Patient being treated for depression has taken 300 mg ...

[waynest]

patient being treated for depression has taken 300 mg amitriptyline (Elavil) daily for a year. The patient calls the case manager at the clinic and says, I stopped taking my antidepressant 2 days ago.
 
  Now I am having cold sweats, nausea, a rapid heartbeat, and nightmares. The nurse should advise the patient:
 
  a. Go to the nearest emergency department immediately.
  b. Do not to be alarmed. Take two aspirin and drink plenty of fluids.
  c. Take one dose of the antidepressant. Come to the clinic to see the health care provider.
  d. Resume taking the antidepressant for 2 more weeks, and then discontinue them again.

Question 2

A patient with depression does not interact with others except when addressed and then only in monosyllables. The nurse wants to show nonjudgmental acceptance and support for the patient. Select the nurse's most effective action.
 
  a. Make observations.
  b. Ask the patient direct questions.
  c. Phrase questions to require yes or no answers.
  d. Frequently reassure the patient to reduce guilt feelings.

[polinasid]

Answer to Question 1

ANS: C
The patient has symptoms associated with abrupt withdrawal of the tricyclic antidepressant. Taking a dose of the drug will ameliorate the symptoms. Seeing the health care provider will allow the patient to discuss the advisability of going off the medication and to be given a gradual withdrawal schedule if discontinuation is the decision. This situation is not a medical emergency, although it calls for medical advice. Resuming taking the antidepressant for 2 more weeks and then discontinuing again would produce the same symptoms the patient is experiencing.

Answer to Question 2

ANS: A
Making observations about neutral topics such as the environment draws the patient into the reality around him or her but places no burdensome expectations on the patient for answers. Acceptance and support are shown by the nurse's presence. Direct questions may make the patient feel that the encounter is an interrogation. Open-ended questions are preferable if the patient is able to participate in dialog. Platitudes are never acceptable; they minimize patient feelings and can increase feelings of worthlessness.