C HAPTER 21 - A NTIDEPRESSANT A GENTS
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 acet ylcholine
b. Norepinephrine, dopamine, and serotonin
c. Acet ylcholine, gamma-aminobut yric acid, and serotonin
d. Gamma-aminobut yric 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. Acet ylcholine 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 -aminobut yric acid is a neurotransmitter that inhibits nerve
activit y and prevents over excitabilit y or stimulation.
2. What is the physiological action of tricyclic antidepressants (TCAs)?
a. Inhibiting monoamine oxidase inhibitors that break down
norepinephrine
b. Inhibiting nerve activit y, which prevents over excitabilit y 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 neurotransmi tters 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 -
aminobut yric acid inhibits nerve activit y.
3. A nurse is working with a 9 -year-old child who exhibits signs and
s ymptoms of obsessive -compulsive disorder (OCD). What drug will the
nurse anticipate may be prescribed for the child?
a. Phenelzine (Nardil)
b. Amitript yline (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 phenel zine are monoamine oxidase inhibitors and
should be avoided in pediatric use because of the potential drugfood
interactions and other serious adverse effects. Amitript yline is also a
tricyclic antidepressant not recommended for pediatric use.
4. A patient ex plains 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 resp onse 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 amitript yline 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 similarl y 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
dail y 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 weig ht is a common adverse
effect with this medication
Ans: D
Feedback:
Adverse effects of fluoxetine include anorexia and weight loss. Although
teaching about healthy eating is a good idea, it is more important to teach the
patient how to take the medicatio n in a way that will reduce adverse effects
as well as how to optimize healthy calories to maintain weight. The patient
should increase caloric intake, not just fluid intake. The patient should
continue the medication to see whether therapeutic effects are obtained and
adjust nutritional intake if necessary. More information about the patient’s
baseline weight is needed before congratulating the patient because a patient
who is already too thin would not appreciate the nurse’s comment.
6. A patient diagnosed with t ype 1 diabetes mellitus is receiving insulin. The
physician has prescribed a monoamine oxidase inhibitor (MAOI) to treat
this patient’s depression. What interaction will the nurse assess for with
this drug combination?
a. Increased risk of hypogl ycemia
b. Increased risk of hypergl ycemia
c. Increase in appetite
d. Increased total cholesterol
Ans: A
Feedback:
MAOIs can cause an additive hypogl ycemic effect if taken with insulin or
oral diabetic agents. This patient would have to be monitored closel y and
appropriat e dosage adjustments made; he should be taught the importance of
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 acet ylcholine
b. Norepinephrine, dopamine, and serotonin
c. Acet ylcholine, gamma-aminobut yric acid, and serotonin
d. Gamma-aminobut yric 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. Acet ylcholine 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 -aminobut yric acid is a neurotransmitter that inhibits nerve
activit y and prevents over excitabilit y or stimulation.
2. What is the physiological action of tricyclic antidepressants (TCAs)?
a. Inhibiting monoamine oxidase inhibitors that break down
norepinephrine
b. Inhibiting nerve activit y, which prevents over excitabilit y 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 neurotransmi tters 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 -
aminobut yric acid inhibits nerve activit y.
3. A nurse is working with a 9 -year-old child who exhibits signs and
s ymptoms of obsessive -compulsive disorder (OCD). What drug will the
nurse anticipate may be prescribed for the child?
a. Phenelzine (Nardil)
b. Amitript yline (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 phenel zine are monoamine oxidase inhibitors and
should be avoided in pediatric use because of the potential drugfood
interactions and other serious adverse effects. Amitript yline is also a
tricyclic antidepressant not recommended for pediatric use.
4. A patient ex plains 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 resp onse 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 amitript yline 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 similarl y 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
dail y 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 weig ht is a common adverse
effect with this medication
Ans: D
Feedback:
Adverse effects of fluoxetine include anorexia and weight loss. Although
teaching about healthy eating is a good idea, it is more important to teach the
patient how to take the medicatio n in a way that will reduce adverse effects
as well as how to optimize healthy calories to maintain weight. The patient
should increase caloric intake, not just fluid intake. The patient should
continue the medication to see whether therapeutic effects are obtained and
adjust nutritional intake if necessary. More information about the patient’s
baseline weight is needed before congratulating the patient because a patient
who is already too thin would not appreciate the nurse’s comment.
6. A patient diagnosed with t ype 1 diabetes mellitus is receiving insulin. The
physician has prescribed a monoamine oxidase inhibitor (MAOI) to treat
this patient’s depression. What interaction will the nurse assess for with
this drug combination?
a. Increased risk of hypogl ycemia
b. Increased risk of hypergl ycemia
c. Increase in appetite
d. Increased total cholesterol
Ans: A
Feedback:
MAOIs can cause an additive hypogl ycemic effect if taken with insulin or
oral diabetic agents. This patient would have to be monitored closel y and
appropriat e dosage adjustments made; he should be taught the importance of
