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 D

Explanation

d. Do not reduce normal dietary sodium intake.

Explanation of Choices

Choice A Reason: Limit Fluid Intake to 1,000 mL of Fluid per Day

Limiting fluid intake to 1,000 mL per day is not recommended for clients taking lithium carbonate. Adequate hydration is crucial because lithium can affect kidney function and fluid balance. Dehydration can increase lithium levels in the blood, leading to toxicity. Therefore, clients should maintain normal fluid intake to ensure proper hydration and avoid complications.

Choice B Reason: Adjust the Dose if You Feel Out of Control

Clients should never adjust their lithium dose on their own. Lithium has a narrow therapeutic range, meaning the difference between an effective dose and a toxic dose is small. Any changes in dosage should be made under the supervision of a healthcare provider to avoid the risk of lithium toxicity or subtherapeutic levels. Self-adjusting the dose can lead to serious health risks.

Choice C Reason: Have Serum Lithium Levels Checked Every 6 Months

While regular monitoring of serum lithium levels is essential, checking levels every 6 months may not be sufficient. Initially, serum lithium levels should be checked more frequently, such as every 1 to 2 weeks, until stable therapeutic levels are achieved. After stabilization, levels are typically monitored every 3 to 6 months, depending on the patient’s clinical status and any changes in medication or health condition. Regular monitoring helps ensure the medication remains within the therapeutic range and prevents toxicity.

Choice D Reason: Do Not Reduce Normal Dietary Sodium Intake

Maintaining normal dietary sodium intake is crucial for clients taking lithium. Sodium levels in the body can affect lithium levels; a decrease in sodium intake can lead to higher lithium levels and increase the risk of toxicity. Conversely, an increase in sodium intake can lower lithium levels, reducing its effectiveness. Therefore, clients should be advised to maintain a consistent sodium intake to help stabilize lithium levels in the blood.

A. We can call Alcoholics Anonymous (AA) and go to a closed meeting to see what happens inside. B. We should wait until the client is ready to stop drinking before the family goes to support meetings. C. The family can go to Al-Anon meetings for support. D. Support groups are an option for the client, not the family.

Correct Answer is C

Explanation

Choice A Reason: We can call Alcoholics Anonymous (AA) and go to a closed meeting to see what happens inside.

Alcoholics Anonymous (AA) is a support group specifically for individuals struggling with alcohol use disorder. Closed meetings are typically reserved for those who identify as alcoholics and are seeking help for their own drinking problems. Family members and friends are generally not allowed to attend these meetings unless they are open meetings. Therefore, this choice does not reflect an effective understanding of the appropriate support resources available for family members.

Choice B Reason: We should wait until the client is ready to stop drinking before the family goes to support meetings.

Waiting until the client is ready to stop drinking before seeking support is not advisable. Family members can benefit from attending support groups like Al-Anon regardless of the client’s readiness to change. These groups provide emotional support, education, and coping strategies for dealing with the challenges of living with someone who has an alcohol use disorder. This choice suggests a misunderstanding of the importance of seeking support for oneself, independent of the client’s actions.

Choice C Reason: The family can go to Al-Anon meetings for support.

Al-Anon is a support group specifically designed for family members and friends of individuals with alcohol use disorder. These meetings provide a safe space for loved ones to share their experiences, gain support, and learn effective coping strategies. Attending Al-Anon meetings can help family members understand the nature of addiction, reduce feelings of isolation, and improve their own well-being. This choice reflects an accurate understanding of the appropriate support resources available for families.

Choice D Reason: Support groups are an option for the client, not the family.

This statement is incorrect because support groups like Al-Anon are specifically designed for family members and friends of individuals with alcohol use disorder. These groups recognize that addiction affects not only the individual but also their loved ones. By participating in support groups, family members can gain valuable insights, emotional support, and practical advice for coping with the challenges associated with a loved one’s addiction. This choice reflects a misunderstanding of the role and availability of support groups for families.

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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?

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Naxlex Comprehensive Predictor Exams

A client who is prescribed lithium carbonate is being discharged from inpatient care. Which medication information should the nurse teach this client?

Correct Answer is D

Explanation

Correct Answer is C

Explanation

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