Question 1

For 2 weeks a patient has taken lithium and risperidone daily for mania.The patient now reports diarrhea, vomiting, and blurred vision.The nurse observes a coarse hand tremor.What is the nurse's priority action to these assessment finding?

Accepted Answer

The combination of lithium and risperidone can lead to lithium toxicity, which can cause gastrointestinal symptoms, blurred vision, and tremors. Therefore, it is important to notify the prescribing physician immediately to ensure appropriate management of the patient's symptoms and monitoring of their lithium levels. Administering a PRN dose of benztropine may help with the tremors but will not address the underlying issue of lithium toxicity. Holding the next dose of risperidone may be appropriate, but it is not the priority action as the patient's symptoms may be due to lithium toxicity. Reassuring the patient is important, but it is not the priority action as the patient's symptoms may require medical attention.

Question 2

A nurse should schedule a weekly complete blood cell count (CBC) for a patient beginning therapy with which antimanic drug?

Accepted Answer

Carbamazepine can cause blood dyscrasias such as aplastic anemia and agranulocytosis, especially within the first few months of therapy. Therefore, monitoring with a weekly complete blood cell count (CBC) is recommended when initiating therapy.

Question 3

A patient has taken lithium 600 mg three times daily for 1 week.A laboratory result in which range shows that the desired serum lithium level was achieved?

Accepted Answer

The therapeutic range for lithium is generally considered to be between 0.6 and 1.2 mEq/L. Therefore, the desired serum lithium level would fall within this range. A level below 0.6 mEq/L may not be effective, while a level above 1.5 mEq/L may increase the risk of toxicity.

Question 4

Which patient should be assessed most carefully for evidence of lithium toxicity when lithium is prescribed with which additional medication?

Accepted Answer

Indomethacin is known to increase lithium levels and can lead to lithium toxicity, therefore patients taking these two medications should be monitored closely for signs of lithium toxicity.

Question 5

When should the nurse scheduling the serum lithium level blood draw for a patient arrange for it to be obtained?

Accepted Answer

The serum lithium level blood draw should be obtained before the first morning dose to accurately assess the patient's therapeutic level.

Question 6

What phrase represents accurate information about the pharmacokinetics of lithium?

Accepted Answer

Lithium is primarily excreted unchanged in the urine, with a half-life ranging from 18-36 hours. This can be impacted by factors such as renal function, hydration status, and drug interactions. It has a narrow therapeutic index, meaning that the difference between a therapeutic dose and a toxic dose is relatively small. Lithium is well-absorbed in the GI tract and should not provide immediate relief of symptoms.

Question 7

Before beginning lithium therapy, the nurse should educate a patient about laboratory tests to assess for adequate function of which system?

Accepted Answer

Before beginning lithium therapy, the nurse should educate the patient about laboratory tests to assess for adequate renal function, as lithium is primarily excreted by the kidneys and can cause renal toxicity.

Question 8

A patient with rapid-cycling bipolar disorder is not responding to lithium therapy.At the next multidisciplinary team meeting, the nurse should point out that many rapid-cycling patients have been effectively treated using what medication?

Accepted Answer

Divalproex has been shown to be effective in treating rapid-cycling bipolar disorder. Sertraline is an antidepressant and can potentially worsen manic symptoms, phenytoin is an anticonvulsant that is not commonly used to treat bipolar disorder, and benztropine is an anticholinergic agent used to treat extrapyramidal symptoms associated with antipsychotic medication.

Question 9

Which patient would require careful assessment for toxic effects of lithium when combined with what additional medication?

Accepted Answer

Hydrochlorothiazide can increase lithium levels in the body by reducing its excretion through the kidneys, potentially leading to lithium toxicity.

Question 10

A patient who has taken lithium for 6 months reports, "I go to the bathroom many times a day and pass large amounts of very pale urine." The nurse's action should be based on the understanding that these symptoms may indicate which problem?

Accepted Answer

The symptoms of frequent urination and large amounts of very pale urine may suggest diabetes insipidus, which is a potential side effect of lithium therapy. Lithium can affect the kidneys' ability to concentrate urine, leading to excessive urination and diluted urine. Atactic toxicity and uremic syndrome are not associated with these symptoms, and interstitial nephritis may present with dark urine and low urine output rather than increased urination.

Question 11

A patient's serum lithium level is 1.8 mEq/L.What is the nurse's priority action related to this evidence?

Accepted Answer

A serum lithium level of 1.8 mEq/L is above the therapeutic range and indicates potential for toxicity. Therefore, the priority action for the nurse is to assess for signs of toxicity such as gastrointestinal disturbances, tremors, confusion, and arrhythmias. Restricting fluid intake and encouraging high-potassium foods are not relevant actions in this situation. Ensuring that the patient is swallowing the capsules may be necessary, but it is not the priority action at this time.

Question 12

A patient diagnosed with mild lithium toxicity with a serum level of 1.6 mEq/L.Which assessment findings are most likely and will require nursing attention? (Select all that apply.)

Accepted Answer

Mild lithium toxicity, typically defined by serum levels ranging from 1.5 to 2.0 mEq/L, can manifest with symptoms such as coarse hand tremor, dizziness, and coordination problems. These symptoms reflect the neurological effects of lithium at elevated levels and require nursing attention to prevent further toxicity and ensure patient safety.

Question 13

For patients diagnosed with bipolar disorder, valproate anticonvulsants are likely to help control rapid-cycling episodes by what process?

Accepted Answer

Valproate anticonvulsants inhibit kindling activity in the brain, which is a process that contributes to the development of rapid-cycling episodes in bipolar disorder. By reducing kindling activity, valproate can help prevent the occurrence of these episodes.

Question 14

Teaching for a patient who is to be discharged on a maintenance dose of lithium should emphasize the importance of management activity?

Accepted Answer

Maintaining therapeutic serum levels of lithium is critical for patient safety and optimal therapeutic outcomes. Regular serum lithium level testing is essential to ensure that the patient is receiving an appropriate maintenance dose.

Question 15

A patient has taken lithium 300 mg three times daily for 1 week.The patient reports the presence of fine hand tremors and thirst.What is the nurse's priority action to these assessment finding?

Accepted Answer

The answer of A patient has taken lithium 300 mg...

Question 16

A patient with a long history of multiple sclerosis developed psychosis with acute mania.The nurse should anticipate that the health care provider will probably prescribe which medication to help stabilize the mania?

Accepted Answer

Divalproex is a mood stabilizer commonly used to treat mania in bipolar disorder and can be effective in managing acute manic episodes.

Question 17

A patient diagnosed with mania begins lithium therapy on October 1.What is the earliest date a nurse can expect to see clinical improvement in the patient's condition?

Accepted Answer

The onset of action for lithium therapy is usually 5 to 7 days after starting treatment, so the earliest date a nurse can expect to see clinical improvement is October 8.

Question 18

Maintenance of a therapeutic serum level of lithium is dependent on adequate serum levels of which electrolyte?

Accepted Answer

Adequate serum levels of sodium are necessary for the maintenance of a therapeutic serum level of lithium, as they impact the clearance of lithium by the kidneys.

Question 19

The spouse of a patient diagnosed with bipolar disorder tells the nurse, "Every time my partner recovers from a manic episode, depression follows soon.It's very discouraging." The nurse's reply should include what information?

Accepted Answer

Olanzapine is an atypical antipsychotic medication that has been shown to be helpful as a mood stabilizer in patients with bipolar disorder. It can be used to prevent episodes of mania and depression. Combining lithium with haloperidol is not a recommended treatment for rapid cycling. The course of depression associated with bipolar disorder can vary and often requires treatment. Age is not a determining factor in rapid cycling.

Question 20

A patient diagnosed with bipolar disorder asks the nurse, "Why can't I take my lithium just once a day at bedtime? It's hard to remember to take it three times." The nurse's reply should be based on what information?

Accepted Answer

The half-life of lithium is short, meaning that it is eliminated from the body relatively quickly. Therefore, in order to maintain therapeutic levels, it is necessary to take the medication multiple times throughout the day. Once-a-day dosing would not provide consistent blood levels and could lead to decreased effectiveness or toxicity.

Quiz 16: Antimanic Drugs