Chapter 33: Drugs for Bipolar Disorder

Chapter 33: Drugs for Bipolar Disorder

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. 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.

 

 

ANS:  B

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.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   p. 365 | pp. 369-370

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

2. 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.”

 

 

ANS:  A

Patients experiencing manic symptoms often do not see anything wrong with their thinking and behavior and therefore do not believe they need treatment. Moreover, these symptoms are often enjoyable, and they do not want them to stop. Gastrointestinal side effects and central nervous system (CNS) effects of memory impairment subside over time and would diminish with long-term treatment. Patients are usually most uncomfortable during depressive episodes, and it is during these episodes that they often seek treatment.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   pp. 366-367 | p. 371

TOP:   Nursing Process: Diagnosis

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

3. 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].

 

 

ANS:  A

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.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   pp. 366-367

TOP:   Nursing Process: Evaluation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

4. 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.”

 

 

ANS:  A

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.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   pp. 366-367

TOP:   Nursing Process: Implementation

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