Mood Stabilizers

Every question here, with the answer

1. A client on long-term lithium has had vomiting, diarrhea, a new tremor and muscle weakness since yesterday. What should the nurse tell the client to do?

   1. Take an extra dose to make up for what was lost by vomiting.
   2. Reduce salt intake until the diarrhea stops.
   3. Stop taking the drug and notify the health care provider immediately.
   4. Continue the drug and increase exercise to feel stronger.

   Answer: Stop taking the drug and notify the health care provider immediately.

   Vomiting, diarrhea, ataxia, tremor, drowsiness and muscle weakness are manifestations of lithium overdose; the client stops the drug and notifies the provider immediately. An extra dose adds to toxicity, lowering salt raises lithium levels, and exercise worsens dehydration.

2. A client stabilized on lithium is prescribed a diuretic for hypertension. Why should the nurse be concerned?

   1. Diuretics make lithium work faster with no other effect.
   2. Diuretics prevent lithium from reaching the brain.
   3. Drugs that affect sodium balance can alter lithium levels and lead to toxicity or treatment failure.
   4. There is no interaction between lithium and diuretics.

   Answer: Drugs that affect sodium balance can alter lithium levels and lead to toxicity or treatment failure.

   Lithium is tied to sodium resorption, so any drug that affects sodium balance, such as diuretics, NSAIDs and ACE inhibitors, may alter lithium concentrations and cause toxicity or treatment failure. The other options ignore or misstate this interaction.

3. The nurse is teaching a client who is starting lithium. Which instructions should be included? Select all that apply.

   1. Keep your sodium intake consistent.
   2. Cut out salt completely to protect your heart.
   3. Do not take the morning dose until the blood sample for the lithium level is drawn.
   4. Increase your exercise routine during hot weather.
   5. Drink 8 to 12 glasses of water daily.

   Answer: Keep your sodium intake consistent., Do not take the morning dose until the blood sample for the lithium level is drawn., Drink 8 to 12 glasses of water daily.

   Adequate water prevents dehydration that could cause lithium toxicity, a consistent sodium intake keeps levels stable, and the morning dose is held until the blood sample is obtained. Extra exercise in hot weather raises the risk of dehydration and toxicity, and decreasing salt can cause lithium toxicity.

4. A client with Addison's disease is being evaluated for bipolar disorder. Why is lithium contraindicated for this client?

   1. Lithium raises aldosterone to dangerous levels.
   2. Lithium is not absorbed in clients with Addison's disease.
   3. Lithium causes hyperthyroidism in these clients.
   4. Loss of sodium through the kidneys causes lithium to be reabsorbed, quickly leading to toxicity.

   Answer: Loss of sodium through the kidneys causes lithium to be reabsorbed, quickly leading to toxicity.

   In Addison's disease the person loses more sodium through the kidneys because of the lack of aldosterone, so the kidneys reabsorb lithium back into the bloodstream, which can quickly cause toxicity. The other options are not supported; lithium causes hypothyroidism, not hyperthyroidism.

5. A nurse is caring for a client taking a mood stabilizer. Which actions are appropriate? Select all that apply.

   1. Stop lithium abruptly if the client's mood improves.
   2. Monitor renal function while the client is on lithium.
   3. Encourage the client to reduce dietary salt.
   4. Assess for suicidal ideation.
   5. Obtain a baseline electrocardiogram.

   Answer: Monitor renal function while the client is on lithium., Assess for suicidal ideation., Obtain a baseline electrocardiogram.

   Nursing care includes a baseline electrocardiogram, assessment for suicidal ideation with precautions for at-risk clients, and monitoring renal function on lithium. Lithium should not be stopped abruptly, and decreasing salt can cause lithium toxicity.

6. A client taking carbamazepine for bipolar disorder uses an oral hormonal contraceptive. What should the nurse teach?

   1. Carbamazepine makes hormonal contraceptives more effective.
   2. Consider an additional or alternate form of contraception.
   3. No change is needed because there is no interaction.
   4. Stop carbamazepine while taking the contraceptive.

   Answer: Consider an additional or alternate form of contraception.

   Carbamazepine decreases the effectiveness of certain hormonal contraceptives, so the client should consider an additional or alternate form of contraception. It does not increase their effect, and stopping the mood stabilizer is not the teaching.