1. The client taking sertraline for treatment of depression for the past 11
months reports feeling much better and wishes to discontinue the
medication. Which is the nurse’s most appropriate response?
A. “The medication will have to be reduced gradually to prevent undesirable symptoms.”
B. “You should not stop the medication without talking to your health care provider first.”
C. “It appears that the medication has worked very well. It should be safe to discontinue its
use.”
D. “You should take this medication indefinitely to prevent recurrence of depressive
symptoms.”
ANSWER: A
A. Sertraline (Zoloft) is an SSRI antidepressant. Stopping these abruptly can cause
withdrawal symptoms. The dose should be reduced gradually.
B. Clients have the right to discontinue medication treatment, although it is advisable that
the client should discuss this with the HCP and taper off rather than discontinue abruptly.
C. It should not be discontinued. Antidepressants should not be stopped abruptly due to
precipitating symptoms of withdrawal.
D. Treatment with antidepressants may effectively last for months to several years but
should not be used indefinitely.
2. The client calls the clinic to discuss medications being taken and
possible adverse effects. The nurse should conclude that the client is
experiencing a common side effect of sertraline when the client provides
which information?
A. States last bowel movement was 5 days ago
B. Feeling palpitations and an irregular heartbeat
C. BP was 170/90 mm Hg when taken one day ago
D. States needing to drink fluids more often than usual
ANSWER: D
A. Diarrhea (not constipation) is a more common side effect of sertraline.
Constipation is more commonly a side eflect of both TCAs and MAOIs due to
, their anticholinergic side effects.
B. An irregular heart rhythm is more commonly a side effect of TCAs.
C. Hypertension is more commonly a side effect of MAOIs.
D. The nurse should consider that the client has a dry mouth when stating the need
to drink fluids more often than usual. Dry mouth is a common side effect of
sertraline (Zoloft).
3. The client’s dose of mirtazapine was increased from 15 to 30 mg at
bedtime two days ago. When the nurse is preparing to administer
mirtazapine, the client reports having insomnia, irritability, and panic
attacks. What should the nurse do next?
A. Document the symptoms, hold the dose, and notify the HCP.
B. Telephone the HCP to request a pm sedative to help the client sleep.
C. Have the client participate in a card game with other clients on the unit.
D. Reassure the client that these symptoms will subside after taking this dose.
ANSWER: A
A. Mirtazapine (Remeron) is an antidepressant. Adverse effects include insomnia,
irritability, panic attacks, and suicidal ideation. A change in medication may be
needed rather than a dosage increase.
B. The nurse is ignoring the possible adverse effects of mirtazapine.
C. The client should be in a low-stimulus environment.
D. It can take 1 to 2 weeks before the desired therapeutics effects are observed, but
the symptoms indicate that the client is having an adverse effect.
4. The client is started on citalopram for treatment of depression. Which
information is most important for the nurse to include when teaching the
client?
A. “Activity levels should be increased to include a daily exercise routine.”
B. “If sexual side effects become unbearable, consult your health care provider.”
C. “Taking St. John’s wort with your citalopram can enhance its effectiveness.”
, D. “Take your blood pressure every morning and report any significant changes.”
ANSWER: B
A. The client’s activity level is likely to increase with treatment for depression. A
daily exercise routine is recommended for everyone and not just those taking
antidepressants.
B. Sexual dysfunction is a common side effect associated with the use of SSRIs;
the client taking citalopram (Celexa), an SSRI, should consult the HCP if having
unbearable sexual side effects.
C. Taking St. John’s wort with citalopram can cause serotonin syndrome.
D. Cardiovascular effects are associated with the use of TCAs; there is no need to
take the BP daily.
5. The client taking imipramine is preparing for a summer vacation. Which
information should the nurse include when planning client education
regarding imipramine? Select all that apply.
A. Drink additional fluids and add extra fiber to the diet
B. Stop imipramine if experiencing any unpleasant side effects.
C. Avoid alcohol, which can cause an additive depressant effect.
D. Request an “as needed” sleeping pill in the event of insomnia.
E. Wear sunglasses, protective clothing, and sunscreen while outdoors.
ANSWER: A, C, E
A. TCAs such as imipramine (Tofranil) may cause constipation. Increasing liquids
and dietary fiber can reduce constipation.
B. Clients should not abruptly stop taking any antidepressant medication.
C. Alcohol combined with imipramine (Tofranil) can cause CNS depression.
D. TCAs usually cause sedation and should not be combined with a sleeping agent.
E. Wearing sunglasses, protective clothing, and sunscreen protects against
photosensitivity, a concern with TCAs.
, 6. The client taking paroxetine telephones the mental health clinic nurse
and states, “Since I started taking St. John’s wort, I have had a high fever
and muscle stiffness, and I am sweating a lot.” Which statement is most
appropriate?
A. “You may have the flu; call your primary provider to make an appointment.”
B. “Take ibuprofen, drink fluids, and rest; call tomorrow if the symptoms worsen.”
C. “Could you have doubled up on your medication, taking more than prescribed?”
D. “You should be taken to the emergency department right away to be evaluated.”
ANSWER: D
A. Making an appointment with another HCP delays the client receiving appropriate
treatment; this client may require hospitalization due to serotonin syndrome.
B. The client should not be instructed to call tomorrow. The client should be
assessed in the ED because serotonin syndrome is possible and can be life-
threatening.
C. Asking whether the client doubled up taking paroxetine is not a priority at this
time.
D. Fever, muscles stiffness (rigidity), and diaphoresis are symptoms of serotonin
syndrome, a potentially fatal condition that may occur with concurrent use of St.
John’s wort and paroxetine (Paxil). The client should be taken to the ED.
7. The nurse is assessing the client who has begun therapy with
duloxetine. Which assessment parameter should be the nurse’s priority?
A. 1 . Relief of neuropathic pain
B. 2. Increase in anxiety or irritability
C. 3. Liver function test (LFT) results
D. 4. Experiencing suicidal ideations
ANSWER: D
A. Duloxetine is used in relieving neuropathic pain, but assessing its effectiveness
is of lesser importance than assessing for suicidal ideation.
B. While assessing if the medication is effective, assessing the level of increased
anxiety or irritability is of lesser importance than assessing for suicidal ideation.
months reports feeling much better and wishes to discontinue the
medication. Which is the nurse’s most appropriate response?
A. “The medication will have to be reduced gradually to prevent undesirable symptoms.”
B. “You should not stop the medication without talking to your health care provider first.”
C. “It appears that the medication has worked very well. It should be safe to discontinue its
use.”
D. “You should take this medication indefinitely to prevent recurrence of depressive
symptoms.”
ANSWER: A
A. Sertraline (Zoloft) is an SSRI antidepressant. Stopping these abruptly can cause
withdrawal symptoms. The dose should be reduced gradually.
B. Clients have the right to discontinue medication treatment, although it is advisable that
the client should discuss this with the HCP and taper off rather than discontinue abruptly.
C. It should not be discontinued. Antidepressants should not be stopped abruptly due to
precipitating symptoms of withdrawal.
D. Treatment with antidepressants may effectively last for months to several years but
should not be used indefinitely.
2. The client calls the clinic to discuss medications being taken and
possible adverse effects. The nurse should conclude that the client is
experiencing a common side effect of sertraline when the client provides
which information?
A. States last bowel movement was 5 days ago
B. Feeling palpitations and an irregular heartbeat
C. BP was 170/90 mm Hg when taken one day ago
D. States needing to drink fluids more often than usual
ANSWER: D
A. Diarrhea (not constipation) is a more common side effect of sertraline.
Constipation is more commonly a side eflect of both TCAs and MAOIs due to
, their anticholinergic side effects.
B. An irregular heart rhythm is more commonly a side effect of TCAs.
C. Hypertension is more commonly a side effect of MAOIs.
D. The nurse should consider that the client has a dry mouth when stating the need
to drink fluids more often than usual. Dry mouth is a common side effect of
sertraline (Zoloft).
3. The client’s dose of mirtazapine was increased from 15 to 30 mg at
bedtime two days ago. When the nurse is preparing to administer
mirtazapine, the client reports having insomnia, irritability, and panic
attacks. What should the nurse do next?
A. Document the symptoms, hold the dose, and notify the HCP.
B. Telephone the HCP to request a pm sedative to help the client sleep.
C. Have the client participate in a card game with other clients on the unit.
D. Reassure the client that these symptoms will subside after taking this dose.
ANSWER: A
A. Mirtazapine (Remeron) is an antidepressant. Adverse effects include insomnia,
irritability, panic attacks, and suicidal ideation. A change in medication may be
needed rather than a dosage increase.
B. The nurse is ignoring the possible adverse effects of mirtazapine.
C. The client should be in a low-stimulus environment.
D. It can take 1 to 2 weeks before the desired therapeutics effects are observed, but
the symptoms indicate that the client is having an adverse effect.
4. The client is started on citalopram for treatment of depression. Which
information is most important for the nurse to include when teaching the
client?
A. “Activity levels should be increased to include a daily exercise routine.”
B. “If sexual side effects become unbearable, consult your health care provider.”
C. “Taking St. John’s wort with your citalopram can enhance its effectiveness.”
, D. “Take your blood pressure every morning and report any significant changes.”
ANSWER: B
A. The client’s activity level is likely to increase with treatment for depression. A
daily exercise routine is recommended for everyone and not just those taking
antidepressants.
B. Sexual dysfunction is a common side effect associated with the use of SSRIs;
the client taking citalopram (Celexa), an SSRI, should consult the HCP if having
unbearable sexual side effects.
C. Taking St. John’s wort with citalopram can cause serotonin syndrome.
D. Cardiovascular effects are associated with the use of TCAs; there is no need to
take the BP daily.
5. The client taking imipramine is preparing for a summer vacation. Which
information should the nurse include when planning client education
regarding imipramine? Select all that apply.
A. Drink additional fluids and add extra fiber to the diet
B. Stop imipramine if experiencing any unpleasant side effects.
C. Avoid alcohol, which can cause an additive depressant effect.
D. Request an “as needed” sleeping pill in the event of insomnia.
E. Wear sunglasses, protective clothing, and sunscreen while outdoors.
ANSWER: A, C, E
A. TCAs such as imipramine (Tofranil) may cause constipation. Increasing liquids
and dietary fiber can reduce constipation.
B. Clients should not abruptly stop taking any antidepressant medication.
C. Alcohol combined with imipramine (Tofranil) can cause CNS depression.
D. TCAs usually cause sedation and should not be combined with a sleeping agent.
E. Wearing sunglasses, protective clothing, and sunscreen protects against
photosensitivity, a concern with TCAs.
, 6. The client taking paroxetine telephones the mental health clinic nurse
and states, “Since I started taking St. John’s wort, I have had a high fever
and muscle stiffness, and I am sweating a lot.” Which statement is most
appropriate?
A. “You may have the flu; call your primary provider to make an appointment.”
B. “Take ibuprofen, drink fluids, and rest; call tomorrow if the symptoms worsen.”
C. “Could you have doubled up on your medication, taking more than prescribed?”
D. “You should be taken to the emergency department right away to be evaluated.”
ANSWER: D
A. Making an appointment with another HCP delays the client receiving appropriate
treatment; this client may require hospitalization due to serotonin syndrome.
B. The client should not be instructed to call tomorrow. The client should be
assessed in the ED because serotonin syndrome is possible and can be life-
threatening.
C. Asking whether the client doubled up taking paroxetine is not a priority at this
time.
D. Fever, muscles stiffness (rigidity), and diaphoresis are symptoms of serotonin
syndrome, a potentially fatal condition that may occur with concurrent use of St.
John’s wort and paroxetine (Paxil). The client should be taken to the ED.
7. The nurse is assessing the client who has begun therapy with
duloxetine. Which assessment parameter should be the nurse’s priority?
A. 1 . Relief of neuropathic pain
B. 2. Increase in anxiety or irritability
C. 3. Liver function test (LFT) results
D. 4. Experiencing suicidal ideations
ANSWER: D
A. Duloxetine is used in relieving neuropathic pain, but assessing its effectiveness
is of lesser importance than assessing for suicidal ideation.
B. While assessing if the medication is effective, assessing the level of increased
anxiety or irritability is of lesser importance than assessing for suicidal ideation.
