A depressed older adult client is being treated with a tricyclic antidepressant (TCA). Which side effects are important to assess for?

Pseudoparkinsonism and tardive dyskinesia.

Diarrhea and electrolyte imbalance.

Orthostatic hypotension and urinary retention.

Photosensitivity and skin rashes.

Answer and Explanation

The Correct Answer is C

Choice A reason: Pseudoparkinsonism and tardive dyskinesia are side effects of antipsychotics, not TCAs, due to dopamine blockade in the basal ganglia. TCAs primarily affect serotonin and norepinephrine reuptake, causing anticholinergic and cardiovascular effects, not extrapyramidal symptoms.

Choice B reason: Diarrhea and electrolyte imbalance are not common TCA side effects. TCAs’ anticholinergic properties cause constipation, not diarrhea, and do not significantly disrupt electrolyte balance. Their primary effects involve serotonin and norepinephrine modulation, leading to other systemic effects.

Choice C reason: TCAs like amitriptyline cause orthostatic hypotension via alpha-1 adrenergic blockade and urinary retention due to anticholinergic effects on bladder muscles. These result from altered autonomic signaling, impacting cardiovascular and urinary systems, making them critical side effects to monitor in older adults.

Choice D reason: Photosensitivity and skin rashes are rare with TCAs. Their primary side effects stem from anticholinergic and adrenergic blockade, affecting cardiovascular and urinary function, not dermatological reactions, which are more common with other drug classes like antipsychotics.

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Correct Answer is D

Explanation

Choice A reason: Neuroleptic malignant syndrome is associated with antipsychotics, not SSRIs like paroxetine, causing muscle rigidity and hyperthermia via dopamine blockade. The client’s symptoms, including hyperreflexia and diarrhea, align with serotonin excess, not dopamine-related issues, making this condition unlikely.

Choice B reason: Agranulocytosis, a severe reduction in white blood cells, is unrelated to paroxetine’s mechanism. SSRIs increase serotonin, not affecting hematopoiesis. The client’s symptoms like hyperpyrexia and hyperreflexia indicate serotonin toxicity, not an immunological or bone marrow disorder.

Choice C reason: Acute dystonic reactions involve muscle spasms from antipsychotics’ dopamine antagonism, not SSRIs. Paroxetine’s serotonin increase causes hyperreflexia and hyperpyrexia, consistent with serotonin syndrome, not extrapyramidal symptoms, making this diagnosis inappropriate for the described clinical presentation.

Choice D reason: Serotonin syndrome results from excessive serotonin due to paroxetine, an SSRI, overstimulating 5-HT receptors, causing hyperreflexia, hyperpyrexia, and autonomic instability. These symptoms reflect serotonin-driven neural excitation, particularly in the brainstem and spinal cord, matching the client’s clinical presentation accurately.

A. Persistent depressive disorder. B. Treatment-resistant depression. C. Moderate depression. D. Mild depression.

Correct Answer is B

Explanation

Choice A reason: Persistent depressive disorder responds better to SSRIs or psychotherapy, as MAOIs’ risk of hypertensive crises due to monoamine buildup limits their use. MAOIs increase serotonin, dopamine, and norepinephrine, but are reserved for severe cases due to complex neural interactions.

Choice B reason: MAOIs like phenelzine are used for treatment-resistant depression, where SSRIs fail, by increasing serotonin, dopamine, and norepinephrine via enzyme inhibition. This broad monoamine enhancement alters prefrontal-amygdala circuits, addressing severe depressive symptoms unresponsive to other treatments, making it the primary indication.

Choice C reason: Moderate depression is typically treated with SSRIs or SNRIs, which have safer profiles. MAOIs’ risk of serotonin and norepinephrine overload, causing hypertensive crises, makes them unsuitable for moderate cases, where less aggressive neural modulation is effective.

Choice D reason: Mild depression is managed with psychotherapy or SSRIs, not MAOIs, which risk serious side effects like tyramine-induced hypertensive crises due to excessive monoamine levels. MAOIs are reserved for severe, resistant cases, not mild neural dysregulation.

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A depressed older adult client is being treated with a tricyclic antidepressant (TCA). Which side effects are important to assess for?

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Naxlex Comprehensive Predictor Exams

A client is brought to the emergency department after exhibiting vital sign instability, diaphoresis, shivering, incoordination, hyperreflexia, hyperpyrexia, and diarrhea. The client is taking paroxetine (Paxil) for depression. Which condition should the nurse most likely suspect?

Correct Answer is D

Explanation

Monoamine oxidase inhibitors are used to treat which of the following?

Correct Answer is B

Explanation

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