ATI RN
Mental Health Nursing Practice Questions Questions
Question 1 of 5
The healthcare provider is providing medication education to a patient who has been prescribed lithium to stabilize mood. Which early signs and symptoms of toxicity should the healthcare provider stress to the patient? Select one that does not apply.
Correct Answer: C
Rationale: Lithium is a mood stabilizer commonly used for bipolar disorder, but it has a narrow therapeutic index, making early recognition of toxicity crucial. The correct answer is C (Improved vision) because this is never listed as a sign of lithium toxicity in clinical guidelines or pharmacological literature. Vision changes associated with lithium are typically **blurred vision** (a sign of severe toxicity) rather than improved vision, which has no pathophysiological basis in lithium's mechanism of action or side effect profile. **Why the other options are incorrect:** **A: Increased attentiveness** – While this may seem unrelated, it can actually be an early sign of mild lithium toxicity. Lithium affects the central nervous system (CNS), and subtle cognitive changes, including unusual alertness or cognitive hyperactivity, can precede more severe neurological symptoms like tremors or confusion. Early toxicity may manifest as paradoxical effects before progressing to impairment. **B: Getting up at night to urinate** – Polyuria (excessive urination) is a classic **early** side effect of lithium due to its interference with renal concentrating ability, often leading to nephrogenic diabetes insipidus. Patients frequently report nocturia (nighttime urination) before other symptoms arise. This is a well-documented and clinically significant warning sign. **D: An upset stomach for no apparent reason** – Gastrointestinal disturbances (nausea, vomiting, diarrhea) are among the **earliest** and most common signs of lithium toxicity. These symptoms result from lithium's irritation of the gastric mucosa and its impact on the CNS at higher serum levels. Patients are routinely advised to monitor for unexplained GI distress as a potential red flag. **Why C is correct:** Improved vision is not associated with lithium toxicity or its therapeutic effects. While blurred vision or difficulty focusing can occur in severe toxicity, **enhanced** visual acuity has no physiological correlation with lithium’s pharmacological actions (e.g., altered sodium transport in neurons and kidneys). This distractor is included to test the student’s ability to differentiate between plausible side effects and unrelated, implausible symptoms. The question reinforces the importance of recognizing **early** versus **late** and **severe** toxicity signs. Nocturia, GI upset, and subtle CNS changes precede life-threatening symptoms (ataxia, seizures, coma), whereas improved vision is irrelevant to lithium’s adverse effects. Students must prioritize memorizing clinically validated symptoms and disregarding distractors without a pathophysiological basis.
Question 2 of 5
Which intervention should the nurse implement when caring for a patient demonstrating manic behavior? Select one that doesn't apply.
Correct Answer: B
Rationale: When caring for a patient demonstrating manic behavior, it is crucial to monitor vital signs frequently to ensure the patient's physical health is stable. Providing nutrition, such as milkshakes and protein drinks, is essential to meet the patient's dietary needs. Diminishing environmental stimuli by reducing the volume on the television and dimming bright lights can help create a calmer environment. However, keeping the patient distracted with group-oriented activities may not be the most appropriate intervention as it could potentially exacerbate the manic behavior by overstimulating the patient. Therefore, this choice is the one that doesn't apply in managing manic behavior effectively.
Question 3 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 4 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 5 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.