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Greene is an 85-year-old male placed on a 5150 by the crisis team after his nurse called them. He has taken a fall in his driveway after his dialysis. He has end-stage kidney disease, diabetes, and a history of myocardial infarction 4 years ago. He was living alone until his home health nurse found him crying out in pain, clutching onto his leg in the kitchen. “I’m so tired,” he says.Nortriptyline and some tricyclic antidepressants may be helpful with neuropathic pain but are often contraindicated in elderly clients such as Mr. Greene because (select the best answer)

A.

Are outdated medications

B.

Can increase cardiac side effects and urinary retention

C.

Are only taken at night

D.

Are expensive

E.

Are expensive

Answer and Explanation

The Correct Answer is B

Choice A reason:

While some may consider tricyclic antidepressants outdated, they are still used for certain conditions, including neuropathic pain. The primary concern with their use in elderly clients is not their age but their side effect profile.

 

Choice B reason:

Tricyclic antidepressants, including nortriptyline, can increase cardiac side effects and urinary retention, which are significant concerns in elderly clients. These medications can cause orthostatic hypotension, arrhythmias, and exacerbate urinary retention, making them less suitable for older adults with pre-existing health conditions.

 

Choice C reason:

The timing of medication administration (e.g., only taken at night) is not the primary issue with tricyclic antidepressants. The concern lies in their side effects, which can be particularly problematic for elderly clients.

 

Choice D reason:

While the cost of medication can be a factor in treatment decisions, it is not the primary reason tricyclic antidepressants are contraindicated in elderly clients. The main concern is their potential to cause serious side effects.


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View Related questions

Correct Answer is A

Explanation

Choice A reason:

Yogurt is one of the foods that can interact with MAOI inhibitors like Nardil. MAOIs can cause dangerous increases in blood pressure when taken with foods containing high levels of tyramine, such as aged cheeses, yogurt, fermented foods, and certain meats. Patients on MAOIs must follow strict dietary restrictions to avoid these interactions.

Choice B reason:

Vegetable salad is generally safe for individuals taking MAOI inhibitors. Fresh vegetables do not contain high levels of tyramine and do not pose a risk of interaction with MAOIs.

Choice C reason:

Oatmeal is also safe for individuals taking MAOI inhibitors. It does not contain high levels of tyramine and is not associated with adverse interactions with these medications.

Choice D reason:

Crackers are typically safe for individuals taking MAOI inhibitors, provided they do not contain aged cheeses or other high-tyramine ingredients. Plain crackers do not pose a risk of interaction with MAOIs.

Correct Answer is A

Explanation

Choice A reason:

Expressing an active suicide ideation by stating, “I will take an overdose if I return to the dorm room,” meets the criteria for a 5150 involuntary hold for “Danger to Self.” This statement indicates a clear and immediate risk of self-harm, which warrants immediate intervention to ensure Edward’s safety.

Choice B reason:

Starting to cry when discussing his grandfather’s death is a normal emotional response to grief and does not meet the criteria for a 5150 involuntary hold. While it indicates emotional distress, it does not suggest an immediate risk of self-harm.

Choice C reason:

Refusing to take antidepressant medication is concerning and may indicate non-compliance with treatment, but it does not meet the criteria for a 5150 involuntary hold unless it is accompanied by behaviors that indicate an immediate risk of self-harm.

Choice D reason:

Admitting to feeling hopeless but agreeing to return to the clinic in the morning escorted by his classmate who will stay with him does not meet the criteria for a 5150 involuntary hold. While feelings of hopelessness are serious, the plan to return to the clinic with support indicates that Edward is not an immediate danger to himself.

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