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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Are outdated medications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While some may consider tricyclic antidepressants outdated, they are still used for certain conditions, including neuropathic pain.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","B","C","D"]

Explanation

Choice A reason:

Supportive friends and family members play a crucial role in the recovery process for individuals with depression. Social support can provide emotional comfort, reduce feelings of isolation, and encourage adherence to treatment plans. Having a strong support network can significantly improve mental health outcomes.

Choice B reason:

Attending outpatient therapy or a partial hospital program offers structured support and treatment for individuals with depression. These programs provide access to mental health professionals, group therapy, and other therapeutic activities that can help manage symptoms and promote recovery. They offer a higher level of care than standard outpatient visits but do not require full hospitalization.

Choice C reason:

Consistent daily structure and exercise that is not overwhelming can help manage depression by providing routine and physical activity. Regular exercise has been shown to improve mood, reduce anxiety, and increase overall well-being. Establishing a daily routine can also help individuals with depression feel more in control and reduce feelings of chaos or unpredictability.

Choice D reason:

A well-balanced diet and restful sleep are essential components of mental health. Proper nutrition supports brain function and overall health, while adequate sleep is crucial for emotional regulation and cognitive function. Addressing these basic needs can help improve mood and energy levels, making it easier to cope with depression.

Correct Answer is C

Explanation

Choice A reason:

Being afraid of medical providers is not a determining factor for the suitability of rTMS. While patient comfort and willingness to undergo treatment are important, the primary considerations for rTMS eligibility are medical and safety-related.

Choice B reason:

His family’s agreement to take him to the hospital each week is supportive but not a primary criterion for rTMS eligibility. The focus should be on the patient’s medical suitability and safety for the procedure.

Choice C reason:

Signing an informed consent and having no presence of metal in the area of the magnetic stimulation, such as cochlear implants or medication pumps, are critical factors for rTMS eligibility. Metal implants in the head or neck can interfere with the magnetic fields used in rTMS, posing safety risks. Informed consent ensures that the patient understands the procedure, risks, and benefits.

Choice D reason:

Being angry about the death of his father is an emotional response and does not impact the medical suitability for rTMS. The decision to use rTMS should be based on medical criteria and safety considerations.

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