Bipolar and Related Disorders

Which documentation indicates that the treatment plan for a patient diagnosed with acute mania has been effective?

a. "Converses with few interruptions; clothing matches; participates in activities." The descriptors given indicate the patient is functioning at an optimal level, using appropriate behavior, and thinking without becoming overstimulated by unit activities.

A patient diagnosed with bipolar disorder commands other patients, "Get me a book. Take this stuff out of here," and other similar demands. The nurse wants to interrupt this behavior without entering into a power struggle. Which initial approach should the nurse select?

a. Distraction: "Let's go to the dining room for a snack." The distractibility characteristic of manic episodes can assist the nurse to direct the patient toward more appropriate, constructive activities without entering into power struggles.

The exact cause of bipolar disorder has not been determined; however, for most patients:

a. several factors, including genetics, are implicated. The best explanation at this time is that bipolar disorder is most likely caused by interplay of complex independent variables.

The nurse receives a laboratory report indicating a patient's serum level is 1 mEq/L. The patient's last dose of lithium was 8 hours ago. This result is:

a. within therapeutic limits. Normal range for a blood sample taken 8 to 12 hours after the last dose of lithium is 0.4 to 1 mEq/L.

To best assure safety, the nurse's first intervention is to:

b. clear the room of all other patients. Safety is of primary importance.

A patient diagnosed with bipolar disorder has rapidly changing mood cycles. The health care provider prescribes an anticonvulsant medication. To prepare teaching materials, which drug should the nurse anticipate will be prescribed?

d. carbamazepine (Tegretol) Carbamazepine seems to work better in patients with rapid cycling and in severely paranoid, angry manic patients.

An outpatient diagnosed with bipolar disorder is prescribed lithium. The patient telephones the nurse to say, "I've had severe diarrhea for 4 days. I feel very weak and unsteady when I walk. My usual hand tremor has gotten worse. What should I do?" The nurse will advise the patient to:

b. have someone bring the patient to the clinic immediately. The symptoms described suggest lithium toxicity. The patient should have a lithium level drawn and may require further treatment.

A patient waves a newspaper and says, "I must have my credit card and use the computer right now. A store is having a big sale, and I need to order 10 dresses and four pairs of shoes." Select the nurse's appropriate intervention. The nurse:

b. invites the patient to sit together and look at new fashion magazines. Situations such as this offer an opportunity to use the patient's distractibility to staff's advantage.

A nurse assesses a patient who takes lithium. Which findings demonstrate evidence of complications?

c. Diaphoresis, weakness, and nausea Diaphoresis, weakness, and nausea are early signs of lithium toxicity.

A person was online continuously for over 24 hours, posting rhymes on official government web-sites and inviting politicians to join social networks. The person has not slept or eaten for 3 days. What features of mania are evident?

c. Poor judgment and hyperactivity Hyperactivity (activity without sleep) and poor judgment (posting rhymes on government web-sites)

The plan of care for a patient in the manic state of bipolar disorder should include which inter-ventions? Select all that apply.

c. Provide a structured environment for the patient. d. Ensure that the patient's nutritional needs are met. People with mania are hyperactive, grandiose, and distractible.

Consider these three anticonvulsant medications: divalproex (Depakote), carbamazepine (Tegretol), and gabapentin (Neurontin). Which medication also belongs to this classification?

c. lamotrigine (La-mictal) The three drugs in the stem of the question are all anticonvulsants. Lamotrigine is also an anticonvulsant.

A patient experiencing acute mania undresses in the group room and dances. The nurse intervenes initially by:

c. putting a blanket around the patient and walking with the patient to a quiet room. Patients must be protected from the embarrassing consequences of their poor judgment whenever possible.

A patient diagnosed with bipolar disorder is in the maintenance phase of treatment. The patient asks, "Do I have to keep taking this lithium even though my mood is stable now?" Select the nurse's appropriate response.

b. "Taking the medication every day helps reduce the risk of a relapse." Patients diagnosed with bipolar disorder may be maintained on lithium indefinitely to prevent recurrences.

Which nursing diagnosis would most likely apply to both a patient diagnosed with major depression as well as one experiencing acute mania?

b. Disturbed sleep pattern Patients with mood disorders, both depression and mania, experience sleep pattern disturbances.

A nurse prepares the plan of care for a patient experiencing an acute manic episode. Which nursing diagnoses are most likely? Select all that apply.

b. Disturbed thought processes. c. Sleep deprivation. People with mania are hyperactive and often do not take time to eat and drink properly.

A patient demonstrating behaviors associated with acute mania has exhausted the staff by noon. Staff members are feeling defensive and fatigued. Which action will the staff take initially?

b. Hold a staff meeting to discuss consistency and limit-setting approaches. When staff members are at their wits' end, the patient has succeeded in keeping the environment unsettled and avoided outside controls on behavior.

At a unit meeting, the staff discusses decor for a special room for patients with acute mania. Which suggestion is appropriate?

b. Neutral walls with pale, simple accessories The environment for a manic patient should be as simple and non-stimulating as possible.

A patient diagnosed with bipolar disorder is dressed in a red leotard and bright scarves. The patient twirls and shadow boxes. The patient says gaily, "Do you like my scarves? Here; they are my gift to you." How should the nurse document the patient's mood?

a. Euphoric The patient has demonstrated clang associations and pleasant, happy behavior. Excessive happiness indicates euphoria.

A patient diagnosed with bipolar disorder will be discharged tomorrow. The patient is taking a mood stabilizing medication. What is the priority nursing intervention for the patient as well as the patient's family during this phase of treatment?

a. Attending psychoeducation sessions During the continuation phase of treatment for bipolar disorder, the physical needs of the patient are not as important an issue as they were during the acute episode.

Which suggestions are appropriate for the family of a patient diagnosed with bipolar disorder who is being treated as an outpatient during a hypomanic episode? Select all that apply.

a. Limit credit card access. b. Provide a structured environment. e. Monitor the patient's sleep patterns. A patient with hypomania is expansive, grandiose, and labile; uses poor judgment; spends inappropriately; and is over-stimulated by a busy environment.

A patient tells the nurse, "I'm ashamed of being bipolar. When I'm manic, my behavior embarrasses everyone. Even if I take my medication, there are no guarantees. I'm a burden to my family." These statements support which nursing diagnoses? Select all that apply.

a. Powerlessness c. Chronic low self-esteem Chronic low self-esteem and powerlessness are interwoven in the patient's statements. No data support the other diagnoses.

A patient diagnosed with acute mania has distributed pamphlets about a new business venture on a street corner for 2 days. Which nursing diagnosis has priority?

a. Risk for injury Although each of the nursing diagnoses listed is appropriate for a patient having a manic episode, the priority lies with the patient's physiological safety.

Four new patients were admitted to the behavioral health unit in the past 12 hours. The nurse directs a psychiatric technician to monitor these patients for safety. Which patient will need the most watchful supervision? A patient diagnosed with:

a. bipolar I disorder Bipolar I is a mood disorder characterized by excessive activity and energy.

A health teaching plan for a patient taking lithium should include instructions to:

a. maintain normal salt and fluids in the diet. Sodium depletion and dehydration increase the chance for development of lithium toxicity.

An outpatient diagnosed with bipolar disorder takes lithium carbonate 300 mg three times daily. The patient reports nausea. To reduce the nausea most effectively, the nurse suggests that the lithium be taken with:

a. meals. Some patients find that taking lithium with meals diminishes nausea. The incorrect options are less helpful.

The spouse of a patient diagnosed with bipolar disorder asks what evidence supports the possibility of genetic transmission of bipolar disorders. Which response should the nurse provide?

b. "A higher rate of relatives with bipolar disorder is found among patients with bi-polar disorder."

A patient experiencing acute mania dances around the unit, seldom sits, monopolizes conversations, interrupts, and intrudes. Which nursing intervention will best assist the patient with energy conservation?

b. Provide a subdued environment. All the options are reasonable interventions with a patient with acute mania, but providing a subdued environment directly relates to the outcome of energy conservation by decreasing stimulation and helping to balance activity and rest.

When a hyperactive patient diagnosed with acute mania is hospitalized, what is the initial nursing intervention?

b. Set limits on patient behavior as necessary. This intervention provides support through the nurse's presence and provides structure as necessary while the patient's control is tenuous.

A patient demonstrating characteristics of acute mania relapsed after discontinuing lithium. New orders are written to resume lithium twice daily and begin olanzapine (Zyprexa). What is the rationale for the addition of olanzapine to the medication regimen? It will:

b. bring hyperactivity under rapid control. Manic symptoms are controlled by lithium only after a therapeutic serum level is attained.

Outcome identification for the treatment plan of a patient experiencing grandiose thinking associated with acute mania will focus on:

b. distorted thought self-control. The desired outcome is that the patient will be able to control the grandiose thinking associated with acute mania as evidenced by making realistic comments about self, abilities, and plans.

This nursing diagnosis applies to a patient with acute mania: Imbalanced nutrition: less than body requirements related to insufficient caloric intake and hyperactivity as evidenced by 5-pound weight loss in 4 days. Select an appropriate outcome. The patient will:

b. drink six servings of a high-calorie, high-protein drink each day. High-calorie, high-protein food supplements will provide the additional calories needed to offset the patient's extreme hyperactivity.

A patient diagnosed with bipolar disorder becomes hyperactive after discontinuing lithium. The patient threatens to hit another patient. Which comment by the nurse is appropriate?

c. "Do not hit anyone. If you are unable to control yourself, we will help you." When the patient is unable to control his or her behavior and violates or threatens to violate the rights of others, limits must be set in an effort to deescalate the situation.

Which dinner menu is best suited for a patient with acute mania?

c. Broiled chicken breast on a roll, an ear of corn, and an apple These foods provide adequate nutrition, but more important they are finger foods that the hyperactive patient could "eat on the run."

A person was directing traffic on a busy street, rapidly shouting, "To work, you jerk, for perks" and making obscene gestures at cars. The person has not slept or eaten for 3 days. Which assessment findings will have priority concern for this patient's plan of care?

c. Hyperactivity; not eating and sleeping Hyperactivity, poor nutrition, hydration, and not sleeping take priority in terms of the needs listed above because they threaten the physical integrity of the patient.

A patient with diagnosed bipolar disorder was hospitalized 7 days ago and has been taking lithium 600 mg tid. Staff observes increased agitation, pressured speech, poor personal hygiene, and hyperactivity. Which action demonstrates that the nurse understands the most likely cause of the patient's behavior?

d. Consider the need to check the lithium level. The patient may not be swallowing medications. The patient is continuing to exhibit manic symptoms. The lithium level may be low from "cheeking" (not swallowing) the medication.

A newly diagnosed patient is prescribed lithium. Which information from the patient's history indicates that monitoring of serum concentrations of the drug will be challenging and critical?

d. Heart failure The patient with congestive heart failure will likely need diuretic drugs, which will complicate the maintenance of the fluid balance necessary to avoid lithium toxicity.

A patient with acute mania has disrobed in the hall three times in 2 hours. The nurse should:

d. arrange for one-on-one supervision. A patient who repeatedly disrobes despite verbal limit setting needs more structure. One-on-one supervision may provide the necessary structure.