Question 1

A patient with bipolar disorder has been taking lithium [Lithobid] for several years. The patient has developed a goiter, and serum tests reveal hypothyroidism. What will the nurse expect the provider to order for this patient?

A) Administration of levothyroxine
B) Increasing the lithium dose
C) Iodine supplements
D) Referral to an endocrinologist

Accepted Answer

Patients taking lithium may experience reduced incorporation of iodine into the thyroid hormone, resulting in goiter and hypothyroidism. Administration of levothyroxine or withdrawing the lithium will reverse both. Increasing the lithium dose will make this worse. Iodine supplements are not indicated. The provider will either order stopping the lithium or administration of levothyroxine, which will reverse this condition, so referral to an endocrinologist is not necessary.

Question 2

A nurse is preparing to administer medications to a hospitalized patient who has been taking lithium [Lithobid] for 3 days. The patient is complaining of mild nausea and abdominal bloating. The patient's lithium level is 0.8 mEq/L. What will the nurse do?

A) Administer the dose and tell the patient that the side effects are temporary.
B) Contact the prescriber to request an order for serum electrolytes.
C) Hold the dose and notify the prescriber of the patient's lithium level.
D) Request an order for amiloride [Midamor].

Accepted Answer

This patient is experiencing side effects that are common and that occur at therapeutic levels of the drug. The lithium level is therapeutic and not toxic, so the nurse should give the dose and reassure the patient that the side effects will diminish over time. In the presence of low sodium, lithium can accumulate to toxic doses; therefore, if the lithium level were elevated, evaluating serum electrolytes would be advisable. The dose does not need to be withheld, because the patient does not have toxic levels of lithium. Amiloride is used if patients are experiencing lithium-induced polyuria, which this patient does not have.

Question 3

A patient with bipolar disorder who is taking divalproex sodium [Valproate] has just been admitted to the hospital. During the admission assessment, the patient tells the nurse about recent suicidal ideation. The nurse observes several areas of bruising over soft tissue areas and notes a weight gain of 10 lb since the last admission 1 year ago. What will the nurse do?

A) Ask the patient whether the bruises are self-inflicted.
B) Contact the provider to report these findings.
C) Give the patient information about weight loss.
D) Request an order for an increased dose to help with depressive symptoms.

Accepted Answer

Divalproex sodium is used to control symptoms during manic episodes and can prevent relapse into mania. It is less effective than lithium at reducing the risk of suicide. It can cause thrombocytopenia, which results in bruising and is an indication for immediate drug withdrawal. Weight gain can be serious and chronic. All of these findings are an indication for withdrawing the drug and should be reported to the provider. Until platelet levels determine whether the bruises are drug induced, it is not appropriate to ask the patient if they are self-inflicted. Because weight gain is common and can be severe with this drug, information about weight loss is not likely to have an effect. Divalproex sodium is better than lithium at treating depression; however, in light of the other symptoms, it is probably not the best choice.

Question 4

A patient with bipolar disorder is admitted to the hospital. The patient has been taking lithium [Lithobid] for several years and has not been evaluated by a provider for over a year. Besides obtaining a lithium level, the nurse caring for this patient will anticipate orders for which laboratory tests?

A) Calcium level
B) Complete blood count with differential
C) Liver function tests
D) Renal function tests
E) Serum potassium
F) Thyroid function tests

Accepted Answer

Patients taking lithium can develop a mild, reversible leukocytosis, so annual CBC evaluation with differential is recommended. Chronic lithium use is associated with degenerative changes in the kidneys, so renal function should be assessed annually. Lithium can reduce the incorporation of iodine into thyroid hormone and can inhibit thyroid secretion; therefore, thyroid hormone and thyroid-stimulating hormone (TSH) levels should be measured annually. Lithium is affected by sodium levels but not by calcium or potassium levels. Because lithium is excreted by the kidneys, hepatic function tests are not indicated.

Question 5

A patient with bipolar disorder takes lamotrigine [Lamictal]. Which statement by the patient would prompt the nurse to hold the drug and notify the prescriber for further assessment?&#10;A) &#34;I get a little dizzy sometimes.&#34;&#10;B) &#34;I had a headache last week that lasted for about an hour.&#34;&#10;C) &#34;I've broken out in a rash on my chest and back.&#34;&#10;D) &#34;Last night I woke up twice with a bad dream.&#34;

Accepted Answer

Evidence of a rash in a patient taking lamotrigine requires further assessment, because this may indicate the development of Stevens-Johnson syndrome. Although dizziness and headaches are side effects of lamotrigine, they are not potentially life threatening. A bad dream is not necessarily related to the lamotrigine.

Question 6

A patient with bipolar disorder has frequent manic episodes alternating with depressive episodes. The prescriber orders risperidone [Risperdal] in addition to the lithium [Lithobid] that the patient is already taking. The patient asks the nurse why another drug is needed. The nurse will tell the patient that the risperidone is used to:

A) elevate mood during depressive episodes.
B) help control symptoms during manic episodes.
C) manage tremors associated with lithium use.
D) prevent recurrence of depressive episodes.

Accepted Answer

Risperidone is an antipsychotic often used in conjunction with lithium to help manage symptoms during manic episodes, regardless of whether psychotic symptoms occur. Risperidone does not elevate mood and is not used during depressive episodes. It is not used to counter side effects associated with lithium. It does not prevent recurrence of depressive episodes.

Question 7

A patient with bipolar disorder who wants to minimize the need for drug therapy asks the nurse what else can be done to treat the disorder. The nurse will recommend which measures?&#10;A) Electroconvulsive therapy&#10;B) Moderate use of alcohol to reduce stress&#10;C) Psychotherapy&#10;D) Regular sleep and exercise&#10;E) Using a chart to monitor mood changes

Accepted Answer

BPD should be treated with a combination of drugs and adjunctive psychotherapy, because drug therapy alone is not optimal. Other measures, such as regular sleep and exercise and recognizing early symptoms of mood change, help minimize extreme mood swings. Electroconvulsive therapy is effective, but it is not the first-choice treatment; it is reserved for patients who have not responded to other therapies. Avoidance of alcohol is recommended.

Question 8

A patient recently was diagnosed with bipolar disorder. The patient, who has a history of seasonal allergies, is an athlete who participates in track. The nurse is teaching the patient about lithium [Lithobid], which the prescriber has just ordered. Which statement by the patient indicates the need for further teaching?

A) "I can continue to use ibuprofen as needed for muscle pain."
B) "I should drink extra fluids before and during exercise."
C) "I should not use antihistamines while taking lithium."
D) "I should report muscle weakness and tremors to my provider."

Accepted Answer

Because nonsteroidal anti-inflammatory drugs (NSAIDs) can increase lithium levels as much as 60%, they should not be used by patients taking lithium. Aspirin does not have this effect. Lithium induces polyuria in 50% to 70% of patients, so patients should be advised to drink extra fluids, especially during exercise. Antihistamines have anticholinergic effects, which cause urinary hesitancy; this can be uncomfortable when patients experience the polyuria associated with lithium use. Muscle weakness and tremors can occur with lithium; tremors can be treated with beta blockers or by altering the lithium regimen.

Question 9

A patient is admitted to a hospital for treatment for first-time symptoms of mania and is exhibiting euphoric mania. Which medication will the provider order?&#10;A) Lithium [Lithobid]&#10;B) Olanzapine [Zyprexa]&#10;C) Risperidone [Risperdal]&#10;D) Divalproex sodium [Valproate]

Accepted Answer

In almost all cases of mania, divalproex sodium is the drug of choice, except for euphoric mania symptoms. Lithium is used to treat euphoric mania. Olanzapine and risperidone are used to treat other symptoms associated with BPD.

Question 10

A patient who has recently begun taking carbamazepine [Equetro] for bipolar disorder reports having vertigo and headaches. Which action by the nurse is appropriate?&#10;A) Ask the provider whether another medication can be used for this patient, because the patient is showing signs of toxicity.&#10;B) Contact the provider to request a complete blood count (CBC) to evaluate for other, more serious side effects.&#10;C) Reassure the patient that these effects occur early in treatment and will resolve over time.&#10;D) Review the patient's chart for cytochrome P450 enzymes to see whether an increased dose is needed.

Accepted Answer

Carbamazepine can cause several neurologic side effects early in treatment, including vertigo and headaches. These resolve with continued drug use. These side effects are not related to drug toxicity. A CBC should be obtained at baseline and periodically thereafter. Carbamazepine can cause changes in hematologic laboratory values. The side effects reported by this patient are not associated with hematologic side effects. Carbamazepine induces cytochrome P450 enzymes and can accelerate its own metabolism, which would reduce the amount of drug and decrease side effects, so an increased dose is not appropriate.

Question 11

The spouse of a patient with bipolar disorder (BPD) tells the nurse that the patient will not stay on the lithium ordered by the provider longer than 1 or 2 months at a time. The nurse understands that adherence to medication regimens in patients with BPD is problematic and will tell the spouse:

A) "During manic episodes, many patients don't see the benefit of prophylactic medications."
B) "Increased gastrointestinal side effects occur over time and reduce compliance."
C) "Long-term use of lithium causes memory impairment, causing patients to forget to take their medications."
D) "Patients who are depressed do not want to take their medications."

Accepted Answer

The answer of The spouse of a patient with bipolar...

Deck 33: Drugs for Bipolar Disorder