Question

a nurse is providing teaching to a client who has depression and a new prescription for fluoxetine. which of the following statements by the client indicates an understanding of the teaching?

\i should start to feel better within 24 hours of starting this medication.\
\i will be sure to follow a strict diet to avoid foods with tyramine.\
\i will continue to take st. johns wort to increase the effects of the medication.\
\i should take acetaminophen instead of ibuprofen for my headaches while taking this medication.\

Explanation:

Analyze the therapeutic onset of fluoxetine

Fluoxetine is a Selective Serotonin Reuptake Inhibitor (SSRI). Like most antidepressants, it does not produce immediate therapeutic effects. It typically takes 1 to 4 weeks (or longer) for a client to experience a noticeable improvement in depressive symptoms. Therefore, the statement about feeling better within 24 hours is incorrect.

Evaluate dietary restrictions

A strict low-tyramine diet is required for clients taking Monoamine Oxidase Inhibitors (MAOIs) to prevent a hypertensive crisis. Fluoxetine is an SSRI, not an MAOI, so a strict tyramine-free diet is not required.

Assess herbal supplement interactions

St. John's Wort is an over-the-counter herbal supplement that increases serotonin levels. Taking St. John's Wort concurrently with an SSRI like fluoxetine significantly increases the risk of developing serotonin syndrome, a potentially life-threatening condition. Clients must be instructed to avoid St. John's Wort.

Evaluate analgesic choices and bleeding risk

SSRIs like fluoxetine inhibit serotonin reuptake in platelets, which can impair platelet aggregation and increase the risk of gastrointestinal bleeding. This risk is further compounded when combined with Nonsteroidal Anti-inflammatory Drugs (NSAIDs) like ibuprofen. Therefore, using acetaminophen (which does not affect platelet function in the same way) instead of ibuprofen for mild pain or headaches is a safe and correct practice. This statement demonstrates a correct understanding of Nursing Assessment and patient safety education regarding drug-drug interactions.

Answer:

• "I should start to feel better within 24 hours of starting this medication."
• "I will be sure to follow a strict diet to avoid foods with tyramine."
• "I will continue to take St. John's Wort to increase the effects of the medication."
• "I should take acetaminophen instead of ibuprofen for my headaches while taking this medication." (Correct answer)