Mental Health Exam 3 2024.
1. A secondary amine tricyclic antidepressant is prescribed for a patient. The medication will
significantly increase the availability of which neurotransmitter?
a. GABA
b. Glutamate
c. Serotonin
d. Norepinephrine
ANS: D
Secondary amines increase the availability and enhance the action of norepinephrine. They do have a
similar effect on any of the other options
Nortriptyline was prescribed for a 68-year-old patient diagnosed with depression and insomnia. What
assessment question should the nurse ask to determine the effectiveness of nortriptyline?
a. "Are you having regular bowel movements?"
b. "Are you no longer experiencing insomnia?"
c. "Have you been successful with weight loss?"
d. "Would you say you are concentrating better?"
ANS: B
Nortriptyline is a secondary amine with a good side effect profile. It is somewhat sedating, which is
helpful to patients with insomnia. The other options are not considered outcomes for this medication.
A 75-year-old patient with a long history of depression begins amitriptyline 100 mg/day. The patient
also takes a diuretic daily for hypertension. What is the highest priority nursing diagnosis this patient
is at risk for?
a. Falls related to dizziness and orthostatic hypotension.
b. Ineffective thermoregulation related to anhidrosis.
c. Infection related to suppressed white blood cell count.
d. Constipation related to slowed gastrointestinal peristalsis.
ANS: A
Amitriptyline is a tricyclic antidepressants (TCA) that has a high risk of producing orthostatic
hypotension. The patient is placed at even greater risk because of older age and diuretic therapy, which
reduces fluid volume. The other options are either unassociated or are remote possibilities.
A depressed patient preparing for discharge is prescribed desipramine and will have follow-up
outpatient visits. The patient reports, "Why did they gave me only a 1-week supply of my medicine?"
Select the nurse's best reply.
,a. "Federal law limits the amount you may be given at any one time."
b. "It will save you money if the drug doesn't work well for your symptoms."
c. "This is a way of ensuring that you will come in for your follow-up appointment."
d. "Prescribing a small amount of drug addresses our concerns for your continuing safety."
ANS: D
Desipramine is an activating antidepressant, and it might provide a patient who has suicidal ideation
with the energy to make an attempt. Because the therapeutic dose and lethal dose are not widely
separated, tricyclic antidepressants (TCA) overdose is an often-used suicide plan. Because desipramine
appears to be the most toxic TCA, prescribing only a 7-day supply limits the possibility of using the drug
in a suicide attempt.The other options are either less relevant or incorrect
A patient diagnosed with depression is prescribed the tricyclic antidepressant (TCA) bupropion. What
is the benefit of this medication for non-hospitalized patients?
a. It has antianxiety properties as well as antidepressant effects.
b. It lowers the seizure threshold to a lesser extent than TCAs.
c. There is reduced potential for lethal overdose.
d. It stimulates appetite and weight gain.
ANS: C
Bupropion has no lethal-overdose potential, making it well suited for use in outpatient treatment of
depression. Bupropion has a narrow therapeutic index but is far less lethal than TCAs or monoamine
oxidase inhibitors (MAOIs). However, it might cause agitation, anxiety, seizures, anorexia, and weight
loss.
A patient diagnosed with depression has taken a selective serotonin reuptake inhibitor (SSRI) for 1
month. The nurse should use direct questions to evaluate which potential side effect?
a. Aggressive impulses
b. Sexual dysfunction
c. Paranoid delusions
d. Weight gain
ANS: B
SSRIs often produce sexual dysfunction, such as decreased libido. Patients readily tell nurses about
anticholinergic, gastrointestinal, and other side effects, but are not as forthcoming in reporting sexual
problems. The nurse might need to ask directly to elicit this information. Patients are more willing to
discuss the other options
A patient prescribed fluoxetine is being changed to tranylcypromine. The nurse provides education on
this change that will include a time lapse between the last dose of fluoxetine and the first dose of
tranylcypromine of at least how long?
,a. 7 days.
b. 14 days.
c. 3 weeks.
d. 6 weeks.
ANS: D
Drugs that have a high probability for serious interactions (e.g., monoamine oxidase inhibitors {MAOIs}
like fluoxetine) will need to be withheld for up to 6 weeks or more as fluoxetine is washing out of the
system. The remaining options are too short an interval.
A patient tells the nurse, "I've stopped taking sertraline because the drug made me impotent. Which
statement by the nurse will provide the best patient support?
a. "Your doctor still wants you to continue taking your medication."
b. "Have you talked with your therapist regarding your feelings about sex?"
c. "Let's talk with your doctor. Changing your medication might be a possibility."
"Our priority is to treat your depression. Impotence can be addressed in a few weeks
ANS: C
Selective serotonin reuptake inhibitor (SSRI) commonly causes sexual dysfunction. Changing to another
type of antidepressant or adding bupropion in small doses can be helpful. The other options are not
compassionate or therapeutic.
A tricyclic antidepressant (TCA) is prescribed for a patient newly diagnosed with depression. What
information should be included in patient teaching?
a. "Take this medication on an empty stomach."
b. "Do not eat aged cheese while using this medication."
c. "You might experience sweating, tremors, and excessive urination."
d. "It might be 2 weeks or more before you notice the effects of this medicine."
ANS: D
Antidepressant effects might take several weeks to be noticeable. Avoidance of tyramine (as is present in
aged cheeses) is necessary for monoamine oxidase inhibitors (MAOIs) therapy but not for TCAs. It is not
necessary to take TCAs on an empty stomach. Sweating, tremors, and urination problems are not
commonly experienced with TCA therapy
Why do patients taking tricyclic antidepressants (TCAs) exhibit more side effects than patients taking
selective serotonin reuptake inhibitors (SSRIs)?
a. TCAs inhibit reuptake of norepinephrine and serotonin.
b. TCAs selectively inhibit dopamine reuptake.
, c. TCAs selectively block serotonin uptake.
d. TCAs block enzymatic breakdown.
ANS: A
TCAs inhibit the reuptake of both norepinephrine and serotonin and because of their non=selectivity
produce many side effects. The other options are incorrect statements about the action of TCAs.
When teaching about the monoamine oxidase inhibitor (MAOI) tranylcypromine, the nurse should
consider it a priority to provide what information?
a. A list of tyramine-rich foods
b. A warning to avoid direct sunlight
c. Instructions to manage fever with acetaminophen
d. Directions to report dry mouth and blurred vision
ANS: A
MAOIs and ingested tyramine interact to produce hypertensive crisis, a life-threatening medical
emergency, so it is necessary to teach the patient foods to avoid. The other options are unrelated to
tranylcypromine therapy.
A patient prescribed phenelzine reports a sudden headache and palpitations. What is the nurse's
initial intervention when observing the patient demonstrating dilated pupils and diaphoresis?
a. Assess for cogwheel rigidity.
b. Notify the health care provider.
c. Assess the patient's blood pressure.
d. Withhold the morning dose of phenelzine.
ANS: C
The patient's symptoms are suggestive of hypertensive crisis. It is vital to know whether or not the blood
pressure is elevated, so obtaining the blood pressure is the necessary first action. The most probable
reason for the reaction would be drug-food interaction. The nurse may notify the health care provider
and withhold the morning dose as subsequent actions. Cogwheel rigidity is associated with antipsychotic
medications
What is the nurse's highest priority when caring for a patient after a tricyclic antidepressant (TCA)
overdose?
a. Frequently monitor blood pressure and heart rate/rhythm.
b. Monitor for skin rashes, particularly on the torso.
c. Measure and record intake and output every 12 hours.
d. Institute cooling blankets for hyperthermia.
1. A secondary amine tricyclic antidepressant is prescribed for a patient. The medication will
significantly increase the availability of which neurotransmitter?
a. GABA
b. Glutamate
c. Serotonin
d. Norepinephrine
ANS: D
Secondary amines increase the availability and enhance the action of norepinephrine. They do have a
similar effect on any of the other options
Nortriptyline was prescribed for a 68-year-old patient diagnosed with depression and insomnia. What
assessment question should the nurse ask to determine the effectiveness of nortriptyline?
a. "Are you having regular bowel movements?"
b. "Are you no longer experiencing insomnia?"
c. "Have you been successful with weight loss?"
d. "Would you say you are concentrating better?"
ANS: B
Nortriptyline is a secondary amine with a good side effect profile. It is somewhat sedating, which is
helpful to patients with insomnia. The other options are not considered outcomes for this medication.
A 75-year-old patient with a long history of depression begins amitriptyline 100 mg/day. The patient
also takes a diuretic daily for hypertension. What is the highest priority nursing diagnosis this patient
is at risk for?
a. Falls related to dizziness and orthostatic hypotension.
b. Ineffective thermoregulation related to anhidrosis.
c. Infection related to suppressed white blood cell count.
d. Constipation related to slowed gastrointestinal peristalsis.
ANS: A
Amitriptyline is a tricyclic antidepressants (TCA) that has a high risk of producing orthostatic
hypotension. The patient is placed at even greater risk because of older age and diuretic therapy, which
reduces fluid volume. The other options are either unassociated or are remote possibilities.
A depressed patient preparing for discharge is prescribed desipramine and will have follow-up
outpatient visits. The patient reports, "Why did they gave me only a 1-week supply of my medicine?"
Select the nurse's best reply.
,a. "Federal law limits the amount you may be given at any one time."
b. "It will save you money if the drug doesn't work well for your symptoms."
c. "This is a way of ensuring that you will come in for your follow-up appointment."
d. "Prescribing a small amount of drug addresses our concerns for your continuing safety."
ANS: D
Desipramine is an activating antidepressant, and it might provide a patient who has suicidal ideation
with the energy to make an attempt. Because the therapeutic dose and lethal dose are not widely
separated, tricyclic antidepressants (TCA) overdose is an often-used suicide plan. Because desipramine
appears to be the most toxic TCA, prescribing only a 7-day supply limits the possibility of using the drug
in a suicide attempt.The other options are either less relevant or incorrect
A patient diagnosed with depression is prescribed the tricyclic antidepressant (TCA) bupropion. What
is the benefit of this medication for non-hospitalized patients?
a. It has antianxiety properties as well as antidepressant effects.
b. It lowers the seizure threshold to a lesser extent than TCAs.
c. There is reduced potential for lethal overdose.
d. It stimulates appetite and weight gain.
ANS: C
Bupropion has no lethal-overdose potential, making it well suited for use in outpatient treatment of
depression. Bupropion has a narrow therapeutic index but is far less lethal than TCAs or monoamine
oxidase inhibitors (MAOIs). However, it might cause agitation, anxiety, seizures, anorexia, and weight
loss.
A patient diagnosed with depression has taken a selective serotonin reuptake inhibitor (SSRI) for 1
month. The nurse should use direct questions to evaluate which potential side effect?
a. Aggressive impulses
b. Sexual dysfunction
c. Paranoid delusions
d. Weight gain
ANS: B
SSRIs often produce sexual dysfunction, such as decreased libido. Patients readily tell nurses about
anticholinergic, gastrointestinal, and other side effects, but are not as forthcoming in reporting sexual
problems. The nurse might need to ask directly to elicit this information. Patients are more willing to
discuss the other options
A patient prescribed fluoxetine is being changed to tranylcypromine. The nurse provides education on
this change that will include a time lapse between the last dose of fluoxetine and the first dose of
tranylcypromine of at least how long?
,a. 7 days.
b. 14 days.
c. 3 weeks.
d. 6 weeks.
ANS: D
Drugs that have a high probability for serious interactions (e.g., monoamine oxidase inhibitors {MAOIs}
like fluoxetine) will need to be withheld for up to 6 weeks or more as fluoxetine is washing out of the
system. The remaining options are too short an interval.
A patient tells the nurse, "I've stopped taking sertraline because the drug made me impotent. Which
statement by the nurse will provide the best patient support?
a. "Your doctor still wants you to continue taking your medication."
b. "Have you talked with your therapist regarding your feelings about sex?"
c. "Let's talk with your doctor. Changing your medication might be a possibility."
"Our priority is to treat your depression. Impotence can be addressed in a few weeks
ANS: C
Selective serotonin reuptake inhibitor (SSRI) commonly causes sexual dysfunction. Changing to another
type of antidepressant or adding bupropion in small doses can be helpful. The other options are not
compassionate or therapeutic.
A tricyclic antidepressant (TCA) is prescribed for a patient newly diagnosed with depression. What
information should be included in patient teaching?
a. "Take this medication on an empty stomach."
b. "Do not eat aged cheese while using this medication."
c. "You might experience sweating, tremors, and excessive urination."
d. "It might be 2 weeks or more before you notice the effects of this medicine."
ANS: D
Antidepressant effects might take several weeks to be noticeable. Avoidance of tyramine (as is present in
aged cheeses) is necessary for monoamine oxidase inhibitors (MAOIs) therapy but not for TCAs. It is not
necessary to take TCAs on an empty stomach. Sweating, tremors, and urination problems are not
commonly experienced with TCA therapy
Why do patients taking tricyclic antidepressants (TCAs) exhibit more side effects than patients taking
selective serotonin reuptake inhibitors (SSRIs)?
a. TCAs inhibit reuptake of norepinephrine and serotonin.
b. TCAs selectively inhibit dopamine reuptake.
, c. TCAs selectively block serotonin uptake.
d. TCAs block enzymatic breakdown.
ANS: A
TCAs inhibit the reuptake of both norepinephrine and serotonin and because of their non=selectivity
produce many side effects. The other options are incorrect statements about the action of TCAs.
When teaching about the monoamine oxidase inhibitor (MAOI) tranylcypromine, the nurse should
consider it a priority to provide what information?
a. A list of tyramine-rich foods
b. A warning to avoid direct sunlight
c. Instructions to manage fever with acetaminophen
d. Directions to report dry mouth and blurred vision
ANS: A
MAOIs and ingested tyramine interact to produce hypertensive crisis, a life-threatening medical
emergency, so it is necessary to teach the patient foods to avoid. The other options are unrelated to
tranylcypromine therapy.
A patient prescribed phenelzine reports a sudden headache and palpitations. What is the nurse's
initial intervention when observing the patient demonstrating dilated pupils and diaphoresis?
a. Assess for cogwheel rigidity.
b. Notify the health care provider.
c. Assess the patient's blood pressure.
d. Withhold the morning dose of phenelzine.
ANS: C
The patient's symptoms are suggestive of hypertensive crisis. It is vital to know whether or not the blood
pressure is elevated, so obtaining the blood pressure is the necessary first action. The most probable
reason for the reaction would be drug-food interaction. The nurse may notify the health care provider
and withhold the morning dose as subsequent actions. Cogwheel rigidity is associated with antipsychotic
medications
What is the nurse's highest priority when caring for a patient after a tricyclic antidepressant (TCA)
overdose?
a. Frequently monitor blood pressure and heart rate/rhythm.
b. Monitor for skin rashes, particularly on the torso.
c. Measure and record intake and output every 12 hours.
d. Institute cooling blankets for hyperthermia.
