A patient with bipolar disorder who is taking divalproex sodium ...

[Brittanyd9008]

A patient with bipolar disorder who is taking divalproex sodium (Valproate) has just been admitted to the hospital. During the admission assessment, the patient tells the nurse about recent suicidal ideation.
 
  The nurse observes several areas of bruising over soft tissue areas and notes a weight gain of 10 pounds since the last admission 1 year ago. What will the nurse do?
  a. Ask the patient whether the bruises are self-inflicted.
  b. Contact the provider to report these findings.
  c. Give the patient information about weight loss.
  d. Request an order for an increased dose to help with depressive symptoms.

Question 2

The spouse of a patient with bipolar disorder (BPD) tells the nurse that the patient will not stay on the lithium ordered by the provider longer than 1 or 2 months at a time.
 
  The nurse understands that adherence to medication regimens in patients with BPD is problematic and will tell the spouse that:
  a. During manic episodes, many patients don't see the benefit of prophylactic medications.
  b. Increased gastrointestinal side effects occur over time and reduce compliance.
  c. Long-term use of lithium causes memory impairment, causing patients to forget to take their medications.
  d. Patients who are depressed do not want to take their medications.

[zacnyjessica]

Answer to Question 1

ANS: B
Divalproex sodium is used to control symptoms during manic episodes and can prevent relapse into mania. It is less effective than lithium at reducing the risk of suicide. It can cause thrombocytopenia, which results in bruising and is an indication for immediate drug withdrawal. Weight gain can be serious and chronic. All of these findings are an indication for withdrawing the drug and should be reported to the provider. Until platelet levels determine whether the bruises are drug induced, it is not appropriate to ask the patient if they are self-inflicted. Because weight gain is common and can be severe with this drug, information about weight loss is not likely to have an effect. Divalproex sodium is better than lithium at treating depression; however, in light of the other symptoms, it is probably not the best choice.

Answer to Question 2

ANS: A
Patients experiencing manic symptoms often do not see anything wrong with their thinking and behavior and therefore do not believe they need treatment. Moreover, these symptoms are often enjoyable, and they do not want them to stop. Gastrointestinal side effects and central nervous system (CNS) effects of memory impairment subside over time and would diminish with long-term treatment. Patients are usually most uncomfortable during depressive episodes, and it is during these episodes that they often seek treatment.

[Brittanyd9008]

TYSM

[Missbam101]

Excellent