A client has bipolar I disorder. She has been taking lithium carbonate 300 mg three times daily for maintenance therapy. Her mother reports that the client stopped taking her lithium about 3 months ago because it caused her to gain weight. In the psychiatric unit, the client is agitated, pacing back and forth, talking loudly and abusively as if in response to an unseen person, and flailing her arms in exaggerated gestures. She is begun on lithium carbonate and olanzapine (Zyprexaâ) immediately. What is the rationale for the olanzapine order?

Correct Answer: D

Rationale: The correct answer is D: Olanzapine (Zyprexa) will calm her hyperactivity until the lithium takes effect. Olanzapine is an atypical antipsychotic used to manage acute manic episodes in bipolar disorder. In this scenario, the client is presenting with symptoms of acute mania, such as agitation, loud and abusive speech, and hyperactivity. Olanzapine can help to quickly reduce these manic symptoms while waiting for lithium, which is used for long-term maintenance therapy, to reach therapeutic levels in the body. It does not cure manic symptoms (Choice A), prevent extrapyramidal side effects (Choice B), or solely ensure a good night's sleep (Choice C). Olanzapine's primary role in this case is to provide immediate relief from acute manic symptoms until the lithium fully takes effect.

Correct Answer: C

Rationale: The correct answer is C because beta blockers decrease heart rate and myocardial contractility, which reduces myocardial oxygen demand and improves symptoms of angina. Choice A is incorrect as beta blockers do not directly increase oxygen supply. Choice B is incorrect as beta blockers actually decrease heart rate. Choice D is incorrect because beta blockers decrease, not increase, myocardial contractility to decrease workload on the heart.

Correct Answer: B

Rationale: The correct answer is B because asking about the patient's worst and best times of day can provide insight into disturbances in circadian rhythms commonly seen in major depression. This question directly addresses the patient's sleep-wake cycle, energy levels, and mood fluctuations throughout the day. It helps identify patterns of insomnia, hypersomnia, and diurnal mood variations which are common in depression. Choice A is incorrect as it pertains to hallucinations, not circadian rhythm disturbances. Choice C is irrelevant to assessing circadian rhythms. Choice D focuses on thoughts related to sadness, not specifically related to circadian rhythm disruptions.

Correct Answer: A

Rationale: The correct answer is A because it emphasizes the importance of avoiding certain foods while starting an MAOI medication, provides a clear timeline for the patient to follow, and offers the opportunity to address any questions. This approach ensures the patient is well-informed about dietary restrictions and can make necessary adjustments. Choice B is incorrect because it does not specify the timeline for avoiding certain foods, ordering the new medication, or addressing potential concerns the patient may have. Choice C is incorrect as it delays the prescription for the new medication until after the patient has been off Zoloft for 4 weeks, potentially leaving the patient without treatment during this period. Choice D is incorrect because it rushes the process by only allowing 2 days off Zoloft before starting the new medication, which may not provide enough time for the previous medication to clear the system and may lead to adverse interactions.

Correct Answer: B

Rationale: The correct answer is B: Chronic pain. The patient's pain has been ongoing for 4 months and is gradually increasing, indicating a long-lasting and persistent nature characteristic of chronic pain. Chronic pain is defined as pain lasting beyond the expected healing time. Acute pain (choice A) is sudden and short-term. Somatic pain (choice C) arises from the skin, muscles, or bones and is localized, not consistent with the abdominal pain described. Neuropathic pain (choice D) results from nerve damage and is typically described as burning or shooting, not matching the dull ache described by the patient.