Chapter 16 - Bipolar mood disorders

3

A client is exhibiting behavioral symptoms of depression. Which charting entry would appropriately document these symptoms? 1. "Rates mood as 4/10." 2. "Expresses thoughts of poor self-esteem during group." 3. "Became irritable and agitated on waking." 4. "Rates anxiety as 2/10 after receiving lorazepam (Ativan)."

polyuria

excessive urination

a

11. A nurse receives this laboratory result for a patient diagnosed with bipolar disorder: lithium level 1 mEq/L. This result is: a. within therapeutic limits b. below therapeutic limits c. above therapeutic limits d. incorrect because of inaccurate testing ANS: A

b

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

d

Lithium is prescribed for a new patient. Which information from the patient's history indicates that monitoring serum concentrations of the drug will be especially challenging and critical? a. Arthritis b. Epilepsy c. Psoriasis d. Congestive heart failure

1

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 client for risks to safety. Which factor most indicates this intervention for this client? 1 Mania can result in irresponsible and physically risky behaviors. 2 The manic phase will be followed by a phase of severe depression. 3 This client is an easy target for abuse from other aggressive clients. 4 Older adults experience physical conditions that greatly increase the potential for injury.

0.4-1.0

therapeutic levels of lithium

b

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

2,3,4,5

Which documentation in the medical record of a client diagnosed with bipolar disorder demonstrates achievement of outcomes for the continuation phase of recovery? Select all that apply. 1 The client slept for 3 uninterrupted hours. 2 The client is demonstrating new problem-solving skills. 3 The client is able to identify three early signs of relapse. 4 The client acknowledges the need to be medication-compliant. 5 The client states an understanding of the cyclic nature of the disorder.

a

Which documentation indicates that the treatment plan for a patient experiencing acute mania has been effective? a. "Converses without interrupting; 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." ANS: A

1

Which is an advanced but not severe sign of lithium toxicity? 1 Sedation 2 Polyuria 3 Mild thirst 4 Blurred vision

a

Which is considered the first-line drug used to treat mania? A Lithium B Carbamazepine C Lamotrigine D Clonazepam

2

Which is the basic premise of a recovery model used to treat clients diagnosed with bipolar disorder? 1. Medication adherence 2. Empowerment of the consumer 3. Total absence of symptoms 4. Improved psychosocial relationships

b

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

1,2,3

Which of the following instructions regarding lithium therapy should be included in a nurse's discharge teaching? (Select all that apply.) 1. Avoid excessive use of beverages containing caffeine. 2. Maintain a consistent sodium intake. 3. Consume at least 2,500 to 3,000 mL of fluid per day. 4. Restrict sodium content. 5. Restrict fluids to 1,500 mL per day.

a

0. 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. Select the best initial approach by the nurse. 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."

b

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 most appropriate response. a. "You will be able to stop the medication in approximately 1 month." b. "Taking the medication every day helps prevent relapses and recurrences." c. "Usually patients take this medication for approximately 6 months after discharge." d. "It's unusual that the health care provider has not already stopped your medication."

c

1. A person is directing traffic on a busy street while shouting and making obscene gestures at passing cars. 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 deficit and sad mood

The nurse can most expect a client demonstrating typical manic behavior to be attired in what type of clothing? 1 Dark-colored and modest 2 Colorful and outlandish 3 Compulsively neat and clean 4 Ill-fitted and ragged

2

a

3. A patient experiencing mania has not eaten or slept for 3 days. Which nursing diagnosis has priority? a. Risk for injury b. Ineffective coping c. Impaired social interaction d. Ineffective therapeutic regimen management

a

2. A patient diagnosed with bipolar disorder is dressed in a red leotard and brightly colored scarves. The patient says, "I'll punch you, munch you, crunch you," while twirling and shadowboxing. Then 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. Labile and euphoricb. Irritable and b elligerent c. Highly suspicious and arrogant d. Excessively happy and confident

b

5. This nursing diagnosis applies to a patient experiencing 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 the most appropriate outcome. The patient will: a. ask staff for assistance with feeding within 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 mealtime within 1 week. d. consistently wear appropriate attire for age and sex within 1 week while in the psychiatric unit.

a

8. 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.

d

A patient experiencing 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.

c

4. A patient diagnosed with bipolar disorder is hyperactive and manic 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?"

b

9. The spouse of a patient diagnosed with bipolar disorder asks what evidence supports the possibility of genetic transmission of bipolar disorders. Select the nurse's best response. a. "A high proportion of patients diagnosed with bipolar disorders are found among creative writers." b. "A higher rate of relatives diagnosed with bipolar disorder is found among patients with bipolar disorder." c. "Patients diagnosed with bipolar disorder have higher rates of relatives who respond in an exaggerated way to daily stresses." d. "More individuals diagnosed with bipolar disorder come from high socioeconomic and educational backgrounds."

3

A client admitted with acute mania tells the staff and the other clients that he is on a secret mission given to him by the President of the United States to monitor citizens for terrorist activity. The client states "I am the only one he trusts, because I am the best!" For documentation purposes, which term describes this behavior? 1 Unpredictability 2 Rapid cycling 3 Grandiosity 4 Flight of ideas

3

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."

4

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 101°F (38°C), 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.

2

A client diagnosed with bipolar disorder is distraught over insomnia experienced over the last 3 nights and a 12-lb. 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

4

A client diagnosed with bipolar disorder is in the continuation phase of treatment. Which of the following outcomes most applies to this phase? 1 Demonstrating a labile mood 2 Getting sufficient sleep and rest 3 Demonstrating thought self-control 4 Accurately stating indicators of relapse

1

A client diagnosed with bipolar disorder is showing early signs of mania. The client says, "I need to go visit my daughter but she lives across the country. I put some requests on the internet to get a ride. I'm sure someone will take me." What is the nurse's most therapeutic response? 1 "I'm concerned about your safety when meeting or riding with strangers." 2 "Have you asked friends and family to donate money for your airfare?" 3 "You are not likely to get a ride. Let's consider some other strategies." 4 "Have you asked your daughter if she wants you to come for a visit?"

1

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

4,5

A client hospitalized with an acute manic episode shows progressive improvement with lithium therapy. At the time of discharge, what information should the nurse provide to the client and family? Select all that apply. 1 "Water pills or diuretics will help reduce lithium side effects." 2 "Over-the-counter medications are safe if taken as instructed on the box." 3 "You can reduce the lithium dose if you experience excessive weight gain." 4 "Schedule regular check-ups to test the function of your thyroid and kidney." 5 "Contact your primary health care provider if there is any excessive vomiting."

1,2,4,5

A client is admitted to an in-patient psychiatric unit with a diagnosis of major depres- sive disorder. Which of the following data would the nurse expect to assess? Select all that apply. 1. Loss of interest in almost all activities and anhedonia. 2. A change of more than 5% of body weight in 1 month. 3. Fluctuation between increased energy and loss of energy. 4. Psychomotor retardation or agitation. 5. Insomnia or hypersomnia.

1

A client is diagnosed with bipolar disorder: manic episode. Which nursing intervention would be implemented to achieve the outcome of "Client will gain 2 lbs. 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.

3

A client with mania reports an inability to sleep. What action does the nurse take to help the client sleep better? 1 Provide tea before sleep. 2 Provide a low-protein diet. 3 Instruct the client to perform slow exercises. 4 Help the client perform intense physical activity.

4

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? 1. "Rates mood 8/10. Exhibiting looseness of association. Euphoric." 2. "Mood euthymic. Exhibiting magical thinking. Restless." 3. "Mood labile. Exhibiting delusions of reference. Hyperactive." 4. "Agitated and pacing. Exhibiting grandiosity. Mood labile."

Hypomania

A mild manic state in which the individual seems infectiously merry, extremely talkative, charming, and tireless.

2

A nurse caring for a client who is manic observes that the client has persistent gastrointestinal upset. The nurse expects that the client is showing advanced signs of lithium toxicity and expects the health care provider to test the serum levels of lithium in the client. Beyond which concentration of lithium does the nurse know indicates advanced signs of lithium toxicity? 1 0.5 mEq/L 2 1.8 mEq/L 3 2.5 mEq/L 4 3.4 mEq/L

4,5

A nurse is assessing an adolescent client diagnosed with cyclothymic disorder. Which of the following DSM-5 diagnostic criteria would the nurse expect this client to meet? (Select all that apply.) 1. Symptoms lasting for a minimum of two years 2. Numerous periods with manic symptoms 3. Possible comorbid diagnosis of a delusional disorder 4. Symptoms cause clinically significant impairment in important areas of functioning 5. Depressive symptoms that do not meet the criteria for major depressive episode

1,3,4

A nurse is assisting a client who is manic in dressing and maintaining basic hygiene tasks. Which nursing interventions are appropriate for the client in a manic state? Select all that apply. 1 Provide step-by-step instructions for dressing. 2 Allow the client to wear whatever he or she chooses. 3 Provide simple clothes and hygiene tasks to the client. 4 Provide repeated reminders to finish tasks if necessary. 5 Warn the client that seclusion can be used to control behavior.

2

A nurse is planning a diet chart for a client who is manic and receiving lithium therapy. Which instruction should the nurse include on the diet chart? 1 Reduce sodium intake. 2 Take lithium with meals. 3 Take lithium on an empty stomach. 4 Avoid taking lithium before going to bed.

3

A nurse is planning care for a client diagnosed with bipolar disorder: manic episode. In which order should the nurse prioritize the client outcomes in the exhibit? The following are the outcomes: 1. Maintains nutritional status. 2. Interacts appropriately with peers. 3. Remains free from injury. 4. Sleeps 6 to 8 hours a night. 1. 2, 1, 3, 4 2. 4, 1, 2, 3 3. 3, 1, 4, 2 4. 1, 4, 2, 3

2,3,4

A nurse prepares the plan of care for a client having a manic episode. Which nursing diagnoses are most likely to apply? Select all that apply. 1 Social isolation 2 Sleep deprivation 3 Disturbed thought processes 4 Risk for deficient fluid volume 5 Altered nutrition: more than body requirements

b,c

A nurse prepares the plan of care for a patient having a 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

4

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."

3

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, and these symptoms are absent in hypomania. 2. During a manic episode, clients may experience a decreased need for sleep, and this symptom is absent in hypomania. 3. During a manic episode, clients may experience psychosis, and this symptom is absent in hypomania. 4. During a manic episode, clients may experience flight of ideas and racing thoughts, and these symptoms are absent in hypomania.

b

A patient diagnosed with bipolar disorder and who takes lithium telephones the nurse at the clinic to say, "I've had severe diarrhea 4 days. I feel very weak and unsteady when I walk. My usual hand tremor has gotten worse. What should I do?" The nurse should advise the patient: a. "Restrict oral fluids for 24 hours and stay in bed." b. "Have someone bring you to the clinic immediately." c. "Drink a large glass of water with 1 teaspoon of salt added." d. "Take an over-the-counter antidiarrheal medication hourly until the diarrhea subsides."

d

A patient diagnosed with bipolar disorder has been hospitalized for 7 days and has taken lithium 600 mg three times daily. Staff members observe increased agitation, pressured speech, poor personal hygiene, hyperactivity, and bizarre clothing. What is the nurse's best intervention? 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.

a,b,e

A patient diagnosed with bipolar disorder is being treated as an outpatient during a hypomanic episode. Which suggestions should the nurse provide to the family? Select all that apply. a. Provide structure b. Limit credit card access c. Encourage group social interaction d. Limit work to half days e. Monitor the patient's sleep patterns

a

A patient diagnosed with bipolar disorder is being treated on an outpatient basis with lithium carbonate 300 mg three times daily. The patient complains of nausea. To reduce the nausea, the nurse can suggest that the lithium be taken with: a. meals. b. an antacid. c. a large glass of juice. d. an antiemetic medication.

b

A patient experiencing acute mania has exhausted the staff members by noon. The patient has joked, manipulated, insulted, and fought all morning. Staff members are feeling defensive and fatigued. Which is the best action? a. Confer with the health care provider regarding use of seclusion for this patient. b. Hold a staff meeting to discuss consistency and limit-setting approaches. c. Conduct a meeting with all patients to discuss the behavior. d. Explain to the patient that the behavior is unacceptable.

c

A patient experiencing acute mania is dancing atop the pool table in the recreation room. The patient waves a cue in one hand and says, "I'll throw the pool balls if anyone comes near me." The nurse's first intervention is to: a. tell the patient, "You need to be secluded." b. help the patient down from the table. c. clear the room of all other patients. d. assemble a show of force.

c

A patient experiencing acute mania undresses in the group room and dances. The nurse's first intervention would be to: a. quietly ask the patient, "Why don't you put on your clothes?" b. firmly tell the patient, "Stop dancing, and put on your clothing." c. put a blanket around the patient, and walk with the patient to a quiet room. d. allow the patient stay in the group room. Move the other patients to a different area.

b

A patient experiencing acute mania 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 most appropriate intervention. a. Suggest to the patient to ask a friend do the shopping and bring purchases to the unit. b. Invite the patient to sit with the nurse and look at new fashion magazines. c. Tell the patient that computer use is not allowed until self-control improves. d. Ask whether the patient has enough money to pay for the purchases.

b

A patient experiencing 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 physiologic functioning b. Provide a subdued environment c. Supervise personal hygiene d. Observe for mood changes

c

A patient receiving lithium should be assessed for which evidence of complications? a. Pharyngitis, mydriasis, and dystonia b. Alopecia, purpura, and drowsiness c. Diaphoresis, weakness, and nausea d. Ascites, dyspnea, and edema

a,c

A patient tells the nurse, "I am so ashamed of being bipolar. When I'm manic, my behavior embarrasses my family. Even if I take my medication, there's no guarantee I won't have a relapse. I am such 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

d

After hospital discharge, what is the priority intervention for a patient diagnosed with bipolar disorder who is taking antimanic medication, as well as for the patient's family? a. Decreasing physical activity b. Increasing food and fluids c. Meeting self-care needs d. Psychoeducation

c

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.

3

The client treated with lithium carbonate repeatedly requests water to drink and has slurred speech. What is the priority nursing action in this case? 1 Provide food to the patient. 2 Administer mannitol to the patient. 3 Evaluate the client's blood lithium level. 4 Report to the primary health care provider.

1

To plan care for a client who is manic, the nurse must consider that lithium cannot be started until what takes place? 1 The physical examination and laboratory tests are analyzed. 2 The initial doses of antipsychotic medication have brought behavior under control. 3 Seclusion has proven ineffective as a means of controlling any assaultive behavior. 4 Electroconvulsive therapy can be scheduled to coincide with lithium administration.

2

What information concerning electroconvulsive therapy (ECT) treatment and its effectiveness for clients diagnosed with bipolar disorder is true? 1 It is appropriate for all cases of manic behavior. 2 It is promising for clients with a history of rapid cycling. 3 Treatment is contraindicated for patients during depressive episodes. 4 Treatment shows little effectiveness for patients experiencing paranoid tendencies

4

When a client experiences four or more mood episodes in a 12-month period, what term does the nurse document? 1 Dyssynchronous 2 Incongruent 3 Cyclothymic 4 Rapid cycling

1

When a client taking lithium reports an upset stomach, how does the nurse suggest taking the medication? 1 With meals 2 With an antacid 3 30 minutes before meals 4 2 hours after meals

4

When the spouse of a client who is manic asks about genetic transmission of bipolar disorder, what knowledge informs the nurse's answer? 1 No research exists to suggest genetic transmission. 2 Much depends on the socioeconomic class of the individuals. 3 Highly creative people tend toward development of the disorder. 4 The rate of bipolar disorder is higher in first-degree relatives of people with bipolar disorder.

2

Which approach should the nurse use when communicating with a client experiencing an elated mood and euphoria? 1 Use abstract concepts. 2 Use a calm, firm approach. 3 Give detailed explanations. 4 Encourage frequent self-disclosure.

3

Which assessment finding regarding communication is likely in a client experiencing acute mania? 1 Mutism 2 Poverty of ideas 3 Clang associations 4 Psychomotor retardation

4

Which behavior of the nurse is most appropriate when caring for a client experiencing acute mania? 1 Judging the values of the client as incorrect 2 Giving long, detailed explanations to the client 3 Using a soft and gentle approach with the client 4 Redirecting the client's energy into alternate channels

2

Which behavior would be most characteristic of a client during a manic episode? 1 Watching others intently and talking little 2 Switching rapidly from one activity to another 3 Being unwilling to leave home to see other people 4 Taking frequent rest periods and naps during the day

a,d,e,f

Which behaviors are characteristic of the manic phase of bipolar disorder? Select all that apply. a Excessive energy b Fatigue and increased sleep c Low self-esteem d Pressured speech e Purposeless movement f Racing thoughts

1

Which change in behavior is important to include when teaching the client and the family to recognize possible signs of impending mania? 1 Decreased sleep 2 Increased appetite 3 Decreased social interaction 4 Increased attention to bodily functions

4

Which charting entry most accurately documents a client's mood? 1. "The client expresses an elevation in mood." 2. "The client appears euthymic and is interacting with others." 3. "The client isolates self and is tearful most of the day." 4. "The client rates mood at a 2 out of 10."

1

Which client statement is evidence of the etiology of major depressive disorder from a genetic perspective? 1. "My maternal grandmother was diagnosed with bipolar affective disorder." 2. "My mood is a 7 out of 10, and I won't harm myself or others." 3. "I am so angry that my father left our family when I was 6." 4. "I just can't do anything right. I am worthless."

1,2,4,5

Which client statements support the diagnosis of mania? Select all that apply. 1 "I've telephoned everyone I know and talked for hours." 2 "I really don't need much sleep; 2 hours a night is enough." 3 "I really enjoy cooking and eating all sorts of expensive foods." 4 "My friends all say this outfit is way too sexy, but I like it and wear it all the time." 5 "My family is really upset with me, but it's just because they're jealous of everything I do."

2

Which clients does the nurse know can be safely prescribed lithium therapy to treat bipolar disorder? 1 Clients with myasthenia gravis 2 Clients with erectile dysfunction 3 Clients with thyroid disorders 4 Clients with renal diseases

2

Which comment by a client diagnosed with bipolar disorder most indicates the client is experiencing mania? 1 "I have been sleeping about six hours each night." 2 "Yesterday I made 487 posts on my social network page." 3 "I am having dreams about my father's death eight years ago." 4 "My appetite is so robust that I've gained 4 lb in the past two weeks."

c

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

1,2

Which of the following rationales by a nurse explain to parents why it is difficult to diagnose a child or adolescent exhibiting symptoms of bipolar disorder? (Select all that apply.) 1. Bipolar symptoms mimic attention deficit-hyperactivity disorder symptoms. 2. Children are naturally active, energetic, and spontaneous. 3. Neurotransmitter levels vary considerably in accordance with age. 4. The diagnosis of bipolar disorder cannot be assigned prior to the age of 18. 5. Genetic predisposition is not a reliable diagnostic determinant.

3

Which side effects of lithium can be expected when the medication is at therapeutic levels? 1 Nausea and thirst 2 Ataxia and hypotension 3 Fine hand tremors and polyuria 4 Coarse hand tremors and gastrointestinal upset

4

Which statement describes a major difference between a client diagnosed with major depressive disorder and a client diagnosed with dysthymic disorder? 1. A client diagnosed with dysthymic disorder is at higher risk for suicide. 2. A client diagnosed with dysthymic disorder may experience psychotic features. 3. A client diagnosed with dysthymic disorder experiences excessive guilt. 4. A client diagnosed with dysthymic disorder has symptoms for at least 2 years.

3

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

2,3,4

Which statements regarding therapy with lithium are true? Select all that apply. 1 It is effective for clients with a history of rapid cycling. 2 It demonstrates effectiveness in the treatment of bipolar I. 3 Manic behaviors generally show improvement in 10 to 21 days. 4 Indeterminate maintenance dosing is required for many clients. 5 Associated hypersexual behavior is well-managed with the medication.

4

Which symptom is most commonly seen in clients diagnosed with bipolar II disorder and experiencing hypomania? 1 Hallucinations 2 Disturbed thoughts 3 Impaired social functioning 4 Hyperactivity and high energy

2,4,5

With a serum lithium level of 0.8 mEq/L, which assessment data does the nurse expect to observe? Select all that apply. 1 Diarrhea 2 Polyuria 3 Mild thirst 4 Muscle weakness 5 Fine hand tremors

distractible

during mania people are high ___________

3

hat should the plan of care for a client who takes lithium include? 1 Emphasis on monitoring weight gain carefully 2 Dietary teaching to restrict daily sodium intake 3 Periodic laboratory monitoring of renal and thyroid function 4 Importance of discontinuing the medication if fine hand tremors occur

clang associations

the stringing together of words because of their rhyming sounds, without regard to their meaning.

ECT

used to subdue severe manic behavior, especially in clients with treatment-resistant mania and clients with rapid cycling