A nurse is reviewing medications for a patient with bipolar ...

[Caiter2013]

A nurse is reviewing medications for a patient with bipolar disorder. The nurse has received an order to discontinue the lithium and begin valproic acid (Depakene).
 
  The nurse understands the prescriber's change of order based on which mechanism of action?
  a. Valproic acid works slower and has a lower therapeutic index.
  b. Valproic acid has no serious side effects.
  c. Valproic acid does not require plasma drug levels.
  d. Valproic acid works faster and has a higher therapeutic index.

Question 2

A nurse is discussing lithium levels with another nurse. As they review the laboratory findings, they discover a lithium level of 0.6 mEq/L. Which statement made by one of the nurses best demonstrates an understanding of lithium levels?
 
  a. The patient's plasma level is below the toxic level of 3 mEq/L and is considered therapeutic.
  b. The patient's plasma level exceeds 0.5 mEq/L and is therefore toxic.
  c. The patient's plasma level is between 0.4 and 1 mEq/L and is considered therapeutic.
  d. The patient's plasma level is below the 2.5 mEq/L level that would indicate toxicity.

[shaquita]

Answer to Question 1

ANS: D
Valproic acid works faster and has a higher therapeutic index than lithium, as well as a better side effect profile.
This is incorrect; in fact, valproic acid works faster and has a higher therapeutic index than lithium.
Valproic acid can have serious side effects.
Any anticonvulsant, including valproic acid, when used in a patient with bipolar disorder requires monitoring with periodic plasma drug levels.

Answer to Question 2

ANS: C
For maintenance therapy, lithium levels should range from 0.4 to 1 mEq/L.
Lithium toxicity is defined as a level above 1.5 mEq/L.
A lithium level of 0.5 mEq/L is considered therapeutic.
Lithium toxicity is defined as a level above 1.5 mEq/L.

[Caiter2013]

Thanks

[shaquita]

Welcome