Nursing Elites

1. What information should the nurse provide in patient education for a patient prescribed sertraline for major depressive disorder?

• A. Take the medication with food.
• B. It may take several weeks to feel the full effect.
• C. Avoid consuming grapefruit while taking this medication.
• D. Regular blood tests are necessary to monitor levels.

Correct answer: B

Rationale: Patients prescribed sertraline for major depressive disorder should be educated that it may take several weeks before experiencing the full therapeutic effects of the medication. This delay in onset of action is common with antidepressants like sertraline, and patients need to be aware of this to manage their expectations and continue with the treatment regimen. It's important for the patient to understand that consistent adherence to the prescribed dosage is crucial, even if the full effects are not immediately apparent. Choices A, C, and D are incorrect because taking the medication with food, avoiding grapefruit, and regular blood tests are not specific education points related to the expected timeframe for therapeutic effects of sertraline.

2. A patient with major depressive disorder is started on venlafaxine. Which class of antidepressant does this medication belong to?

• A. Selective serotonin reuptake inhibitors (SSRIs)
• B. Tricyclic antidepressants (TCAs)
• C. Monoamine oxidase inhibitors (MAOIs)
• D. Serotonin-norepinephrine reuptake inhibitors (SNRIs)

Correct answer: D

Rationale: Venlafaxine is classified as a serotonin-norepinephrine reuptake inhibitor (SNRI). SNRIs work by increasing the levels of both serotonin and norepinephrine in the brain, which helps alleviate symptoms of depression. This mechanism of action distinguishes SNRIs from other classes of antidepressants like SSRIs, TCAs, and MAOIs, making venlafaxine an effective choice for patients with major depressive disorder. Therefore, the correct answer is D. Choice A, SSRIs, primarily target serotonin reuptake only. Choice B, TCAs, work by inhibiting the reuptake of norepinephrine and serotonin, but they are not as selective as SNRIs. Choice C, MAOIs, inhibit the enzyme monoamine oxidase, leading to increased levels of various neurotransmitters, including serotonin and norepinephrine, but they are typically used as second- or third-line agents due to dietary restrictions and potential side effects.

3. A patient with major depressive disorder is started on a tricyclic antidepressant (TCA). Which common side effect should the nurse educate the patient about?

• A. Hypertension
• B. Diarrhea
• C. Dry mouth
• D. Weight loss

Correct answer: C

Rationale: The correct answer is C: Dry mouth. Dry mouth is a common side effect associated with tricyclic antidepressants (TCAs). TCAs block acetylcholine receptors, leading to anticholinergic effects such as dry mouth, constipation, blurred vision, and urinary retention. It is important for the nurse to educate the patient about this side effect to promote awareness and provide appropriate management strategies, such as maintaining good oral hygiene and staying hydrated. Choice A, hypertension, is not a common side effect of TCAs. Choice B, diarrhea, is not a typical side effect of TCAs; in fact, TCAs are more likely to cause constipation. Choice D, weight loss, is less common with TCAs as they are more likely to cause weight gain.

4. Gilbert, age 19, is described by his parents as a moody child with an onset of odd behavior at age 14, which caused Gilbert to suffer academically and socially. Gilbert has lost the ability to complete household chores, is reluctant to leave the house, and is obsessed with the locks on the windows and doors. Due to Gilbert's early and slow onset of what is now recognized as schizophrenia, his prognosis is considered:

• A. Favorable with medication
• B. In the relapse stage
• C. Improvable with psychosocial interventions
• D. To have a less positive outcome

Correct answer: D

Rationale: The scenario describes Gilbert as having an early and slow onset of schizophrenia, which typically indicates a less positive prognosis. Individuals with such presentations may experience more severe symptoms and difficulties in functioning, leading to a poorer long-term outcome. In Gilbert's case, his challenges with completing tasks, social withdrawal, and fixation on security measures suggest a more challenging prognosis. Early detection and intervention are crucial in managing schizophrenia, but the described symptoms and onset pattern are concerning for a less favorable outcome.

5. A client is diagnosed with obsessive-compulsive disorder (OCD). Which of the following interventions should the nurse include in the care plan? Select one that does not apply.

• A. Allow the client to perform rituals initially
• B. Set limits on the time allowed for rituals
• C. Encourage the client to verbalize feelings
• D. Provide a structured schedule of activities

Correct answer: A

Rationale: Interventions for a client with OCD should include allowing the client to perform rituals initially, setting limits on the time allowed for rituals, encouraging the client to verbalize feelings, and providing a structured schedule of activities. Allowing the client to perform rituals is an essential part of managing OCD and should not be restricted in the initial stages of care. Setting limits on the time for rituals helps prevent excessive engagement in them. Encouraging the client to verbalize feelings promotes emotional expression and processing. Providing a structured schedule of activities helps establish routine and predictability, which can be beneficial for individuals with OCD.

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