A nurse in an outpatient mental health setting is collecting a health history from a client who is taking paroxetine for depression. The client reports to the nurse that he also takes herbal supplements. The nurse should advise the client that which of the following supplements interacts adversely with paroxetine?

Echinacea

Ginkgo

St. John's Wort

Saw palmetto

Answer and Explanation

The Correct Answer is C

Choice A reason: Echinacea is used for immune support and has no significant interaction with paroxetine, an SSRI that increases serotonin by inhibiting reuptake. Echinacea’s effects on cytokine production do not alter serotonin metabolism or CYP450 enzymes, which paroxetine relies on for clearance, making it a safe supplement in this context.

Choice B reason: Ginkgo enhances cerebral blood flow but has minimal interaction with paroxetine. It may affect platelet aggregation, but paroxetine’s serotonin reuptake inhibition is primarily metabolized via CYP2D6, unaffected by ginkgo’s mechanisms. No significant pharmacodynamic or pharmacokinetic interactions occur, making this supplement safe for concurrent use with paroxetine.

Choice C reason: St. John’s Wort induces CYP3A4 and P-glycoprotein, accelerating paroxetine metabolism, an SSRI reliant on CYP2D6. This reduces paroxetine’s efficacy, lowering serotonin levels and risking treatment failure for depression. It also increases serotonin syndrome risk due to additive serotonergic effects, making it a critical interaction to avoid.

Choice D reason: Saw palmetto, used for prostate health, has no significant interaction with paroxetine. It primarily affects androgen pathways, not serotonin metabolism or CYP2D6, which paroxetine uses for clearance. No pharmacodynamic or pharmacokinetic conflicts arise, making saw palmetto a safe supplement for clients taking paroxetine for depression.

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Correct Answer is C

Explanation

Choice A reason: Phenytoin, an anticonvulsant, is not routinely given before ECT, as the procedure induces controlled seizures to stimulate brain activity, treating depression via neurochemical changes. Administering phenytoin would inhibit seizure activity, reducing ECT efficacy by blocking neuronal excitability, making this an inappropriate action for the procedure.

Choice B reason: Instructing about post-ECT headaches is valid, as they result from cerebral vasoconstriction or muscle tension during seizures. However, this is a post-procedure expectation, not a priority action during planning. Monitoring cardiac rhythm takes precedence, as ECT’s autonomic stimulation poses immediate cardiovascular risks requiring real-time management.

Choice C reason: Monitoring cardiac rhythm during ECT is critical, as the procedure induces seizures that stimulate the autonomic nervous system, causing transient tachycardia or arrhythmias due to catecholamine surges. These can exacerbate underlying cardiac conditions, risking instability. Continuous monitoring ensures early detection and management of cardiovascular complications, prioritizing patient safety.

Choice D reason: Four-point restraints are not used in ECT, as patients are under general anesthesia, preventing movement. Restraints risk injury and are unnecessary, as muscle relaxants like succinylcholine minimize convulsive movements. This approach contradicts ECT’s controlled, anesthetized protocol, making it inappropriate for ensuring safety during the procedure.

A. Diarrhea and weight gain B. Dizziness, drowsiness, and dry mouth C. Convulsions and respiratory difficulties D. Jaundice and agranulocytosis

Correct Answer is B

Explanation

Choice A reason: Diarrhea and weight gain are less common with SSRIs. While some SSRIs may cause gastrointestinal upset via serotonin receptor stimulation in the gut, weight gain is more associated with atypical antipsychotics. SSRIs primarily affect serotonin reuptake, leading to central and anticholinergic-like effects, not these symptoms predominantly.

Choice B reason: SSRIs, by inhibiting serotonin reuptake, cause dizziness, drowsiness, and dry mouth due to central nervous system effects and mild anticholinergic activity. Dizziness and drowsiness result from serotonin modulation in the brainstem, while dry mouth reflects peripheral serotonin effects on salivary glands, making these the most common side effects.

Choice C reason: Convulsions and respiratory difficulties are rare with SSRIs. Seizures may occur in overdose due to excessive serotonin, but not typically at therapeutic doses. Respiratory issues are not associated, as SSRIs primarily affect serotonin pathways, not respiratory centers, making this choice inaccurate for common side effects.

Choice D reason: Jaundice and agranulocytosis are not common SSRI side effects. These are associated with drugs like chlorpromazine, affecting liver or bone marrow. SSRIs primarily cause serotonin-related central and peripheral effects, not hepatotoxicity or bone marrow suppression, making this choice irrelevant to their pharmacological profile.

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Naxlex Comprehensive Predictor Exams

A nurse is planning care for a client who is to undergo electroconvulsive therapy (ECT). Which of the following actions should the nurse include in the plan?

Correct Answer is C

Explanation

What are the most common types of side effects from SSRIs?

Correct Answer is B

Explanation

A client with bipolar disorder begins taking lithium carbonate, 300 mg four times a day. After 3 days of therapy, the client says, "My hands are shaking." The best response by the nurse is which of the following?

The nurse is caring for a client admitted with severe exacerbation of posttraumatic stress disorder that is experiencing flashbacks and hypervigilance. Which is the priority for the nurse to address when caring for this client?

Which of the following would indicate an increased suicidal risk? (Select all that apply)

A client says to the nurse, "You are the best nurse I've ever met. I want you to remember me." What is an appropriate response by the nurse?

A client with advanced Alzheimer's disease keeps searching the unit for her mother who died many years ago. How should the nurse respond?

Which of the following statements by the caregiver of a client newly diagnosed with dementia requires further intervention by the nurse?

When assessing a client with delirium, the nurse will expect to see (Select all that apply)

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