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A client with bipolar disorder having experienced a depressive episode is prescribed lamotrigine. After teaching the client about this medication, the nurse determines that the teaching was successful when the client states which of the following?
- A. I need to notify my physician if I develop a skin rash.
- B. I need to have my blood tested about once a month.
- C. I need to watch how much salt I use every day.
- D. This drug can affect my liver function.
Correct Answer: A
Rationale: Lamotrigine (A) carries a risk of serious skin rashes, such as Stevens-Johnson syndrome, requiring immediate reporting. Blood testing (B) is not routine for lamotrigine, salt intake (C) is irrelevant, and liver function (D) is less commonly affected compared to other mood stabilizers.
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The nurse is preparing a teaching plan for the family of a client who has been diagnosed with bipolar disorder. After teaching them about potential indicators for relapse, the nurse determines that the teaching was effective when they identify which of the following as suggesting mania? Select all that apply.
- A. Avoiding people
- B. Sleeping more than usual
- C. Talking faster than usual
- D. Being hungry all the time
- E. Reading several books at once
Correct Answer: C,E
Rationale: Mania is characterized by rapid speech (C) and multitasking behaviors like reading multiple books simultaneously (E), reflecting increased energy and distractibility. Avoiding people (A) and sleeping more (B) suggest depression, and constant hunger (D) is not specific to mania.
The nurse is reviewing the medical record of a client with bipolar disorder. The nurse would most likely expect to find a history of which of the following?
- A. Panic disorder
- B. Schizophrenia
- C. Delusional disorder
- D. Posttraumatic stress disorder
Correct Answer: A
Rationale: Panic disorder (A) commonly co-occurs with bipolar disorder due to shared neurobiological pathways and anxiety?s prevalence in mood disorders. Schizophrenia (B) and delusional disorder (C) are psychotic disorders with distinct features, and PTSD (D) is less commonly associated with bipolar disorder.
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.
A client asks the nurse if he needs to alter any of his activities because he is taking lithium carbonate. Which of the following responses would be most appropriate?
- A. Increase your salt intake if an activity causes you to perspire heavily.
- B. Wear sunscreen when you are going to be outdoors in the summer time.
- C. Drink less fluid than usual now because you are taking this drug.
- D. No changes are necessary for strenuous activities you do outdoors.
Correct Answer: A
Rationale: Lithium levels can increase to toxic levels with dehydration from heavy perspiration, as sodium loss affects lithium excretion. Increasing salt intake (A) during such activities helps maintain safe lithium levels. Sunscreen (B) is unrelated, reducing fluid (C) risks toxicity, and no changes (D) ignores the risk of dehydration.
A nurse is preparing to administer medications to a female client with bipolar disorder who is experiencing acute mania. Which of the following would be most appropriate for the nurse to do?
- A. Tell the client firmly that she must take her medication.
- B. Allow the client to participate in the treatment decision.
- C. Restrain the client before administering the medication.
- D. Notify the physician about the client?s refusal of the medication.
Correct Answer: B
Rationale: Allowing the client to participate in treatment decisions (B) fosters autonomy and therapeutic alliance, appropriate unless the client is too impaired to decide. Firm insistence (A) may escalate agitation, restraint (C) is a last resort, and notifying the physician (D) assumes refusal prematurely.