Mental Health- PrepU Chapter 26

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

A bipolar client presents to the clinic with reports of headaches and feeling more irritable than usual. What is the best nursing response?

"Can you tell me more about these symptoms?"

The client with mania attempts to hit the nurse. Which of the following is the best response by the nurse?

"Do not swing at me again. If you cannot control yourself, we will help you."

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. Which response by the nurse would be the most therapeutic?

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

After educating a client with bipolar disorder on his prescribed lithium therapy, the nurse determines that additional education is needed when the client states which of the following?

"I need to cut back on my salt intake when it's really hot outside."

In a 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. The best response by the nurse would be ...

"Let's go to the conference room and talk for a while."

A client has been diagnosed with bipolar disorder. Which statement by the client indicates an understanding of this disorder?

"My bipolar began with depression; then I had a manic episode."

A client with bipolar disorder states to the nurse that they have been experiencing mania and depression every day for 2 weeks and cannot work or take care of their children. Which is the best response by the nurse?

"You are rapid-cycling and we may need to make an adjustment with your medication."

A nurse is assessing a client who is brought to the emergency department. The nurse suspects that the client is experiencing mania. Which finding would support the nurse's suspicion? Select all that apply.

- Statements of self-importance - Flight of ideas - Easily distractible

A client with bipolar disorder is receiving lithium therapy. The nurse is reviewing the client's serum plasma drug levels and determines that the client's level is therapeutic based on what?

1.0 mEq/L

Which lab value is within the range of safety for maintenance or treatment with lithium?

1.2 mEq/L

Which sleep pattern is suggestive of a manic episode?

A client stays awake for several days and nights before "crashing" and sleeping for a long period.

A client with mania is demonstrating hypersexual behavior by blowing kisses to other clients, making suggestive remarks, and removing some articles of clothing. Which nursing intervention would be most appropriate at this time?

Accompany the client to their room to get dressed.

A client has been diagnosed with bipolar disorder. After teaching the client about the different medication classifications used to help stabilize mood, the nurse determines tha the teaching was successful when the client identifies which class of medications?

Anticonvulsants

A nurse is reviewing information about medications used to treat bipolar disorders. The nurse demonstrates understanding by identifying which medication classification as effective in stabilizing moods in people with bipolar disorder?

Anticonvulsants

A client has just been diagnosed as having major depression. At which time would the nurse assess the client to be at highest risk for self-harm?

Approximately 2 weeks after starting antidepressant medication

A client recovering from the manic phase of bipolar disorder is distraught to realize all savings account money was spent during the episode. Which action would the nurse make a priority for this client?

Assess for risk of suicide.

A client with bipolar disorder has been ordered a medication that is classified as an anticonvulsant. Which drug does the nurse know falls within this class of medications?

Carbamazepine

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?

During stabilization, discuss the client's individual signs, symptoms, and consequences of relapse.

A nurse is caring for a client diagnosed with bipolar disorder who has been prescribed divalproex. The nurse knows that the client should have which test completed before initiation of drug therapy?

Liver function

Which behavior is the priority concern as the nurse begins a care plan for a client in the manic phase of bipolar disorder?

Hyperactivity, dismissing meals, and sleep disturbance

A client is prescribed lithium to treat mania. The client also has a history of hypertension for which the client takes lisinopril and hydrocholorothiazide. When monitoring this client, the nurse would be especially alert for signs and symptoms of which condition?

Lithium toxicity

A patient with bipolar disorder is prescribed divalproex. Before initiating this therapy, which laboratory test would be most important for the nurse to obtain?

Liver function tests

A client taking lithium therapy has a serum therapeutic level of 0.8 mEq/L. What priority dietary instruction should the nurse include in the teaching plan?

Maintain daily sodium intake.

A client is admitted to an inpatient unit for treatment of mania. Which priority action should the nurse implement?

Maintain round-the-clock monitoring of the client.

A client with bipolar disorder takes lithium 300 mg 3 times daily. The nurse is educating the client on its use, side effects, and need for compliance. Which outcome does the nurse evaluate that indicates the dose is having the beneficial response for the client?

Minimal mood swings

A client in an acute manic phase is pacing the halls and talking in a loud voice with pressured speech. The client is overly involved with coclients and frequently threatens and disrupts others on the unit. After administering lithium treatment for the client, the nurse can expect the plan of care to include which additional intervention?

Monitoring blood levels of the medication.

The nurse observes a client sitting alone at a table, looking sad and preoccupied. The nurse sits down and says, "I saw you sitting alone and thought I will keep you company." The client turns away from the nurse. Which is the most therapeutic nursing intervention?

Move to a chair a little further away and say, "We can just sit together quietly."

A client with bipolar disorder has been taking lithium, and today the client's serum lithium level is 2.0 mEq/L (2.0 mmol/L). What effects would the nurse expect to see?

Nausea, diarrhea, and confusion

Both valproate and carbamazepine may be lethal if high doses are ingested. Toxic symptoms appear in 1 to 3 hours and include what?

Neuromuscular disturbances

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?

Other clients need to be protected from the intrusive behavior.

A visitor comes to see a client who is suicidal. Upon entering the unit, the nurse notices that the visitor has brought the client a can of the client's favorite soda. Which action should the nurse take at his time?

Pour the soda into a plastic cup.

A client was admitted to the psychiatric unit after being picked up by police officers who found the client frantically running back and forth across the freeway. The client's spouse reports that the client stayed up all night, ate very little, and talked incessantly. Additional assessment findings that indicate a manic episode include what?

Pressured speech, combative behavior, and impaired judgment

A client with bipolar disorder is experiencing acute mania. The client is unable to sit still, moving from place to place. Medication therapy has been prescribed but not yet initiated. Which would the nurse include in the plan of care to meet the client's physical needs?

Providing high energy snacks

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

A client who has just been prescribed lithium for bipolar disorder is being given education from the nurse about this medication. Which is important for the nurse to include in teaching?

The higher the sodium level, the lower the lithium level will be.

The nurse is caring for a client that is experiencing mania that is pacing, cannot sit, with pressured speech. Which meal will the nurse provide to best meet the nutritional needs of this client?

Turkey sandwich, cheese slices, milk

The nurse is preparing to administer a client's dose of lithium carbonate and assesses a lithium level of 1.8 mEq/L (1.8 mmol/L). The client is having nausea, vomiting, and diarrhea. Which is the priority action by the nurse?

Withhold the lithium and notify the healthcare provider.

A spouse is concerned because a client demonstrates rapidly changing moods that occur without provocation or reason. For which condition will the nurse assess this client?

bipolar disorder

A client experiencing acute mania from bipolar disorder refuses hospitalization. Which type of treatment would the nurse anticipate being prescribed for this client?

intensive outpatient program

A client with acute mania from bipolar disorder agrees to be hospitalized. Which intervention(s) will the nurse emphasize in the client's plan of care? Select all that apply.

safety psychoeducation promotion of self-care extended length of stay medication management