Question 1 of 5.

Extract:The nurse in the behavioral health clinic is caring for a 48-year-old male client. • Diagnostic Results Diagnostic, Result ,Reference Range Calcium, 10.5 mg/di (2.75mmol/I), 9.0-10.5 mg/dL (2.25-2.75 mmol/L) Chloride, 99 mEq/1 (99 mmol/l), 98 to 106 mEq/L (98 to 106 mmol/l) Creatinine, 0.9 mg/dI (79.6mcmol/L), 0.6 to 1.2 mg/di (53-106 mcmol/L) Potassium, 3.8 mEq/1 (3.8, mmol/D), 3.5-5.0 mEq/L (3.5-5.0 mmol/L) Sodium,137 mEq/1 (137mmol/l), 135 to 145 mEq/1 (135 to 145 mmol/I) Blood urea nitrogen,12 mg/di (4.2mmol/I), 10-20 mg/dL (3.6-7.1 mmol/L) Fasting glucose ,202 mg/dL (11.2mmol/L), 70-110 mg/dL (4-6 mmol/L) White blood cell, 11,000/mm3 (11 × 109 /L), 5,000-10,000/mm 3 (5-10 × 109 /L) Hemoglobin (Hgb), 15 g/dL (150 g/L), Male: 14-18 g/dL (140-180 g/L) Female: 12-16 g/dL (120-160 g/L) Hematocrit (Hct), 45% (0.47), Male: 42%-52% (0.42-0.52) Female: 37%-47% (0.37-0.47) Lithium level, 0.4 mEg/L , 0.6-1.2 mEg/L • Progress Notes 1250: Client reports suboptimal adherence with lithium because of thirst and urination. Client agreed to continue the trial of medication. Will discontinue ziprasidone because of tardive dyskinesia. Will follow up more regularly, considering we are going to monotherapy for mood stabilization. • Orders 1251: • discontinue ziprasidone • continue lithium 900 mg p.o. qHS • hemoglobin A1C • valbenazine 40 mg p.o. daily • follow-up in one week • lithium level in one week • Nurses' Notes 1230: Client presents for a follow-up appointment. He reports 100% adherence with prescribed ziprasidone. Two weeks ago, he was prescribed lithium, for which he reports a mild thirst. This thirst is causing him to go to the bathroom more frequently overnight. He reports that he recently got a second job to save for a vacation. On assessment, the client is alert and completely oriented. He had a logical thought process. Lung sounds clear bilaterally, and peripheral pulses were 2+. Skin is warm, dry, and normal for ethnicity. Rapid eye blinking and persistent chewing motions in his mouth despite not eating any food or gum. He reports that this started two weeks ago. Current weight is 128 kg (282 pounds). Current BMI is 26kg/m2. Previous weight one month ago was 126 kg (277 pounds). The most recent hospitalization was one month ago for a manic episode. Laboratory data reviewed. One week follow-up visit 0900: Client returns for a follow-up visit, reporting full adherence to the prescribed lithium. He reports that he is still gaining weight and is interested in participating in low-impact activities for weight loss. He experienced significant symptom improvement with tardive dyskinesia, with only light chewing motion in the mouth. On assessment, the client's affect is full range, and he exhibited no abnormal facial movements except a slight fine hand tremor. Hemoglobin A1C lab reviewed and was 6.3% [5.7-7%]. The most recent lithium level was 0.8 mEq/L [0.6-1.2 mEq/L].

The nurse and physician review the laboratory results with the client one week later. For each client statement, specify if it indicates effective understanding or requires follow-up.

Question 2 of 5.

The client is taking 50 mg of lamotrigine (Lamictal) daily for bipolar depression. The client shows the nurse a rash on his arm. What should the nurse do?

Question 3 of 5.

The client exhibits a flat affect, psychomotor retardation, and depressed mood. The nurse attempts to engage the client in an interaction but the client does not respond to the nurse. Which response by the nurse is most appropriate?

Question 4 of 5.

During an interaction with the nurse, a client states, 'My husband has supported me every time I've been hospitalized for depression. He'll leave me this time. I'm an awful wife and mother. I'm no good. Nothing I do is right.' Based on this information, which of the following nursing diagnoses should the nurse identify when developing the client's plan of care?

Question 5 of 5.

The client who has been taking venlafaxine (Effexor) 25 mg P.O. three times a day for the past 2 days states, 'This medicine isn't doing me any good. I'm still so depressed.' Which of the following responses by the nurse is most appropriate?