Pharmacology Bipolar Disorder

A nurse is reviewing laboratory findings and notes that a client's lithium level is 2.6 mEq/L.

Which of the following actions should the nurse plan to take ?

• Administer a loop diuretic

• Prepare the client for hemodialysis

• Administer an additional oral dose of lithium

• Restrict fluid to 1.5 L per day

Answer explanation

A loop diuretic promotes excretion of sodium which can increase lithium toxicity

Hemodialysis is appropriate for a client who has a plasma level > 2.5 mEq/L

Asministering an additional dose of lithium will worsen the toxicity

Restricting fluid will cause retention of lithium and worsen toxicity

A nurse is caring for a client who has a new prescription for lithium carbonate. When reinforcing teaching with the client about ways to prevent lithium toxicitym, the nurse should advise the client to do which of the following ?

• Avoid the use of acetaminophen for headaches

• Restrict intake of foods rich in sodium

• Decrease fluid intake to less than 1,500 mL daily

• Limit aerobic activity in hot weather

Answer explanation

The client should use acetaminophen rather than NSAID's for headaches because NSAID's interact with lithium and can cause increased blood levels of lithium

The client should increase not decrease sodium intake to reduce the risk of toxicity lithium levels

The client should avoid activities that have the potential to cause sodium & water depletion whcih can increase the risk of toxicity

A nurse is collecting data from a client who takes lithium carbonate for the treatment of bipolar disorder . The nurse should identify which of the following findings is a possible indication of toxicity to this medication?.

• Severe hypertension

• Coarse tremors

• Constipation

• Muscle Spasms

Answer explanation

Coarse tremors are an indication of toxicity to Lithium Carbonate

Clients usually experience diarrhea and muscle weakness from lithium

A nurse is caring for a client who has a new prescription for valproic acid . The nurse should instruct the client to have which of the following blood laboratory tests completed periodically?

(Select all that apply)

• Thrombocyte count

• Glucose

• Amylase

• Liver function tests

Answer explanation

Thrombocytopenia should be monitored closely with clients on valproic acid and look for easy bruising .

Treatment with valproic acid can result in pancreatitis and amylase levels should be monitored periodically

Treatement with valproic acid can result in liver function hepatotoxicity and can also effect a clients potassium levels

A nurse is contributing to a teaching plan for a client who has bipolar disorder and a new prescription for carbamazipine (Tegretol). Which of the following instructions should the nurse include?

• "This medication can be safely taken during pregnancy."

• "Eliminate grapefruit juice from your diet."

• "You will need to have acomplete blood count and carbamazepine levels drawn periodically."

• "Notify your provider if you decelop a rash."

• "Avoid driving for the first few days after starting this medication."

Answer explanation

Carbamazepine is not safe for pregnancy

Grapefruite should should be avoided

CBC and tegretol levels are monitored as bone marrow suppression is a common adverse effect

Carbamezepine can cause Stevens-Johnson syndrome so client must notify doctor of rash

CNS effects and drowsiness can occur early in treatment