Question 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:

Accepted Answer

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. B

Question 2

A patient with bipolar disorder who is taking divalproex sodium [Valproate] has just been admitted to the hospital. During the admission assessment,the patient tells the nurse about recent suicidal ideation. The nurse observes several areas of bruising over soft tissue areas and notes a weight gain of 10 pounds since the last admission 1 year ago. What will the nurse do?

Accepted Answer

A)   Ask the patient whether the bruises are self-inflicted.
B)   Contact the provider to report these findings.
C)   Give the patient information about weight loss.
D)   Request an order for an increased dose to help with depressive symptoms. B

Question 3

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:

Accepted Answer

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." A

Question 4

A patient with bipolar disorder is admitted to the hospital. The patient has been taking lithium [Lithobid] for several years and has not been evaluated by a provider for over a year. Besides obtaining a lithium level,the nurse caring for this patient will anticipate orders for which laboratory tests? (Select all that apply.)

Accepted Answer

A)   Calcium level
B)   Complete blood count with differential
C)   Liver function tests
D)   Renal function tests
E)   Serum potassium F)  Thyroid function tests

Question 5

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?

Accepted Answer

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].

Question 6

A patient is admitted to a hospital for treatment for first-time symptoms of mania and is exhibiting euphoric mania. Which medication will the provider order?

Accepted Answer

A)   Lithium [Lithobid]
B)   Olanzapine [Zyprexa]
C)   Risperidone [Risperdal]
D)   Divalproex sodium [Valproate]

Question 7

A patient with bipolar disorder who wants to minimize the need for drug therapy asks the nurse what else can be done to treat the disorder. The nurse will recommend which measures? (Select all that apply.)

Accepted Answer

A)   Electroconvulsive therapy
B)   Moderate use of alcohol to reduce stress
C)   Psychotherapy
D)   Regular sleep and exercise
E)   Using a chart to monitor mood changes

Question 8

A patient with bipolar disorder has been taking lithium [Lithobid] for several years. The patient has developed a goiter,and serum tests reveal hypothyroidism. What will the nurse expect the provider to order for this patient?

Accepted Answer

A)   Administration of levothyroxine
B)   Increasing the lithium dose
C)   Iodine supplements
D)   Referral to an endocrinologist

Question 9

A patient with bipolar disorder takes lamotrigine [Lamictal]. Which statement by the patient would prompt the nurse to hold the drug and notify the prescriber for further assessment?

Accepted Answer

A)   "I get a little dizzy sometimes."
B)   "I had a headache last week that lasted for about an hour."
C)   "I've broken out in a rash on my chest and back."
D)   "Last night I woke up twice with a bad dream."

Question 10

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?

Accepted Answer

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."

Question 11

A patient who has recently begun taking carbamazepine [Equetro] for bipolar disorder reports having vertigo and headaches. Which action by the nurse is appropriate?

Accepted Answer

A)   Ask the provider whether another medication can be used for this patient, because the patient is showing signs of toxicity.
B)   Contact the provider to request a complete blood count (CB
C)   to evaluate for other, more serious side effects.
C)   Reassure the patient that these effects occur early in treatment and will resolve over time.
D)   Review the patient's chart for cytochrome P450 enzymes to see whether an increased dose is needed.

Exam 33: Drugs for Bipolar Disorder

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: