Chapter 21  Antidepressant Agents

Chapter 21  Antidepressant Agents

Complete Chapter Questions And Answers
 

Sample Questions

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 acetylcholine

B) Norepinephrine, dopamine, and serotonin

C) Acetylcholine, gamma-aminobutyric acid, and serotonin

D) Gamma-aminobutyric 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. Acetylcholine 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-aminobutyric acid is a
neurotransmitter that inhibits nerve activity and prevents over excitability or stimulation.

2. What is the physiological action of tricyclic antidepressants (TCAs)?

A) Inhibiting monoamine oxidase inhibitors that break down norepinephrine

B) Inhibiting nerve activity, which prevents over excitability 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 neurotransmitters 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-aminobutyric acid inhibits nerve
activity.

Test Bank – Focus on Nursing Pharmacology (7th Edition by Amy Karch) 338

3. A nurse is working with a 9-year-old child who exhibits signs and symptoms of obsessive-compulsive
disorder (OCD). What drug will the nurse anticipate may be prescribed for the child?

A) Phenelzine (Nardil)

B) Amitriptyline (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 phenelzine are monoamine
oxidase inhibitors and should be avoided in pediatric use because of the potential drug​food interactions
and other serious adverse effects. Amitriptyline is also a tricyclic antidepressant not recommended for
pediatric use.

4. A patient explains 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 response 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 amitriptyline 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 similarly 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 nurse​patient 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 daily for the past 3 weeks and that he has lost 3 pounds

Test Bank – Focus on Nursing Pharmacology (7th Edition by Amy Karch) 339

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 weight 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 medication 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.