An 11-year-old client has been hospitalized on the adolescent psychiatry unit with severe depression. For the past several weeks, the client has been prescribed a selective serotonin reuptake inhibitor (SSRI). What is the priority nursing action?
Monitor food intake and eliminate potential sources of tyramine.
Assess for weight loss and difficulty sleeping.
Monitor the client for migraines.
Implement suicide precautions.
The Correct Answer is D
D. Children and adolescents with depression, especially when initiating or adjusting antidepressant medications like SSRIs, are at an increased risk of suicidal ideation and behavior. Therefore, it is crucial to prioritize the safety of the client by implementing suicide precautions, which may include close observation, removing potential means of self-harm, and involving the client in structured activities under supervision.
A. Monitoring food intake and eliminating potential sources of tyramine are considerations for clients taking monoamine oxidase inhibitors (MAOIs), another class of antidepressant medications, due to the risk of hypertensive crisis.
B. Weight loss and difficulty sleeping are potential side effects of SSRIs that may occur, particularly during the initial phases of treatment. However, suicide precautions are a priority
C. While SSRIs may cause headaches or migraines as potential side effects, monitoring for migraines specifically would not typically be a priority
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Related Questions
Correct Answer is B
Explanation
B. Anxiolytics are prescribed to reduce symptoms of anxiety, such as nervousness or restlessness, which can interfere with problem-solving and decision-making abilities. By alleviating anxiety symptoms, the medication can help the client focus more effectively on addressing underlying issues or stressors.
A. While anxiolytics can be effective in managing acute symptoms of anxiety, they are not typically intended for long-term use.
C. Many anxiolytic medications, particularly benzodiazepines, carry a risk of dependence and addiction if used improperly or for an extended period.
D. While anxiolytics can help alleviate symptoms of anxiety, they may not completely eliminate anxiety in all situations.
Correct Answer is B
Explanation
B. Methadone is a long-acting opioid agonist that helps stabilize individuals with opioid dependence by alleviating withdrawal symptoms and reducing drug cravings.
A. Methadone maintenance treatment (MMT) is a recognized and evidence-based approach for managing opioid dependence. When used as prescribed under the supervision of healthcare professionals, methadone is administered orally in controlled doses
C. Methadone is an opioid medication with the potential for dependence and addiction, especially when used improperly or in higher doses than prescribed.
D. Methadone is a long-acting opioid agonist that acts on the same receptors in the brain as heroin and other opioids. However, when used as prescribed for opioid dependence treatment, methadone is administered in controlled doses that are carefully titrated to stabilize individuals without producing euphoria or intoxication.
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