A client with bipolar disorder takes lithium 300 mg 3 times daily. The nurse is educating the client on its use, side effects, and need for compliance. The nurse evaluates that the dose is appropriate when the client reports what?

Increased feelings of self-worth.

Feeling sleepy and less energetic.

Minimal mood swings.

Weight gain of 7 pounds in the last 6 months.

Answer and Explanation

The Correct Answer is C

Lithium carbonate is an antimanic agent that stabilizes glutamatergic neurotransmission. It effectively manages acute mania and prevents bipolar relapse by modulating intracellular signaling pathways. Therapeutic serum levels are narrow, typically 0.6 to 1.2 mEq/L, requiring consistent renal function monitoring and adequate sodium intake to prevent toxicity.

Rationale:

A. Increased feelings of self-worth can signal a return to grandiosity seen in manic or hypomanic episodes. Lithium's purpose is to suppress such manic symptoms rather than enhance them. The nurse should assess if the client is experiencing a breakthrough of symptoms despite the medication.

B. Feeling sleepy and less energetic can be an adverse effect or a sign of lithium toxicity. While lithium modulates activity, excessive lethargy is not the desired therapeutic goal of treatment. This symptom requires further evaluation of the client's serum drug levels and thyroid function.

C. Lithium is effective when the client achieves emotional stability with minimal mood swings. The drug regulates mood fluctuations without causing significant cognitive clouding or sedation. Maintenance of a euthymic state indicates that the dosage is sufficient to control the cycling of bipolar disorder.

D. Weight gain is a common metabolic side effect of lithium therapy but does not indicate efficacy. Significant weight changes can lead to non-compliance and metabolic syndrome. The nurse evaluates clinical success based on psychological stability, not the presence of known adverse reactions.

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Correct Answer is A

Explanation

The Kubler-Ross model identifies five distinct stages of grief. Bargaining involves an internal or external negotiation to delay the inevitable through spiritual appeals or goal-setting. This stage typically manifests when individuals seek more time to reach specific milestones or life events.

Rationale:

A. The client is demonstrating bargaining by attempting to negotiate for more life to witness a specific event. This stage serves as a defense mechanism to maintain hope while acknowledging a terminal prognosis. It often involves making promises to a higher power or setting temporal goals.

B. Depression is characterized by profound sadness, withdrawal, and a sense of great loss. This stage occurs when the individual can no longer deny the inevitability of death and experiences preparatory grief. The client's statement reflects hope and negotiation rather than hopelessness.

C. Acceptance represents a state of being at peace with the reality of the situation. The individual is neither depressed nor angry but has reached a calm expectation of the end. The client's desire to reach a future milestone indicates they have not fully reached this stage.

D. Anger typically involves feelings of resentment, rage, or envy directed toward others or the environment. It is a reaction to the perceived unfairness of the situation or loss of control. The client's plea for a grandchild's birth lacks the hostility associated with this stage.

A. Resilience B. Hardiness C. Self-efficacy D. Sense of belonging

Correct Answer is C

Explanation

Self-efficacy is the cognitive perception of one’s capability to perform specific tasks and achieve desired outcomes. It functions as a mediator for stress management, where high levels correlate with increased persistence and the adoption of healthy coping mechanisms during crises.

Rationale:

A. Resilience describes the ability to rebound from adversity or significant trauma over time. Although the client is seeking improvement, the statement specifically emphasizes their internal conviction in their personal ability to execute a change, rather than just returning to baseline.

B. Hardiness is a personality construct comprising commitment, control, and challenge. It acts as a buffer against stress, but it is a general disposition toward life events rather than the specific belief in mastering a particular situation or skill.

C. Self-efficacy is the specific belief in one's capacity to organize and execute actions required to manage situations. The client's confidence that they can learn and apply new strategies to reduce stress directly reflects this psychological concept.

D. Sense of belonging represents the degree of integration and value an individual feels within a group. The client is focusing on their individual competence and personal agency rather than their social connection or acceptance within the family unit.

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A client with bipolar disorder takes lithium 300 mg 3 times daily. The nurse is educating the client on its use, side effects, and need for compliance. The nurse evaluates that the dose is appropriate when the client reports what?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The client says to the nurse, "I really want to see my first grandchild born before I die. Is that too much to ask?" The nurse would recognize that the client is in which stage of grieving, according to Kubler-Ross?

Correct Answer is A

Explanation

The client says to the nurse, "I know I can learn to cope with my family situation. By getting help here at the clinic, I'll be able to deal with them more effectively, and I won't be so stressed out all the time." This client is demonstrating a high level of which personal characteristic?

Correct Answer is C

Explanation

After the death of a client's spouse, the client tells the nurse, "I can never live without my spouse. They were my whole life." Which is the most therapeutic response from the nurse?

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A client with dependent personality disorder has a goal to increase problem-solving skills. Which client behavior would indicate progress toward meeting that goal?

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