A woman with myoclonic seizures is well controlled with lamotrigine. She becomes pregnant and begins to have breakthrough seizures. What is most likely happening?

Correct Answer: C

Rationale: Pregnancy increases lamotrigine clearance via enhanced glucuronidation (UGT enzyme induction), lowering plasma concentrations and risking breakthrough seizures, as seen here. Worsening epilepsy is possible but less likely without prior progression. Increased concentrations would improve control, not worsen it. Loss of efficacy is unlikely if previously effective; pharmacokinetic changes are more plausible. Monitoring and dose adjustment during pregnancy, per epilepsy guidelines, address this common issue, making decreased concentrations the most likely cause.

Correct Answer: C

Rationale: Lithium is a mood stabilizer used primarily in the treatment of bipolar disorder. It helps to reduce the intensity and frequency of manic episodes in patients with bipolar disorder, as well as prevent the recurrence of both manic and depressive episodes. Lithium is not classified as an anti-diabetic, anti-ulcer agent, or diuretic.

Correct Answer: C

Rationale: Iris darkening in glaucoma treatment points to Latanoprost , a prostaglandin analog. It increases melanin in iridial melanocytes, a known side effect. Acetazolamide , a carbonic anhydrase inhibitor, Epinephrine , Pilocarpine , and Timolol (E) don't cause this. Latanoprost's cosmetic effect is well-documented, fitting her long-term use.

Correct Answer: D

Rationale: Infants have a higher percentage of total body water (approximately 75%) compared to adults. This difference affects the distribution and concentration of water-soluble drugs, often requiring adjustments in dosing to achieve therapeutic effects. Increased protein in circulation, lower fat composition, and more muscular body composition are not primary factors influencing drug therapy in infants. Therefore, the nurse must consider the higher water composition when calculating drug dosages for pediatric patients.

Correct Answer: D

Rationale: Lithium is commonly used in the treatment of bipolar disorder. One of the expected outcomes of lithium treatment is a decreased incidence of acute manic episodes. Lithium helps stabilize mood and reduce the frequency and severity of manic episodes in patients with bipolar disorder. It is considered one of the first-line treatments for managing symptoms of mania in bipolar disorder. While lithium has various physiological effects in the body, its primary use in mental health is to manage mood symptoms associated with bipolar disorder, particularly the manic phase. Therefore, the expected outcome of lithium treatment is a decrease in the incidence of acute manic episodes.