Chapter 16: Antimanic Drugs
Steele: Keltner’s Psychiatric Nursing,
MULTIPLE CHOICE
1. Maintenance of a therapeutic serum level of lithium is dependent on adequate serum levelsof
which electrolyte?
a. Sodium
b. Chloride
c. Potassium
d. Magnesium
ANS: A
It is believed that lithium substitutes for the sodium (Na) ion in neurons. Reductions or increases
in Na intake affect the serum lithium level. The other options have not been identified as critical
to lithium level.
DIF: Cognitive level: Understanding TOP: Nursing process: Assessment
MSC: Client Needs: Physiologic Integrity
2. What phrase represents accurate information about the pharmacokinetics of lithium?
a. Wide therapeutic index
b. Excreted by the kidneys
c. Poorly absorbed in the gastrointestinal (GI) tract
d. Provides immediate relief of symptoms
ANS: B
, Lithium is excreted via the kidneys. The other options are incorrect. The nursing implication is
that individuals with renal damage should not be given lithium or should be monitored closely if
lithium must be administered.
DIF: Cognitive level: Understanding TOP: Nursing process: Assessment
MSC: Client Needs: Physiologic Integrity
3. For 2 weeks a patient has taken lithium and risperidone daily for mania. The patient now reports
diarrhea, vomiting, and blurred vision. The nurse observes a coarse hand tremor. What is the
nurse‘s priority action to these assessment finding?
a. Administer a PRN dose of benztropine to relieve extrapyramidal symptoms
(EPSEs).
b. Hold the next dose of risperidone to prevent further drug-drug interaction.
c. Reassure the patient that these side effects will decrease with time.
d. Notify the prescribing physician immediately.
ANS: D
The symptoms the patient is experiencing are consistent with a serum lithium level above the
therapeutic level. The nurse should withhold the next dose, arrange for a stat serum lithium level
determination, and notify the health care provider. Risperidone can be continued because this is
not a drug-drug interaction problem. Administration of benztropine is inappropriate because
these are not EPSE symptoms. Reassurance would be appropriate, but the patient should not be
told that these symptoms will decrease with time and continued dosing.
DIF: Cognitive level: Applying TOP: Nursing process: Implementation
MSC: Client Needs: Physiologic Integrity
4. A patient has taken lithium 300 mg three times daily for 1 week. The patient reports the presence
of fine hand tremors and thirst. What is the nurse‘s priority action to these assessment finding?
Steele: Keltner’s Psychiatric Nursing,
MULTIPLE CHOICE
1. Maintenance of a therapeutic serum level of lithium is dependent on adequate serum levelsof
which electrolyte?
a. Sodium
b. Chloride
c. Potassium
d. Magnesium
ANS: A
It is believed that lithium substitutes for the sodium (Na) ion in neurons. Reductions or increases
in Na intake affect the serum lithium level. The other options have not been identified as critical
to lithium level.
DIF: Cognitive level: Understanding TOP: Nursing process: Assessment
MSC: Client Needs: Physiologic Integrity
2. What phrase represents accurate information about the pharmacokinetics of lithium?
a. Wide therapeutic index
b. Excreted by the kidneys
c. Poorly absorbed in the gastrointestinal (GI) tract
d. Provides immediate relief of symptoms
ANS: B
, Lithium is excreted via the kidneys. The other options are incorrect. The nursing implication is
that individuals with renal damage should not be given lithium or should be monitored closely if
lithium must be administered.
DIF: Cognitive level: Understanding TOP: Nursing process: Assessment
MSC: Client Needs: Physiologic Integrity
3. For 2 weeks a patient has taken lithium and risperidone daily for mania. The patient now reports
diarrhea, vomiting, and blurred vision. The nurse observes a coarse hand tremor. What is the
nurse‘s priority action to these assessment finding?
a. Administer a PRN dose of benztropine to relieve extrapyramidal symptoms
(EPSEs).
b. Hold the next dose of risperidone to prevent further drug-drug interaction.
c. Reassure the patient that these side effects will decrease with time.
d. Notify the prescribing physician immediately.
ANS: D
The symptoms the patient is experiencing are consistent with a serum lithium level above the
therapeutic level. The nurse should withhold the next dose, arrange for a stat serum lithium level
determination, and notify the health care provider. Risperidone can be continued because this is
not a drug-drug interaction problem. Administration of benztropine is inappropriate because
these are not EPSE symptoms. Reassurance would be appropriate, but the patient should not be
told that these symptoms will decrease with time and continued dosing.
DIF: Cognitive level: Applying TOP: Nursing process: Implementation
MSC: Client Needs: Physiologic Integrity
4. A patient has taken lithium 300 mg three times daily for 1 week. The patient reports the presence
of fine hand tremors and thirst. What is the nurse‘s priority action to these assessment finding?
