You are doing patient teaching for Margaret, who has been prescribed amitriptyline (Elavil) for treatment of depression. Which of the following statements suggests that Margaret needs further instruction?

Correct Answer: C

Rationale: The correct answer is C) Once I start feeling better, I'm looking forward to cutting down on this medication. This statement suggests that Margaret needs further instruction because it indicates a potential misunderstanding about the nature of amitriptyline treatment for depression. A) "I know I might not start feeling better for a few weeks, but I'll keep taking the medication just as the doctor prescribed" is a correct statement. It shows an understanding of the delayed onset of action of antidepressants and the importance of adherence to the prescribed regimen. B) "I'll keep some hard candies in my purse in case my mouth gets dry from the medicine" is also a correct statement. It demonstrates awareness of a common side effect of amitriptyline, which is dry mouth, and a proactive approach to managing it. D) "I'm worried I may gain some weight, but that's a small price to pay for feeling better" is not an ideal statement but does not indicate a need for immediate further instruction. Weight gain can be a side effect of amitriptyline, and the willingness to accept it for improved mental health is reasonable. In an educational context, it is crucial to emphasize to patients starting on psychotropic medications like amitriptyline the importance of following the prescribed regimen consistently, managing potential side effects, and understanding that antidepressants are typically tapered off gradually under medical supervision to prevent relapse. Patients should be encouraged to communicate openly with their healthcare providers about any concerns or misconceptions they may have about their medication.

Correct Answer: B

Rationale: The correct answer is B) Monitor for anticholinergic side effects. When a patient is taking nortriptyline, an important tricyclic antidepressant, it is crucial to monitor for anticholinergic side effects such as dry mouth, constipation, blurred vision, urinary retention, and cognitive impairment. These side effects can significantly impact the patient's quality of life and may require medical intervention or dose adjustments. Monitoring for these effects allows for early detection and management, improving patient safety and treatment outcomes. Option A) Make sure that CBC is ordered to monitor blood counts is incorrect because nortriptyline does not typically affect blood counts. Monitoring blood counts is more relevant for medications that can cause hematological side effects. Option C) Ensure that the patient's diet is gluten-free is incorrect because nortriptyline does not interact with gluten. Dietary considerations are important in specific conditions like celiac disease but are not directly related to nortriptyline use. Option D) Push fluids to prevent dehydration is incorrect because while adequate fluid intake is generally beneficial for overall health, it is not a specific intervention related to nortriptyline use. Dehydration is not a common side effect associated with this medication. In an educational context, understanding the side effect profile of psychotropic medications like nortriptyline is crucial for healthcare professionals to provide safe and effective care to patients. Monitoring for specific side effects and knowing how to address them are essential components of medication management and patient monitoring. By selecting the correct answer, healthcare providers can ensure the well-being of patients and optimize treatment outcomes.

Correct Answer: C

Rationale: In this scenario, the most likely explanation for the sudden change in behavior exhibited by the patient is that she is experiencing a manic episode as part of her illness. This is indicated by the increased talkativeness, decreased need for sleep, and inappropriate behaviors such as being seductive with other patients. The incorrect options can be explained as follows: A) The antidepressants are effective: This option is unlikely because the sudden change in behavior is not typical of a positive response to antidepressants. Manic episodes are not a common side effect of antidepressant medication. B) The patient was diagnosed incorrectly: While misdiagnosis is always a possibility, the symptoms described are more indicative of a manic episode rather than a completely incorrect diagnosis of major depression. D) She is recovering from her depression: This option is incorrect because the symptoms described are not consistent with a typical trajectory of recovery from depression. Instead, they align more closely with manic symptoms. Educationally, it is crucial for healthcare providers, especially those working with psychiatric patients, to be able to recognize the signs and symptoms of various mental health conditions, including manic episodes. Understanding these distinctions is essential for accurate diagnosis and appropriate treatment planning to ensure the safety and well-being of patients.

Correct Answer: C

Rationale: In this scenario, the most therapeutic response by the nurse would be option C, "Let's walk and talk." This response is appropriate because it engages Toni in physical activity, which can help release some of her excess energy due to the manic episode. Walking also provides a non-confrontational environment for communication, allowing Toni to express her feelings while being physically active. This approach can help to de-escalate her agitation and provide a more calming and supportive interaction. Option A, "Would you like to watch TV?" may not be as effective because it does not actively involve Toni in addressing her current state or provide an outlet for her excess energy. Option B, "Would you like me to talk with you?" is also less effective as it does not offer a practical solution to help Toni manage her agitation and pacing behavior. Option D, "Avoid giving attention to the patient by not responding to her behavior," is not recommended as it can be perceived as neglectful and may escalate Toni's feelings of frustration and isolation. In a mental health setting, it is crucial to address and acknowledge the patient's behavior in a supportive and therapeutic manner to promote their well-being and recovery. Educationally, this scenario highlights the importance of understanding and responding appropriately to individuals experiencing manic episodes in bipolar disorder. It emphasizes the significance of engaging patients in activities that can positively impact their emotional state and help manage their symptoms effectively. By choosing the most therapeutic response, nurses can build rapport, establish trust, and create a supportive environment for individuals with mental health challenges.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Moderate. This choice is correct because the patient exhibits multiple risk factors for suicide, including limited social support (only one person to call in times of need), frequent thoughts of suicide, and a history of a previous suicide attempt. These factors indicate an increased risk for suicide that should not be ignored. Option A) Low is incorrect because the presence of multiple risk factors as described above elevates the patient's risk beyond low. Option C) None is incorrect as the patient does exhibit suicide risk factors that need to be addressed. Option D) Imminent is incorrect as there is no immediate indication that the patient is actively planning or about to attempt suicide, but the risk is still significant. Educationally, it is important to understand that suicide risk assessment is a critical skill for healthcare professionals, especially those working with individuals on psychotropic medications. Identifying and addressing risk factors like social isolation, suicidal thoughts, and previous attempts are crucial in preventing suicide. This case highlights the importance of thorough assessment and intervention in managing suicide risk in patients.