A client has been receiving imipramine. The nurse notifies the health care provider if which adverse client response to the medication is noted?

Appeared in: DHS Staff Nurse - 2018 (Shift-2nd)

Explanation

Imipramine, a tricyclic antidepressant (TCA), has moderate sedative properties.
Increased or excessive drowsiness is a significant central nervous system (CNS) side effect that poses a safety risk to the client.
This risk includes potential for falls, accidents while driving, or impaired ability to perform daily activities.
Due to the immediate safety implications, excessive drowsiness is the priority finding to report to the healthcare provider for potential intervention, such as dose adjustment.

Why Other Options Were Wrong

Option A: Increased appetite is a known metabolic side effect of imipramine that can lead to weight gain. However, it is not an immediate safety concern requiring urgent notification.
Option C: A reported decrease in anxiety is a desired therapeutic outcome of antidepressant therapy, not an adverse effect.
Option D: An increased sense of well-being is a primary goal of treating depression and indicates the medication is working effectively.

Related Visual

Clinical Relevance

Nursing practice connection: Use the key finding related to Adverse Effects of Tricyclic Antidepressants (TCAs) to guide bedside assessment, documentation, and the next nursing action.
Nurses must prioritize patient safety. When administering medications with sedative effects like imipramine, the primary nursing concern is the risk of injury from falls or accidents.
Nursing interventions for a client experiencing drowsiness include implementing fall precautions, educating the client to avoid activities requiring alertness (like driving), and suggesting that the provider consider administering the dose at bedtime to minimize daytime sedation.
What if the client reported dizziness when standing up? This would point to orthostatic hypotension, another high-risk side effect of imipramine, which would also require immediate notification of the provider and implementation of safety measures.

How to Approach the Question

First, identify the drug mentioned in the question: Imipramine. Recall or identify its drug class (Tricyclic Antidepressant).
Next, understand the question's core task: identify an adverse response that is significant enough to notify the healthcare provider.
Analyze the options by categorizing them. Two options ('decrease in anxiety', 'increased well-being') are positive, therapeutic effects. These can be eliminated immediately as they are the goals of treatment, not adverse effects.
Compare the remaining two adverse effects: 'Increased appetite' and 'Increased drowsiness'.
Prioritize these adverse effects based on patient safety. Increased appetite is a metabolic issue managed over time. Increased drowsiness is a CNS effect that creates an immediate risk of falls and injury.
Conclude that the most critical adverse effect to report is the one that poses the greatest immediate risk to patient safety, which is increased drowsiness.

Concept Tested & Keywords

Concept Tested: Adverse Effects of Tricyclic Antidepressants (TCAs)
Stem keywords: imipramine, adverse client response, notifies the health care provider
Lead-in keywords: which

Question ID

QCML_hLm8o77G5g40cMf7j

Reference Book

E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) p. 1960-1962

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