Ch 20: Bipolar

Which of the following are the most common comorbid conditions associated with bipolar disorder? A. Eating disorders B. Substance use C. Personality disorders D. Anxiety disorders E. Schizophrenia

Substance use, Anxiety disorders

Carbamazepine black box warning -skin rash -liver damage -agranulocytosis -birth defects

agranulocytosis & aplastic anemia

a pt w bipolar disorder is experiencing a depressive episode. what would the nurse expect to prescribe?

lamotrigine

Mainstays of pharmacology for pt w/ bipolar disorder? -divalproex -lithium carbonate -carbamazepine -lamotrigine -fluoxetine

-divalproex -lithium carbonate -carbamazepine -lamotrigine

which substances may increase serum lithium levels? SATA -ibuprofen -furosemide -alcohol -fluoxetine -haloperidol

-furosemide -alcohol -fluoxetine

which could be a cause of lithium toxicity? SATA -hypernatremia -hot climate -vomiting -strenous exercise -diarrhea

-hot climate -vomiting -strenous exercise -diarrhea

a pt is taking carbamazepine for bipolar disorder. Nurse obtains CBC before starting therapy, when should next CBC be drawn

1 month CBC taken = before starting, 1 month, 3 months, 6 months, then yearly

Both valproate and carbamazepine may be lethal if high doses are ingested, Toxic symptoms appear in 1 to 3 hours and include which of the following? A. Tinnitus B. Bradycardia C. Urinary Frequency D. Neuromuscular disturbances

D. Neuromuscular disturbances

A nurse is caring for a client diagnosed with bipolar disorder who has been prescribed divalproex. The nurse knows that the client should have which test completed before initiation of drug therapy? Thyroid level Cardiac enzymes White blood cell (WBC) count Liver function

Liver function

A client is exhibiting rapid shifts in mood. The nurse documents this as which of the following? a) mood lability b) expansive mood c) irritable mood d) elevated mood

a) mood lability

A client with bipolar disorder has a plasma lithium concentration of 2.7mE/L. Which finding would a nurse most likely assess in this client? Select all that apply. a) fasciculations b) tinnitus c) incoordination d) seizures e) nystagmus

a) fasciculations d) seizures e) nystagmus

which is a food that might incorporated into the plan of care for a client diagnosed in the manic phase of panic disorder -broccoli -bananas -spaghetti -steak

bananas

After educating a client with bipolar disorder on his prescribed lithium therapy, the nurse determines that additional education is needed when the client states which of the following? a) i need to avoid drinking any alcohol b) i need to cut back on my salt intake when it's really hot outside c) i need to report any problems with severe diarrhea or slurred speech d) i can use sugarless candies to help with any metallic taste

i need to cut back on my salt intake when it's really hot outside. Explanation: Clients should increase salt intake during periods of perspiration and periods of increased exercise and dehydration.

A nurse is working with a client diagnosed with bipolar disorder and his family on relapse prevention. Which information would the nurse encourage the family to include in their emergency plan? Select all that apply. a) information about other health problems b) treatment preferences c) past meds taken d) self-care strategies e) list of emergency contacts

info about other health problems, treatment preferences, list of emergency contacts.

which treatment of choice for persons who are severely psychotic

inpatient admission

a client w bipolar disorder is receiving divalproex. before admin, which test should be done? SATA -blood glucose concentration -urinalysis -platelet count -LFT -complete blood count

platelet count CBC LFT

A client with bipolar disorder is experiencing acute mania. The client is unable to sit still, moving from place to place. Medication therapy has been prescribed but not yet initiated. Which would the nurse include in the plan of care to meet the client's physical needs? a) instituting a sleep hygiene program b) providing high energy snacks c) encouraging frequent rest periods d) increasing environmental stimuli

providing high energy snacks.

a nurse is caring for a pt diagnosed w bipolar disorder. the pt is in manic episode. the nurse would be especially alert for

self injury

it is important for the client in acute mania receiving lithium to obtain blood conc. in which time frame -q 3 weeks -monthly -weekly -twice weekly

twice weekly = acute 2-3 months = uncomplicated maintenance