Deck 16: Antimanic Drugs

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?

A) Administer a PRN dose of benztropine to relieve extrapyramidal symptoms (EPSEs).
B) Hold the next dose of risperidone to prevent further drug-drug interaction.
C) Reassure the patient that these side effects will decrease with time.
D) Notify the prescribing physician immediately.

Answer 1

Notify the prescribing physician immediately.

Question 2

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

A) Lithium
B) Valproate
C) Quetiapine
D) Carbamazepine

Answer 2

Carbamazepine

Question 3

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

A) Inhibition of kindling activity in the brain
B) Decreasing availability of norepinephrine
C) Increasing dopamine levels at synapses
D) Decreasing GABA metabolism

Answer 3

Inhibition of kindling activity in the brain

Question 4

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

A) Before the first morning dose
B) 2 hours after the morning dose
C) At bedtime
D) Any time during the day

Question 5

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

A) Peripheral vascular
B) Reproductive
C) Respiratory
D) Renal

Question 6

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?

A) Lithium
B) Amitriptyline
C) Divalproex
D) Diphenhydramine

Question 7

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?

A) Increase sodium in the patient's diet.
B) Immediately obtain a serum lithium level determination.
C) Comfort the patient that these effects will probably decrease over time.
D) Withhold the lithium until the patient no longer exhibits these side effects.

Question 8

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?

A) As the partner ages, rapid cycling will decrease.
B) Combining lithium with haloperidol (Haldol) might prevent rapid cycling.
C) Depression associated with bipolar disorder is usually time-limited, so treatment is not indicated.
D) Recent addition of olanzapine to this patient's drug regime can be helpful as a mood stabilizer.

Question 9

What phrase represents accurate information about the pharmacokinetics of lithium?

A) Wide therapeutic index
B) Excreted by the kidneys
C) Poorly absorbed in the gastrointestinal (GI) tract
D) Provides immediate relief of symptoms

Question 10

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?

A) October 3
B) October 8
C) October 21
D) November 1

Question 11

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

A) Restrict fluid intake.
B) Assess for signs of toxicity.
C) Encourage intake of high-potassium foods.
D) Ensure that the patient is swallowing the capsules.

Question 12

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?

A) Atactic toxicity
B) Uremic syndrome
C) Diabetes insipidus
D) Interstitial nephritis

Question 13

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?

A) 0.2 to 0.6 mEq/L
B) 0.6 to 1.2 mEq/L
C) 1.2 to 2 mEq/L
D) 2 to 2.6 mEq/L

Question 14

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?

A) Sertraline
B) Phenytoin
C) Benztropine
D) Divalproex

Question 15

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

A) Hydrochlorothiazide
B) Lorazepam
C) Clozapine
D) Oxazepam

Question 16

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?

A) The half-life of lithium is short.
B) Renal excretion is greater at night.
C) GI absorption is diminished at night.
D) The toxicity potential increases with once-a-day dosing.

Question 17

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

A) Sodium
B) Chloride
C) Potassium
D) Magnesium

Question 18

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

A) Indomethacin
B) Risperidone
C) Ziprasidone
D) Olanzapine

Question 19

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

A) Keeping appointments for serum lithium level testing
B) Engaging in daily cardiotonic exercise
C) Reporting anticholinergic side effects
D) Maintaining a tyramine-free diet

Question 20

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.)

A) Coarse hand tremor
B) Elevated white blood cell count
C) Dizziness
D) Facial tics
E) Coordination problems

Question 21

Which assessment findings validate that a patient with bipolar disorder is experiencing mania? (Select all that apply.)

A) Pacing
B) Agitation
C) Drowsiness
D) Delusional thoughts
E) Psychomotor retardation

Question 22

A patient who is to be discharged on a maintenance dose of lithium should be taught to report which symptoms/signs immediately? (Select all that apply.)

A) Large amounts of dilute urine
B) Prolonged nasal congestion
C) Severe muscle stiffness
D) Unusual sweating
E) Blurred vision

Question 23

A nurse prepares to lead a psychoeducational group for patients who take anticonvulsants to manage bipolar disorder. The nurse should invite patients who take which drugs? (Select all that apply.)

A) Lithium
B) Aripiprazole
C) Lamotrigine
D) Gabapentin
E) Carbamazepine