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The nurse is caring for a client on long-standing lithium therapy for a bipolar disorder. Which component of drug therapy administration would require follow-up?
- A. A lab result showing serum lithium level of 1 mEq
- B. Client states, 'I use salt on my potato salad.'
- C. Client states, 'I take my medication each morning.'
- D. Client states, 'I only take lithium after breastfeeding.'
Correct Answer: D
Rationale: Follow-up would be required if a client reported breastfeeding and taking lithium. Lithium administered to infants through breast milk can cause toxicity; thus, breastfeeding mothers should avoid use. None of the other options require further intervention.
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The nurse is caring for a client who is receiving valproic acid. What clinical manifestation should the nurse periodically monitor for?
- A. Hepatotoxicity
- B. Hypertensive crisis
- C. Orthostatic hypotension
- D. Hyper alertness
Correct Answer: A
Rationale: The nurse should closely monitor a client on valproic acid, Depakote or Depakene, for hepatotoxicity. Frequent liver function tests and serum ammonia concentrations may be ordered. When a monoamine oxidase inhibitor is mixed with foods containing tyramine, clients are likely to develop a potentially fatal hypertensive crisis, not when taking valproic acid. Risk for orthostatic hypotension from psychotropic drugs is increased in older adults because of decreased functioning of the blood pressure-regulating mechanism. Some clients administered valproic acid experience sedation and ataxia.
The nurse is completing a medication history for a client diagnosed with bipolar disorder. When assessing the medications, which medication classification is noted as an adjunct to lithium therapy?
- A. Antidiabetics
- B. Antihypertensives
- C. Anticonvulsants
- D. Antianginals
Correct Answer: C
Rationale: Anticonvulsant therapy may be co-prescribed for a brief period to sedate the client and relieve bizarre thought processes faster than monotherapy with lithium. Anticonvulsants enhance the action of gamma-aminobutyric acid (GABA) in much the same way that benzodiazepines reduce anxiety and they are believed to inhibit glutamate.
A nurse is caring for a client newly admitted to the emergency department. The nurse obtains the following vital signs: temperature, 101.6?°F; pulse rate, 92 beats/minute; respiratory rate, 28 breaths/minute; and blood pressure, 160/90 mmHg. The client appears disheveled and disoriented. Upon physical assessment, the nurse notes restlessness and muscle spasms with rigidity. Which documented finding in the health history is evaluated as a potential causative factor?
- A. Mixing antibiotics with psychotherapeutic medications
- B. Changing from one psychotherapeutic to another
- C. Initiating psychotherapeutic drug therapy
- D. Combining dairy products with psychotherapeutics
Correct Answer: B
Rationale: Serotonin syndrome is a potentially life-threatening condition that results from elevated levels of serotonin in the blood secondary to drug therapy. When reviewing the client's medication history and relating the symptoms assessed, the nurse relates the client's status with changing from one psychotherapeutic to another psychotherapeutic medication as a potential causative factor. There is no correlation from the client symptoms to combining antibiotic therapy with psychotherapeutics, initiating psychotherapeutics, or combining dairy products with psychotherapeutics.
Anticonvulsants enhance which neurotransmitter in clients diagnosed with bipolar disorder?
- A. Serotonin
- B. Dopamine
- C. GABA
- D. Acetylcholine
Correct Answer: C
Rationale: Anticonvulsants may achieve their therapeutic effects by enhancing the action of GABA in much the same way that benzodiazepines reduce anxiety. Anticonvulsants do not enhance serotonin, dopamine, or acetylcholine.
The nurse is caring for a client who reports 'not feeling very well.' When asking the client for specific symptoms, the client is vague with details but does state feeling better when the sun is shining. With this information, the nurse would document which disorder as a possibility?
- A. Major depression
- B. Seasonal affective disorder
- C. Bipolar disorder
- D. Reactive depression
Correct Answer: B
Rationale: The nurse would document seasonal affective disorder as a possibility based on the comments of feeling better when there is sunlight. The other options do not relate to sunlight or time of the year.