ATI Mental Health & Psychiatric Nursing NCLEX Practice Exam (Quiz #4: 25 Questions) 1. 1. Question Which nursing intervention would be most appropriate if a male client develops orthostatic hypotension while taking amitriptyline (Elavil)? o A. Consulting with the physician about substituting a different type of antidepressant . o B. Advising the client to sit up for 1 minute before getting out of bed . o C. Instructing the client to double the dosage until the problem resolves . o D. Informing the client that this adverse reaction should disappear within 1 week . Answer Correct Answer: B. Advising the client to sit up for 1 minute before getting out of bed. To minimize the effects of amitriptyline -induced orthostatic hypotension, the nurse should advise the client to sit up for 1 minute before getting out of bed. Amitriptyline is FDA approved medication to treat depression in adults. Secondary to its alpha -adrenergic receptor blockade, it can cause orthostatic hypotension, dizziness, and sedation. It can also cause heart rate variability, slow intracardiac conduction, induce various arrhythmias, and cause QTc (corrected QT) prolongation. • Option A: Orthostatic hypotension commonly occurs with tricyclic antidepressant therapy. Cardiac symptoms include tachycardia, hypotension, conduction abnormalities include QTc prolongation. Amitriptyline is in the tricyclic antidepressant (TCA) drug classification and acts by blocking the reuptake of both serotonin and norepinephrine neurotransmitters. The three -ring central structure, along with a side chain, is the basic structure of tricyclic antidepressants. Amitriptyline is a tertiary amine and has strong binding affinities for alpha -adrenergic, histamine (H1), and muscarinic (M1) receptors. It is more sedating and has increased anticholinergic properties compared to other TCAs. • Option C: In these cases, the dosage may be reduced or the physician may prescribe nortriptyline, another tricyclic antidepressant. Once the patient is stable, amitriptyline should be continued for three months or longer to prevent relapse of depression. In cases o f therapy cessation, the clinician should gradually taper to avoid withdrawal. Amitriptyline administration comes in various forms, the most common being oral form. The initial dose recommended for depression is 25 mg/day at bedtime, as it can be sedating. • Option D: Orthostatic hypotension disappears only when the drug is discontinued. The most commonly encountered side effects of amitriptyline include weight gain, gastrointestinal symptoms like constipation, xerostomia, dizziness, headache, and somnolence. Patients on amitriptyline can have anticholinergic, antihistaminic, and alpha -adrenergic blocking effects. It may not be appropriate for patients with cardiac problems. 2. 2. Question Mr. Cruz visits the physician’s office to seek treatment for depression, feelings of hopelessness, poor appetite, insomnia, fatigue, low self -esteem, poor concentration, and difficulty making decisions. The client states that these symptoms began at least 2 years ago. Based on this report, the nurse Tiffany suspects: o A. Cyclothymic disorder . o B. Atypical affective disorder . o C. Major depression . o D. Dysthymic disorder . Answer Correct Answer: D. Dysthymic disorder. Dysthymic disorder is marked by feelings of depression lasting at least 2 years, accompanied by at least two of the following symptoms: sleep disturbance, appetite disturbance, low energy or fatigue, low self -esteem, poor concentration, difficulty making d ecisions, and hopelessness. These symptoms may be relatively continuous or separated by intervening periods of normal mood that last a few days to a few weeks. • Option A: Cyclothymic disorder is a chronic mood disturbance of at least 2 years’ duration marked by numerous periods of depression and hypomania. It is currently classified under the umbrella of bipolar mood disorders. It is a chronic disease that must be present for at least two years in order to be diagnosable in adults and over 1 year in children and adolescents. As with many other psychiatric disorders, it must lead to dysfunction and stress in order to be classified as a disorder and must not be concurrent or caused by another general medical condition or substance use disorder. • Option B: Atypical affective disorder is characterized by manic signs and symptoms. Affective disorders may include manic (elevated, expansive, or irritable mood with hyperactivity, pressured speech, and inflated self -esteem) or depressive (dejected mood with disin terest in life, sleep disturbance, agitation, and feelings of worthlessness or guilt) episodes, and often combinations of the two. • Option C: Major depression is a recurring, persistent sadness or loss of interest or pleasure in almost all activities, with signs and symptoms recurring for at least 2 weeks. The investigation into depressive symptoms begins with inquiries of the neurovegetative s ymptoms which include changes in sleeping patterns, appetite, and energy levels. Positive responses should elicit further questioning focused on evaluating for the presence of the symptoms which are diagnostic of major depression. 3. 3. Question After taking an overdose of phenobarbital (Barbita), Mario is admitted to the emergency department. Dr. Trinidad prescribes activated charcoal (Charcocaps) to be administered by mouth immediately. Before administering the dose, the nurse verifies the dosage ordered. What is the usual minimum dose of activated charcoal? o A. 5 g mixed in 250 ml of wate r o B. 15 g mixed in 500 ml of wate r o C. 30 g mixed in 250 ml of wate r o D. 60 g mixed in 500 ml of wate r Answer Correct Answer: C. 30 g mixed in 250 ml of water The usual adult dosage of activated charcoal is 5 to 10 times the estimated weight of the drug or chemical ingested, or a minimum dose of 30 g, mixed in 250 ml of water. Doses less than this will be ineffective; doses greater than this can increase the ris k of adverse reactions, although toxicity doesn’t occur with activated charcoal, even at the maximum dose. Activated charcoal is widely used in Emergency Departments to treat many types of toxic ingestions. Its use significantly prevents the absorption of many toxic drugs and other poisons if given early post -ingestion. • Option A: An oral suspension of activated charcoal (AC) should merit consideration in poisonings when there is an indication for gastrointestinal decontamination of an ingested toxin, and the clinician can administer activated charcoal within 1 hour of ingestion. W hen the dose of the ingested toxin is known, experts recommend activated charcoal at a 10 to 1 ratio of activated charcoal to the ingested toxin. This ratio may be impractical to achieve when the patient has ingested large doses of a toxin. • Option B: When the amount of toxin ingested is unknown, or it is impractical to achieve a 10 to 1 ratio in large dose toxic ingestions, SDAC should be administered at a dose of 1g/kg of body weight or using a simplified age -based dosing scheme. Formulations have bee n attempted to increase the palatability of activated charcoal, which is black and has a gritty texture. Ready -to-use aqueous suspensions of activated charcoal are available in 15 g, 25 g, and 50 g doses as well as formulations premixed with sorbitol.
