Bipolar Disorder

The family of a 22-year-old client with bipolar disorder is having difficulty coping with the client's rapid mood swings, irritability, grandiose delusions, and overly intrusive behaviors. Following a visit to the unit, the parents discuss their frustration and anger with the nurse and ask what they should do to help the client. Which reply by the nurse is most appropriate? "Help the client monitor medication adherence and watch for changes in mood and sleep." "Let the client move back in with you and take away the client's checkbook and driver's license." "Call the police when the client becomes manic and have the client involuntarily committed." "Make sure the client is taking the medication correctly and help the client get out of debt."

"Help the client monitor medication adherence and watch for changes in mood and sleep."

At 1 a.m., the client with mania rushes to the nurses' station and demands that the psychiatrist come to the unit now to write an order for a pass to go home. What would be the nurse's most therapeutic response? "Go to the day room and wait while I call your psychiatrist." "Don't be unreasonable. I can't call the psychiatrist at this time of night." "You must really be upset to want a pass immediately; I'll give you some medication." "I can't call the psychiatrist now, but you and I can talk about your request for a pass."

"I can't call the psychiatrist now, but you and I can talk about your request for a pass."

The nurse learns at report that a newly admitted client experiencing mania is demonstrating grandiose delusions. The nurse should recognize that which client statement provides supportive evidence of this symptom? A. "I can't stop my sexual urges. They have led me to numerous affairs." B. "I'm the world's most perceptive attorney." C. "My wife is distraught about my overspending." D. "The FBI is out to get me."

"I'm the world's most perceptive attorney."

A client who is manic states, "What time is it? I have to see the doctor. Is breakfast here yet? I've got to see the doctor first. Can I get my cereal out of the kitchen?" Which response by the nurse would be most appropriate ? "Are you hungry?" "Your thoughts seem to be racing this morning." "You will have to be quiet and have breakfast after the doctor comes." "Please slow down. I'm not sure what you need first."

"Please slow down. I'm not sure what you need first."

What is a desired outcome for the maintenance phase of treatment for a manic client? 1. Adhere to follow-up medical appointments. 2. Take medication more than 50% of the time. 3. Use alcohol to moderate occasional mood "highs." 4. Exhibit optimistic, energetic, playful behavior.

1. Adhere to follow-up medical appointments. The client would be living in the community during the maintenance phase. Keeping follow-up appointments is highly desirable. None of the other options are accurate.

Which of the following describe the symptoms of the manic phase of bipolar disorder? (Select all that apply.) Select all that apply. 1. Distractibility 2. Low self-esteem 3. Excessive energy 4. Withdrawal from environment 5. Racing thoughts 6. Purposeless movement 7. Pressured speech 8. Fatigue and increased sleep

1. Distractibility 3. Excessive energy 5. Racing thoughts 6. Purposeless movement 7. Pressured speech

The spouse of a client diagnosed recently with a mood disorder calls the nurse therapist to report a change in the client's mood. The spouse states, "The client is clearly in a better mood than usual. I would say the client seems mildly elated. The client is functioning fine at work and home. The client is energetic, up and doing things at 5:00 a.m. and really confident again. It seems fantastic, but unusual. Is this something to worry about?" Which potential response by the nurse accurately assesses the situation? 1. "Since the client is eating, sleeping, and not behaving inappropriately, there's nothing to worry about. Just let me know if the client starts getting irritable or has trouble sleeping." 2. "The client sounds hypomanic. Let's schedule an appointment for this week for an evaluation. The client may need additional or different medication." 3. "It sounds as though the antidepressants are working well

2. "The client sounds hypomanic. Let's schedule an appointment for this week for an evaluation. The client may need additional or different medication."

Which room placement would be best for a client experiencing a manic episode? 1. A shared room with a client with dementia 2. A single room near the nurses' station 3. A shared room away from the unit entrance 4. A single room near the unit activities area

2. A single room near the nurses' station The room placement that provides a non-stimulating environment is best. Nearness to the nurses' station means close supervision can be provided. None of the other options provide low stimulation.

The nurse is managing the care of an older adult diagnosed with bipolar disorder who is in a manic phase. The nurse closely monitors the patient for risks to his or her safety. What factor makes this intervention especially appropriate for this patient? 1 . Such a patient is abused easily by other aggressive patients. 2. Mania can result in irresponsible and physically risky behaviors. 3. The manic phase will be followed by a phase of severe depression. 4. Older adults experience physical conditions that greatly increase the potential for injury

2. Mania can result in irresponsible and physically risky behaviors.

Which statement is true of the relationship between bipolar disorder and suicide? 1. Patients need to be monitored only in the depressed phase because this is when suicides occur. 2. Suicide is a serious risk because nearly 20% of those diagnosed with bipolar disorder commit suicide. 3. Patients with bipolar disorder are not considered high risk for suicide. 4. As long as patients with bipolar disorder adhere to their medication regimen, there is little risk for suicide.

2. Suicide is a serious risk because nearly 20% of those diagnosed with bipolar disorder commit suicide.

Which symptom related to communication is likely to be present in a patient experiencing mania? 1. Mutism 2. Poverty of ideas 3. Clang associations 4. Psychomotor retardation

3 Clang associations are the stringing together of words because of their rhyming sounds, without regard to their meaning. This communication style occurs commonly in persons experiencing mania. Mutism, poverty of ideas, and psychomotor retardation are assessment findings usually associated with depression.

A nursing instructor is teaching about bipolar disorders. Which statement differentiates the DSM-5 diagnostic criteria of a manic episode from a hypomanic episode? 1. During a manic episode, clients may experience an inflated self-esteem or grandiosity & these symptoms are absent in hypomania. 2. During a manic episode, clients may experience a decreased need for sleep & this symptom is absent in hypomania. 3. During a manic episode, clients may experience psychosis & this symptom is absent in hypomania. 4. During a manic episode, clients may experience flight of ideas & racing thoughts & these symptoms are absent in hypomania.

3 ~ Three or more of the following symptoms may be experienced in both hypomanic & manic episodes: Inflated self-esteem or grandiosity, decreased need for sleep (e.g., feels rested after only 3 hours of sleep), more talkative than usual or pressure to keep talking, flight of ideas and racing thoughts, distractibility, increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation, excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., the person engages in unrestrained buying sprees, sexual indiscretions, or foolish business investments). If there are psychotic features, the episode is, by definition, manic.

Which of the following is true of the relationship between bipolar disorder and suicide? 1. Clients need to be monitored only in the depressed phase because this is when suicides occur. 2. As long as clients with bipolar disorder adhere to their medication regimen, there is little risk for suicide. 3. Suicide is a serious risk those diagnosed with bipolar disorder commit suicide. 4. Clients with bipolar disorder are not considered high risk for suicide.

3. Suicide is a serious risk those diagnosed with bipolar disorder commit suicide. Mortality rates for bipolar disorder are severe because substantial numbers of individuals with bipolar disorder will make a suicide attempt at least once in their lifetime. Suicides occur in both the depressed and the manic phase. Bipolar clients are always considered high risk for suicide because of impulsivity while in the manic phase and hopelessness when in the depressed phase. Although staying on medications may decrease risk, there is no evidence to suggest that only clients who stop medications commit suicide.

The client's family is questioning the nurse about bipolar disorder. Which statements about the etiology of bipolar disorder do most psychoanalytical theories subscribe to? Select all that apply. 1. Norepinephrine levels may be increased in mania. 2. Acetylcholine seems to be implicated in mania. 3. The id takes over the ego and acts as an undisciplined hedonistic being (child). 4. Manic episodes are a "defense" against underlying depression

3. The id takes over the ego and acts as an undisciplined hedonistic being (child). 4. Manic episodes are a "defense" against underlying depression.

A manic client tells a nurse "Bud. Crud. Dud. I'm a real stud! You'd like what I have to offer. Let's go to my room." What is the best initial approach to managing this behavior? 1. Enforcing consequences by responding, "Let's walk down to the seclusion room." 2. Reprimand the client by stating, "What an offensive thing to suggest!" 3. Clarifying the nurse-client relationship by stating, "I don't have sex with clients." 4. Distracting the client by suggesting, "It's time to work on your art project."

4. Distracting the client by suggesting, "It's time to work on your art project." Distractibility works as the nurse's friend. Rather than discuss the invitation, the nurse may be more effective by redirecting the client. This intervention is both therapeutic and less restrictive.

When a hyperactive manic client expresses the intent to strike another client, what is the initial nursing intervention? 1. question the client's motive. 2. initiate physical confrontation. 3. prepare the client for seclusion. 4. set verbal limits.

4. set verbal limits. Verbal limit setting should always precede more restrictive measures. Questioning motives does not address the safety issue that exists.

The cause of bipolar disorder has not been determined, but: a. several factors, including genetics, are implicated. b. brain structures were altered by stresses early in life. c. excess norepinephrine is probably a major factor. d. excess sensitivity in dopamine receptors may exist.

A ~ At this time, the interplay of complex independent variables is most likely the best explanation of the cause for bipolar disorder. Various theories implicate genetics, endocrine imbalance, early stress, and neurotransmitter imbalances.

A patient diagnosed with bipolar disorder commands other patients, "Get me a book. Take this stuff out of here," & other similar demands. The nurse wants to interrupt this behavior without entering into a power struggle. Select the best initial approach by the nurse. a. Distraction: Lets go to the dining room for a snack. b. Humor: How much are you paying servants these days? c. Limit setting: You must stop ordering other patients around. d. Honest feedback: Your controlling behavior is annoying others

A ~ The distractibility characteristic of manic episodes can assist the nurse to direct the patient toward more appropriate, constructive activities without entering into a power struggle. Humor usually backfires by either encouraging the patient or inciting anger. Limit setting and honest feedback may seem heavy-handed to a labile patient & may incite anger.

A patient diagnosed with bipolar disorder is dressed in a red leotard & brightly colored scarves. The patient says, "I'll punch you, munch you, crunch you" while twirling & shadowboxing. Then the patient says gaily, Do you like my scarves? Here, they are my gift to you. How should the nurse document the patients mood? a. Labile and euphoric b. Irritable and belligerent c. Highly suspicious and arrogant d. Excessively happy and confident

A ~ The patient has demonstrated angry behavior & pleasant, happy behavior within seconds of each other. Excessive happiness indicates euphoria. Mood swings are often rapid & seemingly without understandable reason in patients who are manic. These swings are documented as labile. Irritability, belligerence, excessive happiness & confidence are not entirely correct terms for the patient's mood. A high level of suspicion is not evident.

Kelly has come to the mental health clinic for an assessment at the request of her husband. Kelly refuses to talk to the nurse until her personal assistant arrives. She states, "Apparently you don't know that I'm a famous person, and when my fans get here, you'll be glad my personal assistant is here to manage the crowd." The nurse meets with the husband to being the assessment process. Which of the following observations by the husband are consistent with symptoms of a manic episode? (Select all that apply) A. "She has concocted this story about having a personal assistant and being a famous person, none of which is true." B. "She has over-extended our credit cards, buying huge quantities of unnecessary items." C. "Ever since we married, she has had periods where she makes superficial cuts on her wrists and becomes convinced I'm going to divorce her." D."I've noticed her behaving in a very provocative manner around

A. "She has concocted this story about having a personal assistant and being a famous person, none of which is true." B. "She has over-extended our credit cards, buying huge quantities of unnecessary items." D."I've noticed her behaving in a very provocative manner around other men." Feedback 1: Kelly's false belief that she is a famous person is evidence by a delusion of grandeur, which is a symptom of a manic episode Feedback 2: Excessive spending is a common symptom in manic episodes Feedback 4: In acute manic episodes, one of the symptoms is increased sex drive, which could manifest in provocative and/or high-risk behavior

The parents of a teenage son who was recently diagnosed with bipolar disorder ask the nurse to provide them with information about this illness, since they had previously been told their son had ADHD. Which of the following is evidenced-based information that can be shared with the family? (Select all that apply) A. ADHD is the most common comorbid condition in children and adolescents with bipolar disorder B. Bipolar disorder in children and adolescents is an acute condition that they usually outgrow C. there is evidence to support that psychosocial therapy enhances the effectiveness of pharmacological therapy in treatment of bipolar disorder in children and adolescents. D. Stimulants used in the treatment of ADHD can exacerbate mania in children and adolescents with bipolar disorder E. Medication discontinuation can be considered after the patient has been in remission for 2 months.

A. ADHD is the most common comorbid condition in children and adolescents with bipolar disorder C. there is evidence to support that psychosocial therapy enhances the effectiveness of pharmacological therapy in treatment of bipolar disorder in children and adolescents. D. Stimulants used in the treatment of ADHD can exacerbate mania in children and adolescents with bipolar disorder

Harold is admitted to the psychiatric unit with bipolar I disorder: manic episode in a highly-agitated state. His speech is rapid and incoherent, he is pacing and in constant motion, and he is loudly proclaiming that his "lawyers are on the way and every one of you is going to be sued for malpractice." Which of the following nursing interventions are appropriate in this situation? (Select all that apply) A. Provide an environment with low levels of stimulation B. Set limits on Harold's threats by instructing him that he is not permitted to sue the staff C. Convey a calm attitude and voice when communicating with Harold. D. Put Harold in seclusion with restraints for the protection of himself and others. E. Offer activities that will provide safe outlets for Harold's agitation and excessive energy.

A. Provide an environment with low levels of stimulation C. Convey a calm attitude and voice when communicating with Harold. E. Offer activities that will provide safe outlets for Harold's agitation and excessive energy. Feedback 1: Even little amounts of stimulation can increase symptoms and agitation in an acutely manic patient. Providing an environment with the low levels of stimulation is a priority to reduce the risk of further escalation. Feedback 3: Even little amounts of stimulation can increase symptoms and agitation in an acutely manic patient. Conveying a calm attitude and voice contributes to a lower level of stimulation when communicating with this client Feedback 5: Offering activities that provide safe outlets for the excessive energy and hyperactivity that occur in manic episodes can term-20be an effective distraction and a tool to reduce agitation

To assist the psychiatrist in determining appropriate medication needs, the nurse has been asked to assess whether a patient is in a hypomanic or an acute manic state. Which of the following symptoms are consistent with hypomania? (Select all that apply) A. cheerful mood, but underlying irritability surfaces rapidly when needs are not fulfilled B. fragmented cognition and perception; often psychotic C. delusions of grandeur D. easily distracted, which sometimes interferes with completing goal-directed activity E. extroverted and sociable

A. cheerful mood, but underlying irritability surfaces rapidly when needs are not fulfilled D. easily distracted, which sometimes interferes with completing goal-directed activity E. extroverted and sociable Feedback 1: This symptom is consistent with hypomania. In contrast, the individual in an acute manic state presents as euphoric, as if on a continuous "high". Feedback 4: This symptom is consistent with hypomania. In contrast, the person in an acute manic episode manifests with inexhaustible energy, poor impulse control, and marked interference with completing tasks Feedback 5: The person in a hypomanic episode typically presents as extroverted and sociable. In contrast, the individual in an acute manic episode typically presents as uninhibited and manipulative. Dress and behavior may appear disorganized and bizarre.

Haley is a 35-year old woman being assessed for complaints of racing thoughts, impulsive agitation, and distractibility. She denies having ever been diagnosed with a mental disorder. Which of the following items are important for the nurse to include in Haley's initial assessment to assist in identifying the correct diagnosis? (Select all that apply) A. family history of thyroid disorders B. family history of depression or bipolar disorders C. medications and other substances currently being taken D. birth order E. interest in attending group therapy

A. family history of thyroid disorders B. family history of depression or bipolar disorders C. medications and other substances currently being taken Feedback 1: Thyroid disorders, particularly hyperthyroidism, could manifest as the symptoms Haley is describing, and since these disorders show a familial tendency it is beneficial to assess for family history of these disorders Feedback 2: The symptoms Haley is experiencing could be evidence of a bipolar disorder. Bipolar disorders and depression show familial tendencies, so it is beneficial to assess for history of these Feedback 3: Several medications and other substances can produce the symptoms Haley is describing so a thorough history of substance and medication use is essential

A client is admitted in a manic episode of bipolar I disorder. Which nursing intervention should be most therapeutic for this client? A. Using a calm, unemotional approach during client interactions B. Focusing primarily on enforcing limits C. Limiting interactions to decrease external stimuli D. Encouraging the client to establish social relationships with peers

ANS: A Clients experiencing mania are subject to frequent mood variations, easily changing from irritability and anger to sadness and crying. Therefore, it is necessary to maintain a calm, unemotional approach during client interactions. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A nurse begins the intake assessment of a client diagnosed with bipolar I disorder. The client shouts, "You can't do this to me. Do you know who I am?" Which is the priority nursing action in this situation? A. To provide self and client with a safe environment B. To redirect the client to the needed assessment information C. To provide high-calorie finger foods to meet nutritional needs D. To reorient the client to person, place, time, and situation

ANS: A During a manic episode the client's mood is elevated, expansive, and irritable. Providing a safe environment should be prioritized to protect the client and staff from potential injury. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Safe and Effective Care Environment

Which of the following explanations should a nurse include when teaching parents why is it difficult to diagnose a child or adolescent exhibiting symptoms of bipolar disorder? Select all that apply. A. Bipolar symptoms are similar to attention deficit-hyperactivity disorder symptoms. B. Children are naturally active, energetic, and spontaneous. C. Neurotransmitter levels vary considerably in accordance with age. D. The diagnosis of bipolar disorder cannot be assigned prior to the age of 18. E. Genetic predisposition is not a reliable diagnostic determinant.

ANS: A, B It is difficult to diagnose a child or adolescent with bipolar disorder because bipolar symptoms are similar to attention deficit-hyperactivity disorder symptoms and because children are naturally active, energetic, and spontaneous. Symptoms may also be comorbid with other childhood disorders, such as conduct disorder. KEY: Cognitive Level: Application | Integrated Processes: Teaching/Learning | Client Need: Psychosocial Integrity

A newly admitted client is diagnosed with bipolar disorder: manic episode. Which symptom related to altered thought is the nurse most likely to assess? A. Pacing B. Flight of ideas C. Lability of mood D. Irritability

ANS: B Clients diagnosed with bipolar disorder: manic episode experience cognition and perception fragmentation often with psychosis during acute mania. Rapid thinking proceeds to racing and disjointed thinking (flight of ideas) and may be manifested by a continuous flow of accelerated, pressured speak with abrupt changes from topic to topic. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

A client's spouse asks, "What evidence supports the possibility of genetic transmission of bipolar disorder?" Which is the best nursing reply? A. "Clients diagnosed with bipolar disorders have alterations in neurochemicals that affect behaviors." B. "Higher rates of relatives diagnosed with bipolar disorder are found in families of clients diagnosed with this disorder." C. "Higher rates of relatives of clients diagnosed with bipolar disorder respond in an exaggerated way to daily stress." D. "More individuals diagnosed with bipolar disorder come from higher socioeconomic and educational backgrounds."

ANS: B Family studies have shown that if one parent is diagnosed with bipolar disorder, the risk that a child will have the disorder is around 28%. If both parents are diagnosed with the disorder, the risk is two to three times as great. KEY: Cognitive Level: Application | Integrated Processes: Teaching/Learning | Client Need: Health Promotion and Maintenance

A nurse learns at report that a newly admitted client experiencing mania is demonstrating grandiose delusions. The nurse should recognize that which client statement would provide supportive evidence of this symptom? A. "I can't stop my sexual urges. They have led me to numerous affairs." B. "I'm the world's most perceptive attorney." C. "My wife is distraught about my overspending." D. "The FBI is out to get me."

ANS: B Grandiosity is defined as a belief that personal abilities are better than anyone else's. This client is experiencing delusions of grandeur, which are commonly experienced in mania. KEY: Cognitive Level: Application | Integrated Processes: Evaluation | Client Need: Psychosocial Integrity

What tool should a nurse use to differentiate occasional spontaneous behaviors of children from behaviors associated with bipolar disorder? A. "Risky Activity" tool B. "FIND" tool C. "Consensus Committee" tool D. "Monotherapy" tool

ANS: B The Consensus Group recommends that clinicians use the FIND tool to differentiate occasional spontaneous behaviors of children from behaviors associated with bipolar disorder. FIND is an acronym that stands for frequency, intensity, number, and duration and is used to assess behaviors in children. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

A nursing instructor is teaching about the prevalence of bipolar disorder. Which student statement indicates that learning has occurred? A. "This disorder is more prevalent in the lower socioeconomic groups." B. "This disorder is more prevalent in the higher socioeconomic groups." C. "This disorder is equally prevalent in all socioeconomic groups." D. "This disorder's prevalence cannot be evaluated on the basis of socioeconomic groups."

ANS: B The nursing student is accurate when stating that bipolar disorder is more prevalent in higher socioeconomic groups. Theories consider both hereditary and environmental factors in the etiology of bipolar disorder. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Health Promotion and Maintenance

1. A nurse is developing a plan of care for a patient admitted with a diagnosis of bipolar disorder, manic phase. Which nursing diagnoses address priority needs for the patient? (Select all that apply.) a. Risk for caregiver strain b. Impaired verbal communication c. Risk for injury d. Imbalanced nutrition, less than body requirements e. Ineffective coping f. Sleep deprivation

ANS: C, D, F Risk for injury, poor nutrition, and impaired sleep are priority needs of the patient experiencing mania related to their impulsivity, inability to attend to activities of daily living such as diet and hygiene, and disruption of sleep. Caregiver strain is important to be addressed but is not a priority need on admission for the patient. Verbal communication improves when the mania is managed, and racing thoughts return to normal patterns. Ineffective coping will require stabilization of the acute phase along with cognitive therapy over time.

The inpatient psychiatric unit is being redecorated. At a unit meeting, staff discusses bedroom décor for clients experiencing mania. The nurse manager evaluates which suggestion as most appropriate? A. Rooms should contain extra-large windows with views of the street. B. Rooms should contain brightly colored walls with printed drapes. C. Rooms should be painted deep colors and located close to the nurse's station. D. Rooms should be painted with neutral colors and contain pale-colored accessories.

ANS: D Clients experiencing mania are subject to frequent mood variations, easily changing from irritability and anger to sadness and crying. Therefore, it is necessary to maintain low levels of stimuli in the client's environment (low lighting, few people, simple décor, low noise levels). Anxiety levels rise in a stimulating environment. Neutral colors and pale accessories are most appropriate for a client experiencing mania. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A highly agitated client paces the unit and states, "I could buy and sell this place." The client's mood fluctuates from fits of laughter to outbursts of anger. Which is the most accurate documentation of this client's behavior? A. "Rates mood 8/10. Exhibiting looseness of association. Euphoric." B. "Mood euthymic. Exhibiting magical thinking. Restless." C. "Mood labile. Exhibiting delusions of reference. Hyperactive." D. "Agitated and pacing. Exhibiting grandiosity. Mood labile."

ANS: D The nurse should document that this client's behavior is "Agitated and pacing. Exhibiting grandiosity. Mood labile." The client is exhibiting signs of irritation accompanied by aggressive behavior. Grandiosity refers to an exaggerated sense of power, importance, knowledge, or identity. KEY: Cognitive Level: Application | Integrated Processes: Communication and Documentation | Client Need: Safe and Effective Care Environment

At a unit meeting, staff members discuss the decor for a special room for patients experiencing mania. Select the best option. a. Extra-large window with a view of the street b. Neutral walls with pale, simple accessories c. Brightly colored walls and print drapes d. Deep colors for walls and upholstery

B ~ The environment for a patient experiencing mania should be as simple & as nonstimulating as possible. Patients experiencing mania are highly sensitive to environmental distractions & stimulation. Draperies present a risk for injury.

A client diagnosed with bipolar disorder has been hospitalized for 2 weeks. The client asks the nurse, "Do you think that the doctor is ever going to discharge me?" Which is the appropriate nursing response? A. "Ask your doctor when you can be discharged." B. "Tell me more about your feelings about being hospitalized." C. "You are not ready to go yet." D. "Let the doctor know your feelings."

B. "Tell me more about your feelings about being hospitalized." This is a therapeutic response that explores the client's feelings and addresses the client's concerns about the length of hospitalization

As clients are leaving the dayroom following a group therapy session, the nurse notices a client admitted for acute mania is clenching and unclenching both fists, swearing, and glaring at a staff member. Which action should the nurse take first? A. Calmly ask the client to go to the "quiet room." B. Instruct clients to return to the dayroom. C. Prepare to administer a sedative medication. D. Ask a staff member to call hospital security.

B. Instruct clients to return to the dayroom.

Margaret, a 68-year old widow experiencing a manic episode is admitted to the psychiatric unit after being brought to the emergency department by her sister-in-law. Margaret yells, "My sister-in-law is just jealous of me! She's trying to make it look like I'm insane!" This behavior is an example of A. a delusion of grandeur B. a delusion of persecution C. a delusion of reference D. a delusion of control or influence

B. a delusion of persecution

Tori has been diagnosed with bipolar I disorder and presents at her clinic appointment with complaints of feeling depressed and hopeless. What is the most important assessment for the nurse to make at this point? A. if Tori has been taking her medication B. if Tori is having thoughts of suicide C. if Tori has had any new stressors in her life. D. If Tori is using alcohol

B. if Tori is having thoughts of suicide

A client newly diagnosed in a manic episode of bipolar disorder tells the nurse, "Now that I'm only sleeping 4 hours a night, I can get so much more accomplished." Which ego defense mechanism is this client using? A. denial B. intellectualization C. rationalization D. suppression

B. intellectualization Intellectualization occurs when an individual attempts to avoid expressing actual emotions associated with a stressful situation by using the intellectual processes of logic, reasoning, and analysis. the individual in the question is using reasoning to avoid dealing with feelings about the new diagnosis of bipolar disorder.

A suicidal client, with a history of manic behavior, is admitted to the ED. The client's diagnosis is documented as Bipolar I disorder: current episode depressed. What is the rationale for this diagnosis instead of a diagnosis of major depressive disorder? A. The physician does not believe the client is suffering from major depression B. the client has experienced a manic episode in the past. C. the client does not exhibit psychotic symptoms. D. There is no history of major depression in the client's family

B. the client has experienced a manic episode in the past. The client's past history of mania and current suicide attempt support the diagnosis of Bipolar I disorder: current episode depressed. According to the DSM-5 criteria, a manic episode rules out the diagnosis of major depressive disorder.

Which dinner menu is best suited for the patient diagnosed with bipolar disorder experiencing acute mania? a. Spaghetti and meatballs, salad, a banana b. Beef and vegetable stew, a roll, chocolate pudding c. Broiled chicken breast on a roll, an ear of corn, apple d. Chicken casserole, green beans, flavored gelatin with whipped cream

C ~ The correct foods provide adequate nutrition but, more importantly, are finger foods that the hyperactive patient could eat on the run. The foods in the incorrect options cannot be eaten without utensils.

Outcome identification for the treatment plan of a patient with grandiose thinking associated with acute mania focuses on: a. maintaining an interest in the environment. b. developing an optimistic outlook. c. self-control of distorted thinking. d. stabilizing the sleep pattern.

C ~ 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. Patients with acute mania are already unduly optimistic as a result of their use of denial, and they are overly interested in their environment. Sleep stability is a desired outcome but is not related to distorted thought processes.

A client demonstrating manic behavior has become demanding and hyperactive. Which is the most appropriate nursing intervention to address these client behaviors? A. Help lessen the client's feelings of guilt and rejection B. Warn the client that restraints may be necessary if behavior does not improve C. Maintain a supportive, structured environment, setting firm limits in a non-threatening manner. D. Introduce the client to peers in order to increase interpersonal contacts

C. Maintain a supportive, structured environment, setting firm limits in a nonthreatening manner. The client is having difficulty controlling behavior and maintaining impulse control. the nurse must help the client to do so in an objective, nonjudgmental way, focusing on the behavior and not the client

Margaret, age 68, is diagnosed with Bipolar I disorder, current episode manic. She is extremely hyperactive and has lost weight. One way to promote adequate nutritional intake for Margaret is to: A. sit with her during meals to ensure that she eats everything on her tray. B. have her sister-in-law bring all her food from home because she knows Margaret's likes and dislikes C. Provide high-calorie, nutritious finger foods and snacks that Margaret can eat "on the run". D. Tell Margaret that she will be on room restriction until she starts gaining weight.

C. Provide high-calorie, nutritious finger foods and snacks that Margaret can eat "on the run".

A client is diagnosed with bipolar disorder. the family describes the client as being "on the move". The client sleeps 3-4 hours nightly, spends excessively, and has recently lost 10 pounds. During the initial client assessment, which client response would the nurse expect? A. short, polite responses to interview questions. B. introspection related to present situations C. inability to remain seated and racing thoughts D. Feelings of helplessness and hopelessness

C. inability to remain seated and racing thoughts In the manic phase of bipolar disorder the client experiences hyperactivity, restlessness, and flight of ideas. This would cause the client to have difficulty remaining seated and have problems organizing thoughts.

A client diagnosed with bipolar disorder is experiencing hyperactive behavior and weight loss. Which nutritional intervention would be most therapeutic for this client? A. Allow the client full kitchen privileges to eat anything as needed (PRN) B. Initiate tube feedings with nutritional supplements C. provides small, frequent feedings of finger foods. D. Provide a quiet place where the client can sit down to eat meals.

C. provides small, frequent feedings of finger foods. The client experiencing mania is unable to sit still long enough to eat an adequate nutritious meal. Small, frequent feedings with finger foods allows the client to eat during periods of hyperactivity.

A client experiencing a manic episode enters the milieu area dressed in a provocative and physically revealing outfit. Which of the following is the most appropriate intervention by the nurse? A. Tell the client she cannot wear this outfit while she is in the hospital B. Do nothing and allow her to learn from the responses of her peers. C. quietly walk with her back to her room and help her change into something more appropriate D. Explain to her that if she wears this outfit she must remain in her room.

C. quietly walk with her back to her room and help her change into something more appropriate

The nurse can expect a client demonstrating typical manic behavior to be attired in clothing that includes with characteristics? Ill-fitted and ragged Dark colored and modest Colorful and inappropriate Compulsively neat and clean

Colorful and inappropriate Manic clients often manage to dress and apply makeup in ways that create a colorful, inappropriate, even bizarre, appearance. None of the remaining options meet that criteria.

During report, the nurse learns that a client with mania has not slept since admission 2 days ago. On entering the day room, the nurse finds this client dancing to loud music. Which would be the most appropriate statement by the nurse? "Do you think you could sit still for a few minutes so we can talk?" "How are you ever going to get any rest if you keep that music on?" "Let's go to the conference room and talk for a while." "Turn the radio down so we can hear ourselves talk."

Correct response: "Let's go to the conference room and talk for a while." Explanation: Redirecting the client to a quieter, smaller room will decrease external stimuli and promote calmness so the client will eventually rest and sleep. It is more effective and therapeutic for the nurse to suggest an alternative rather than adopting a reprimanding or confrontational tone. Making a new suggestion is likely more effective than asking a client who is manic to simply stop what he or she is doing. Stating "turn down the radio" is more likely to provoke a confrontation than suggesting that they go to a different room. The client is manic, so is unlikely to respond to a reason-based argument about the need for rest.

When teaching a client who is recently diagnosed bipolar I disorder, the nurse correctly tells the client that the difference between bipolar I disorder and bipolar II disorder is what? 1. Bipolar I disorder is often more disruptive than bipolar II disorder. 2. Bipolar I disorder more often effects women. 3. Bipolar I disorder is characterized by hypomanic episodes. 4. Bipolar I disorder involves altered moods of anger and paranoia.

Correct response: 1. Bipolar I disorder is often more disruptive than bipolar II disorder. Explanation: Bipolar I disorder is often more severe, thus symptoms tend to create more disruption in functioning compared to bipolar II disorder. Bipolar I disorder is characterized by one or more manic or mixed episodes in which the individual experiences rapidly alternating moods accompanied by symptoms of a manic mood and a major depressive episode.

The nurse is seeing a 26-year-old client and the client's family. The client's family describes the client as being "very, very different." The family describes a history of periods of unpredictable behavior and disregard for consequences occurring a few times each year. The client has recently been diagnosed with bipolar I disorder, a condition that is characterized by what? 1. The presence of objective signs of depression without the presence of anhedonia 2. An elevated mood that lasts for at least 1 week 3. Failure to respond to conventional pharmacological treatments for mood disorders 4. The client's admission of a mood disorder

Correct response: 2. An elevated mood that lasts for at least 1 week Explanation: During manic episodes that characterize bipolar disorder, the individual exhibits an abnormal, persistently elevated, or irritable mood that lasts for at least 1 week. Failure to respond to treatment, the presence of signs of depression without anhedonia, and the client's admission of a mood disorder are neither diagnostic nor typical of bipolar disorder.

Which sleep pattern is suggestive of a manic episode? 1. A client stays awake for several days and nights before "crashing" and sleeping for a long period. 2. A client experiences day-night reversal, sleeping until late in the afternoon and going to bed near dawn. 3. A client reports having fitful sleep that is characterized by frequent awakenings and nightmares. 4. A client takes multiple short naps at varied times throughout the day and night.

Correct response: A client stays awake for several days and nights before "crashing" and sleeping for a long period. Explanation: During a manic episode, an individual will typically go several nights without sleep before collapsing from exhaustion.

A nurse is providing psycho-education to a client who has been admitted to the inpatient mental health unit for a manic episode. In order to ensure the teaching is effective, the nurse must first determine which regarding the client? Ability to concentrate and process the information Likelihood to assume responsibility for self-care Cognitive awareness and intellectual abilities Interest in learning about the disorder

Correct response: Ability to concentrate and process the information Explanation: To best assure successful outcomes related to client education of an individual experiencing a manic episode, the nurse's initial assessment is focused on the client's ability to concentrate and process the information.

A nurse is reading a journal article about bipolar disorder and common comorbidities. The nurse demonstrates understanding of the article by identifying which condition as a common comorbidity? Select all that apply. Anxiety disorders Substance use Personality disorders Schizophrenia Eating disorders

Correct response: Anxiety disorders Substance use Explanation: The two most common comorbid conditions are anxiety disorders and substance use. Individuals with a comorbid anxiety disorder are more likely to experience a more severe course. A history of substance use further complicates the course of illness and results in less chance for remission and poorer treatment compliance. Personality disorders, schizophrenia, and eating disorders are not the most common comorbid conditions.

Which is a food that might be incorporated into the plan of care for a client diagnosed in the manic phase of bipolar disorder? Bananas Brocolli Spaghetti Steak

Correct response: Bananas Explanation: For a client who is unable to sit long enough to eat, snacks and high-energy foods that can be eaten while moving should be provided.

A client is admitted to the unit in an acute manic episode. The client has had three major depressive episodes in the past 10 years and two other hospitalizations for mania. Which disorders would reflect the client's symptom profile? Bipolar II Cyclothymic disorder Bipolar I Euthymic state

Correct response: Bipolar I Explanation: Bipolar I disorder is characterized by one or more manic episodes, usually alternating with major depressive episodes.

A 35-year-old client with bipolar disorder has a history of discontinuing medication when feeling well and then becoming manic again. During the client's last episode of mania, the client lost several thousand dollars in risky investments. Which intervention will be most helpful in achieving medication adherence? 1. Point out that each time the client stops taking medication, the client becomes manic again. 2. During stabilization, discuss the client's individual signs, symptoms, and consequences of relapse. 3. Ensure that a family member takes responsibility for administering medications. 4. Remind the client that the client owes it to the client's spouse and children to stay well.

Correct response: During stabilization, discuss the client's individual signs, symptoms, and consequences of relapse. Explanation: To help link the importance of taking medication with relapse prevention, the nurse lists target symptoms and identifies signs of imminent relapse. The nurse engages in problem solving with the client about early management of symptoms so severity does not increase.

On admission to the psychiatric unit, a client is dressed in a red leotard and exercise bra, with an assortment of chains and brightly colored scarves on the client's head, waist, wrists, and ankles. The client's first words to the nurse are, "I'll punch you, munch you, crunch you," as the client dances into the room, shadow boxing. The client shakes the nurse's hand and says cheerfully, "We need to become better acquainted. I have the world's greatest intellect, and you are probably an intellectual midget." How can the nurse document the client's mood? Belligerent and blunted. Expansive and grandiose. Anxious and unpredictable. Suspicious and paranoid.

Correct response: Expansive and grandiose. Explanation: The client is demonstrating an expansive and grandiose mood state. Although the client also exhibits aspects of belligerence, the client does not have a blunted affect. The client is not demonstrating anxious or unpredictable behavior, suspicion, or paranoia.

The police bring a client to the hospital. They found the client in a hospital gown, swimming in a local creek. The client states that the client was "being baptized by Mother Nature, who loves and worships me." How would the nurse describe the client's current alterations in mental status? Visual hallucinations Grandiose delusions Neologisms Dysphoria

Correct response: Grandiose delusions Explanation: Disturbed thinking marked by expanded sense of self with false beliefs, such as religious connections or physical powers, are grandiose delusions. Visual hallucinations are perceptual disturbances. Neologisms are made-up words. Also, the client is not experiencing dysphoria (low mood) at this time.

Which meal would the nurse provide to best meet the nutritional needs of a client who is manic? Peanut butter sandwich, chips, cola Fried chicken, mashed potatoes, milk Ham sandwich, cheese slices, milk Spaghetti, garlic bread, salad, tea

Correct response: Ham sandwich, cheese slices, milk Explanation: Finger foods, or things clients can eat while moving around, are the best options to improve nutrition. Such foods should be as high in calories and protein as possible. Sandwiches and cheese are finger foods and are calorie-dense. Chips and cola are not nutritious, even though they are high in calories. Fried chicken, potatoes and spaghetti cannot be eaten while the client is moving.

A client is exhibiting rapid shifts in mood. The nurse documents this as which of the following? Elevated mood Expansive mood Irritable mood Mood lability

Correct response: Mood lability Explanation: Mood lability is a term used for rapid shifts in mood that often occur with bipolar disorder. Elevated mood refers to exaggerated feelings of well-being (euphoria) or feeling ecstatic or high (elation). An expansive mood is characterized by lack of restraint in expressing feelings, an overvalued sense of self-importance, and a constant and indiscriminate enthusiasm for interpersonal, sexual or occupational interactions. An irritable mood is indicated by being easily annoyed and provoked to anger, especially when wishes are challenged or thwarted.

A client with mania is in the dining room at lunchtime and is observed taking food from other clients' trays. The nurse's intervention should be based on which rationale? As soon as lunch is over, the client will calm down. Other clients need to be protected from the intrusive behavior. The client's behavior is not an imminent threat to anyone's physical safety. The client needs food and fluids in any way possible.

Correct response: Other clients need to be protected from the intrusive behavior. Explanation: The nurse must set limits on this intrusive behavior because other clients have the right to be protected. The client is in the manic phase; the client may not calm down after lunch. The behavior could be an imminent threat to individual safety for many reasons, infection control included. The client's need for food and fluids does not supersede any of the other clients' needs for food and fluids.

A nurse is caring for a client diagnosed with bipolar disorder. The client is experiencing a manic episode. The nurse would be especially alert for signs indicating what? Self-injury Sleep disruption Dehydration Weight loss

Correct response: Self-injury Explanation: During a manic episode, client safety is a priority. Risk of suicide is always present for those having a depressive or manic episode. During a depressive episode, the client may believe that life is not worth living. During a manic episode, the client may believe that he or she has supernatural powers, such as the ability to fly. Although changes in sleep, fluid balance (such as dehydration), and inadequate nutrition manifested by weight loss would be important to assess, safety and prevention of self-injury are the priority.

The client with mania attempts to hit the nurse. Which is the best response by the nurse? 1. "Do not swing at me again. If you cannot control yourself, we will help you." 2. "If you do that one more time, you will be put in seclusion immediately." 3. "Stop that. I didn't do anything to provoke an attack." 4. "Why do you continue that kind of behavior? You know I won't let you do it."

Correct response: 1 "Do not swing at me again. If you cannot control yourself, we will help you." Explanation: Stating, "Do not swing at me again. If you cannot control yourself, we will help you," firmly states behavioral expectations and lets the client know his behavior will be safely controlled if he is unable to do so. Arguing that the nurse does not deserve the attack provokes confrontation rather than communicating clear expectations. Stating "If you do that one more time, you will be put in seclusion immediately" is likely to be perceived as a threat rather than an assertive statement. Similarly, stating "Why do you continue that kind of behavior? You know I won't let you do it" may be perceived as a challenge or threat.

The most common comorbid condition in children with bipolar disorder is: A. Schizophrenia B. substance disorders C. oppositional defiant disorder D. attention-deficit/hyperactivity disorder

D. attention-deficit/hyperactivity disorder

The activity therapist is planning an individualized program for a client diagnosed with bipolar I disorder: manic episode who is exhibiting hostility and excessive energy. Which activity would be most appropriate? A. writing memoirs B. team sports C. ping-pong D. walking

D. walking Walking is the best activity choice because it is not considered competitive and provides an opportunity for the release of energy

A client hospitalized for a psychotic relapse is being discharged home to family. Which topic is important to address when teaching both the client and the family to recognize possible signs of impending mania? Decreased social interaction Increased appetite Increased attention to bodily functions Decreased sleep

Decreased sleep Changes in sleep patterns are especially important because they usually precede mania. Even a single night of unexplainable sleep loss can be taken as an early warning of impending mania. The other options do not indicate impending mania.

A client with bipolar disorder is experiencing a major depressive episode. Which would the nurse expect to assess? Select all that apply. Widespread shopping sprees Difficulty concentrating Hypersomnia Obsessive rumination Flight of ideas

Difficulty concentrating Hypersomnia Obsessive rumination

A client with a history of bipolar disorder is at home with family. The family calls the mental health clinic because they suspect that the client may be experiencing a relapse of mania. Which would support the family's suspicions? Avoidance of people Lack of appetite Excessive energy levels Focus on one topic

Excessive energy levels

A newly admitted client is diagnosed with Bipolar Disorder: Manic Episode. Which symptom related to altered thought is the nurse most likely to assess? A. Pacing B. Flight of ideas C. Lability of mood D. Irritability

Flight of ideas

Which behavior would be characteristic of a client during a manic episode? Going rapidly from one activity to another Being unwilling to leave home to see other people Taking frequent rest periods and naps during the day Watching others intently and talking little

Going rapidly from one activity to another Hyperactivity and distractibility are basic to manic episodes. None of the other options demonstrate such characteristics.

A bipolar client tells the nurse, "I have the finest tenor voice in the world. The three tenors who do all those TV concerts are going to retire because they can't compete with me." What term should the nurse use to identify this behavior? Limit testing Flight of ideas Grandiosity Distractibility

Grandiosity Exaggerated belief in one's own importance, identity, or capabilities is seen with grandiosity. None of the other options are associated with this behavior.

A 31-year-old client admitted with acute mania tells the staff and the other clients that he is on a secret mission for the President of the United States. He states, "I am the only one he trusts, because I am the best!" What term will the nurse use when documenting this behavior? Flight of ideas Grandiosity Rapid cycling Unpredictability

Grandiosity Grandiosity is inflated self-regard. People with mania may exaggerate their achievements or importance, state that they know famous people, or believe they have great powers. Although clients with mania are unpredictable, the scenario does not describe unpredictability: rapid cycling is switching between mania and depression in a given time period. The scenario does not describe flight of ideas, which means a continuous flow of speech with abrupt topic changes.

A 30-year-old woman has been brought to the emergency department after causing a disturbance. She is wearing a pair of tight, pink yoga pants, high heels, a sports bra, and a bright-colored hat. The woman's care providers would recognize that the woman's dress may suggest what? Acute confusion Antisocial personality disorder Mania Chronic low self-esteem

Mania

What is the priority nursing diagnosis for a hyperactive manic client during the acute phase of treatment? Impaired verbal communication Risk for injury/suicide Ineffective role performance Risk for other-directed violence

Risk for injury/suicide Risk for injury is high, related to the client's hyperactivity and poor judgment. Safety is always the priority when considering client care.

In response to a change in the community health nurse, a client has recently discontinued use of lithium. As a result of the discontinuation of the medication, the client has began to exhibit early signs of mania. The client is brought to the emergency department at the hospital for assessment. Which is the best nursing approach for this client? Insisting that the client remain active throughout the day so the client will sleep Offering high-calorie meals and insisting the client finish all meals Allowing the client maximum opportunity for freedom and self-expression Setting limits, providing a low-stimulation environment, and maintaining a neutral attitude

Setting limits, providing a low-stimulation environment, and maintaining a neutral attitude

When the partner of a manic client asks about genetic transmission of bipolar disorder, the nurse's answer should be predicated on which information? 1. Much depends on the socioeconomic class of the individuals. 2. Highly creative people tend toward development of the disorder. 3. No research exists to suggest genetic transmission. 4. The rate of bipolar disorder is higher in relatives of people with bipolar disorder.

The rate of bipolar disorder is higher in relatives of people with bipolar disorder. This understanding will allow the nurse to directly address the question. Responses based on the other statements would be tangential or untrue.

An acute phase nursing intervention aimed at reducing hyperactivity is demonstrated by which intervention? Directing unit activities Orienting a new client to the unit Writing in a diary Exercising in the gym

Writing in a diary Manic clients often respond well to the invitation to write. They will fill reams of paper. While writing they are less physically active. None of the remaining options presents this opportunity to reduce physical activity.