Bipolar and Related Disorders

The inpatient psychiatric unit is being redecorated. At a unit meeting, staff discusses bedroom dcor 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 nurses station. D. Rooms should be painted with neutral colors and contain pale-colored accessories.

D. Rooms should be painted with neutral colors and contain pale-colored accessories.

Which behavior is important to include for the patient and the family to recognize possible signs of impending mania? Decreased sleep Increased appetite Decreased social interaction Increased attention to body functions

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. Increased appetite, decreased social interaction, and increased attention to bodily functions do not indicate impending mania. p. 237

A nurse assesses a patient who takes lithium. Which findings demonstrate evidence of complications? a. Pharyngitis, mydriasis, and dystonia b. Alopecia, purpura, and drowsiness c. Diaphoresis, weakness, and nausea d. Ascites, dyspnea, and edema

Diaphoresis, weakness, and nausea

Which side effects of lithium can be expected at therapeutic levels?

Fine hand tremor and polyuria

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? a. Arthritis b. Epilepsy c. Psoriasis d. Heart failure

Heart failure

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? a. Confer with the health care provider to consider use of seclusion for this patient. b. Hold a staff meeting to discuss consistency and limit-setting approaches. c. Conduct a meeting with all staff and patients to discuss the behavior. d. Explain to the patient that the behavior is unacceptable.

Hold a staff meeting to discuss consistency and limit-setting approaches.

The plan of care for a patient who takes lithium should include Dietary teaching to restrict daily sodium intake Periodic laboratory monitoring of renal and thyroid function The requirement for laboratory tests to monitor serum potassium level Tthe importance of discontinuing the medication if fine hand tremors occur

Periodic laboratory monitoring of renal and thyroid function Two major long-term risks of lithium therapy are hypothyroidism and impairment of the kidney's ability to concentrate urine; therefore, a person receiving lithium therapy must have periodic follow-ups to assess thyroid and renal function. Weight gain and fine tremors are common side effects associated with this medication, but the patient should continue taking the medication. Sodium intake for patients who take lithium is not restricted. p. 235, Box 13.1

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? a. Monitor physiological functioning. b. Provide a subdued environment. c. Supervise personal hygiene. d. Observe for mood changes.

Provide a subdued environment.

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 b. Ineffective coping c. Impaired social interaction d. Ineffective therapeutic regimen management

Risk for injury

When a hyperactive patient diagnosed with acute mania is hospitalized, what is the initial nursing intervention? a. Allow the patient to act out feelings. b. Set limits on patient behavior as necessary. c. Provide verbal instructions to the patient to remain calm. d. Restrain the patient to reduce hyperactivity and aggression.

Set limits on patient behavior as necessary.

What action should the nurse take on learning that a manic client's serum lithium level is 1.8 mEq/L?

Withhold medication and notify the physician.

A desired outcome for the maintenance phase of treatment for a manic client would be that the client will

adhere to follow-up medical appointments.

For assessment purposes, the nurse should identify the body system most at risk for decompensation during a severe manic episode as:

cardiac

An outcome for a manic client during the acute phase that would indicate that the treatment plan was successful would be that the client

is free of injury

When a hyperactive manic client expresses the intent to strike another client, the initial nursing intervention would be to

set verbal limits.

To plan care for a manic client the nurse must consider that lithium cannot be started until

the physical examination and laboratory tests are analyzed.

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." The best approach for the nurse to use would be

"It's time to work on your art project."

11. A client is diagnosed with bipolar disorder: manic episode. Which nursing intervention would be implemented to achieve the outcome of "Client will gain 2 lb by the end of the week?" 1. Provide client with high-calorie finger foods throughout the day. 2. Accompany client to cafeteria to encourage adequate dietary consumption. 3. Initiate total parenteral nutrition to meet dietary needs. 4. Teach the importance of a varied diet to meet nutritional needs.

1. Provide client with high-calorie finger foods throughout the day.

7. A client began taking lithium carbonate (Lithobid) for the treatment of bipolar disorder approximately 1 month ago. The client asks if it is normal to have gained 12 pounds in this time frame. Which is the appropriate nursing response? 1. "That's strange. Weight loss is the typical pattern." 2. "What have you been eating? Weight gain is not usually associated with lithium." 3. "Weight gain is a common, but troubling, side effect." 4. "Weight gain only occurs during the first month of treatment with this drug."

3. "Weight gain is a common, but troubling, side effect."

10. A nursing instructor is discussing various challenges in the treatment of clients diagnosed with bipolar disorder. Which student statement demonstrates an understanding of the most critical challenge in the care of these clients? 1. "Treatment is compromised when clients can't sleep." 2. "Treatment is compromised when irritability interferes with social interactions." 3. "Treatment is compromised when clients have no insight into their problems." 4. "Treatment is compromised when clients choose not to take their medications."

4. "Treatment is compromised when clients choose not to take their medications."

8. A client diagnosed with bipolar disorder has been taking lithium carbonate (Lithobid) for one year. The client presents in an emergency department with a temperature of 101F (38C), severe diarrhea, blurred vision, and tinnitus. How should the nurse interpret these symptoms? 1. Symptoms indicate consumption of foods high in tyramine. 2. Symptoms indicate lithium carbonate discontinuation syndrome. 3. Symptoms indicate the development of lithium carbonate tolerance. 4. Symptoms indicate lithium carbonate toxicity.

4. Symptoms indicate lithium carbonate toxicity.

Which room placement would be best for a client experiencing a manic episode?

A single room near the nurses' station

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

A. Using a calm, unemotional approach during client interactions

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 b. Decreasing physical activity c. Increasing food and fluids d. Meeting self-care needs

Attending psychoeducation sessions

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

B. Flight of ideas

8. 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 disorders prevalence cannot be evaluated on the basis of socioeconomic groups.

B. This disorder is more prevalent in the higher socioeconomic groups.

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? a. "A high proportion of patients with bipolar disorders are found among creative writers." b. "A higher rate of relatives with bipolar disorder is found among patients with bi-polar disorder." c. "Patients with bipolar disorder have higher rates of relatives who respond in an exaggerated way to daily stress." d. "More individuals with bipolar disorder come from high socioeconomic and educational backgrounds."

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

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." b. "Irritable, suggestible, distractible; napped for 10 minutes in afternoon." c. "Attention span short; writing copious notes; intrudes in conversations." d. "Heavy makeup; seductive toward staff; pressured speech."

"Converses with few interruptions; clothing matches; participates in activities."

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? a. "Stop that! No one did anything to provoke an attack by you." b. "If you do that one more time, you will be secluded immediately." c. "Do not hit anyone. If you are unable to control yourself, we will help you." d. "You know we will not let you hit anyone. Why do you continue this behavior?"

"Do not hit anyone. If you are unable to control yourself, we will help you."

Which patient statement supports the diagnosis of mania? "I really don't need much sleep; two hours a night is enough." "I really enjoy cooking and eating all sorts of expensive foods." "My mother says this outfit is way too sexy but I like it and wear it all the time." "I've telephoned everyone I know and talked for hours; my husband will be mad." "My family is really upset with me but it's just because they're jealous of all I do."

"I really don't need much sleep; two hours a night is enough." "My mother says this outfit is way too sexy but I like it and wear it all the time." "I've telephoned everyone I know and talked for hours; my husband will be mad." "My family is really upset with me but it's just because they're jealous of all I do." When in full-blown mania, a person constantly goes from one activity, place, or project to another with little or no regard for sleep or food. Inactivity is impossible, even for the shortest period of time. Flowery and lengthy letters are written, and excessive phone calls are made. The behaviors often alienate family, friends, employers, health care providers, and others. Modes of dress often reflect the person's grandiose yet tenuous grasp of reality. Dress may be described as outlandish, bizarre, colorful, and noticeably inappropriate. The statement regarding cooking and eating is not supportive of manic behavior. pp. 223-224

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. a. "You will be able to stop the medication in about 1 month." b. "Taking the medication every day helps reduce the risk of a relapse." c. "Usually patients take medication for approximately 6 months after discharge." d. "It's unusual that the health care provider hasn't already stopped your medication."

"Taking the medication every day helps reduce the risk of a relapse."

4. A client diagnosed with bipolar disorder: depressive episode intentionally overdoses on sertraline (Zoloft). Family members report that the client has experienced anorexia, insomnia, and recent job loss. Which nursing diagnosis should a nurse prioritize? 1. Risk for suicide R/T hopelessness 2. Anxiety: severe R/T hyperactivity 3. Imbalanced nutrition: less than body requirements R/T refusal to eat 4. Dysfunctional grieving R/T loss of employment

1. Risk for suicide R/T hopelessness

A client diagnosed with bipolar disorder is distraught over insomnia experienced over the last 3 nights and a 12-pound weight loss over the past 2 weeks. Which should be this client's priority nursing diagnosis? 1. Knowledge deficit R/T bipolar disorder AEB concern about symptoms 2. Altered nutrition: less than body requirements R/T hyperactivity AEB weight loss 3. Risk for suicide R/T powerlessness AEB insomnia and anorexia 4. Altered sleep patterns R/T mania AEB insomnia for the past 3 nights

2. Altered nutrition: less than body requirements R/T hyperactivity AEB weight loss

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

A single room near the nurses' station The room placement that provides a nonstimulating environment is best. Nearness to the nurses' station means close supervision can be provided. p. 231, Table 13.3

A client diagnosed with bipolar disorder states, I hate oatmeal. Lets get everybody together to do exercises. Im thirsty and Im burning up. Get out of my way; I have to see that guy. What should be the priority nursing action? A. Assess the clients vital signs. B. Offer to have the dietitian discuss food preferences. C. Encourage the client to lead the exercise program in the community meeting. D. Acknowledge the client briefly and then walk away.

A. Assess the clients vital signs.

Which of the following instructions regarding lithium therapy should be included in a nurses discharge teaching? Select all that apply. A. Avoid excessive use of beverages containing caffeine. B. Maintain a consistent sodium intake. C. Consume at least 2,500 to 3,000 mL of fluid per day. D. Restrict sodium content. E. Restrict fluids to 1,500 mL per day.

A. Avoid excessive use of beverages containing caffeine. B. Maintain a consistent sodium intake. C. Consume at least 2,500 to 3,000 mL of fluid per day.

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.

A. Bipolar symptoms are similar to attention deficit-hyperactivity disorder symptoms. B. Children are naturally active, energetic, and spontaneous.

A client is diagnosed with bipolar disorder: manic phase. Which nursing intervention would be implemented to achieve the outcome of "Client will gain 2 lbs by the end of the week?" A. Provide client with high-calorie finger foods throughout the day. B. Accompany client to cafeteria to encourage adequate dietary consumption. C. Initiate total parenteral nutrition to meet dietary needs. D. Teach the importance of a varied diet to meet nutritional needs.

A. Provide client with high-calorie finger foods throughout the day.

A nurse begins the intake assessment of a client diagnosed with bipolar I disorder. The client shouts, You cant 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

A. To provide self and client with a safe environment

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 has tapped my room and are out to get me.

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

A client has been taking lithium for several years with good symptom control. The client presents in the emergency department with blurred vision, tinnitus, and severe diarrhea. The nurse should correlate these symptoms with which lithium level? A. 1.3 mEq/L B. 1.7 mEq/L C. 2.3 mEq/L D. 3.7 mEq/L

B. 1.7 mEq/L

A clients 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.

B. Higher rates of relatives diagnosed with bipolar disorder are found in families of clients diagnosed with this disorder.

Which client statement would the nurse recognize as indicating that the client understands dietary teaching related to lithium carbonate (Lithobid) treatment? A. I will limit my intake of fluids daily. B. I will maintain normal salt intake. C. I will take Lithobid on an empty stomach. D. I will increase my caloric intake to prevent weight loss.

B. I will maintain normal salt intake.

After teaching a client about lithium carbonate (Lithane), a nurse would consider the teaching successful on the basis of which client statement? A. I should expect to feel better in a couple of days. B. Ill call my doctor immediately if I experience any diarrhea or ringing in my ears. C. If I forget a dose, I can double the dose the next time I take this drug. D. I need to restrict my intake of any food containing salt.

B. Ill call my doctor immediately if I experience any diarrhea or ringing in my ears.

A client is diagnosed with cyclothymic disorder. What client behaviors should the nurse expect to assess? A. The client expresses feeling blue most of the time. B. The client has endured periods of elation and dysphoria lasting for more than 2 years. C. The client fixates on hopelessness and thoughts of suicide continually. D. The client has labile moods with periods of acute mania.

B. The client has endured periods of elation and dysphoria lasting for more than 2 years.

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

Broiled chicken breast on a roll, an ear of corn, and an apple

A client on an inpatient unit is diagnosed with bipolar disorder: manic phase. During a discussion in the dayroom about weekend activities, the client raises voice, becomes irritable, and insists that plans change. What should be the nurse's initial intervention? A. Ask the group to take a vote on alternative weekend events. B. Remind the client to quiet down or leave the dayroom. C. Assist the client to move to a calmer location. D. Discuss with the client impulse control problems

C. Assist the client to move to a calmer location.

A newly admitted client is experiencing a manic episode of bipolar I disorder and presents as very agitated. The nurse should assign which priority nursing diagnosis to this client? A. Ineffective individual coping R/T hospitalization AEB alcohol abuse B. Altered nutrition: less than body requirements R/T mania AEB 10-pound weight loss C. Risk for violence: directed toward others R/T agitation and hyperactivity D. Sleep pattern disturbance R/T flight of ideas AEB sleeps 1 to 2 hours per night

C. Risk for violence: directed toward others R/T agitation and hyperactivity

A client is diagnosed with bipolar disorder and admitted to an inpatient psychiatric unit. Which is the priority outcome for this client? A. The client will accomplish activities of daily living independently by discharge. B. The client will verbalize feelings during group sessions by discharge. C. The client will remain safe throughout hospitalization. D. The client will use problem solving to cope adequately after discharge.

C. The client will remain safe throughout the hospitalization.

Which antianxiety medication should be prescribed to patients with acute mania? Citalopram (Celexa) Propranolol (Inderal) Labetalol (Normodyne) Clonazepam (Klonopin)

Clonazepam (Klonopin) Antianxiety medications are prescribed to patients with acute mania who are resistant to lithium therapy. They are prescribed to reduce the psychomotor agitation in the patients. Clonazepam is a benzodiazepine class of drug and usually is prescribed to patients with mania because of its efficacy and fewer side effects. Citalopram belongs to the class of medications known as selective serotonin reuptake inhibitor. These medications are not prescribed because they produce side effects like nervousness and agitation. Labetalol is a beta blocker medication that is usually prescribed to reduce the blood pressure. Propranolol (Inderal) is a beta blocker used for the treatment of hypertension in the patients with anxiety. It is not prescribed for patients with acute mania. p. 233

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? a. Educate the patient about the proper ways to perform personal hygiene and coordinate clothing. b. Continue to monitor and document the patient's speech patterns and motor activity. c. Ask the health care provider to prescribe an increased dose and frequency of lithium. d. Consider the need to check the lithium level. The patient may not be swallowing medications.

Consider the need to check the lithium level. The patient may not be swallowing medications.

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."

D. "Agitated and pacing. Exhibiting grandiosity. Mood labile."

A client diagnosed with bipolar disorder, who has taken lithium carbonate (Lithane) for 1 year, presents in an emergency department with severe diarrhea, blurred vision, and tinnitus. How should the nurse interpret these symptoms? A. Symptoms indicate consumption of foods high in tyramine. B. Symptoms indicate lithium carbonate discontinuation syndrome. C. Symptoms indicate the development of lithium carbonate tolerance. D. Symptoms indicate lithium carbonate toxicity.

D. Symptoms indicate lithium carbonate toxicity

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." 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."

Distraction: "Let's go to the dining room for a snack."

Which nursing diagnosis would most likely apply to both a patient diagnosed with major depression as well as one experiencing acute mania? a. Deficient diversional activity b. Disturbed sleep pattern c. Fluid volume excess d. Defensive coping

Disturbed sleep pattern

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 b. Irritable c. Suspicious d. Confident

Euphoric

Which behavior would be most characteristic of a client during a manic episode?

Going rapidly from one activity to another

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? a. Insulting, aggressive behavior b. Pressured speech and grandiosity c. Hyperactivity; not eating and sleeping d. Poor concentration and decision making

Hyperactivity; not eating and sleeping

The first-line drug used to treat mania is Lamotrigine Clonazepam Carbamazepine Lithium carbonate

Lithium carbonate Lithium, a mood stabilizer, is the first-line drug for use in treating bipolar disorder. pp. 233-234

The nurse is writing a plan of care for a patient in the manic phase of bipolar I disorder. What is the most important outcome for the patient? Decreasing food intake Increasing physical activity Sleeping for 8 to 10 hours a night Maintaining a stable cardiac status

Maintaining a stable cardiac status During the manic phase of bipolar I disorder, the most important outcome for the patient is to maintain a stable cardiac status because cardiac problems can be life threatening. Other important outcomes include ensuring at least 4 to 6 hours of sleep a night, increasing food and fluid intake, and decreasing physical activity. p. 230

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? Such a patient is abused easily by other aggressive patients. Mania can result in irresponsible and physically risky behaviors. The manic phase will be followed by a phase of severe depression. Older adults experience physical conditions that greatly increase the potential for injury.

Mania can result in irresponsible and physically risky behaviors. Patients in the manic phase of bipolar disorder may have misperceptions about their power and importance and involve themselves in senseless, irresponsible, and risky activities that can result in physical harm. Although it is true that older adults are at risk for injury related to both acute and chronic illness, that depression generally follows mania, and that manic individuals are at risk for injury caused by those who are affected by or who misunderstand the behavior, the primary risk to this patient comes from the manic behavior itself. p. 230, Table 13.2

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

Neutral walls with pale, simple accessories

Nadia has been diagnosed with bipolar disorder. Which is an outcome for Nadia in the continuation of treatment phase of bipolar disorder?

Patient will adhere to medication regimen.

A medication teaching plan for a patient receiving lithium should include:

Periodic monitoring of renal and thyroid function.

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? a. Increased muscle tension and anxiety b. Vegetative signs and poor grooming c. Poor judgment and hyperactivity d. Cognitive deficits and paranoia

Poor judgment and hyperactivity

A nurse is assisting a manic patient in dressing and maintaining basic hygiene tasks. Which nursing interventions are appropriate for the patient in a manic state? Provide step-by-step instructions for dressing. Allow the patient to wear whatever he or she chooses. Provide simple clothes and hygiene tasks to the patient. Warn the patient that seclusion can be used to control behavior. Provide repeated reminders to finish tasks if necessary.

Provide step-by-step instructions for dressing. Provide simple clothes and hygiene tasks to the patient. Provide repeated reminders to finish tasks if necessary. The nurse should supervise the clothes and hygiene of the patient who is in a manic state. The patient should be provided simple clothing and can be instructed in a step-by step manner so that the patient can understand and follow the instructions. The patient may need to be given frequent reminders to maintain hygiene because manic patients can be easily distracted and have poor concentration. Manic patients may choose overly flamboyant or bizarre fashion and should be provided with clothes that help to maintain their dignity while in a manic state. Frequent warning of seclusion to the patient can cause depression and withdrawal of the patient. p. 232, Table 13.3

A manic patient showed progressive improvement with continued lithium therapy. After successful treatment, the patient is discharged from the hospital. What appropriate suggestions should the nurse make to the patient and his or her family during discharge? Water pills or diuretics will help with lithium side effects. You can reduce the lithium dose if there is an excessive weight gain. Over-the-counter medications are safe if taken as instructed on the box. Schedule regular checkups to test the function of your thyroid and kidney. Contact the primary health care provider if there is any excessive vomiting.

Schedule regular checkups to test the function of your thyroid and kidney. Contact the primary health care provider if there is any excessive vomiting. Lithium affects thyroid and kidney functioning so the patient should be advised to have regular assessment of functioning after being discharged. Lithium may cause diarrhea, vomiting, or sweating as a result of dehydration, so the patient should be advised to consult the primary health care provider if these symptoms occur. Patients on lithium should be advised not to take over-the-counter medicine without consulting the primary health care provider. Patients should not be advised to reduce the medication if there is a weight gain; dosage should only be adjusted by the health care provider. Lithium causes dehydration in the patients, so water pills or other diuretics should not be taken by the patient. p. 235, Box 13.1

The nurse assesses laboratory results for an adult patient who takes lithium 600 mg twice a day. The patient has taken this dose of lithium for 3 years. Which laboratory value should alert the nurse to confer promptly with the health care provider? Hemoglobin 15 g/dL Serum sodium 142 mEq/L Fasting glucose 99 mg/dL Serum creatinine 1.95 mg/dL

Serum creatinine 1.95 mg/dL The serum creatinine in this scenario is elevated, which indicates problems with renal function; the normal value is 0.5 to 1.2 mg/dL. A major long-term risk of lithium therapy is impairment of the kidney's ability to concentrate urine. The hemoglobin, fasting glucose, and serum sodium levels show normal laboratory findings. p. 234, Table 13.4

A bipolar client whose continuing phase treatment consists of lithium therapy and cognitive-behavioral therapy may become noncompliant with medication. Which factor would be of least concern to the nurse developing a psychoeducation plan to foster compliance?

The voices tell the client to stop taking it.

A major principle the nurse should observe when communicating with a patient experiencing elated mood is to:

Use a calm, firm approach.

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. c. Encourage group social interaction. d. Suggest limiting work to half-days. e. Monitor the patient's sleep patterns.

a. Limit credit card access. b. Provide a structured environment. e. Monitor the patient's sleep patterns.

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 b. Defensive coping c. Chronic low self-esteem d. Impaired social interaction e. Risk-prone health behavior

a. Powerlessness c. Chronic low self-esteem

A patient with acute mania has disrobed in the hall three times in 2 hours. The nurse should: a. direct the patient to wear clothes at all times. b. ask if the patient finds clothes bothersome. c. tell the patient that others feel embarrassed. d. arrange for one-on-one supervision.

arrange for one-on-one supervision.

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. a. Imbalanced nutrition: more than body requirements b. Disturbed thought processes c. Sleep deprivation d. Chronic confusion e. Social isolation

b. Disturbed thought processes c. Sleep deprivation

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 b. bipolar II disorder. c. dysthymic disorder d. cyclothymic disorder

bipolar I disorder

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: a. minimize the side effects of lithium. b. bring hyperactivity under rapid control. c. enhance the antimanic actions of lithium. d. be used for long-term control of hyperactivity.

bring hyperactivity under rapid control.

The plan of care for a patient in the manic state of bipolar disorder should include which inter-ventions? Select all that apply. a. Touch the patient to provide reassurance. b. Invite the patient to lead a community meeting. c. Provide a structured environment for the patient. d. Ensure that the patient's nutritional needs are met. e. Design activities that require the patient's concentration.

c. Provide a structured environment for the patient. d. Ensure that the patient's nutritional needs are met.

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? a. phenytoin (Dilantin) b. clonidine (Catapres) c. risperidone (Risperdal) d. carbamazepine (Tegretol)

carbamazepine (Tegretol)

To best assure safety, the nurse's first intervention is to: a. tell the patient, "You need to be secluded." b. clear the room of all other patients. c. help the patient down from the table. d. assemble a show of force.

clear the room of all other patients.

The nurse can expect a client demonstrating typical manic behavior to be attired in clothing that is

colorful and outlandish.

A person who has numerous hypomanic and dysthymic episodes can be assessed as demonstrating characteristics of

cyclothymia.

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

distorted thought self-control.

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: a. ask staff for assistance with feeding with-in 4 days. b. drink six servings of a high-calorie, high-protein drink each day. c. consistently sit with others for at least 30 minutes at meal time within 1 week. d. consistently wear appropriate attire for age and sex within 1 week while on the psychiatric unit.

drink six servings of a high-calorie, high-protein drink each day.

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." The nurse would make the assessment that the client is displaying

grandiosity.

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: a. restrict food and fluids for 24 hours and stay in bed. b. have someone bring the patient to the clinic immediately. c. drink a large glass of water with 1 tea-spoon of salt added. d. take one dose of an over-the-counter anti-diarrheal medication now.

have someone bring the patient to the clinic immediately.

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: a. suggests the patient have a friend do the shopping and bring purchases to the unit. b. invites the patient to sit together and look at new fashion magazines. c. tells the patient computer use is not allowed until self-control improves. d. asks whether the patient has enough money to pay for the purchases.

invites the patient to sit together and look at new fashion magazines

Consider these three anticonvulsant medications: divalproex (Depakote), carbamazepine (Tegretol), and gabapentin (Neurontin). Which medication also belongs to this classification? a. clonazepam (Klonopin) b. risperidone (Risperdal) c. lamotrigine (La-mictal) d. aripiprazole (Abilify)

lamotrigine (La-mictal)

The first-line drug used to treat mania is

lithium carbonate (Lithium).

A health teaching plan for a patient taking lithium should include instructions to: a. maintain normal salt and fluids in the diet. b. drink twice the usual daily amount of flu-id. c. double the lithium dose if diarrhea or vomiting occurs. d. avoid eating aged cheese, processed meats, and red wine.

maintain normal salt and fluids in the diet.

A desirable short-term goal for the nursing diagnosis Defensive coping related to biochemical changes as evidenced by aggressive verbal and physical behaviors would be

making no attempts at self-harm within 12 hours of admission.

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. b. an antacid. c. an antiemetic. d. a large glass of juice.

meals.

A patient experiencing acute mania undresses in the group room and dances. The nurse intervenes initially by: a. quietly asking the patient, "Why don't you put your clothes on?" b. firmly telling the patient, "Stop dancing and put on your clothing." c. putting a blanket around the patient and walking with the patient to a quiet room. d. letting the patient stay in the group room and moving the other patients to a different area.

putting a blanket around the patient and walking with the patient to a quiet room.

When a client experiences four or more mood episodes in a 12-month period, the client is said to be

rapid cycling

The priority nursing diagnosis for a hyperactive manic client during the acute phase is

risk for injury

The exact cause of bipolar disorder has not been determined; however, for most patients: a. several factors, including genetics, are implicated. b. brain structures were altered by stress early in life. c. excess sensitivity in dopamine receptors may trigger episodes. d. inadequate norepinephrine reuptake disturbs circadian rhythms.

several factors, including genetics, are implicated.

When the wife of a manic client asks about genetic transmission of bipolar disorder, the nurse's answer should be predicated on the knowledge that

the rate of bipolar disorder is higher in relatives of people with bipolar disorder.

Which symptom related to communication is likely to be present in a patient experiencing mania?

verbosity

When a client reports that lithium causes an upset stomach, the nurse suggests taking the medication:

with meals

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. b. below therapeutic limits. c. above therapeutic limits. d. invalid because of the time lapse since the last dose.

within therapeutic limits.

An acute phase nursing intervention aimed at reducing hyperactivity is redirecting the client to

write in a diary