Bipolar Disorder

b,c,e

ATI: A nurse is planning care for a client who has bipolar disorder and is experiencing a manic episode. Which of the following interventions should the nurse include in the plan of care? Select all that apply a. provide flexible client behavior expectations b. offer concise explanations c. establish consistent limits d. disregard client complaints e. use a firm approach with communication

2

Cyclothymic disorder is characterized by at least ___years of chronic fluctuating periods of hypomanic and depressive behaviors.

Mania

__________ is an abnormal and persistent period of​ increased, expanded, or irritable mood that is characterized by increased energy for a period of time.

5,2

A depressive state is characterized by _____ or more symptoms in a​ ___-week period that demonstrate either a depressed mood or a decrease in pleasure or interest in daily activities.

a,b,c,e (Rationale A goal that states that the client who is currently depressed will have no symptoms of depression is inappropriate. All other answer choices are appropriate choices for the client with bipolar disorder with depression.)

The nurse is planning care for a client with bipolar disorder who is experiencing depression. What outcomes are appropriate for the nurse to include in the client​'s plan of​ care? Select all that apply. a The client will have no suicidal ideations. b The client will maintain a safe environment and remain free from injury. c The client and family will become knowledgeable about the​ disorder, effective​ communication, and problem solving. d The client will have no symptoms of depression. e The client will maintain appropriate personal​ self-care.

b,c,e (Psychotherapies that are appropriate for a client diagnosed with bipolar disorder include individual​ therapy, CBT, and family therapy. ECT is not a therapy that is typically used for the treatment of bipolar disorder. Lithium therapy is an appropriate pharmacologic therapy for bipolar​ disorder, but it is not a type of psychotherapy.)

What treatment modalities of psychotherapy are used to treat bipolar​ disorder? Select all that apply. a Electroconvulsive therapy​ (ECT) b Family therapy c Individual therapy d Lithium therapy ​e Cognitive-behavioral therapy​ (CBT)

c,d,e (Psychotherapies that are appropriate for a client diagnosed with bipolar disorder include individual​ therapy, CBT, and family therapy. ECT is not a therapy that is typically used for the treatment of bipolar disorder. Lithium therapy is an appropriate pharmacologic therapy for bipolar​ disorder, but it is not a type of psychotherapy.)

What treatment modalities of psychotherapy are used to treat bipolar​ disorder? Select all that apply. a Lithium therapy b Electroconvulsive therapy​ (ECT) c Individual therapy d Family therapy ​e Cognitive-behavioral therapy​ (CBT)

b,d,e (Rationale: People in the hypomanic state experience a dramatically decreased need for sleep. Clients in a hypomanic state develop emotional attachments rapidly and may engage in impulsive or simultaneous sexual relationships. Clients in a hypomanic state have increased neurotransmission, which leads to racing thoughts and pressured or rapid speech. Anhedonia and guilt are not symptoms of the hypomanic phase.)

What would the nurse expect to observe in a client in the hypomanic phase of bipolar disorder? (Select all that apply.) a Anhedonia b Preoccupation with sex c Guilt d Lack of sleep e Rapid speech

a,b,c,d

A nurse is providing discharge instructions for a client with bipolar disorder who presented to the hospital in a manic state. What instructions will the nurse include in the home care instruction of the client with bipolar​ disorder? Select all that apply. a Seek help when needed. b Learn effective​ self-administration of medications. c Recognize medication side effects. d Recognize the importance of adhering to therapy schedules. e Learn methods to prevent the disorder.

a (Rationale Cyclothymic disorder involves a mood range from moderate depression to hypomania. Bipolar I disorder is characterized by a single manic episode with no past major depressive episodes. Seasonal affective disorder is a form of depression occurring in the fall and winter.)

A client in an outpatient mental health clinic is diagnosed with cyclothymic disorder. Which statement about cyclothymic disorder is​ true? a It involves a mood range from moderate depression to hypomania. b It involves a single manic episode. c It is a form of depression that occurs in the fall and winter. d It is a mood disorder similar to major​ depression, but of mild to moderate severity.

d (Rationale It takes 10 -21 days to achieve a lithium level within the therapeutic range. During an acute manic​ episode, the normal therapeutic range is 0.8 -1.2 ​mEq/L. At higher​ dosages, the client would be exhibiting signs and symptoms of toxicity.)

A client who has bipolar disorder and is in a manic phase has been taking lithium carbonate 600 mg orally 3 times per day for 14 days. What serum lithium level does the nurse note is​ therapeutic? a 3.3 -4.0 ​mEq/L b 2.6 -3.2 ​mEq/L c 0.6 -1.6 ​mEq/L d 0.8 -1.2 ​mEq/L

a,b,c,d (Rationale Appropriate nursing diagnoses for a client with bipolar disease who is displaying mania​ include: Impaired knowledge about the disease​ process; potential for appropriate medication​ management; risk for altered nutritional​ status; and impaired coping mechanisms. The client with mania who has overdosed on medication has an impaired knowledge about his or her disease and has a potential for appropriate medication management. The client with mania is also at risk for altered nutritional status due to the decreased need for eating. The client with mania who overdoses on medication has impaired coping mechanisms. It is not known if the client has alterations in interpersonal relationships. This information may be obtained in a psychosocial assessment.)

A nurse is caring for a client with bipolar disorder who is admitted to the hospital after an accidental overdose of sleeping medication. What are appropriate nursing diagnoses for this​ client? Select all that apply. a Risk for altered nutritional status b Potential for appropriate medication management c Impaired knowledge about the disease process d Impaired coping mechanisms e Alterations in interpersonal relationships

a (Rationale Edema of the lower extremities may indicate lithium carbonate toxicity. The nurse should notify the healthcare provider immediately. The other answer choices are not appropriate as the best response.)

A nurse is caring for a client with bipolar disorder who is being treated for this condition with lithium carbonate. Upon​ assessment, the nurse notes that the client​'s lower extremities appear swollen. What is the nurse​'s best response to this clinical​ finding? a Notify the healthcare provider immediately. b Continue to monitor the client. c Document the client findings in the clinical chart. d Elevate the client​'s extremities above the heart.

d (Rationale The nurse must assess the client for suicidal ideations. The client is expressing thoughts of​ worthlessness, which may indicate the client is suicidal. The other aspects are important for the nurse to assess during the psychosocial​ assessment; however, these are not the most important in this client at this time.)

A nurse is caring for a client with bipolar disorder with a depressive episode. The client tells the​ nurse, "I don​'t know why I even try anymore. I always fail at everything in my life. I should just give up. " What aspect of the psychosocial history during the nursing exam is most important at this time for this​ client? a Interpersonal relationship assessment b Hallucination assessment ​c Self-esteem assessment d Suicide assessment

a,b (Rationale Olanzapine​ (Zyprexa) is an antipsychotic mood stabilizer that is often taken with an anticonvulsant mood​ stabilizer, not an anxiolytic. Lithium​ carbonate, not​ Zyprexa, must be monitored with a blood test.)

A nurse is caring for a client with bipolar disorder. The healthcare provider has prescribed olanzapine​ (Zyprexa) for the collaborative treatment of the client​'s condition. What information will the nurse include in the client teaching regarding this​ medication? Select all that apply. a "This medication is often taken with an anticonvulsant mood stabilizer. b "This medication is called an antipsychotic mood stabilizer. " c "This medication is often taken with an anxiolytic. d "This medication is called an anxiolytic. " e "This medication must be monitored with a blood test.

a,b,d,e (Rationale ​Nausea, vomiting, and diarrhea —not constipation —are symptoms of lithium toxicity. Lithium carbonate should not be used in pregnant clients and may be used in combination with antipsychotic mood stabilizers. Lab work is needed to monitor the therapeutic level of this medication.)

A nurse is caring for a female client with bipolar disorder. The healthcare provider has prescribed lithium carbonate for the collaborative treatment of the client​'s condition. What information will the nurse include in the client teaching regarding this​ medication? Select all that apply. a "Monitor for nausea and​ vomiting, as this could indicate a lithium toxicity. b "This medication should not be used if you suspect you may be pregnant. c "Monitor for​ constipation, as this could indicate a lithium toxicity. d "This medication may be used with an antipsychotic mood stabilizer. e "Lab work will be needed to monitor the therapeutic level of this medication.

d

A nurse is caring for an adolescent client with bipolar disorder. The nurse understands that this client may also have additional psychosocial alterations. Which condition is most likely complicating the client​'s ​diagnosis? a Personality disorder b Schizophrenia c Anorexia nervosa d Substance abuse

b (Feedback Rationale: This response makes an observation, gives some health information about risks, and allows the client to choose. The client experiencing mania does not sleep or eat well, which can cause health problems. The client has stated that sleep is not necessary, so telling the client that the medication will help the client be in good shape tomorrow is meaningless to the client. Reminding the client of the rules is a threat and not acceptable. It is incorrect to state that the medication will potentiate the mood stabilizing medication.)

Prior to bedtime, the nurse offers trazodone (Desyrel) for the client with bipolar disorder who is experiencing mania. The client "declines the medication, stating they do not need sleep. The most therapeutic response by the nurse is the following: a "The medication should help you sleep so you'll be at your best tomorrow." b "You stated that you did not sleep at all last night. That can be tough on your system." c "You'll be in trouble if you break the unit rule that lights are out at 11 p.m." d "This medication will potentiate your mood stabilizer so that you'll be discharged sooner."

c (Rationale: Stress can cause the release of neurotransmitters, over time causing more rapid mood swings even though the lithium level is normal. The body does not develop a tolerance to lithium and the sleep cycle is not disturbed. A decreased production of melatonin will cause depression, not mood swings.)

The client, who is on lithium for bipolar disorder, is experiencing more mood swings despite a therapeutic lithium level. What is the cause of these mood swings? a "The shorter days in the fall decreases the production of melatonin, which affects mood." b "The body develops a tolerance to the medication, so a higher dose is needed." c When under constant stress, "The brain releases extra neurotransmitters, causing more rapid mood swings." d "The sleep-wake cycle is disturbed by the medication."

c (Rationale Bipolar disorders are a group of mood disorders that include manic​ episodes, hypomanic​ episodes, and mixed episodes. Symptoms may include​ euphoria, inability to take time to​ eat, sleep​ disturbances, and possibly sexual disinhibition. Cyclothymic disorder symptoms include fluctuating mood​ disturbances, involving numerous periods of hypomanic symptoms and numerous periods of depressive symptoms. Hypomania is a less extreme form of mania that is not severe enough to markedly impair functioning or require hospitalization. A depressed episode occurs when manic or hypomanic episodes have occurred in the​ past, but the features of the current episode are purely depressive.)

The nurse is assessing a new client on the mental health unit. The client states that she has been overly busy every day most of the time for the past 2 years and is unable to cope with family responsibilities. The nurse suspects that this client is suffering from which type of​ disorder? a Bipolar disorder with depression b Bipolar disorder with hypomania c Bipolar disorder with mania d Cyclothymic disorder

a,b,d,e

The nurse is evaluating the effectiveness of the nursing interventions for a client with bipolar disorder. Which evaluation of outcomes are appropriate for this​ client? Select all that apply. a The client remained in a safe environment and free from injury. b The client was able to demonstrate​ reality-based thinking by making an effective decision. c The client was able to sleep at least 4 hours at night. d The client was able to set appropriate limits in a variety of situations. e The client did not commit violent or harmful acts against self or others.

b,c,d,e (Rationale A goal that states the client will not experience any additional episodes of mania is​ incorrect, because this is not specific to the client​'s problem right now. The other​ outcomes/goals are appropriate for a client with bipolar disorder experiencing mania.)

The nurse is planning care for a client with bipolar disorder who is experiencing mania. What outcomes are appropriate for the nurse to include in the client​'s plan of​ care? Select all that apply. a The client will not experience any additional episodes of mania. b The client will maintain a safe environment and remain free from injury. c The client will get at least 6 hours of sleep per night. d The client will demonstrate socially appropriate behaviors during interactions with others in a variety of settings. e The client will not commit violent or harmful acts against self or others.

a (Rationale By giving the client​ high-calorie foods that can be eaten while the client is​ active, the nurse facilitates the client​'s nutritional intake. The client​'s metabolic rate is not useful information when the client is experiencing mania. The client will not be able to sit still long enough to focus on what the dietitian is saying during a manic episode or to sit in the dining area to eat.)

The nurse is planning care for a client with bipolar disorder. Which intervention would the nurse implement to maintain adequate nutrition during a manic​ episode? a Give the client foods to be eaten while the client is active. b Have the client interact with a dietitian twice a week. c Make the client sit down for each meal and snack in the dining area. d Determine the client​'s metabolic rate.

a,b,c,d (Rationale Appropriate nursing interventions for the client experiencing mania​ include: Administering medications as​ ordered, maintaining proper client nutritional​ status, assisting with personal hygiene as​ needed, and discussing sleep patterns and methods to promote at least 6 hours of sleep at night. The nurse should not encourage the client with mania to sit while​ eating, as this is very difficult or impossible for the client to do.)

The nurse is writing a plan of care for a client with acute mania. Which nursing interventions are appropriate when caring for this​ client? Select all that apply. a Administer medications as ordered. b Discuss sleep patterns and methods to promote at least 6 hours of sleep at night. c Assist with personal hygiene as needed. d Maintain proper client nutritional status. e Encourage the client to sit down while eating.

a (Rationale: This complicated activity requires concentration and a long-attention span. Most bipolar clients in the manic phase have increased sexual desire. The client with bipolar disorder is capable of understanding the disease without treatment. 3 hours of sleep would indicate the client is experiencing the hypomanic phase.)

Which outcome indicates that a client taking lithium is responding effectively to therapy? a The client completes the crossword puzzle in the daily newspaper. b The client reports an increase in sexual desire. c The client verbalizes complete understanding of bipolar disorder. d The client reports feeling refreshed after sleeping for 3 hours at night.