A client who has been taking fluvoxamine (Luvox) without significant improvement asks a nurse, “I heard about something called a monoamine oxidase inhibitor (MAOI). Can’t my doctor add that to my medications?” Which is an appropriate nursing response?

Correct Answer: B

Rationale: The correct answer is B) “A combination of an MAOI and Luvox can lead to a life-threatening hypertensive crisis.” This response is appropriate because combining an MAOI with fluvoxamine can result in a dangerous interaction known as serotonin syndrome or hypertensive crisis. MAOIs inhibit the breakdown of neurotransmitters like serotonin, and when combined with another drug that also affects serotonin levels, such as fluvoxamine, it can lead to excessive levels of serotonin in the body, causing severe and potentially life-threatening symptoms like high blood pressure, fever, seizures, and even death. Option A is incorrect because delirium tremens is not typically associated with the combination of fluvoxamine and MAOIs. Option C is incorrect as it suggests the combination is a good idea, which is false due to the risk of serious adverse reactions. Option D is incorrect as it trivializes the potential risks of combining these medications by focusing on cost rather than safety. In an educational context, this question highlights the importance of understanding drug interactions and the potential dangers of combining medications that affect similar pathways in the body. Nurses must be knowledgeable about pharmacology to provide safe and effective care to their patients, including recognizing and educating patients about the risks associated with certain drug combinations.

Correct Answer: A

Rationale: In this scenario, the correct answer is option A) Thyroid-stimulating hormone (TSH) level of 6.2 U/mL, which could potentially rule out a diagnosis of major depressive disorder. Major depressive disorder can be caused or exacerbated by thyroid dysfunction, particularly hypothyroidism. An elevated TSH level, indicating decreased thyroid function, could present with symptoms mimicking depression. Therefore, ruling out hypothyroidism is crucial before diagnosing major depressive disorder to ensure appropriate treatment. Option B) carbamazepine is an anticonvulsant and mood stabilizer used in conditions like bipolar disorder, not typically for major depressive disorder. Option C) Geodon is an atypical antipsychotic mainly used to treat schizophrenia and bipolar disorder, not a first-line treatment for major depressive disorder. Option D) SSRI (Selective Serotonin Reuptake Inhibitors) are commonly used as first-line pharmacotherapy for major depressive disorder, so the presence of an elevated TSH level would not rule out this diagnosis. Educationally, understanding the importance of considering differential diagnoses and conducting thorough assessments, including laboratory investigations, is crucial in pharmacology and nursing practice to ensure accurate diagnosis and appropriate treatment selection based on individual patient needs and conditions.

Correct Answer: B

Rationale: The correct answer is B: "Because the effectiveness of a placebo is not caused by the placebo itself but by cultural meanings surrounding treatment." Moerman and Jonas critique the popular use of the phrase 'placebo effect' because they argue that the term oversimplifies the complex interactions between a patient's beliefs, expectations, and the context of treatment. Option A is incorrect because while placebos may be less effective than actual drugs for certain conditions, the critique by Moerman and Jonas focuses on a deeper issue beyond mere comparative effectiveness. Option C is incorrect because the critique is not primarily about the ethical considerations of using placebos in clinical trials, although this is an important aspect of the placebo effect discussion. Option D is incorrect because while the concept of placebo effect can lead to confusion about correlation and causation, this is not the main focus of Moerman and Jonas' critique. Educationally, understanding the nuances of the placebo effect is crucial in pharmacology and healthcare. It highlights the importance of considering psychological and sociocultural factors in addition to pharmacological mechanisms when assessing treatment outcomes. It also emphasizes the need for healthcare providers to engage in open discussions with patients about treatment expectations and beliefs to optimize therapeutic outcomes.

Correct Answer: A

Rationale: Most patients who respond initially to antidepressant therapy require at least 1 year of therapy and may take medication on a lifetime basis. This is similar to patients who take antihypertensives or insulin. The patient’s statement alerts the nurse to set clear therapy goals that extend beyond medication assessment. Prozac takes 2 to 4 weeks to reach a steady state and is maintained in the body for several weeks after it is discontinued, but the nurse’s suggestion of tapering off the medication is a wise intervention for this patient, who seems impulsive about medication adherence. A patient with a knowledge deficit and nonadherence potential requires communication that recalls prior teaching and that builds on the knowledge he or she already has. Reminding the patient of the time it takes to become depressed provides anticipatory guidance about the possibility of needing medication on a lifetime basis. Sarcastic humor is usually a poor response that demeans the patient and may reflect the nurse’s impatience and a judgmental attitude toward the patient, and a laissez-faire response does not reflect a caring attitude. Withdrawal usually is not a problem for medications with a long half-life.

Correct Answer: D

Rationale: The parietal lobe is responsible for associating and processing sensory information that allows for functions such as following directions on a map, reading a clock, dressing self, keeping appointments, and distinguishing right from left. 1. Emotional expression is associated with frontal lobe function. 2. Detecting auditory stimuli is a temporal lobe function. 3. Receiving visual images is related to occipital lobe function.