CH.13 bipolar and related disorders

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

"A higher rate of relatives with bipolar disorder is found among clients with bipolar disorder."

This nursing diagnosis applies to a client experiencing 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. What is an appropriate outcome for this client?

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

A client experiencing acute mania undresses in the group room and dances. How should the nurse intervene initially?

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

A client 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 client's behavior?

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

A client 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?

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

A client demonstrating characteristics of acute mania relapsed after discontinuing lithium. New orders are written to resume lithium twice daily and begin olanzapine. What is the rationale for the addition of olanzapine to the medication regimen?

To bring hyperactivity under rapid control.

A health teaching plan for a client taking lithium should include which instructions?

maintain normal salt and fluids in the diet.

22. Which dinner menu is best suited for a client with acute mania?

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

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

Provide a subdued environment.

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

Risk for injury

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

Set limits on client behavior as necessary.

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

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

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

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

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

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

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

Heart failure

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

Attending psychoeducation sessions

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

Diaphoresis, weakness, and nausea

A client diagnosed with bipolar disorder commands other clients, "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?

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

Which nursing diagnosis would most likely apply to a client diagnosed with major depressive disorder as well as one experiencing acute mania?

Disturbed sleep pattern

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

Euphoric

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 client's plan of care?

Hyperactivity; not eating and sleeping

A nurse prepares the plan of care for a client experiencing an acute manic episode. Which nursing diagnoses are most likely?

Impaired mood regulation Sleep deprivation

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

Neutral walls with pale, simple accessories

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

Poor judgment and hyperactivity

The plan of care for a client in the manic state of bipolar disorder should include which interventions?

Provide a structured environment for the client. Ensure that the client's nutritional needs are met.

A client diagnosed with acute mania has disrobed in the hall three times in 2 hours. What intervention should the nurse implement?

arrange for one-on-one supervision.

Four new clients were admitted to the behavioral health unit in the past 12 hours. The nurse directs a psychiatric technician to monitor these clients for safety. Which client diagnosis will need the most watchful supervision?

bipolar I disorder.

A client 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?

carbamazepine

A client experiencing acute mania is dancing atop a pool table in the recreation room. The client waves a cue in one hand and says, "I'll throw the pool balls if anyone comes near me." To best assure safety, what is the nurse's first intervention?

clear the room of all other clients

Outcome identification for the treatment plan of a client experiencing grandiose thinking associated with acute mania will focus on what?

distorted thought self-control.

A client diagnosed with bipolar disorder who takes lithium carbonate 300 mg three times daily reports nausea. To reduce the nausea most effectively, the nurse suggests that the lithium be taken with what?

food.

A client diagnosed with bipolar disorder is prescribed lithium. The client 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?" What advise will they give to the client?

have someone bring the client to the clinic immediately.

A client 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." What is the nurse's appropriate intervention?

inviting the client to sit together and look at new fashion magazines.

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

lamotrigine

While the exact cause of bipolar disorder has not been determined; however, what is consistent for most clients?

several factors, including genetics, are implicated.

The nurse receives a laboratory report indicating a client's serum level is 1 mEq/L. The client's last dose of lithium was 8 hours ago. What does this result indicate?

within therapeutic limits. (Normal range for a blood sample taken 8 to 12 hours after the last dose of lithium is 0.6 to 1.2 mEq/L.)