Deck 16: Antimanic Drugs

Question 1

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:

A) sertraline (Zoloft).
B) phenytoin (Dilantin).
C) benztropine (Cogentin).
D) divalproex (Depakote).

Answer 1

divalproex (Depakote).

Question 2

Select the 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

Answer 2

Excreted by the kidneys

Question 3

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

Answer 3

October 8

Question 4

Which patient should be assessed most carefully for evidence of lithium toxicity? A patient taking lithium ( Lithobid ) and:

A) indomethacin ( Indocin ).
B) risperidone ( Risperdal ).
C) ziprasidone ( Geodon ).
D) olanzapine ( Zyprexa ).

Question 5

A patient who is to be discharged on a maintenance dose of lithium should be taught to report which symptoms/signs immediately?

A) Large amounts of dilute urine and blurred vision
B) Nasal congestion and dry mouth
C) Muscle stiffness and anorexia
D) Drowsiness and sweating

Question 6

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 7

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 8

A patient has taken lithium ( Lithobid ) 300 mg three times daily for 1 week. The patient reports the presence of fine hand tremors and thirst. Select the nurse's best action.

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 9

A patient's serum lithium level is 1.8 mEq/L. Select the nurse's priority action.

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 10

For patients with bipolar disorder, valproate anticonvulsants are likely to help control rapid-cycling episodes by:

A) inhibition of kindling activity in the brain.
B) decreasing availability of norepinephrine.
C) increasing dopamine levels at synapses.
D) decreasing GABA metabolism.

Question 11

Maintenance of a therapeutic serum level of lithium is dependent on adequate serum levels of:

A) sodium.
B) chloride.
C) potassium.
D) magnesium.

Question 12

For 2 weeks a patient has taken lithium (Lithane) and risperidone (Risperdal) daily for mania. The patient now reports diarrhea, vomiting, and blurred vision. The nurse observes a coarse hand tremor. Select the nurse's priority action.

A) Administer a PRN dose of benztropine (Cogentin) 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.

Question 13

The nurse scheduling the serum lithium level blood draw for a patient should 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 14

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

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 15

A patient has mild lithium toxicity with a serum level of 1.6 mEq/L. Which assessment findings are most likely?

A) Coarse hand tremor, coordination problems, and dizziness
B) Elevated white blood cell count, temperature, and blood pressure
C) Orthostatic hypotension, fainting, and nystagmus
D) Restlessness, shuffling gait, and tics

Question 16

Which patient would require careful assessment for toxic effects of lithium? The individual taking lithium and:

A) hydrochlorothiazide (HCTZ).
B) lorazepam (Ativan).
C) clozapine (Clozaril).
D) oxazepam (Serax).

Question 17

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 18

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 ( Zyprexa ) to this patient's drug regime can be helpful as a mood stabilizer.

Question 19

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 ( Lithobid )
B) Amitriptyline ( Elavil )
C) Divalproex ( Depakote )
D) Diphenhydramine ( Benadryl )

Question 20

A patient has taken lithium (Lithane) 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 21

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 (Abilify)
C) Lamotrigine (Lamictal)
D) Gabapentin (Neurontin)
E) Carbamazepine (Tegretol)

Question 22

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 23

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

A) Lithium
B) Valproate ( Depakote )
C) Quetiapine ( Seroque l)
D) Carbamazepine ( Tegretol )