Review Practice Exercise 3

Drugs Used for Depressive and Bipolar Disorders > Pharmacology

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Practice Exercise 3

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Total Questions : 5

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Question 1:

Patient teaching for a patient receiving an MAOI would include instructions to avoid which food products? Select all that apply

A. Orange juice B. Swiss cheese C. Shrimp D. Milk E. Pepperoni pizza

Answer and Explanation

Choice A:

Orange juice — Fresh fruits and juices, including orange juice, are low in tyramine and safe to consume with MAOIs.

Choice B:

Swiss cheese — Aged cheeses are high in tyramine, which can interact with MAOIs to cause a hypertensive crisis. Clients must avoid all aged, fermented, or cured cheeses.

Choice C:

Shrimp — Fresh seafood is low in tyramine and does not interact adversely with MAOIs.

Choice D:

Milk — Fresh milk and most dairy products that are not aged or fermented are safe for clients on MAOIs.

Choice E:

Pepperoni pizza — Processed and cured meats are also high in tyramine and pose the same risk for dangerous blood pressure elevation. These foods should be avoided.

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Question 2:

After a patient has been treated for depression for 4 weeks, the nurse calls the patient to schedule a follow-up visit. What concern will the nurse assess for during the conversation with the patient?

A. Weakness B. Hallucinations C. Suicidal ideation D. Difficulty with urination

Answer and Explanation

Choice A:

Weakness — While some patients may experience mild fatigue as a side effect, it is not the primary concern in early antidepressant follow-up.

Choice B:

Hallucinations — Hallucinations are not a typical adverse effect of standard antidepressant therapy and are not expected in routine follow-up.

Choice C:

Suicidal ideation — Antidepressants can increase energy and motivation before mood improves, which may place patients at higher risk for acting on pre-existing suicidal thoughts. Assessing for suicidal ideation is a priority during follow-up.

Choice D:

Difficulty with urination — Urinary retention is uncommon with most antidepressants and is not a primary concern for early treatment monitoring.

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Question 3:

The nurse is teaching a patient about treatment with an SSRI antidepressant. Which teaching considerations are appropriate? Select all that apply.

A. The patient should be told which foods contain tyramine and instructed to avoid these foods. B. The patient should be instructed to use caution when standing up from a sitting position. C. The patient should not take any products that contain the herbal product St. John's wort. D. This medication should not be stopped abruptly. E. Drug levels may become toxic if dehydration occurs. F. The patient should be told to check with the prescriber before taking any over-the-counter medications.

Answer and Explanation

Choice A:

Tyramine-containing foods and 5: dehydration — These are not relevant for SSRIs; tyramine restrictions apply to MAOIs, and dehydration-related toxicity is more relevant for lithium.

Choice B:

Use caution when standing up from a sitting position — SSRIs can cause orthostatic hypotension, especially in older adults or those taking other medications affecting blood pressure. Patients should rise slowly to prevent dizziness or falls.

Choice C:

Do not take products containing St. John’s wort — Combining SSRIs with St. John’s wort can increase serotonin levels, raising the risk for serotonin syndrome, a potentially life-threatening condition.

Choice D:

Do not stop abruptly — Abrupt discontinuation of SSRIs can lead to withdrawal symptoms, such as dizziness, irritability, nausea, and flu-like symptoms. Gradual tapering under prescriber guidance is essential.

Choice E:

Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed for depression and anxiety. While generally safe, SSRIs can interact with other medications and herbal supplements, cause mild adverse effects, and require careful monitoring during initiation or discontinuation. Nurses play a key role in educating patients on safe use, potential interactions, and proper adherence to therapy.

Choice F:

Check with the prescriber before taking over-the-counter medications — Many over-the-counter drugs, including decongestants and cold remedies, can interact with SSRIs or exacerbate side effects. Patient education ensures safe concurrent use.

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Question 4:

A patient with a feeding tube will be receiving risperidone (Risperdal) 8 mg in two divided doses via the feeding tube. The medication is available in a 1 mg/mL solution. How many milliliters will the nurse administer for each dose?

Answer and Explanation

Correct Answer: "4" mL

Explanation

To find the amount to administer for each dose, the nurse must first determine the amount of medication per dose, then calculate the corresponding volume.

Step 1: Calculate the dose for each administration

The patient is to receive a total of 8 mg per day, divided into two equal doses.

Total daily dose ÷ Number of doses per day = Dose per administration
8mg÷2doses=4mgperdose

Step 2: Calculate the volume for each dose

The medication is available as a solution with a concentration of 1 mg per 1 mL. Use the following formula to find the volume needed for the 4 mg dose.

Dose per administration ÷ Concentration of solution = Volume to administer
4mg÷1mg/mL=4mL

The nurse will administer 4 mL for each dose.

Take-home points:

Always divide the total daily dose by the number of scheduled doses to determine the amount per administration.
Use the formula: Dose ordered ÷ Drug concentration = Volume to administer when converting mg to mL.

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Question 5:

Which statement is true concerning lithium?

A. The maximum dose is C.4 g/d. B. The therapeutic drug range is B.5 to C.5 mEq/L. C. Lithium increases receptor sensitivity to GABA. D. Concurrent NSAIDs may increase lithium levels.

Answer and Explanation

Choice A:

The maximum dose is C.4 g/d.Lithium dosing varies based on therapeutic levels and individual response; it is titrated according to serum concentrations, not by a fixed maximum dose.

Choice B:

The therapeutic drug range is B.5 to C.5 mEq/L.This range is toxic, not therapeutic. The therapeutic range is 0.6–A.2 mEq/L for maintenance, with levels above A.5 mEq/L considered toxic.

Choice C:

Lithium increases receptor sensitivity to GABA.
Lithium’s exact mechanism is not fully understood, but it is thought to alter sodium transport and influence neurotransmitter activity, not directly increase GABA receptor sensitivity.T

Choice D:

Concurrent NSAIDs may increase lithium levels.NSAIDs reduce renal clearance of lithium, potentially causing toxic accumulation. This interaction requires close monitoring or avoidance of NSAIDs.

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Practice Exercise 3

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