Mood Stabilization Medications
A client prescribed lithium carbonate (lithium) 300 mg QAM and 600 mg QHS enters the emergency department experiencing impaired consciousness, nystagmus, and arrhythmias. Earlier today the client had two seizures. Which serum lithium level would the nurse expect to assess? 1. 3.7 mEq/L. 2. 3.0 mEq/L. 3. 2.5 mEq/L. 4. 1.9 mEq/L.
1. Clients with a serum level greater than 3.5 mEq/L may show signs such as impaired consciousness, nystagmus, seizures, coma, oliguria/anuria, arrhythmias, myocardial infarction, or cardiovascular collapse.
A client is newly prescribed lithium carbonate (lithium). Which teaching point by the nurse takes priority? 1. "Make sure your salt intake is consistent." 2. "Limit your fluid intake to 2000 mL/day." 3. "Monitor your caloric intake because of potential weight gain." 4. "Get yourself in a daily routine to assist in avoiding relapse."
1. Lithium is similar in chemical structure to sodium, behaving in the body in much the same manner and competing with sodium at various sites in the body. If sodium intake is reduced, or the body is depleted of its normal sodium, lithium is reabsorbed by the kidneys, and this increases the potential for toxicity.
A client diagnosed with bipolar affective disorder is prescribed divalproex sodium (Depakote). Which of the following lab tests would the nurse need to monitor throughout drug therapy? Select all that apply. 1. Platelet count and bleeding time. 2. Aspartate aminotransferase (AST). 3. Fasting blood sugar (FBS). 4. Alanine aminotransferase (ALT). 5. Valproic acid level.
1. Platelet counts and bleeding times need to be monitored before and during therapy with divalproex sodium (Depakote) because of the potential side effects of blood dyscrasias and prolonged bleeding time. 2. Aspartate aminotransferase is a liver enzyme test that needs to be monitored before and during therapy with divalproex sodium (Depakote) because of the potential side effect of liver toxicity. 4. Alanine aminotransferase is a liver enzyme test that needs to be monitored before and during therapy with divalproex sodium (Depakote) because of the potential side effect of liver toxicity. 5. Divalproex sodium (Depakote) levels need to be monitored to determine therapeutic levels and assess potential toxicity.
Lithium carbonate (lithium) is to mania as clozapine (Clozaril) is to: 1. Anxiety. 2. Depression. 3. Psychosis. 4. Akathisia.
3. Clozapine (Clozaril), an atypical antipsychotic, is used to treat symptoms of thought disorders, such as, but not limited to, psychoses.
Which list contains medications that the nurse may see prescribed to treat clients diagnosed with bipolar affective disorder? 1. Lithium carbonate (lithium), loxapine (Loxitane), and carbamazepine (Tegretol). 2. Gabapentin (Neurontin), thiothixene (Navane), and clonazepam (Klonopin). 3. Divalproex sodium (Depakote), verapamil (Calan), and olanzapine (Zyprexa). 4. Lamotrigine (Lamictal), risperidone (Risperdal), and benztropine (Cogentin).
3. Divalproex sodium (Depakote), an anticonvulsant, and verapamil (Calan), a calcium channel blocker, are used in the long-term treatment of BPAD. Olanzapine (Zyprexa), an antipsychotic, has been approved by the Food and Drug Administration for the treatment of acute manic episodes.
A client diagnosed with bipolar affective disorder is prescribed carbamazepine (Tegretol). The client exhibits nausea, vomiting, and anorexia. Which is an appropriate nursing intervention at this time? 1. Stop the medication, and notify the physician. 2. Hold the next dose until symptoms subside. 3. Administer the next dose with food. 4. Ask the physician for a stat carbamazepine (Tegretol) level.
3. When clients prescribed carbamazepine (Tegretol) experience nausea, vomiting, and anorexia, it is important for the nurse to administer the medication with food to decrease these uncomfortable, but acceptable, side effects. If these side effects do not abate, other interventions may be necessary.
The nurse is evaluating lab test results for a client prescribed lithium carbonate (lithium). The client's lithium level is 1.9 mEq/L. Which nursing intervention takes priority? 1. Give next dose because the lithium level is normal for acute mania. 2. Hold the next dose, and continue the medication as prescribed the following day. 3. Give the next dose after assessing for signs and symptoms of lithium toxicity. 4. Immediately notify the physician, and hold the dose until instructed further.
4. The nurse needs to notify the physician immediately of the serum level, which is outside the therapeutic range, to avoid any risk for further toxicity.
A client prescribed lithium carbonate (lithium) 300 mg bid 3 months ago is brought into the hospital emergency department with mental confusion, excessive diluted urine output, and consistent tremors. Which lithium level would the nurse expect? 1. 1.2 mEq/L. 2. 1.5 mEq/L. 3. 1.7 mEq/L. 4. 2.2 mEq/L.
4. When the serum lithium level is 2.0 to 3.5 mEq/L, the client may exhibit signs such as excessive output of diluted urine, increased tremors, muscular irritability, psychomotor retardation, mental confusion, and giddiness.
A client on an in-patient psychiatric unit is prescribed lamotrigine (Lamictal) 50 mg QD. After client teaching, which client statement reflects understanding of important information related to lamotrigine? 1. "I know the importance of reporting any alteration in my medication schedule." 2. "I will schedule an appointment for my blood to be drawn at the lab next week." 3. "I will call the doctor immediately if my temperature rises above 100°F." 4. "I will stop my medication if I start having muscle rigidity of my face or neck."
incorrectly, the risk for Stevens-Johnson syndrome increases. Clients need to be taught the importance of taking the medication as prescribed and accurately reporting compliance.
