A patient with rapid cycling bipolar disorder is not responding ...

[segrsyd]

A patient with rapid cycling bipolar disorder is not responding well to lithium. The pa-tient tells the nurse, It feels as though I'll never get well. I get better, and then I get worse.
 
  The reply that is based on knowledge of current therapy would be:
  a. You're feeling very discouraged aren't you?
  b. It's not all bad, is it? Sometimes you like being high.
  c. Another drug, valproic acid, is proving effective for rapid cycling.
  d. If your kidneys hold out, the lithium will eventually control the symptoms.

Question 2

A patient who has received lithium for 3 weeks to control acute mania has the following symptoms: coarse hand tremor, diarrhea, vomiting, lethargy, and mild confusion. The pri-ority nursing action should be to:
 
  a. Administer prn Cogentin to relieve the symptoms.
  b. Provide reassurance that the symptoms are transient.
  c. Obtain a stat lithium level; hold lithium pending results.
  d. Assist the patient to decrease the sodium in their daily diet.

[JYan]

Answer to Question 1

ANS: C
Valproic acid is a first-line agent for the treatment of bipolar disorder. It is particularly effec-tive with rapid cycling. The other options are not responsive to the question stem, which asks for knowledge of current therapy.

Answer to Question 2

ANS: C
The symptoms the patient is experiencing are consistent with moderate lithium toxicity. The nurse should hold lithium, obtain a stat lithium level, and notify the physician. Cogentin is inappropriate; the symptoms are not EPS. The nurse may reassure the patient but cannot sug-gest that the symptoms will resolve over time. Minimizing salt would worsen lithium toxicity.