Chapter 33: Drugs for Bipolar Disorder

Chapter 33: Drugs for Bipolar Disorder

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

1. A nurse is reviewing a patient’s laboratory findings prior to medication administration. The most recent serum lithium level is 2.2 mEq/L and was drawn yesterday. The patient takes 300 mg of lithium carbonate 4 times a day. Which of the following is the nurse’s most appropriate action?

a.	Administer the drug as prescribed.
b.	Recognize that the dose is subtherapeutic.
c.	Administer half of the dose.
d.	Hold the next dose and notify the prescriber.

 

 

ANS:   D

The lithium level is toxic, therefore the dose should be held and the prescriber notified.

The drug should not be administered as prescribed, because it will increase the toxicity.

The dose is not subtherapeutic; rather, the patient’s lithium level indicates toxicity.

It is up to the prescriber to change the dosage ordered. Changing the dosage without discussing it with the prescriber is a violation of the Nurse Practice Act, because nurses do not prescribe.

 

DIF:    Cognitive Level: Application             REF:    p. 363

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

 

2. A nurse is discussing lithium levels with another nurse. As they review the laboratory findings, they discover a lithium level of 0.6 mEq/L. Which statement made by one of the nurses best demonstrates an understanding of lithium levels?

a.	The patient’s plasma level is below the toxic level of 3 mEq/L and is considered therapeutic.
b.	The patient’s plasma level exceeds 0.5 mEq/L and is therefore toxic.
c.	The patient’s plasma level is between 0.4 and 1 mEq/L and is considered therapeutic.
d.	The patient’s plasma level is below the 2.5 mEq/L level that would indicate toxicity.

 

 

ANS:   C

For maintenance therapy, lithium levels should range from 0.4 to 1 mEq/L.

Lithium toxicity is defined as a level above 1.5 mEq/L.

A lithium level of 0.5 mEq/L is considered therapeutic.

Lithium toxicity is defined as a level above 1.5 mEq/L.

 

DIF:    Cognitive Level: Comprehension      REF:    p. 363

TOP:    Nursing Process: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

 

3. A patient recently diagnosed with bipolar disorder has been admitted to the unit with severe mania. Home medications include valproic acid (Depakene). An antipsychotic medication is added to the medication regimen as a STAT order. After the new medication is explained to the patient, he states, “I’m not crazy. Why am I receiving this antipsychotic medication?” What is the nurse’s most appropriate response to the patient?

a.	“The antipsychotic drug reduces your manic episode.”
b.	“The antipsychotic will help control symptoms during severe manic episodes.”
c.	“The antipsychotic allows higher levels of valproic acid without signs of toxicity.”
d.	“The antipsychotic is actually the primary drug therapy for bipolar disorder.”

 

 

ANS:   B

In patients with bipolar disorder, antipsychotic drugs are given to help control symptoms during severe manic episodes, even if psychotic symptoms are absent. The antipsychotic drugs usually are given in combination with a mood stabilizer.

The antipsychotic drug addresses the symptoms, not the duration, of the manic episode.

Antipsychotic medications do not affect valproic acid levels.

Antipsychotics are not the primary therapy for bipolar disorder.

 

DIF:    Cognitive Level: Application             REF:    p. 360

TOP:    Nursing Process: Evaluation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

4. A patient with a history of bipolar disorder has been on lithium therapy for 3 years. The patient begins to develop hypertension. Which class of drugs, if given concurrently with lithium, would result in an adverse drug-to-drug interaction?

a.	ACE inhibitors
b.	Vasodilators
c.	Diuretics
d.	Calcium channel blockers

 

 

ANS:   C

Diuretics promote sodium loss and thereby can increase the risk of lithium toxicity. Toxicity occurs because in the presence of low sodium, renal excretion of lithium is reduced, which causes lithium levels to rise.

There are no adverse drug-to-drug interactions between lithium and ACE inhibitors, vasodilators, and calcium channel blockers, therefore any of them can be given to treat the patient’s hypertension.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 364

TOP:    Nursing Process: Evaluation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential