ATI RN
Mental Health Nursing Practice Questions Questions
Question 1 of 5
A male patient calls to tell the nurse that his monthly lithium level is 1.7 mEq/L. Which nursing intervention will the nurse implement initially?
Correct Answer: B
Rationale: A lithium level of 1.7 mEq/L is above the therapeutic range, indicating a potential risk of toxicity. The initial nursing intervention should be to instruct the patient to hold the next dose of medication and promptly contact the prescriber for further guidance and management. This action aims to prevent adverse effects and ensure the patient's safety by addressing the elevated lithium level appropriately.
Question 2 of 5
Substance abuse is often present in individuals diagnosed with bipolar disorder. Laura, a 28-year-old with a bipolar disorder diagnosis, chooses to drink alcohol instead of taking her prescribed medications. The nurse caring for this patient recognizes that:
Correct Answer: B
Rationale: Individuals with bipolar disorder may turn to alcohol as a form of self-medication to cope with their symptoms. This behavior is often seen as an attempt to manage mood swings and alleviate distress. It is important for healthcare providers to address and manage substance abuse issues in patients with bipolar disorder to ensure proper treatment and overall well-being.
Question 3 of 5
Ted, a former executive, is now unemployed due to manic episodes at work. He was diagnosed with bipolar I 8 years ago. Ted has a history of IV drug abuse, which resulted in hepatitis C. He is taking his lithium exactly as scheduled, a fact that both Ted's wife and his blood tests confirm. To reduce Ted's mania, the psychiatric nurse practitioner recommends:
Correct Answer: C
Rationale: Electroconvulsive therapy (ECT) can be an effective treatment for reducing mania in patients with bipolar disorder who have not responded to medication. In Ted's case, where he has a history of bipolar I disorder, lithium treatment, and manic episodes, ECT may be recommended by the psychiatric nurse practitioner to help manage his symptoms.
Question 4 of 5
A 33-year-old female diagnosed with bipolar I disorder has been functioning well on lithium for 11 months. At her most recent checkup, the psychiatric nurse practitioner states, 'You are ready to enter the maintenance therapy stage, so at this time I am going to adjust your dosage by prescribing:'
Correct Answer: C
Rationale: Bipolar I disorder is a chronic condition requiring long-term management, and lithium remains a first-line mood stabilizer for both acute episodes and maintenance therapy. The key principle in maintenance therapy is to prevent recurrence of manic or depressive episodes while minimizing side effects and maintaining the patient's quality of life. After 11 months of stability, the patient has likely achieved therapeutic lithium levels (typically 0.6–1.2 mEq/L for acute treatment). In the maintenance phase, the goal shifts to sustaining stability at the *lowest effective dose*, often reducing the serum level to 0.6–0.8 mEq/L. This adjustment decreases the risk of long-term adverse effects (e.g., renal toxicity, thyroid dysfunction, or cognitive dulling) while still providing prophylaxis against relapse. Thus, **a lower dosage (C)** is correct because it aligns with evidence-based practice for maintenance therapy—balancing efficacy with safety. **Why other choices are incorrect:** - **A higher dosage (A):** Increasing the dose is unnecessary for a patient already stable on lithium. Higher doses raise serum levels, increasing the risk of toxicity without proven added benefit in maintenance. Elevated levels could lead to adverse effects (e.g., tremors, polyuria, or electrolyte imbalances), undermining adherence and long-term outcomes. - **Once-weekly dosing (B):** Lithium has a narrow therapeutic index and requires consistent dosing to maintain stable serum levels. Its half-life (12–27 hours) necessitates *daily* administration to avoid fluctuations that could trigger breakthrough symptoms or toxicity. Weekly dosing would cause erratic absorption, risking subtherapeutic levels (and relapse) or toxic peaks. - **A different drug (D):** Switching medications is not indicated for a patient responding well to lithium. Lithium has unique neuroprotective and anti-suicidal properties in bipolar disorder, and abrupt changes could destabilize the patient. Alternatives (e.g., valproate or lamotrigine) are reserved for intolerance or inadequate response, neither of which is described here. The rationale hinges on the *maintenance phase objective*: optimizing long-term outcomes by reducing dosage while monitoring for stability. This approach reflects clinical guidelines emphasizing minimal effective dosing to mitigate risks without compromising relapse prevention.
Question 5 of 5
Tatiana has been hospitalized for an acute manic episode. On admission, the nurse suspects lithium toxicity. What assessment findings would indicate the nurse's suspicion as correct?
Correct Answer: B
Rationale: The correct answer is B. Ataxia, severe hypotension, and a large volume of dilute urine are classic signs of lithium toxicity. Ataxia refers to a lack of muscle coordination, severe hypotension indicates dangerously low blood pressure, and the large volume of dilute urine is a result of the kidneys' inability to concentrate urine properly, a common feature of lithium toxicity.