Chapter 17: Antidepressants
MULTIPLE CHOICE
1. A nurse performs a medication history on a newly admitted patient. The patient reports
taking amitriptyline (Elavil) 75 mg at bedtime for 6 weeks to treat depression. The patient
reports having continued fatigue, lack of energy, and depressed mood. The nurse will contact
the provider to discuss which intervention? a. Beginning to taper the amitriptyline
b. Changing to a morning dose schedule
c. Giving the amitriptyline twice daily
d. Increasing the dose of amitriptyline
ANS: A
The response to tricyclic antidepressants (TCAs) should occur after 2 to 4 weeks of therapy. If
there is no improvement at this time, the TCA should be gradually withdrawn and an SSRI
prescribed. TCAs should never be stopped abruptly. TCAs cause fatigue and drowsiness, so
they should be given at bedtime. Changing the dose or the dosing schedule are not indicated.
DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 387
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
2. The nurse is teaching a patient who will begin taking doxepin (Sinequan) to treat
depression.
Which statement by the patient indicates a need for further teaching?
a. I should expect results within 2 to 4 weeks.
b. I should increase fluids and fiber while taking this medication.
c. I should take care when rising from a sitting to standing position.
d. I will take the medication in the morning before breakfast.
ANS: D
Tricyclic antidepressants (TCAs) should begin to show effects within 1 to 4 weeks. Tricyclic
antidepressants are known to cause orthostatic hypotension and constipation, so patients
should be counseled on how to minimize these effects. TCAs should be taken at bedtime
because of their tendency to cause drowsiness.
DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 392
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
3. A patient who is taking amitriptyline (Elavil) reports constipation and dry mouth. The
nurse will give the patient which instruction? a. Increase fluid intake.
b. Notify the provider.
c. Request another antidepressant.
d. Stop taking the medication immediately.
ANS: A
, Constipation and dry mouth are common side effects of tricyclic antidepressants (TCAs), and
patients should be taught to manage these symptoms. There is no need to notify the provider or
to switch medications unless the side effects become too uncomfortable. Patients should not
stop taking TCAs abruptly.
DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 397
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
4. A patient who has had a loss of interest in most activities, weight loss, and insomnia is
diagnosed with a major depressive disorder and will begin taking fluoxetine (Prozac) daily.
The patient asks about the weekly dosing that a family member follows. What will the nurse
tell the patient about a weekly dosing regimen?
a. It can be used after daily maintenance dosing proves effective and safe.
b. It is used after a trial of tricyclic antidepressant medication fails.
c. It is not effective for this type of depression and its symptoms.
d. It will cause more adverse effects than daily dosing regimens.
ANS: A
Before weekly dosing is begun, the patient should respond to a daily maintenance dose of 20
mg/day without serious effects. It is not necessary to undergo a trial of tricyclic antidepressants
(TCAs). Weekly dosing is used for this type of depression, and although it may have some
adverse effects, these are not more common than with daily dosing.
DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 388
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
5. A patient has been taking sertraline (Zoloft) 20 mg/mL oral concentrate, 1 mL daily
for several weeks and reports being unable to sleep well. What will the nurse do next? a.
Ask the patient what time of day the medication is taken.
b. Counsel the patient to take the medication at bedtime.
c. Recommend asking the provider about weekly dosing.
d. Suggest that the patient request a lower dose.
ANS: A
Selective serotonin reuptake inhibitors (SSRIs) cause nervousness and insomnia. Patients can
minimize these effects by taking the drug in the morning. The nurse should assess this with
this patient. Taking the medication at bedtime will only increase the insomnia. Requesting a
lower dose or changing to weekly dosing are not recommended.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 392
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
6. A patient has been taking paroxetine (Paxil) 20 mg per day for 2 weeks and reports
headaches, nervousness, and poor appetite. Which action will the nurse take? a. Counsel the
patient to take the medication with food.
MULTIPLE CHOICE
1. A nurse performs a medication history on a newly admitted patient. The patient reports
taking amitriptyline (Elavil) 75 mg at bedtime for 6 weeks to treat depression. The patient
reports having continued fatigue, lack of energy, and depressed mood. The nurse will contact
the provider to discuss which intervention? a. Beginning to taper the amitriptyline
b. Changing to a morning dose schedule
c. Giving the amitriptyline twice daily
d. Increasing the dose of amitriptyline
ANS: A
The response to tricyclic antidepressants (TCAs) should occur after 2 to 4 weeks of therapy. If
there is no improvement at this time, the TCA should be gradually withdrawn and an SSRI
prescribed. TCAs should never be stopped abruptly. TCAs cause fatigue and drowsiness, so
they should be given at bedtime. Changing the dose or the dosing schedule are not indicated.
DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 387
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
2. The nurse is teaching a patient who will begin taking doxepin (Sinequan) to treat
depression.
Which statement by the patient indicates a need for further teaching?
a. I should expect results within 2 to 4 weeks.
b. I should increase fluids and fiber while taking this medication.
c. I should take care when rising from a sitting to standing position.
d. I will take the medication in the morning before breakfast.
ANS: D
Tricyclic antidepressants (TCAs) should begin to show effects within 1 to 4 weeks. Tricyclic
antidepressants are known to cause orthostatic hypotension and constipation, so patients
should be counseled on how to minimize these effects. TCAs should be taken at bedtime
because of their tendency to cause drowsiness.
DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 392
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
3. A patient who is taking amitriptyline (Elavil) reports constipation and dry mouth. The
nurse will give the patient which instruction? a. Increase fluid intake.
b. Notify the provider.
c. Request another antidepressant.
d. Stop taking the medication immediately.
ANS: A
, Constipation and dry mouth are common side effects of tricyclic antidepressants (TCAs), and
patients should be taught to manage these symptoms. There is no need to notify the provider or
to switch medications unless the side effects become too uncomfortable. Patients should not
stop taking TCAs abruptly.
DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 397
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
4. A patient who has had a loss of interest in most activities, weight loss, and insomnia is
diagnosed with a major depressive disorder and will begin taking fluoxetine (Prozac) daily.
The patient asks about the weekly dosing that a family member follows. What will the nurse
tell the patient about a weekly dosing regimen?
a. It can be used after daily maintenance dosing proves effective and safe.
b. It is used after a trial of tricyclic antidepressant medication fails.
c. It is not effective for this type of depression and its symptoms.
d. It will cause more adverse effects than daily dosing regimens.
ANS: A
Before weekly dosing is begun, the patient should respond to a daily maintenance dose of 20
mg/day without serious effects. It is not necessary to undergo a trial of tricyclic antidepressants
(TCAs). Weekly dosing is used for this type of depression, and although it may have some
adverse effects, these are not more common than with daily dosing.
DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 388
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
5. A patient has been taking sertraline (Zoloft) 20 mg/mL oral concentrate, 1 mL daily
for several weeks and reports being unable to sleep well. What will the nurse do next? a.
Ask the patient what time of day the medication is taken.
b. Counsel the patient to take the medication at bedtime.
c. Recommend asking the provider about weekly dosing.
d. Suggest that the patient request a lower dose.
ANS: A
Selective serotonin reuptake inhibitors (SSRIs) cause nervousness and insomnia. Patients can
minimize these effects by taking the drug in the morning. The nurse should assess this with
this patient. Taking the medication at bedtime will only increase the insomnia. Requesting a
lower dose or changing to weekly dosing are not recommended.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 392
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
6. A patient has been taking paroxetine (Paxil) 20 mg per day for 2 weeks and reports
headaches, nervousness, and poor appetite. Which action will the nurse take? a. Counsel the
patient to take the medication with food.
