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:

Accepted Answer

Valproates (like divalproex) are considered first-line agents in the treatment of mania. Valproates are especially effective in the treatment of rapid-cycling bipolar disorders. None of the other drugs mentioned are indicated for treatment of manic states.

Question 2

Select the accurate information about the pharmacokinetics of lithium.

Accepted Answer

Lithium is excreted via the kidneys. The other options are incorrect. The nursing implication is that individuals with renal damage should not be given lithium or should be monitored closely if lithium must be administered.

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?

Accepted Answer

Lithium must be given for 7 to 10 days before clinical improvement is achieved.

Question 4

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

Accepted Answer

The combination of lithium and indomethacin is more likely to produce lithium toxicity than lithium and any other drug listed. Nonsteroidal antiinflammatory drugs reduce renal elimination of lithium, thereby increasing serum lithium levels.

Question 5

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

Accepted Answer

Patients must be taught the difference between symptoms of minor toxicity and those of major toxicity, such as giddiness, tinnitus, blurred vision, dilute urine, and ataxia.

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?

Accepted Answer

Symptoms of diabetes insipidus include voiding large amounts of dilute urine many times a day. Nephrogenic diabetes insipidus is caused by the inhibition of the cyclic adenosine monophosphate (cAMP)-dependent action of the antidiuretic hormone on the distal-tubule collecting duct cells. This problem is sometimes associated with lithium therapy. The symptoms detailed are not consistent with any of the other options.

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?

Accepted Answer

Lithium has a short half-life, high toxicity, and rapid renal excretion, so multiple daily doses are required. The other statements are incorrect or are not factors considered in 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.

Accepted Answer

These side effects are common and often decrease or disappear over time with continued lithium therapy. Dietary sodium should remain unchanged to keep the lithium level stable. These side effects do not suggest the need for determination of a lithium level. Lithium should not be withheld, because these are not toxic symptoms.

Question 9

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

Accepted Answer

A serum level of 1.8 mEq/L is higher than desirable. It suggests that the patient might be experiencing toxic effects. Clinical assessment should be conducted. A nurse should not rely entirely on laboratory tests but should make careful clinical assessments. None of the other options would be appropriate.

Question 10

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

Accepted Answer

The effectiveness of valproate anticonvulsants for management of bipolar disorder may be related to inhibition of kindling activity, which stabilizes neuronal activity and increases the threshold of stimulation necessary for cell firing. There is no current research to support any of the other options.

Question 11

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

Accepted Answer

It is believed that lithium substitutes for the sodium (Na) ion in neurons. Reductions or increases in Na intake affect the serum lithium level. The other options have not been identified as critical to lithium level.

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.

Accepted Answer

The symptoms the patient is experiencing are consistent with a serum lithium level above the therapeutic level. The nurse should withhold the next dose, arrange for a stat serum lithium level determination, and notify the health care provider. Risperidone can be continued because this is not a drug-drug interaction problem. Administration of benztropine is inappropriate because these are not EPSE symptoms. Reassurance would be appropriate, but the patient should not be told that these symptoms will decrease with time and continued dosing.

Question 13

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

Accepted Answer

Lithium levels should be drawn 8 to 12 hours after the last dose, making premedication morning blood draws optimal.

Question 14

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

Accepted Answer

Regular evaluation of serum lithium levels will be part of the patient's aftercare for as long as he or she takes lithium. The other items are not included in discharge teaching for a patient taking lithium.

Question 15

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

Accepted Answer

The symptoms of mild toxicity are often related to central nervous system disturbance. Difficulty concentrating might also be noted. Mild GI disturbances are also seen. The other options are not symptoms of early lithium toxicity.

Question 16

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

Accepted Answer

Hydrochlorothiazide is a diuretic used to treat hypertension. The diuretic effect would increase serum concentrations of lithium, potentially producing toxicity. Benzodiazepine and antipsychotic drugs are commonly used concurrently with lithium to control mania.

Question 17

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

Accepted Answer

Because lithium is excreted via the kidneys, renal system function must be adequate if lithium toxicity is to be prevented. Functioning of the other systems has no direct relationship to lithium therapy.

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?

Accepted Answer

Olanzapine, an atypical antipsychotic, has proven effective in controlling mania and acting as a mood stabilizer to reduce depression following treatment for acute mania. The other statements are incorrect or irrelevant.

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?

Accepted Answer

The valproates are first-line drugs for treatment of manic episodes associated with bipolar disorder or resulting from general medical problems. They have a rapid onset and are well tolerated. Lithium takes 7 to 10 days to modify symptoms. Diphenhydramine and amitriptyline have sedative side effects but would not stabilize the mania.

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?

Accepted Answer

Therapeutic serum lithium levels are 0.6 to 1.2 mEq/L. The other options are either too low or too high. Serum levels above 1.5 mEq/L can cause symptoms of toxicity.

Quiz 16: Antimanic Drugs