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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Postpartum hypomania can occur in both primiparous and multiparous women; it is not limited to those with multiple births.
Choice B reason: Postpartum hypomania is relatively common, with higher rates reported than 1%, making this incorrect.
Choice C reason: Postpartum hypomania often precedes or predicts postpartum depression and is considered a risk factor for its development.
Choice D reason: It typically occurs early in the postpartum period, not late, often within the first few days after delivery.
Correct Answer is D
Explanation
Choice A reason: While liver function tests are sometimes monitored, lithium is primarily excreted renally, making creatinine more critical than liver function tests for baseline evaluation.
Choice B reason: Liver function tests alone are insufficient; kidney function must be assessed because lithium can cause nephrotoxicity.
Choice C reason: A complete blood count is not required prior to initiating lithium; the focus is on renal and thyroid function and pregnancy status.
Choice D reason: Baseline thyroid function is essential because lithium can affect thyroid activity. Creatinine assesses renal function since lithium is renally excreted. A pregnancy test is important due to potential teratogenic effects during pregnancy.
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