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A client diagnosed with bipolar disorder and experiencing mania is admitted to the inpatient psychiatric setting. During the acute phase of mania, which medication would the nurse expect to most likely administer?
- A. Lithium carbonate (Lithium)
- B. Haloperidol lactate (Haldol)
- C. Fluoxetine (Prozac)
- D. Paroxetine (Paxil)
Correct Answer: B
Rationale: Haloperidol (B), a typical antipsychotic, is commonly used in acute mania to rapidly control severe agitation, impulsivity, and psychotic symptoms due to its fast-acting nature. Lithium (A) is effective for long-term mood stabilization but slower in acute mania. Fluoxetine (C) and paroxetine (D), SSRIs, are used for depression, not mania, and may worsen manic symptoms.
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A client?s blood level of carbamazepine is increased. When reviewing the client?s medication history, which of the following would alert the nurse to a possible interaction?
- A. Phenobarbital
- B. Primidone
- C. Phenytoin
- D. Diltiazem
Correct Answer: D
Rationale: Diltiazem (D), a calcium channel blocker, inhibits the metabolism of carbamazepine, increasing its blood levels and risking toxicity. Phenobarbital (A), primidone (B), and phenytoin (C) are enzyme inducers that typically decrease carbamazepine levels.
The nurse is assessing a client with bipolar disorder who is experiencing mania. The client states, I?m just so beautiful. Everyone just stops and stares at how gorgeous I am. Men constantly want to have sex with me. The nurse interprets these statements as indicative of which type of mood?
- A. Irritable
- B. Elevated
- C. Expansive
- D. Euphoric
Correct Answer: C
Rationale: Expansive mood (C) in mania is characterized by grandiose, exaggerated self-perception, as seen in the client?s statements about beauty and desirability. Irritable mood (A) involves agitation, elevated mood (B) is less specific, and euphoric mood (D) reflects intense happiness without the grandiose quality.
A client with bipolar disorder has had a history of multiple episodes and states, I?m so frustrated with what?s happened because of these episodes. Which of the following would the nurse encourage to help support this client?s recovery?
- A. Codependence
- B. Hope
- C. Self-control
- D. Independent decision making
Correct Answer: B
Rationale: Encouraging hope (B) fosters resilience and motivation for recovery in bipolar disorder, countering frustration. Codependence (A) is unhealthy, self-control (C) is important but less primary, and independent decision-making (D) may be impaired during episodes.
A client is brought to the emergency department by his brother. The client has a history of bipolar disorder for which he is taking divalproex. The brother reports that he watched his brother take the medication about 2 hours ago. He stated, A little while ago, he got very disoriented and agitated. The nurse suspects toxicity based on assessment of which of the following? Select all that apply.
- A. Tachypnea
- B. Bradycardia
- C. Hypotension
- D. Nystagmus
- E. Vomiting
Correct Answer: D,E
Rationale: Divalproex toxicity may present with nystagmus (D) and vomiting (E), alongside disorientation and agitation, due to neurological and gastrointestinal effects. Tachypnea (A), bradycardia (B), and hypotension (C) are less specific to valproate toxicity.
A client with bipolar disorder has a lithium drug level of 1.2 mEq/L. Which of the following would the nurse expect to assess? Select all that apply.
- A. Metallic taste
- B. Ataxia
- C. Diarrhea
- D. Slurred speech
- E. Fasciculations
- F. Muscle weakness
Correct Answer: A,C,F
Rationale: A lithium level of 1.2 mEq/L is within the therapeutic range (0.6?1.2 mEq/L) but at the upper limit, where mild side effects like metallic taste (A), diarrhea (C), and muscle weakness (F) may occur. Ataxia (B), slurred speech (D), and fasciculations (E) are more typical of toxicity (>1.5 mEq/L).