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A client is to receive lithium therapy as part of the treatment plan for bipolar disorder. When reviewing the client?s medication history, which agents would alert the nurse to the possibility that a decrease in lithium dosage may be needed? Select all that apply.
- A. Lisinopril
- B. Hydrochlorothiazide
- C. Indomethacin
- D. Caffeine
- E. Aspirin
Correct Answer: B,C
Rationale: Hydrochlorothiazide (B) and indomethacin (C) reduce lithium excretion, increasing lithium levels and requiring potential dose reduction to avoid toxicity. Lisinopril (A), caffeine (D), and aspirin (E) have minimal impact on lithium pharmacokinetics.
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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.
A client who is receiving lithium comes to the clinic for an evaluation. During the visit, the client reports a fine hand tremor. Which action by the nurse would be most appropriate?
- A. Immediately obtain a specimen to determine the client?s blood drug level.
- B. Suggest that the client take the medication with meals or snacks.
- C. Assist the client in minimizing exposure to stressors.
- D. Encourage the client to elevate the affected hand on a pillow.
Correct Answer: B
Rationale: A fine hand tremor is a common, benign side effect of lithium. Taking the medication with meals or snacks (B) can reduce gastrointestinal irritation and tremor severity. Immediate blood testing (A) is unnecessary unless toxicity is suspected, stress reduction (C) is less relevant, and elevation (D) is ineffective.
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.
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 is receiving divalproex sodium as part of the treatment plan. When monitoring the client?s blood level for this drug, which level would alert the nurse to the need to change the dosage?
- A. 30 ng/mL
- B. 55 ng/mL
- C. 75 ng/mL
- D. 115 ng/mL
Correct Answer: D
Rationale: The therapeutic range for divalproex sodium (valproic acid) is 50?100 µg/mL (often reported as ng/mL in some contexts). A level of 115 ng/mL (D) is above this range, indicating potential toxicity and the need for dosage reduction. Levels of 30, 55, and 75 ng/mL (A, B, C) are below or within the therapeutic range.