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Which neurotransmitter is most directly associated with the
therapeutic mechanism of selective serotonin reuptake inhibitors
(SSRIs)?
A. Serotonin
B. Acetylcholine
C. Gamma-aminobutyric acid
D. Glutamate
Answer: A. Serotonin
Rationale: SSRIs primarily inhibit the serotonin transporter, reducing
serotonin reuptake into the presynaptic neuron and increasing
serotonergic signaling. This mechanism contributes to their
therapeutic effects in depressive and anxiety disorders. Although
downstream adaptations occur over time, the initial pharmacologic
action is increased synaptic serotonin availability.
,A patient taking sertraline reports nausea and mild gastrointestinal
discomfort during the first week of treatment. Which response by the
psychiatric nurse is most appropriate?
A. "You should discontinue the medication immediately."
B. "Mild gastrointestinal effects can occur early and may improve as
your body adjusts."
C. "This indicates serotonin syndrome."
D. "The medication is causing permanent gastrointestinal damage."
Answer: B. "Mild gastrointestinal effects can occur early and may
improve as your body adjusts."
Rationale: Gastrointestinal symptoms such as nausea, diarrhea, and
abdominal discomfort are common early adverse effects of SSRIs.
They often become less prominent with continued treatment. The
patient should be monitored, but mild nausea alone does not indicate
serotonin syndrome or require abrupt discontinuation.
Which adverse effect is particularly important to monitor in a patient
taking an SSRI?
A. Severe hypoglycemia
B. Agranulocytosis
C. Increased risk of suicidal thoughts, particularly early in treatment
D. Permanent hearing loss
Answer: C. Increased risk of suicidal thoughts, particularly early in
treatment
,Rationale: Antidepressants carry an important monitoring concern for
increased suicidal thoughts or behaviors, particularly in children,
adolescents, and young adults and during periods of dose changes. The
nurse should assess suicidal ideation regularly and educate patients
and families about warning signs. This risk does not mean
antidepressants should automatically be discontinued.
A patient taking an SSRI develops agitation, diaphoresis, diarrhea,
tremor, hyperreflexia, and fever. Which condition should the nurse
suspect?
A. Neuroleptic malignant syndrome
B. Anticholinergic toxicity
C. Lithium toxicity
D. Serotonin syndrome
Answer: D. Serotonin syndrome
Rationale: Serotonin syndrome results from excessive serotonergic
activity. Characteristic findings include agitation, autonomic
instability, gastrointestinal symptoms, tremor, hyperreflexia, clonus,
and hyperthermia. Severe cases can become life-threatening and
require prompt intervention.
Which medication is classified as a serotonin-norepinephrine reuptake
inhibitor (SNRI)?
A. Venlafaxine
, B. Fluoxetine
C. Bupropion
D. Mirtazapine
Answer: A. Venlafaxine
Rationale: Venlafaxine is an SNRI that increases serotonergic and
noradrenergic neurotransmission. Fluoxetine is an SSRI, bupropion
primarily affects dopamine and norepinephrine, and mirtazapine is
classified as a noradrenergic and specific serotonergic antidepressant.
Which antidepressant is generally considered less likely to cause sexual
dysfunction and may be useful when this adverse effect is a major
concern?
A. Paroxetine
B. Bupropion
C. Escitalopram
D. Sertraline
Answer: B. Bupropion
Rationale: Bupropion has a lower incidence of sexual dysfunction than
many serotonergic antidepressants. It primarily influences
norepinephrine and dopamine rather than directly increasing
serotonin. It is also commonly used for smoking cessation. Bupropion
should generally be avoided in patients with seizure disorders or
certain eating disorders because it can lower the seizure threshold.