Test Bank - Focus on Nursing Pharmacology (8th Edition by Karch)
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.
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 drugfood 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 nursepatient 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 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.
6. A patient diagnosed with type 1 diabetes mellitus is receiving insulin. The
physician has prescribed a monoamine oxidase inhibitor (MAOI) to treat this
patient’s depression. What interaction will the nurse assess for with this drug
combination?
a. Increased risk of hypoglycemia
b. Increased risk of hyperglycemia
c. Increase in appetite
d. Increased total cholesterol
Ans: A
Feedback:
MAOIs can cause an additive hypoglycemic effect if taken with insulin or oral
diabetic agents. This patient would have to be monitored closely and appropriate
dosage adjustments made; he should be taught the importance of more frequent blood
sugar monitoring. The drug combination in this question would not cause an increase
in appetite or increased total cholesterol.
7. A patient has been taking Prozac (fluoxetine) for the past 3 years for depression.
She is seeing her gynecologist for premenopausal symptoms and during the
interview with the nurse she says that she would like to try Sarafem because her
friend is taking it and she says it works great. The nurse’s best response is what?
, a. Sarafem and Prozac are different brand names for the same generic
medication.
b. Before changing drugs it is important to consider how well you responded
to Prozac.
c. You cannot take both drugs at the same time so it will be important to
decide which is best.
d. When taking both of these drugs, it is best to take one in the morning and
one at night.
Ans: A
Feedback:
Prozac and Sarafem are different brand names for fluoxetine, so there is no benefit in
changing the patient’s medication regimen and, if taken together, would result in a
drug overdose. The other three responses are incorrect or inappropriate because they
do not recognize that both drugs are the same.
8. A 12-year-old patient is hospitalized with severe depression. The patient has been
taking a selective serotonin reuptake inhibitor (SSRI). What is the priority nursing
action for the patient?
a. Monitor food intake for levels of tyramine.
b. Assess for weight loss and difficulty sleeping.
c. Monitor the patient for severe headaches.
d. Implement suicide precautions.
Ans: D
Feedback:
Recent studies have linked the incidence of suicide attempts to the use of SSRIs in
pediatric patients (see box 21.3 Focus on the Evidence). The priority concern for the
nurse would be safety for the patient. Severe headache and reactions to tyramine-
containing foods are associated with monoamine oxidase therapy. Weight loss and
difficulty sleeping are of a lower priority concern than the patient’s safety.
9. What drug, if prescribed for the patient, would indicate the need to assess the
patient for depression characterized by anxiety and addictive behaviors?
a. Imipramine (Tofranil)
b. Venlafaxine (Effexor)
c. Fluvoxamine (Luvox)
d. Tranylcypromine (Parnate)
Ans: B
Feedback:
Venlafaxine is used to treat and prevent depression in generalized anxiety disorder,
social anxiety disorder; it also diminishes addictive behavior. Fluvoxamine is a
selective serotonin reuptake inhibitor, tranylcypromine is a monoamine oxidase
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