Chapter 17: Drugs Used for Mood Disorders My Nursing Test Banks

Chapter 17: Drugs Used for Mood Disorders

Test Bank

MULTIPLE CHOICE

1. What occurs with mania associated with bipolar disorder?

a.

Varying degrees of sadness

b.

Distinct episodes of elation

c.

Suicide

d.

Psychomotor retardation

ANS: B

Mania is characterized by distinct episodes of euphoria and elation. Sadness is characteristic of depression. Suicide is not generally associated with mania; it is more commonly associated with depression. Psychomotor retardation is not associated with mania.

DIF: Cognitive Level: Comprehension REF: pp. 252-253 OBJ: 2

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Psychosocial Integrity

2. Which postoperative narcotic analgesic will most likely be prescribed to a patient whose current medications include a monoamine oxidase inhibitor (MAOI), a thyroid hormone, and a multivitamin?

a.

Meperidine (Demerol)

b.

Morphine

c.

Ibuprofen (Advil)

d.

Acetaminophen (Tylenol)

ANS: B

Morphine is the narcotic analgesic of choice because it will not interact with the patients MAOI. Meperidine will interact with the patients medication. Ibuprofen and acetaminophen are not narcotic analgesics.

DIF: Cognitive Level: Application REF: p. 261 OBJ: 6

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

3. What is the major advantage of selective serotonin reuptake inhibitors (SSRIs) over other types of antidepressant therapy?

a.

They are less expensive than the other classes of antidepressants.

b.

They cure major depressive illnesses.

c.

They do not cause the anticholinergic and cardiovascular adverse effects.

d.

Therapeutic relief is immediate.

ANS: C

SSRIs are the most widely used class of antidepressants. Although they are as effective in treating depression as the tricyclic antidepressants, they do not cause the anticholinergic and cardiovascular adverse effects that often limit the use of tricyclic antidepressants. SSRIs tend to be more expensive than other available antidepressants. SSRIs do not cure major depressive illnesses. As with other antidepressants, it takes 2 to 4 weeks to obtain the full therapeutic benefit when taking SSRIs.

DIF: Cognitive Level: Knowledge REF: p. 261 OBJ: 8

TOP: Nursing Process Step: Planning

MSC: NCLEX Client Needs Category: Physiological Integrity

4. Lithium (Eskalith) is the drug of choice for which of the following disorders?

a.

Psychotic episodes

b.

Obsessive compulsive disorders (OCDs)

c.

Bipolar disorders

d.

Depressive disorders

ANS: C

Lithium is used to treat acute mania and for prophylactic treatment of recurrent manic and depressive episodes in bipolar disorders. Psychotic episodes are treated with major tranquilizers that have an antipsychotic effect. The drugs of choice for treating OCD are SSRIs. Depressive disorders are not primarily treated with lithium.

DIF: Cognitive Level: Comprehension REF: p. 271 OBJ: 3

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

5. Which psychological manifestation of depression will improve in response to antidepressant therapy?

a.

Loss of energy

b.

Palpitations

c.

Sleep disturbances

d.

Social withdrawal

ANS: D

Social withdrawal and lack of interest in surroundings are psychological responses that will improve within 2 to 4 weeks of the patient receiving an effective dosage of antidepressant therapy. An increase in energy, decreased palpitations, and improvement in sleep patterns are physiological responses.

DIF: Cognitive Level: Comprehension REF: p. 254 OBJ: 5

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Psychological Integrity

6. On what is the choice of tricyclic antidepressants based?

a.

The need to decrease the action of norepinephrine, dopamine, or serotonin

b.

Patient age and gender

c.

An absence of adverse effects, such as orthostatic hypotension

d.

The need for stimulation and increased mental alertness

ANS: B

The choice of tricyclic antidepressants is based on their individual therapeutic characteristics. Tricyclics prolong the action of norepinephrine, dopamine, and serotonin. All tricyclics produce orthostatic hypotension to some degree. All tricyclics produce sedation, not stimulation.

DIF: Cognitive Level: Comprehension REF: p. 264 OBJ: 7

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Psychosocial Integrity

7. The nurse is teaching a patient about medication treatment for depression. The patient asks how long it will take before sleep and appetite will begin to improve. Which response by the nurse is most accurate?

a.

3 days

b.

1 week

c.

4 weeks

d.

2 months

ANS: B

The physiological manifestations of depression (sleep disturbance, change in appetite, loss of energy, fatigue, palpitations) begin to be alleviated within the first week of therapy. It takes longer than 3 days for the symptoms to improve. Four weeks and 2 months are longer than it takes for the symptoms to improve.

DIF: Cognitive Level: Comprehension REF: p. 254 OBJ: 5

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

8. What is the action of MAOIs on neurotransmitters?

a.

Blocking their reuptake

b.

Increasing their production

c.

Blocking their destruction

d.

Increasing their reuptake

ANS: C

MAOIs act by blocking the metabolic destruction of epinephrine, norepinephrine, dopamine, and serotonin neurotransmitters by the enzyme monoamine oxidase in the presynaptic neurons of the brain. They prevent the degradation of these central nervous system (CNS) neurotransmitters so that their concentration is increased. MAOIs do not block or increase the reuptake of neurotransmitters. MAOIs do not increase production of neurotransmitters.

DIF: Cognitive Level: Comprehension REF: p. 258 OBJ: 3

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

9. A patient who is taking an MAOI to treat depression admits to eating pickled herring and cheese and drinking red wine. Which assessment finding alerts the nurse to a potential complication?

a.

Constipation

b.

Hypotension

c.

Neck stiffness

d.

Urinary retention

ANS: C

Hypertensive crisis is a major potential complication. Common prodromal symptoms of hypertensive crisis include severe occipital headache, stiff neck, sweating, nausea, vomiting, and sharply elevated blood pressure. Constipation, hypotension, and urinary retention are not indicative of a major potential complication when patients consume foods high in tyramine.

DIF: Cognitive Level: Application REF: p. 261 OBJ: 6

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

10. Which assessment would the nurse expect to observe in a patient who has been prescribed trazodone for treatment anxiety?

a.

Excessive thirst

b.

Hand tremor

c.

Drowsiness

d.

Diarrhea

ANS: C

Drowsiness is a common adverse effect, and people who work with machinery, drive a car, administer medicines, or perform other duties in which they must remain mentally alert should not take trazodone while working. Excessive thirst, hand tremors, and diarrhea are not an adverse effect associated with trazodone.

DIF: Cognitive Level: Comprehension REF: p. 270 OBJ: 4

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

11. The nurse is caring for a patient who is taking a newly prescribed drug, nefazodone, for treatment of depression. Which physical assessment finding is most important for the nurse to report to the health care provider immediately?

a.

Bradycardia

b.

Dizziness

c.

Drowsiness

d.

Urinary retention

ANS: A

Bradycardia with a drop in 15 beats/min is to be reported to the health care provider immediately; withholding the dose is warranted until approved. Dizziness, drowsiness, and urinary retention are common adverse effects that would not need to be reported to the health care provider.

DIF: Cognitive Level: Comprehension REF: p. 268 OBJ: 4

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

12. The nurse is providing education to a patient who has been prescribed bupropion (Wellbutrin) for smoking cessation. Which statement by the patient would indicate the need for further teaching?

a.

My dose will increase after 3 days.

b.

I should swallow this medication whole.

c.

If I have the urge to smoke, I will take more medication.

d.

I do not need to taper my dose when the drug is discontinued.

ANS: C

Dosage will begin at 150 mg/day for the first 3 days and then, for most patients, be increased to 300 mg/day. The patient is maintained on doses of 300 mg/day for 7 to 12 weeks and dosage is not based on a desire to smoke. Bupropion should be swallowed whole, not crushed, divided, or chewed. Dose tapering is not required when discontinuing bupropion.

DIF: Cognitive Level: Application REF: p. 266 OBJ: 6

TOP: Nursing Process Step: Evaluation

MSC: NCLEX Client Needs Category: Physiological Integrity

13. Which nursing action is most important when providing care to a patient diagnosed with a mood disorder?

a.

Assess the patient for thoughts of suicide.

b.

Provide supplemental feedings as needed.

c.

Assist with activities of daily living.

d.

Offer opportunities for interaction with other patients.

ANS: A

Determining if there is a risk for suicide, monitoring at specified intervals, and providing patient safety and supervision are the highest priorities with severe mood disorders. Providing supplemental feedings, assisting with activities of daily living, and offering opportunities for interaction with other patients are not priorities of care.

DIF: Cognitive Level: Application REF: pp. 251-252 OBJ: 1

TOP: Nursing Process Step: Intervention

MSC: NCLEX Client Needs Category: Physiological Integrity

14. A patient is admitted to a long term psychiatric setting. The MAOI medication previously prescribed is discontinued by the physician. New orders are obtained to initiate imipramine therapy. The nurse will provide the first dose of imipramine to the patient _____ the MAOI drug.

a.

immediately following the last dose of

b.

in 1 week following the last dose of

c.

in 14 days following the last dose of

d.

before discontinuing

ANS: C

MAOIs and TCAs, especially imipramine and desipramine, should not be administered concurrently. It is recommended that at least 14 days lapse between discontinuing an MAOI and starting SSRI/SNRI therapy.

DIF: Cognitive Level: Analysis REF: p. 261 OBJ: 4

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Safe, Effective Care Environment; Physiological Integrity

15. A patient taking vilazodone has been vomiting persistently for 12 hours. The priority nursing diagnosis for this patient is:

a.

nausea.

b.

imbalanced nutrition (less than body requirements).

c.

fluid volume deficit.

d.

altered peripheral tissue perfusion.

ANS: C

Nausea and vomiting are common adverse effects of vilazodone. Persistent vomiting should be evaluated for other causes, as well as for the development of electrolyte imbalance. Fluid volume deficit can lead to life threatening cardiac arrhythmias and therefore is the priority nursing diagnosis. The nursing diagnosis nausea is appropriate, but is not the priority. Imbalanced nutrition is an appropriate nursing diagnosis but is not the priority at this time. Altered peripheral tissue perfusion does not apply to this scenario.

DIF: Cognitive Level: Analysis REF: p. 270 OBJ: 4

TOP: Nursing Process Step: Diagnosis

MSC: NCLEX Client Needs Category: Physiological Integrity

MULTIPLE RESPONSE

16. Which area(s) should be addressed by the nurse when obtaining a history of a patient admitted with depression? (Select all that apply.)

a.

Current medications and medical history

b.

Recent stressors and support system

c.

Family history of mood disorder

d.

Dietary patterns

e.

Insurance coverage

ANS: A, B, C, D

It is important to obtain a thorough history when assessing the patient with depression, including current medical status and medications, recent stressors, support system, family history of mood disorders, and nutritional patterns. Financial matters should not be part of the nursing assessment.

DIF: Cognitive Level: Application REF: p. 255 OBJ: 1

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Psychosocial Integrity

17. Which instruction(s) is/are most pertinent to include in the discharge teaching of a patient on lithium (Eskalith) who is being discharged? (Select all that apply.)

a.

Persistent vomiting and profuse diarrhea are signs of toxicity and must be reported to the health care provider immediately.

b.

It is important to comply with schedules for blood tests to assess therapeutic levels.

c.

You should avoid foods such as Chianti wine and aged cheeses.

d.

The common adverse effects to expect, which are excessive nausea, anorexia, and abdominal cramps, tend to resolve.

e.

You will be gradually weaned off this medication.

f.

Take the medication with food or milk.

ANS: A, B, D, F

Patients should be informed of the importance of toxic symptoms to report and monitoring therapeutic lithium levels. Nausea, vomiting, and abdominal cramps are common adverse effects and tend to resolve. Lithium should be administered with food or milk. Chianti wine and aged cheeses are to be avoided during MAOI therapy. The bipolar patient may be on lithium treatment for the rest of his or her life and will not be weaned from the medication.

DIF: Cognitive Level: Application REF: pp. 271-272 OBJ: 3

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Psychosocial Integrity

18. What will the nurse include in a teaching plan for a patient with depression being treated with amitriptyline (Elavil)? (Select all that apply.)

a.

Dryness of the mouth is normal; sucking on sugar free hard candy and ice chips or chewing gum may help alleviate this problem.

b.

Rise slowly from a supine or sitting position to avoid dizziness and orthostatic hypotension.

c.

Avoid alcohol and barbiturates.

d.

If adverse effects occur, discontinue the medication.

e.

An immediate elevation in mood will be noted.

ANS: A, B, C

Common adverse effects associated with tricyclic antidepressants are dry mouth and orthostatic hypotension. Alcohol and barbiturates should be avoided while taking tricyclic antidepressants because they enhance sedation.Adverse effects are likely to occur, and the medication should not be discontinued without the direction of the health care provider. Tricyclic antidepressants typically take several weeks to produce a therapeutic effect.

DIF: Cognitive Level: Application REF: pp. 264-265 OBJ: 6

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

19. Which food(s) containing significant amounts of tyramine will be contraindicated when a patient is on MAOI therapy? (Select all that apply.)

a.

Beer

b.

Red meat

c.

Aged cheeses

d.

Green vegetables

e.

Bananas

ANS: A, C, E

Beer, red wines, well ripened cheeses (such as camembert, edam, roquefort, parmesan, mozzarella, and cheddar), and overripe bananas contain tyramine. Red meat and green vegetables do not contain tyramine.

DIF: Cognitive Level: Knowledge REF: p. 261 OBJ: 4

TOP: Nursing Process Step: Planning

MSC: NCLEX Client Needs Category: Physiological Integrity

20. Which nursing assessment(s) is/are important before the initiation of antidepressant therapy? (Select all that apply.)

a.

Compliance with medication therapy within the last 2 months

b.

Nonverbal interactions among patient and significant others present

c.

Evaluation of the coherency, relevancy, and organization of thoughts in responses

d.

Appearance and posture

e.

Elimination pattern

ANS: A, B, C, D

Compliancy with prescribed medications over the last 2 months provides the health care provider with information regarding the patients state of mind and ability to follow through with medication administration independently. Patients with altered thought processes often display inconsistencies between statements of feelings and behavior norms in social settings. Coherency, relevancy, and organization of thoughts are often affected by thought disorders. This assessment also provides information regarding the accuracy of other information that the patient has offered. Note general appearance and appropriateness of attire and posture because these are often affected by mood disorders. Elimination pattern is not a priority premedication assessment.

DIF: Cognitive Level: Analysis REF: p. 255 | p. 264

OBJ: 1 TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

21. Which statement(s) is/are true regarding the pharmacologic actions of certain antidepressant drugs? (Select all that apply.)

a.

MAOIs block the effects of dopamine in the CNS.

b.

SSRIs inhibit the destruction and reuptake of serotonin at the synaptic cleft.

c.

Tricyclic antidepressants block the action of norepinephrine and epinephrine in the SNS.

d.

Monocyclic antidepressants such as bupropion (Wellbutrin) have an unknown mechanism of action.

e.

SNRIs prolong the action of neurotransmitters by decreasing the destruction of serotonin and norepinephrine.

ANS: B, D, E

SSRIs block the destruction and storage of serotonin at the synaptic cleft, therefore increasing the amount of serotonin available. Monocyclic antidepressants have an unknown mechanism of action. They are weaker inhibitors of the reuptake and inactivation of the neurotransmitters serotonin norepinephrine and dopamine. SNRIs act by inhibiting the reuptake and destruction of serotonin and norepinephrine and, to a lesser extent, dopamine, from the synaptic cleft, thereby prolonging the action of the neurotransmitters. MAOIs act by blocking the metabolic destruction of dopamine, so concentration is increased. Tricyclics block the reuptake of neurotransmitters, not their effects.

DIF: Cognitive Level: Comprehension REF: p. 261 | p. 263

OBJ: 9 TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

22. Which drug(s) interact(s) with SSRI agents? (Select all that apply.)

a.

Tranylcypromine (Parnate)

b.

Lithium (Eskalith)

c.

Warfarin (Coumadin)

d.

Furosemide (Lasix)

e.

Propranolol (Inderal)

ANS: A, B, C, E

A 14-day lapse is recommended between MAOIs, such as Parnate, and SSRI agents.

The incidence of lithium toxicity is increased with SSRI agents. The anticoagulant effects of warfarin may be enhanced with SSRIs. The SSRIs fluvoxamine and citalopram inhibit the metabolism of beta adrenergic blocking agents such as propranolol. Lasix does not interact with SSRI agents.

DIF: Cognitive Level: Comprehension REF: pp. 262-263 OBJ: 9

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

23. The nurse must be sure to instruct the patient about which potential adverse effect(s) of tricyclic antidepressants? (Select all that apply.)

a.

Diarrhea

b.

Dryness of mouth, nose, and throat

c.

Constipation

d.

Nocturia

e.

Urinary retention

f.

Blurred vision

ANS: B, C, E, F

The patient may experience difficulty with dryness of the mouth, nose, and throat as well as smooth muscle contraction (resulting in constipation, urinary retention, and blurred vision). Diarrhea and nocturia are not adverse effects of tricyclic antidepressants.

DIF: Cognitive Level: Knowledge REF: pp. 264-265 OBJ: 4

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

24. The nurse is preparing 0800 medications for a patient with the medical diagnosis of end stage renal disease. When reviewing the medication administration record (MAR), the nurse notices the patient is scheduled to receive an MAOI drug. Which intervention(s) will the nurse perform before administering the drug? (Select all that apply.)

a.

Assess temperature.

b.

Provide an alternative drug.

c.

Hold the MAOI drug.

d.

Consult with the prescribing health care provider.

e.

Assess urine output prior to administration.

ANS: C, D

If the patient prescribed an MAOI drug has a history of severe renal disease, the medication must not be given and the prescribing health care provider consulted. It is not necessary to assess temperature at this time. An alternative medication needs to be ordered by a health care provider licensed to prescribe. Assessing urine output does not apply to this situation.

DIF: Cognitive Level: Analysis REF: p. 258 | p. 261

OBJ: 4 TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Safe, Effective Care Environment; Physiological Integrity

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