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NurseDive Free Nursing Practice Question
The psychiatric-mental health nurse practitioner has just diagnosed a 23-year-old man with bipolar disorder. He has had one manic episode with suicidal ideation and no depressive episodes to date. Which of the following is the most appropriate at this time?
A. Divalproex (Depakote)
Divalproex is an effective mood stabilizer, especially for rapid cycling or mixed episodes, but lithium is generally first-line for classic mania with suicidal ideation.
B. Lamotrigine (Lamictal)
Lamotrigine is more effective for bipolar depression than mania and is not ideal for initial treatment of a first manic episode.
C. Carbamazepine (Tegretol)
Carbamazepine is an alternative mood stabilizer but has more drug interactions and is not the preferred first-line for initial mania.
D. Lithium (Eskalith)
Lithium is considered first-line treatment for acute mania in bipolar disorder and provides prophylactic benefits; it is particularly indicated for patients with suicidal ideation.
This question is an excerpt from Nurse Dive's nursing test bank - Mental Health Northern Kentucky University Proctored Exam 6. Take the full exam now
Full Explanation
Choice A reason: Divalproex is an effective mood stabilizer, especially for rapid cycling or mixed episodes, but lithium is generally first-line for classic mania with suicidal ideation.
Choice B reason: Lamotrigine is more effective for bipolar depression than mania and is not ideal for initial treatment of a first manic episode.
Choice C reason: Carbamazepine is an alternative mood stabilizer but has more drug interactions and is not the preferred first-line for initial mania.
Choice D reason: Lithium is considered first-line treatment for acute mania in bipolar disorder and provides prophylactic benefits; it is particularly indicated for patients with suicidal ideation.
Similar Questions
Which of the following aspects of bipolar disorder predicts a favorable response to lithium treatment?
A. Rapid cycling
Rapid cycling is associated with a poorer response to lithium, often requiring alternative or adjunctive therapies.
B. Euthymic intervals
Clear euthymic intervals between episodes are associated with classic bipolar disorder, which predicts a favorable response to lithium treatment.
C. Psychotic symptoms
Psychotic symptoms do not reliably predict lithium response; these patients may require additional antipsychotic therapy.
D. Mixed episodes
Mixed episodes often respond less predictably to lithium alone and may need combination therapy.
Full Explanation
Choice A reason: Rapid cycling is associated with a poorer response to lithium, often requiring alternative or adjunctive therapies.
Choice B reason: Clear euthymic intervals between episodes are associated with classic bipolar disorder, which predicts a favorable response to lithium treatment.
Choice C reason: Psychotic symptoms do not reliably predict lithium response; these patients may require additional antipsychotic therapy.
Choice D reason: Mixed episodes often respond less predictably to lithium alone and may need combination therapy.
A 2-year-old boy presents to the nurse practitioner with new onset seizures and a history of a port-wine stain at birth. Which of the following is not a clinical feature of Sturge-Weber syndrome (SWS)?
A. Sturge-Weber syndrome (SWS) is a rare disorder affecting the skin and nervous system
SWS is indeed a rare neurocutaneous disorder affecting the skin (port-wine stains) and central nervous system, making this a true clinical feature.
B. Symptoms of SWS may include seizures, muscle weakness, and developmental and intellectual disability
Neurologic manifestations, including seizures, hemiparesis, and intellectual disability, are characteristic features of SWS.
C. Treatment may include anti-seizure medications, medications and/or surgery for glaucoma, and low-dose aspirin to reduce the pressure in the eyes and brain
Management often involves anticonvulsants, glaucoma treatment, and sometimes low-dose aspirin to reduce vascular complications, confirming these are accurate features.
D. The prognosis for SWS is usually poor, with an average lifespan of 30 years
The prognosis of SWS varies widely; many patients live well into adulthood, making the statement of an average lifespan of 30 years inaccurate.
Full Explanation
Choice A reason: SWS is indeed a rare neurocutaneous disorder affecting the skin (port-wine stains) and central nervous system, making this a true clinical feature.
Choice B reason: Neurologic manifestations, including seizures, hemiparesis, and intellectual disability, are characteristic features of SWS.
Choice C reason: Management often involves anticonvulsants, glaucoma treatment, and sometimes low-dose aspirin to reduce vascular complications, confirming these are accurate features.
Choice D reason: The prognosis of SWS varies widely; many patients live well into adulthood, making the statement of an average lifespan of 30 years inaccurate.
A 54-year-old Latino man receives a phone call that his mother has had a stroke and is in ICU at his local hospital. Soon after, he begins trembling, then shouting and screaming. The impression is that he is completely out of control. Which culture-bound syndrome should the PMHNP include in the differential diagnosis?
A. Khayal
Khayal is a South Asian culture-bound syndrome associated with anxiety and somatic complaints, not acute episodes of shouting and aggression.
B. Ataque de nervios
Ataque de nervios is a Latino culture-bound syndrome triggered by acute stress or trauma, characterized by shouting, trembling, and emotional outbursts, matching this patient’s presentation.
C. Amok
Amok is a Southeast Asian syndrome involving sudden aggressive outbursts, but it is culturally specific to Malaysia and the Philippines.
D. Dhat
Dhat is a South Asian culture-bound syndrome involving anxiety about semen loss, not acute aggressive episodes.
Full Explanation
Choice A reason: Khayal is a South Asian culture-bound syndrome associated with anxiety and somatic complaints, not acute episodes of shouting and aggression.
Choice B reason: Ataque de nervios is a Latino culture-bound syndrome triggered by acute stress or trauma, characterized by shouting, trembling, and emotional outbursts, matching this patient’s presentation.
Choice C reason: Amok is a Southeast Asian syndrome involving sudden aggressive outbursts, but it is culturally specific to Malaysia and the Philippines.
Choice D reason: Dhat is a South Asian culture-bound syndrome involving anxiety about semen loss, not acute aggressive episodes.