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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.
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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.
A nurse is developing a presentation for families who have members that have been diagnosed with bipolar disorders. When describing this condition to the group, which of the following would the nurse most likely include?
- A. As the person ages, the episodes tend to decrease over time.
- B. Environmental stressors are a key cause of these disorders.
- C. The risk for suicide is high with either depression or mania.
- D. Risk-taking behaviors are more common with a depressive episode.
Correct Answer: C
Rationale: Bipolar disorder carries a high suicide risk during both depressive and manic episodes (C), due to despair in depression and impulsivity in mania. Episodes often persist or worsen with age (A), stressors (B) are triggers but not primary causes, and risk-taking is more common in mania, not depression (D).
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.
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.
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.