Chapter 11, Drugs for Mental Health: Drugs for Depression and Mood Disorders-

Question 1 of 18

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Which symptom indicates a depressive disorder? Select all that apply. One, some, or all responses may be correct.

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  • Lack of participation in usual activitiesAn inability of a patient to enjoy and participate in hobbies and activities that they once found pleasure in is a symptom of depression.
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  • Unable to fall asleep at nightChanges in or unusual sleeping patterns, such as insomnia, chronic fatigue, waking early, or oversleeping are symptoms of depression.
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  • Persistently upset stomachPersistent pain or physical symptoms, such as digestive disorders, that do not respond to treatment are a symptom of depression.
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  • New onset of forgetfulnessChanges in cognitive function, such as difficulty making decisions, remembering, or concentrating are symptoms of depression.
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  • More frequent eating food between mealsSudden changes in eating habits or appetite and related weight loss or gain are symptoms of depression.

Question 2 of 18

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Which statement indicates that a patient may be experiencing a depressive disorder?

• • “Even though I lost my husband over a year ago, sometimes I still feel lonely.”A patient experiencing a depressive disorder after the death of a spouse may feel prolonged and intense feelings of hopelessness, not occasional loneliness.
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  • “I don’t feel sad, just empty and numb inside.”A symptom of depressive disorder is numbness, emptiness, or absence of feelings, not just sadness.
• • “Headaches have been a long-term problem for me, but usually taking prescription pain relievers help.”A symptom of depressive disorder is persistent physical symptoms that do not respond to treatment, such as prescription pain relievers.
• • “Although I can no longer enjoy playing sports, I find myself watching them more on TV now.”A symptom of a depressive disorder is no longer finding pleasure in hobbies or activities that a patient once enjoyed. This statement indicates the patient still enjoys watching or taking pleasure in sports.

Question 3 of 18

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Which statement would a nurse provide a patient who has been prescribed a medication for a depressive disorder? Select all that apply. One, some, or all responses may be correct.

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  • “It is important to let your healthcare provider know of any harmful thoughts you have after starting this medication.”Some patients may experience thoughts of suicide or self-harm, especially when starting drug therapy or changing medications.
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  • “Let your healthcare provider know if you are pregnant or want to become pregnant while taking this medication.”Because antidepressants can cause harm to the fetus, is important that any patient who is pregnant or wants to become pregnant alerts the healthcare provider while taking an antidepressant.
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  • “You may need to try out several different medications to determine which works best for you.”Most patients will need to try a course of different drugs to determine which one works best to manage their symptoms.
• • “You will need to learn how to manage any unpleasant side effects from this medication.”Different classes of antidepressant drugs produce side effects differently in patients, so it may require several trials for patients to determine which ones produce the fewest unpleasant side effects.
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  • “This medication should not be stopped suddenly, rather gradually reduced in dosage by a healthcare provider if you need to stop taking it.”Antidepressant drugs should not be stopped suddenly because this may cause withdrawal symptoms or a relapse of depressive symptoms. Instead, they should be tapered off slowly. This should also be done in consultation with a healthcare provider.

Question 4 of 18

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Which statement describes the action of selective serotonin reuptake inhibitors (SSRIs)?

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  • “SSRIs block the reabsorption of serotonin.”SSRIs act by blocking the reabsorption of serotonin, which increases the concentration of serotonin available for binding to postsynaptic receptors.
• • “SSRIs are able to produce more serotonin in the brain.”SSRIs do not produce more serotonin in the central nervous system (CNS), but they make more serotonin synthesized naturally in the CNS available.
• • “These drugs work by suppressing an enzyme that destroys serotonin.”Monoamine oxidase inhibitors, not SSRIs, block enzymes that breakdown serotonin.
• • “Taking an SSRI causes serotonin to bind quicker to postsynaptic receptors.”SSRIs do not cause serotonin to bind quicker to receptors, rather they make more serotonin available to bind to them.

Question 5 of 18

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Which symptom alerts the nurse to potential serotonin syndrome in a patient who is taking a selective serotonin reuptake inhibitor (SSRI)?

• • Low blood pressureExtremely high, not low, blood pressure is a symptom of too much serotonin in a patient with serotonin syndrome.
• • Extreme sleepinessRestlessness, not sleepiness, is a symptom of too much serotonin in a patient with serotonin syndrome.
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  • Neurological dysfunctionNeurological dysfunction caused by too much serotonin, such as confusion, agitation, and seizures are all symptoms of serotonin syndrome.
• • Low sodium levelHyponatremia is an adverse effect of selective serotonin reuptake inhibitors, but it is not a symptom of serotonin syndrome.

Question 6 of 18

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Which information would the nurse include when teaching a patient about the administration of a selective serotonin reuptake inhibitor (SSRI)? Select all that apply. One, some, or all responses may be correct.

• • “Take this drug at bedtime to prevent sleepiness during the day.”Taking an SSRI may cause insomnia, so it should be taken in the morning rather than the evening.
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  • “Do not take the herbal drug St. John’s wort with the SSRI.”Herbal and over-the-counter drugs may affect SSRIs, especially St. John’s wort, and can cause dangerous adverse effects, such as serotonin syndrome.
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  • “You may experience changes in your sexual desire.”Some patients may experience sexual side effects while taking SSRIs, such as a decreased sex drive.
• • “You should feel the effects of this medication in the next one to two days.”SSRIs may take several weeks to be effective, so a patient would not feel the effects within one to two days.
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  • “Report and thoughts of suicide to your healthcare provider.”SSRIs can cause thoughts of suicide or self-harm, so a patient should report any of these symptoms to a healthcare provider immediately.

Question 7 of 18

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Which condition is a serotonin norepinephrine reuptake inhibitor (SNRI) indicated for use? Select all that apply. One, some, or all responses may be correct.

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  • Diabetic neuropathySNRIs increase the availability of serotonin and norepinephrine, which may reduce painful symptoms of diabetic neuropathy.
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  • Fibromyalgia-related painSNRIs can be used to treat chronic pain, including pain that a patient may experience with fibromyalgia.
• • Increased sweatingHyperhidrosis, or increased sweating, can be a side effect of SNRIs and is not an indication for treatment.
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  • Premenstrual dysphoric disorderSNRIs can be used to treat depression and other symptoms associated with premenstrual dysphoric disorder in female patients.
• • Sexual dysfunctionSNRIs can cause sexual side effects, such as decreased sex drive, decreased ability to have an orgasm, or erectile dysfunction, and are not used to treat sexual dysfunction.

Question 8 of 18

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Which side effect or adverse effect would a nurse monitor when a patient is taking a serotonin norepinephrine reuptake inhibitor (SNRI) drug? Select all that apply. One, some, or all responses may be correct.

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  • High blood pressureSome patients experience hypertension when taking SNRIs, especially when starting the medication.
• • Increased appetiteSNRIs can cause a loss of appetite from exposure to higher levels of serotonin and norepinephrine.
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  • Excessive bleedingNosebleeds and gastrointestinal bleeding are adverse reactions to taking SNRIs.
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  • Liver damageSNRIs can cause liver damage, which might result in yellowish skin or eyes.
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  • Low sodium levelHyponatremia, or low sodium level in the blood, is an adverse effect of SNRIs.

Question 9 of 18

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Which information would the nurse provide a female patient who has been prescribed a serotonin norepinephrine reuptake inhibitor (SNRI) for chronic pain?

• • “Sexual side effects are more common in women than in men.”Sexual side effects of SNRIs are more common in men than in women.
• • “This medication should relieve your pain in the next two to three days.”SNRIs can take a few weeks to begin working in both men and women. The patient’s pain is not expected to be improved in the next two to three days.
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  • “Do not take this medication if you think you are pregnant.”SNRIs should not be taken by a pregnant woman because of the risk of neonatal abstinence syndrome from fetal exposure to the drug.
• • “This drug can be taken with non-steroidal anti-inflammatory drugs (NSAIDs).”SNRI’s can potentially interact with NSAIDS used for pain management.

Question 10 of 18

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Which diagnosis would the nurse expect if the patient is prescribed a tricyclic antidepressant (TCA) for mental health concerns?

• • Mild dysthymic depressionA patient experiencing mild dysthymic depression disorder is not usually prescribed a TCA because of the high risk of side effects.
• • Bipolar mood disorderTCAs can trigger a manic episode in a patient who has bipolar disorder, so it is not usually prescribed in this patient population.
• • SchizophreniaTCAs are not used in the management of schizophrenia.
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  • Severe unresponsive depressionWhile the drugs can be used for mild to moderate depression, they have more side effects than selective serotonin reuptake inhibitors or serotonin norepinephrine reuptake inhibitors. As such, TCAs are usually only prescribed for patients who have severe depression that has not responded to other treatments.

Question 11 of 18

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Which information would the nurse provide a young adult who has been prescribed a tricyclic antidepressant (TCA)? Select all that apply. One, some, or all responses may be correct.

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  • Risk of self-harmTCAs increase the risk of suicide, especially in younger patients.
• • Episodes of deliriumThere is an increased risk of delirium when taking TCAs but typically in older patients with cognitive impairment.
• • Decreased sex driveDecreased sex drive is a common side effect in other antidepressants, such as SSRIs and SNRIs, especially in men.
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  • Increased chance of sunburnTCAs increase sensitivity to the sun and therefore increase the risk of sunburn.
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  • Dizziness when standing upTCAs may cause orthostatic hypotension, so patients may develop dizziness or lightheadedness when changing positions quickly.

Question 12 of 18

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Which information would the nurse provide a patient who has been prescribed a tricyclic antidepressant (TCA)? Select all that apply. One, some, or all responses may be correct.

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  • “It is important to quit smoking before taking this drug.”Tobacco can decrease the effectiveness of TCAs, so patients should not use tobacco in any form with it.
• • “You can take a sedative with this medication if you experience insomnia.”Drugs that depress the central nervous system, such as sedatives, should not be combined with TCAs because they increase the risk for respiratory depression, sedation, and severe hypotension.
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  • “It is important not to use marijuana products while taking this drug.”Marijuana can cause serious cardiac side effects and should be avoided in patients taking TCAs.
• • “Stop this medication right away if you experience nausea, vomiting, or diarrhea.”Patients should not suddenly stop taking TCAs if they experience side effects such as nausea, vomiting, or diarrhea, but they should consult with their healthcare provider.
• • “This medication can be combined with other classes of antidepressants to improve its effectiveness.”Other antidepressants should not be taken with TCAs because they can increase the risk of serotonin syndrome.

Question 13 of 18

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Monoamine Oxidase Inhibitors (MAOI) are contraindicated for use with which patients?

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  • Patients who are taking insulin for type I diabetesA patient who has diabetes and is taking insulin or oral hypoglycemic drugs is at risk for a hypoglycemic reaction while taking an MAOI drug.
• • Patients who are being treated for Parkinson’s diseasePatients who have been diagnosed with Parkinson’s disease may be prescribed MAOIs to manage symptoms.
• • Patients who are having difficulty controlling symptoms using other drugsMAOI drugs are usually reserved for patients who have unsuccessfully tried other antidepressant drugs, due to the high risk of side effects.
• • Patients who are experiencing symptoms of severe depressive disorderMAOI drugs are usually only prescribed for patients who are experiencing severe depression due to the risk for interaction with other drugs and foods.

Question 14 of 18

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Which food would the nurse instruct the patient to avoid while taking a monoamine oxidase inhibitor (MAOI)? Select all that apply. One, some, or all responses may be correct.

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  • Cheddar cheeseMature cheeses, such as cheddar, are a food that is high in tyramine that patients taking MAOIs should avoid due to a risk for a hypertensive crisis.
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  • Banana breadBananas are a fruit that contains tyramine and should not be eaten when a patient is taking MAOIs due to a risk for a hypertensive crisis.
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  • Alcohol-free beerEven though the beer may not contain alcohol, it is still a high-tyramine food to avoid when taking an MAOI drug due to a risk for a hypertensive crisis.
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  • Sausage linksSausage is a cured meat product that contains tyramine, and it should not be consumed when a patient is taking an MAOI drug due to a risk for a hypertensive crisis.
• • Steamed broccoliBroccoli is a vegetable that does not contain tyramine, so it is acceptable for a patient to eat broccoli while taking an MAOI drug.
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  • Chocolate candy barChocolate contains tyramine, so a patient should not eat a chocolate candy bar while on a MAOI drug due to a risk for a hypertensive crisis.

Question 15 of 18

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Which information would the nurse include when teaching a patient about the administration of a monoamine oxidase inhibitor (MAOI)? Select all that apply. One, some, or all responses may be correct.

• • “Do not take a selective serotonin reuptake inhibitor (SSRI) class drug within a week of taking this MAOI.”MAOIs should not be given within 2 weeks of an SSRI because MAOIs stay in the patient’s system for as long as two weeks. This can cause serotonin syndrome.
• • “Do not be surprised if you feel restless while on this drug.”MAOIs often cause drowsiness, not restlessness. However, symptoms of restlessness and agitation might suggest serotonin syndrome.
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  • “Avoid coffee or any other products containing caffeine.”MAOIs can cause significant hypertension when caffeine is consumed, which increases the patient’s risk for cardiovascular effects.
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  • “Symptom relief with this drug may take several weeks.”It generally takes 3–4 weeks of drug therapy for patients to experience the treatment effects of MAOIs.
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  • “Practice good oral hygiene to avoid dental problems.”Because MAOIs can cause dry mouth, patients taking these drugs are at a higher risk for dry mouth, cavities, and other dental problems.

Question 16 of 18

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Which information would a nurse provide a patient prescribed lithium? Select all that apply. One, some, or all responses may be correct.

• • “You may feel sleepy while taking this drug.”Lithium has the advantage of not causing the adverse effect of sedation.
• • “This medication is not appropriate for acute mania episodes.”Lithium is used to treat both acute mania episodes and for long-term maintenance therapy.
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  • “It may take several weeks to notice improvement in symptoms.”Lithium may take 2–3 weeks for the patient to experience the full benefits of the drug.
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  • “If you have kidney disease, you should not take this drug.”Kidney disease is a risk factor for lithium toxicity.
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  • “Avoid being in the heat and stay hydrated.”A patient on lithium should avoid excessive sweating and dehydration to prevent lithium toxicity.

Question 17 of 18

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Which side effect would the nurse expect a patient to experience when starting lithium therapy for treatment for bipolar disorder? Select all that apply. One, some, or all responses may be correct.

• • Slight weight lossMild weight gain, not weight loss, is an expected side effect of taking lithium.
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  • DrowsinessDrowsiness is an expected side effect of starting drug therapy with lithium, but it usually decreases with continued use.
• • Blurred visionBlurred vision is not associated with beginning lithium.
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  • Shaking of the handsHand tremors occur in about half of patients taking lithium, but they usually decrease with continued use.
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  • Stomach upsetWhen first taking lithium patients may experience stomach upset, such as diarrhea, nausea, and vomiting. However, if this occurs after taking lithium for some time, it may indicate lithium toxicity.

Question 18 of 18

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Which information would the nurse include when teaching a patient about the administration of lithium carbonate for treatment of bipolar disorder?

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  • “It is important to get blood work done regularly to monitor drug levels.”Lithium has a very narrow therapeutic range, so it is important to regularly monitor lithium blood levels through blood work.
• • “Reduce your consumption of foods that have sodium or are salted.”Sodium is needed in the patient’s diet to prevent dehydration and lithium toxicity, so the patient would not be told to avoid salt or sodium.
• • “Mood stabilizer medication is not effective if taken long-term.”Drug therapy with mood stabilizers is usually taken long term because bipolar disorder does not have a cure; rather, it must be managed.
• • “Do not take this medication with fruit juice, such as apple juice.”Lithium oral solutions can be taken with fruit juice to improve the taste and it will not affect the action of the drug.