Practice Question
When patients are taking selective SSRIs for the first time for depression, which is most important to monitor for during the first few weeks of therapy?
Answer Choices:
Correct Answer:
Suicidal thoughts.
Rationale:
✨ SSRIs (e.g., sertraline, fluoxetine, citalopram) can increase energy before they significantly improve mood, especially in the first few weeks.
✨ This mismatch may allow a depressed client to now have enough energy to act on preexisting suicidal ideation, increasing their suicide risk.
✨ Because of this, regulatory agencies warn about increased suicidality, particularly in children, adolescents, and young adults, when starting antidepressants.
✨ Nurses must closely monitor for new or worsening depression, suicidal thoughts, plans, or unusual behavior changes early in treatment.
✨ For exam purposes, the priority assessment during initial SSRI therapy is always suicidal ideation and safety planning.
Hypertensive crisis
✨ A hypertensive crisis is most classically associated with MAOIs (e.g., phenelzine, tranylcypromine) when combined with tyramine-rich foods or certain medications.
✨ SSRIs do not typically cause hypertensive crises in the same way and are not high-yield for this complication.
✨ While SSRIs may interact with other drugs, they are more frequently associated with serotonin syndrome, GI upset, and sexual dysfunction rather than sudden extreme hypertension.
✨ Focusing on hypertensive crisis would distract from the more life-threatening and exam-relevant risk of suicidality in early antidepressant therapy.
✨ Therefore, this is not the most important thing to monitor for in the first weeks of SSRI treatment.
Convulsions
✨ SSRIs are not primarily known for causing seizures; seizure risk is far more strongly associated with bupropion, overdose, or pre-existing seizure disorders.
✨ Although any psychotropic medication can potentially lower seizure threshold in rare cases, it is not the key early monitoring priority with SSRIs.
✨ The bigger, exam-focused safety issue is suicidal behavior, especially in younger populations.
✨ Overemphasizing seizures could lead the nurse to under-monitor for behavioral changes that signal suicidality.
✨ Thus, convulsions are not the best, high-priority answer for this question.
Orthostatic hypotension
✨ Orthostatic hypotension is more commonly associated with tricyclic antidepressants (TCAs) and some antipsychotics, not primarily with SSRIs.
✨ While SSRIs can sometimes affect blood pressure, they typically have a more favorable cardiovascular side-effect profile compared to older antidepressants.
✨ Monitoring blood pressure is always part of good nursing care, but it is not the number one priority specifically in the first few weeks of SSRI therapy.
✨ The most critical risk to monitor for with newly started SSRIs is worsening depression or suicidal ideation.
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This question is from ☑️Custom-25Q4 218 Exam 5 which contains 30 questions.
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Question Details
- Category: RN Nursing Exam(s)
- Subcategory: ATI Exam(s)
- Domain: RN ATI MedSurg
- Answer Choices: 4