Question 1

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

A)   Atactic toxicity
B)   Uremic syndrome
C)   Diabetes insipidus
D)   Interstitial nephritis C

Question 2

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

A)   October 3
B)   October 8
C)   October 21
D)   November 1 B

Question 3

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

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. C

Question 4

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

Accepted Answer

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 5

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

Accepted Answer

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

Question 6

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

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

Question 7

Which assessment findings validate that a patient with bipolar disorder is experiencing mania? Select all that apply.

Accepted Answer

A)   Pacing
B)   Agitation
C)   Drowsiness
D)   Delusional thoughts
E)   Psychomotor retardation

Question 8

Select the accurate information about the pharmacokinetics of lithium.

Accepted Answer

A)   Wide therapeutic index
B)   Excreted by the kidneys
C)   Poorly absorbed in the gastrointestinal (GI)  tract
D)   Provides immediate relief of symptoms

Question 9

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

Accepted Answer

A)   before the first morning dose.
B)   2 hours after the morning dose.
C)   at bedtime.
D)   any time during the day.

Question 10

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

Accepted Answer

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

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

Accepted Answer

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 12

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

Accepted Answer

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

Question 13

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

Accepted Answer

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

Question 14

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

Accepted Answer

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

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

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

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

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 17

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

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

Question 18

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

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 19

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

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 20

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

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.

Exam 16: Antimanic Drugs