A client with a diagnosis of bipolar I disorder, current episode manic, tells a physician that she does not want to take lithium carbonate because she has gained a lot of weight while taking this medication. She says that if the physician sends her home on this drug she will just stop taking it. The physician decides to change the client's medication so she will be more compliant. Which medication should a nurse anticipate that the physician will choose to prescribe for this client?

Correct Answer: B

Rationale: The correct answer is B: Valproic acid (Depakote). In bipolar I disorder, mood stabilizers like lithium and valproic acid are commonly used to manage manic episodes. Valproic acid is often chosen as an alternative to lithium for patients who experience weight gain on lithium. Valproic acid is effective in stabilizing mood and has a lower likelihood of causing weight gain compared to lithium. Sertraline, trazodone, and paroxetine are antidepressants and not typically used as first-line treatments for bipolar disorder. Therefore, the physician is likely to choose valproic acid to address the client's concerns about weight gain and improve medication compliance.

Correct Answer: B

Rationale: The correct answer is B: Headaches. Nitrates dilate blood vessels, leading to vasodilation and potentially causing headaches due to increased blood flow to the brain. This is a common side effect of nitrate therapy. Nausea and vomiting (A) are less likely as direct effects of nitrates. Stomach cramps (C) are also less common since nitrates primarily affect blood vessels. Irregular pulse rate (D) is not a typical symptom of nitrate use.

Correct Answer: B

Rationale: The correct answer is B: MRI. An MRI is the best test to rule out a brain tumor due to its ability to provide detailed images of the brain structure, helping to identify any abnormalities like tumors. PET scans (A) are used to detect brain activity, not for tumor identification. EEG (C) is used to evaluate brain electrical activity, not for tumor detection. Cerebral arteriogram (D) is used to assess blood vessels in the brain, not for tumor detection.

Correct Answer: A

Rationale: The correct answer is A because lithium is excreted in breast milk, posing a risk of toxicity to the infant. This statement demonstrates understanding of the direct impact of lithium on breast milk composition. Choice B is incorrect as lithium does not typically affect the taste of breast milk or cause gas in infants. Choice C is incorrect as lithium may not necessarily impact lactation directly. Choice D is incorrect as mood fluctuations from lithium do not directly affect breast milk production.

Correct Answer: C

Rationale: The correct answer is C because a client who has had a total knee replacement may have metal implants, which can interfere with the MRI imaging and pose a safety risk. The nurse should decline to make test arrangements without further discussion with the physician to ensure the safety and appropriateness of the test. Choice A (breastfeeding) is not a contraindication for an MRI, as it is safe for breastfeeding mothers. Choice B (allergic to iodine) is also not a reason to decline an MRI, as contrast agents without iodine can be used. Choice D (neuroleptic medication) may affect the MRI results, but it is not a reason to decline the test outright without further discussion with the physician.