but other factors such as drug or alcohol abuse that may be contributing to the diagnosis must be ruled out first. Patients should be asked about suicidal ideation so that measures can be taken to prevent a suicide attempt. Symptoms of major depression require treatment. Exercise should be a part of any plan but should not be the only intervention.

DIF:    Cognitive Level: Applying (Application)                           REF:   521

2. A patient reports feelings of sadness and hopelessness along with difficulty sleeping and weight loss. The primary care NP learns that the patient’s mother died 6 months earlier. The NP should:

ANS:  A

Bereavement over the loss of a loved one may be associated with symptoms of major depression. Although only 17% of these patients receive pharmacologic treatment, 94% of symptoms have been found to resolve in 13 months or less. Bereavement counseling should be the first step. Pharmacologic treatment may be warranted if symptoms do not improve. This patient has a clear cause for depression. It is not enough to reassure the patient that the symptoms will resolve because this belittles their concerns.

DIF:    Cognitive Level: Applying (Application)                           REF:   520

3. A patient has been taking paroxetine (Paxil) for major depressive symptoms for 8 months. The patient tells the primary care NP that these symptoms improved after 2 months of therapy. The patient is experiencing weight gain and sexual dysfunction and wants to know if the medication can be discontinued. The NP should:

ANS:  D

Once a patient achieves remission, a continuation phase of 16 to 20 weeks followed by a maintenance phase of 4 to 9 months should be carried out. Some responders, called apathetic responders, may have a decrease in most symptoms but continue to have lack of pleasure, decreased libido, and lack of energy. Bupropion can be added to therapy to treat these symptoms. Patients should not change medications during this phase, should not begin a drug taper, and should never stop the medication abruptly.

DIF:    Cognitive Level: Applying (Application)                           REF:   525

4. The primary care NP has prescribed sertraline (Zoloft) for a patient who initially reported daily symptoms of hopelessness, sadness, insomnia, and weight loss. After several months of therapy, the patient no longer feels hopeless or sad but continues to have difficulty eating and sleeping. The NP should contact the patient’s psychiatrist to discuss:

ANS:  A

Mirtazapine may be added to the drug regimen for partial responders who continue to feel anxious. Changing medications is not recommended. Adding another SSRI is contraindicated because of the risk of serotonin syndrome. An inpatient hospital admission is not warranted.

DIF:    Cognitive Level: Applying (Application)                           REF:   525