The psychiatric-mental health nurse practitioner has just diagnosed a 23-year-old man with bipolar disorder. He has had one manic episode with suicidal ideation and no depressive episodes to date. Which of the following is the most appropriate at this time?
Divalproex (Depakote)
Lamotrigine (Lamictal)
Carbamazepine (Tegretol)
Lithium (Eskalith)
The Correct Answer is D
Choice A reason: Divalproex is an effective mood stabilizer, especially for rapid cycling or mixed episodes, but lithium is generally first-line for classic mania with suicidal ideation.
Choice B reason: Lamotrigine is more effective for bipolar depression than mania and is not ideal for initial treatment of a first manic episode.
Choice C reason: Carbamazepine is an alternative mood stabilizer but has more drug interactions and is not the preferred first-line for initial mania.
Choice D reason: Lithium is considered first-line treatment for acute mania in bipolar disorder and provides prophylactic benefits; it is particularly indicated for patients with suicidal ideation.
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Correct Answer is D
Explanation
Choice A reason: Divalproex is an effective mood stabilizer, especially for rapid cycling or mixed episodes, but lithium is generally first-line for classic mania with suicidal ideation.
Choice B reason: Lamotrigine is more effective for bipolar depression than mania and is not ideal for initial treatment of a first manic episode.
Choice C reason: Carbamazepine is an alternative mood stabilizer but has more drug interactions and is not the preferred first-line for initial mania.
Choice D reason: Lithium is considered first-line treatment for acute mania in bipolar disorder and provides prophylactic benefits; it is particularly indicated for patients with suicidal ideation.
Correct Answer is B
Explanation
Choice A reason: Providing limited information without consent still breaches patient confidentiality and legal protections under HIPAA.
Choice B reason: The patient, being 18, is legally an adult and has the right to confidentiality regarding her medical and psychiatric care. Consent must be obtained before sharing any information.
Choice C reason: Health insurance coverage does not give a parent the right to access a patient’s medical details; legal protections ensure patient privacy.
Choice D reason: Telling the father to make an appointment does not resolve the confidentiality issue and could lead to inappropriate disclosure.
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