When an older adult diagnosed with depression reports that she has been taking over-the-counter (OTC) melatonin, the nurse asks:

Correct Answer: B

Rationale: The correct answer is B: "Have you been having trouble sleeping?" This is the correct question because melatonin is commonly used as a sleep aid. The nurse should inquire about the patient's sleep patterns to assess the effectiveness of melatonin and potential side effects related to sleep. Choices A, C, and D are incorrect as they do not directly relate to the use of melatonin as a sleep aid in older adults with depression. Asking about memory, anxiety, or weight loss is not as relevant in this context.

Correct Answer: A

Rationale: The correct answer is A: Buspirone (BuSpar). Buspirone is commonly used for patients with GAD due to its non-addictive nature and lack of sedative effects like benzodiazepines. It works by affecting serotonin receptors in the brain, reducing anxiety symptoms. ECG changes (choice B) are not a treatment for GAD. Valium (choice C) is a benzodiazepine, which can be addictive and is not recommended for long-term use in GAD. Divalproex (Depakote) (choice D) is typically used for mood disorders like bipolar disorder and not as a first-line treatment for GAD.

Correct Answer: A

Rationale: The correct answer is A: Selective serotonin reuptake inhibitors (SSRIs). SSRIs block the reuptake of serotonin at the presynaptic membrane, leading to increased availability of serotonin in the synaptic cleft. This helps alleviate symptoms of depression and anxiety. Choice B, Polyuria, is a symptom related to excessive urination and is not a class of medication. Choice C, Carbamazepine, is an anticonvulsant and mood stabilizer that works by different mechanisms, not by increasing serotonin availability. Choice D, Lithium, is also a mood stabilizer primarily used in bipolar disorder and does not directly increase serotonin levels.

Correct Answer: B

Rationale: The correct answer is B: Urinary retention. Elavil, a tricyclic antidepressant, can cause anticholinergic effects leading to urinary retention, which can be a serious side effect requiring immediate intervention to prevent complications like urinary retention, necessitating prompt medical attention to prevent potential complications such as bladder distention or urinary retention-induced kidney damage. A: Orthostatic hypotension - While Elavil can cause orthostatic hypotension, it is not typically considered a serious side effect that requires immediate intervention. C: ECG changes - Elavil can cause ECG changes, but they may not always necessitate immediate intervention. D: Sedation - Sedation is a common side effect of Elavil but is not typically considered a serious side effect requiring immediate intervention.

Correct Answer: B

Rationale: The correct answer is B: Divalproex (Depakote). Jaundice is a condition characterized by yellowing of the skin and eyes due to liver dysfunction. Divalproex is metabolized in the liver, and in patients with jaundice, liver function may be compromised, leading to potential toxicity. Therefore, holding Divalproex for a patient with jaundice is essential to prevent further liver damage. A: Valium is primarily metabolized in the liver, but it is generally safe to use in patients with mild to moderate liver impairment. C: Lithium is primarily cleared through the kidneys, so liver dysfunction would not directly impact its clearance. D: Verapamil is also primarily metabolized in the liver, but it is not contraindicated in patients with jaundice unless there is severe liver impairment.