Test Bank - Focus on Nursing Pharmacology (8th Edition by Karch)
1. The mental health nursing instructor is talking with the class about depression.
What deficiency does the instructor explain will result in depression?
a. Epinephrine, norepinephrine, and acetylcholine
b. Norepinephrine, dopamine, and serotonin
c. Acetylcholine, gamma-aminobutyric acid, and serotonin
d. Gamma-aminobutyric acid, dopamine, and epinephrine
Ans: B
Feedback:
A current hypothesis regarding the cause of depression is a deficiency of
norepinephrine, dopamine, or serotonin, which are all biogenic amines, in key areas of
the brain. Acetylcholine is a neurotransmitter that communicates between nerves and
muscles. Epinephrine is a catecholamine that serves as a neurotransmitter that is
released in the sympathetic branch of the autonomic nervous system and can be
hormones when released from cells in the adrenal medulla. Gamma-aminobutyric acid
is a neurotransmitter that inhibits nerve activity and prevents over excitability or
stimulation.
2. What is the physiological action of tricyclic antidepressants (TCAs)?
a. Inhibiting monoamine oxidase inhibitors that break down norepinephrine
b. Inhibiting nerve activity, which prevents over excitability or stimulation
c. Blocking the reuptake of serotonin, which increases the levels of
norepinephrine
d. Inhibiting reuptake of norepinephrine and serotonin
Ans: D
Feedback:
TCAs inhibit presynaptic reuptake of norepinephrine and serotonin, which cause an
accumulation of the neurotransmitters that is thought to create the antidepressant
effect. Monoamine oxidase inhibitors irreversibly inhibit monoamine oxidase that
breaks down norepinephrine and serotonin. Selective serotonin reuptake inhibitors
block the reuptake of serotonin; gamma-aminobutyric acid inhibits nerve activity.
3. A nurse is working with a 9-year-old child who exhibits signs and symptoms of
obsessive-compulsive disorder (OCD). What drug will the nurse anticipate may be
prescribed for the child?
a. Phenelzine (Nardil)
b. Amitriptyline (Elavil)
c. Fluvoxamine (Prozac)
, d. Isocarboxazid (Marplan)
Ans: C
Feedback:
Fluvoxamine is a selective serotonin reuptake inhibitor that has established pediatric
dosage guidelines for the treatment of obsessive-compulsive disorder. Isocarboxazid
and phenelzine are monoamine oxidase inhibitors and should be avoided in pediatric
use because of the potential drugfood interactions and other serious adverse effects.
Amitriptyline is also a tricyclic antidepressant not recommended for pediatric use.
4. A patient explains to a nurse that he had been taking amitriptyline (Elavil) for
depression and that his physician changed his medication to clomipramine
(Anafranil). The patient is confused and does not understand why his medication
was changed. The nurse’s best response to the patient would be what?
a. These drugs are similar but some patients respond better to one drug than
another.
b. Did you take the amitriptyline like you should have?
c. Maybe the old medicine wasn’t working anymore.
d. Clomipramine is newer and will be much better for you.
Ans: A
Feedback:
Because all tricyclic antidepressants (TCAs) are similarly effective, the choice of
which TCA depends on individual response to the drug and tolerance of adverse
effects. A patient who does not respond to one TCA may respond to another drug
from this class. In addition, the nurse might inform the physician of the patient’s
question so the physician can explain his or her rationale for changing medications.
By asking the patient if he took the medication as prescribed, the nurse is insinuating
that he may not have and could damage the trusting nursepatient relationship. The
nurse has no basis for commenting that the medication might not be working or that
another drug would work better.
5. A patient comes to the mental health clinic for a regular appointment. The patient
tells the nurse he has been taking oral fluoxetine (Prozac) 20 mg daily for the past
3 weeks and that he has lost 3 pounds during that time due to a loss of appetite.
What action should the nurse take?
a. Teaching the patient about healthy eating to maintain weight
b. Congratulating the patient on his weight loss and commenting how well he
looks
c. Encouraging the patient to increase fluid intake to avoid further weight loss
d. Reassuring the patient that a decrease in weight is a common adverse effect
with this medication
Ans: D
1. The mental health nursing instructor is talking with the class about depression.
What deficiency does the instructor explain will result in depression?
a. Epinephrine, norepinephrine, and acetylcholine
b. Norepinephrine, dopamine, and serotonin
c. Acetylcholine, gamma-aminobutyric acid, and serotonin
d. Gamma-aminobutyric acid, dopamine, and epinephrine
Ans: B
Feedback:
A current hypothesis regarding the cause of depression is a deficiency of
norepinephrine, dopamine, or serotonin, which are all biogenic amines, in key areas of
the brain. Acetylcholine is a neurotransmitter that communicates between nerves and
muscles. Epinephrine is a catecholamine that serves as a neurotransmitter that is
released in the sympathetic branch of the autonomic nervous system and can be
hormones when released from cells in the adrenal medulla. Gamma-aminobutyric acid
is a neurotransmitter that inhibits nerve activity and prevents over excitability or
stimulation.
2. What is the physiological action of tricyclic antidepressants (TCAs)?
a. Inhibiting monoamine oxidase inhibitors that break down norepinephrine
b. Inhibiting nerve activity, which prevents over excitability or stimulation
c. Blocking the reuptake of serotonin, which increases the levels of
norepinephrine
d. Inhibiting reuptake of norepinephrine and serotonin
Ans: D
Feedback:
TCAs inhibit presynaptic reuptake of norepinephrine and serotonin, which cause an
accumulation of the neurotransmitters that is thought to create the antidepressant
effect. Monoamine oxidase inhibitors irreversibly inhibit monoamine oxidase that
breaks down norepinephrine and serotonin. Selective serotonin reuptake inhibitors
block the reuptake of serotonin; gamma-aminobutyric acid inhibits nerve activity.
3. A nurse is working with a 9-year-old child who exhibits signs and symptoms of
obsessive-compulsive disorder (OCD). What drug will the nurse anticipate may be
prescribed for the child?
a. Phenelzine (Nardil)
b. Amitriptyline (Elavil)
c. Fluvoxamine (Prozac)
, d. Isocarboxazid (Marplan)
Ans: C
Feedback:
Fluvoxamine is a selective serotonin reuptake inhibitor that has established pediatric
dosage guidelines for the treatment of obsessive-compulsive disorder. Isocarboxazid
and phenelzine are monoamine oxidase inhibitors and should be avoided in pediatric
use because of the potential drugfood interactions and other serious adverse effects.
Amitriptyline is also a tricyclic antidepressant not recommended for pediatric use.
4. A patient explains to a nurse that he had been taking amitriptyline (Elavil) for
depression and that his physician changed his medication to clomipramine
(Anafranil). The patient is confused and does not understand why his medication
was changed. The nurse’s best response to the patient would be what?
a. These drugs are similar but some patients respond better to one drug than
another.
b. Did you take the amitriptyline like you should have?
c. Maybe the old medicine wasn’t working anymore.
d. Clomipramine is newer and will be much better for you.
Ans: A
Feedback:
Because all tricyclic antidepressants (TCAs) are similarly effective, the choice of
which TCA depends on individual response to the drug and tolerance of adverse
effects. A patient who does not respond to one TCA may respond to another drug
from this class. In addition, the nurse might inform the physician of the patient’s
question so the physician can explain his or her rationale for changing medications.
By asking the patient if he took the medication as prescribed, the nurse is insinuating
that he may not have and could damage the trusting nursepatient relationship. The
nurse has no basis for commenting that the medication might not be working or that
another drug would work better.
5. A patient comes to the mental health clinic for a regular appointment. The patient
tells the nurse he has been taking oral fluoxetine (Prozac) 20 mg daily for the past
3 weeks and that he has lost 3 pounds during that time due to a loss of appetite.
What action should the nurse take?
a. Teaching the patient about healthy eating to maintain weight
b. Congratulating the patient on his weight loss and commenting how well he
looks
c. Encouraging the patient to increase fluid intake to avoid further weight loss
d. Reassuring the patient that a decrease in weight is a common adverse effect
with this medication
Ans: D
