When a patient is taking an antidepressant, what should the nurse do? Select all that apply
Monitor the patient for suicidal tendencies.
Observe the patient for orthostatic hypotension.
Teach the patient to take the drug with food if GI distress occurs.
Tell the patient that the drug may not have full effectiveness for 1 to 2 weeks.
Advise the patient to maintain adequate fluid intake of 2 L/d.
Correct Answer : A,B,C
When caring for a patient prescribed an antidepressant, the nurse plays a crucial role in ensuring both safety and therapeutic effectiveness. Monitoring for side effects, providing education, and recognizing risks such as suicidal ideation are essential components of nursing care.
A. Monitor the patient for suicidal tendencies.
Antidepressants can initially increase energy before mood improves, which may heighten suicide risk, especially in the first weeks of therapy.
B. Observe the patient for orthostatic hypotension.
Some antidepressants, particularly tricyclics and MAOIs, can cause significant drops in blood pressure when standing.
C. Teach the patient to take the drug with food if GI distress occurs.
Nausea and GI upset are common side effects; taking the drug with food can reduce discomfort.
D. Tell the patient that the drug may not have full effectiveness for 1 to 2 weeks.
Most antidepressants require time before noticeable improvement occurs, which patients must understand to avoid premature discontinuation.
E. Advise the patient to maintain adequate fluid intake of 2 L/d.
This advice is not a standard precaution for antidepressants; it is more relevant for medications like lithium.
Take-Home Points:
- Nurses should closely monitor for suicidal thoughts during early therapy.
- Education on delayed onset of action helps improve adherence.
- Managing side effects like GI upset and orthostatic hypotension enhances patient safety and comfort.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Selective serotonin reuptake inhibitors (SSRIs) are a first-line treatment for depression and anxiety disorders. They act by inhibiting the reuptake of serotonin, thereby increasing its availability in the synaptic cleft and enhancing mood regulation. Knowing which drugs belong to this class is essential for safe nursing practice.
A. paroxetine (Paxil)
– Paroxetine is an SSRI, along with fluoxetine, sertraline, citalopram, and escitalopram. These drugs are widely prescribed because they are effective, well tolerated, and have fewer cardiovascular and anticholinergic effects compared to older antidepressants. Patients should be counseled that benefits may take several weeks to appear and to watch for adverse effects such as sexual dysfunction and insomnia.
B. amitriptyline (Elavil)
– Amitriptyline is a tricyclic antidepressant (TCA). TCAs work by blocking the reuptake of both serotonin and norepinephrine but are less selective than SSRIs. They carry risks of sedation, orthostatic hypotension, and anticholinergic effects (dry mouth, urinary retention, constipation).
C. divalproex sodium (Depakote)
– Divalproex is a mood stabilizer and anticonvulsant, commonly prescribed for bipolar disorder and seizure disorders. It does not act on serotonin reuptake and therefore is not classified as an SSRI.
D. bupropion HCl (Wellbutrin)
– Bupropion is an atypical antidepressant that inhibits the reuptake of dopamine and norepinephrine. It is useful in depression and smoking cessation but is not serotonergic and carries a risk of seizures at higher doses.
Take-Home Points:
- SSRIs: fluoxetine, paroxetine, sertraline, citalopram, escitalopram.
- SSRIs are first-line for depression/anxiety due to better tolerability.
- Always assess for serotonin syndrome and suicidal ideation when initiating therapy.
Correct Answer is C
Explanation
Phenelzine (Nardil) is a monoamine oxidase inhibitor (MAOI) used for treatment-resistant depression. The most important safety concern with MAOIs is the risk of a hypertensive crisis when foods or medications containing tyramine or sympathomimetic agents are ingested. Teaching should emphasize dietary and drug restrictions.
C. Read labels of food and over-the-counter drugs to avoid those with substances that should be avoided as directed. – This is the priority teaching point. Tyramine-containing foods (aged cheese, cured meats, wine) and many OTC medications (cold remedies, stimulants) can trigger hypertensive crisis when combined with phenelzine.
A. Headaches may occur. OTC medications will usually be effective. – OTC drugs such as decongestants can dangerously interact with MAOIs and precipitate a hypertensive crisis; this statement is unsafe.
B. Hyperglycemia may occur and any unusual thirst, hunger, or urination should be reported. – Blood sugar changes are not a major risk with phenelzine, so this teaching is not a priority.
D. Monitor blood pressure for hypotension and report any BP below 90/60. – Orthostatic hypotension may occur, but it is not as life-threatening as a hypertensive crisis, making this less critical than dietary and drug restrictions.
Take-Home Points:
- The most important teaching for clients on MAOIs is to avoid tyramine-rich foods and contraindicated OTC drugs.
- Failure to follow these precautions can lead to hypertensive crisis, a life-threatening emergency.
- Nurses should provide clients with a clear list of restricted foods and medications before discharge.
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