A client with major depressive disorder has been taking fluoxetine, an SSRI, for 5 weeks. During the first outpatient visit, the client smiles and states, “I feel like a great weight is off my chest.” How should the nurse interpret this behavior change?

The client’s behavioral change is expected after the time period of medication.

The client may have worked out details of their suicide plan.

The medication dosage should be decreased and a mood stabilizer added.

The medication has potentiated serotonin syndrome.

Answer and Explanation

The Correct Answer is A

The correct answer is a. The client’s behavioral change is expected after the time period of medication.

Choice A Reason:

This choice is correct because fluoxetine, a selective serotonin reuptake inhibitor (SSRI), typically takes about 4 to 6 weeks to start showing its full effects. The client’s statement, “I feel like a great weight is off my chest,” indicates a positive response to the medication, which aligns with the expected timeline for SSRIs to improve mood and alleviate symptoms of depression. This behavioral change suggests that the medication is working as intended, helping to lift the depressive symptoms.

Choice B Reason:

This choice is incorrect and concerning. While it is true that some individuals may experience a temporary increase in energy before their mood improves, which could potentially increase the risk of suicide, the client’s positive statement does not necessarily indicate suicidal planning. It is important for healthcare providers to continuously monitor for any signs of suicidal ideation, but in this context, the client’s statement more likely reflects an improvement in their depressive symptoms.

Choice C Reason:

This choice is incorrect because there is no indication that the medication dosage should be decreased or that a mood stabilizer should be added. Fluoxetine is generally well-tolerated, and the client’s positive response suggests that the current dosage is effective. Mood stabilizers are typically used in the treatment of bipolar disorder, not major depressive disorder, unless there is a specific indication for their use.

Choice D Reason:

This choice is incorrect and indicates a misunderstanding of serotonin syndrome. Serotonin syndrome is a potentially life-threatening condition caused by excessive serotonin activity in the brain, often due to drug interactions or overdose. Symptoms include agitation, confusion, rapid heart rate, and high blood pressure4. The client’s statement of feeling relieved does not align with the symptoms of serotonin syndrome, which are generally severe and require immediate medical attention.

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Correct Answer is A

Explanation

a. Charming, dramatic, seductive, and seeks admiration.

Explanation of Choices

Choice A Reason: Charming, Dramatic, Seductive, and Seeks Admiration

Clients with histrionic personality disorder often exhibit behaviors that are charming, dramatic, and seductive. They seek constant attention and admiration from others. These individuals may use their appearance and behavior to draw attention to themselves and can be very expressive and theatrical. Their need for approval and validation is a core feature of the disorder, and they may go to great lengths to ensure they are the center of attention.

Choice B Reason: Preoccupied with Minute Details and Is a Perfectionist

This description is more characteristic of obsessive-compulsive personality disorder (OCPD), not histrionic personality disorder. Individuals with OCPD are often preoccupied with orderliness, perfectionism, and control. They may focus excessively on details, rules, and schedules, often at the expense of flexibility and efficiency. This behavior is not typically seen in those with histrionic personality disorder.

Choice C Reason: Grandiose, Self-Important, and Has a Sense of Entitlement

These traits are more indicative of narcissistic personality disorder. Individuals with narcissistic personality disorder often have an inflated sense of their own importance, a deep need for excessive attention and admiration, and a lack of empathy for others. They may believe they are superior to others and expect special treatment. While there can be some overlap in behaviors, these traits are not the primary characteristics of histrionic personality disorder.

Choice D Reason: Describes Difficulty Being Alone and Shows Indecisiveness and Submissiveness

This description aligns more closely with dependent personality disorder. Individuals with dependent personality disorder often have difficulty making decisions without excessive advice and reassurance from others. They may feel uncomfortable or helpless when alone and may go to great lengths to avoid being alone. They often exhibit submissive and clingy behavior, seeking others to take care of them.

A. 0.8 mEq/L B. 2.3 mEq/L C. 1.8 mEq/L D. 1.2 mEq/L

Correct Answer is B

Explanation

Choice A Reason: 0.8 mEq/L

The therapeutic range for lithium is typically between 0.6 and 1.2 mEq/L. A level of 0.8 mEq/L falls within this range and is considered normal. Therefore, it is unlikely that a client with this lithium level would present with symptoms such as mental confusion, frequent urination, and coarse tremors. These symptoms are more indicative of lithium toxicity, which occurs at higher levels.

Choice B Reason: 2.3 mEq/L

A lithium level of 2.3 mEq/L is significantly above the therapeutic range and indicates lithium toxicity. Symptoms of lithium toxicity include mental confusion, frequent urination, and coarse tremors, which match the client’s presentation. Severe toxicity can occur at levels above 2.0 mEq/L and can be life-threatening if not treated promptly. Therefore, this is the most likely lithium level for the client described.

Choice C Reason: 1.8 mEq/L

A lithium level of 1.8 mEq/L is above the therapeutic range but below the level typically associated with severe toxicity. While some symptoms of toxicity might appear at this level, they are generally less severe than those described in the scenario. The client’s symptoms suggest a more severe level of toxicity, making this choice less likely.

Choice D Reason: 1.2 mEq/L

A lithium level of 1.2 mEq/L is at the upper limit of the therapeutic range. While it is possible for some mild side effects to occur at this level, the severe symptoms described (mental confusion, frequent urination, and coarse tremors) are more indicative of a higher, toxic level of lithium. Therefore, this choice is also less likely.

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A client with major depressive disorder has been taking fluoxetine, an SSRI, for 5 weeks. During the first outpatient visit, the client smiles and states, “I feel like a great weight is off my chest.” How should the nurse interpret this behavior change?

Nursing Test Bank

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Correct Answer is A

Explanation

A client prescribed lithium carbonate 300 mg twice daily a month ago comes to the Emergency Department with mental confusion, frequent urination in large amounts, and coarse tremors. Which lithium level would the nurse expect?

Correct Answer is B

Explanation

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