NURS417 Ch26: Bipolar Disorders

A patient with bipolar disorder is prescribed divalproex. Before initiating this therapy, which laboratory test would be most important for the nurse to obtain? Blood glucose level Liver function tests Clotting function tests Renal function tests

Liver function tests For clients who are prescribed divalproex, baseline liver function tests and a complete blood count with platelets should be obtained before starting therapy because of the increased risk for hepatotoxicity. Clotting function tests, renal function tests, and blood glucose level are not needed prior to initiating therapy.

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? Limit fluid intake to 6-8 oz (180-340 mL) glasses a day. Maintain daily sodium intake. Monitor weight pattern. Switch to a DASH diet.

Maintain daily sodium intake. Consistent sodium intake is critical with lithium therapy. A serum therapeutic level of 0.8mEq/L is within the therapeutic range of 0.6-1.2 mEq/L. Fluid intake on lithium therapy should be increased to 2 L/day. Switching to a DASH diet is used to treat HTN. Monitoring weight pattern should be included but it is not the current priority.

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

Mania

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? Feels sleepy and less energetic Minimal mood swings Increased feelings of self-worth Weight gain of 7 pounds in the last 6 months

Minimal mood swings

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? Weight gain of 7 pounds in the last 6 months Increased feelings of self-worth Feels sleepy and less energetic Minimal mood swings

Minimal mood swings

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

Other clients need to be protected from the intrusive behavior.

A nurse is reviewing information about the drug, lithium carbonate. The nurse demonstrates understanding of the information by identifying which situation as a potential cause of lithium toxicity? Select all that apply. Diarrhea Vomiting Hypernatremia Strenuous exercise Hot climate

Strenuous exercise Diarrhea Hot climate Vomiting Hypernatremia would LOWER lithium levels, so would not lead to lithium toxicity.

A bipolar client presents to the clinic with reports of headaches and feeling more irritable than usual. What is the best nursing response? "Have you been taking your medication correctly?" "Can you tell me more about these symptoms?" "Continue to take your medication because the symptoms are minor." "Let's get some bloodwork done."

"Can you tell me more about these symptoms?"

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

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

The family of a client with bipolar disorder is having difficulty coping with the client's rapid mood swings, irritability, grandiose delusions, and overly intrusive behaviors. Following a visit to the unit, the parents discuss their frustration and anger with the nurse and ask what they should do to help the client. Which response by the nurse is most appropriate? "Have a family member stay with the client at all times and monitor behavior." "Make all decisions for the client since they are ex

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

A client experiencing mania is talking with the nurse but speaking so rapidly, the nurse is unable to decipher what is being said. Which statement to the client will be most effective in facilitating communication between the nurse and client? "If you are unable to slow your thoughts down, I will not be able to meet your needs." "Let's talk again when you are not quite so manic." "Please speak more slowly, I am having trouble following what you are saying." "Why don't you write your thoughts do

"Please speak more slowly, I am having trouble following what you are saying."

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? 2.6 mEq/L 1.0 mEq/L 1.6 mEq/L 2.0 mEq/L

1.0 mEq/L

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

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

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? During the first few days after admission On the anniversary of significant life events in the client's life Immediately after a family visit Approximately 2 weeks after starting antidepressant medication

Approximately 2 weeks after starting antidepressant medication Observe the client closely for suicide potential, especially after antidepressant medication begins to raise the client's mood. Risk for suicide increases as the client's energy level is increased by medication. The other choices are not significantly associated with increased risk for suicide.

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

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

The client's spouse calls the health clinic stating that the client is having a manic episode. What information should alert the nurse to recommend that the client should go to the emergency room for treatment? Client is avoiding eye contact and visibly shaking. Client has stayed up most of the night watching television. Client has experienced work-related stress. Client is pacing around the bedroom.

Client is avoiding eye contact and visibly shaking.

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? Mannitol Methyldopa Carbamazepine Lithium

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? Ensure that a family member takes responsibility for administering medications. Point out that each time the client stops taking medication, the client becomes manic again. During stab

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

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

Grandiose delusions

Which behavior is the priority concern as the nurse begins a care plan for a client in the manic phase of bipolar disorder? Bizarre, colorful, inappropriate dress Insulting, provocative behavior directed at staff Grandiose thinking and poor concentration Hyperactivity, dismissing meals, and sleep disturbance

Hyperactivity, dismissing meals, and sleep disturbance Safety needs are always the first priority in care planning. A client who has not eaten or slept for several days and has been extremely hyperactive may be at risk for exhaustion and malnutrition and the implications of those states. Although thought disorder, expansive mood, and dress are important assessment information, priority interventions must center on the basic needs of hyperactivity, dismissing meals, and sleep disturbance.

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 Cardiac enzymes White blood cell (WBC) count Thyroid level

Liver function Baseline liver function tests and a complete blood count with platelets should be obtained before starting therapy, and clients with known liver disease should not be given divalproex sodium. There is a boxed warning for hepatotoxicity. Thyroid level, WBC count, and cardiac enzymes do not have to be performed routinely before starting this medication.

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 phototherapy response. Monitoring blood levels of the medication. Teaching the client to avoid foods with tyramine. Assessing for post-electrocon

Monitoring blood levels of the medication. Lithium is the drug of choice for clients with bipolar illness and has a high antimanic effectiveness. Lithium decreases the intensity, frequency, and duration of manic and depressive episodes. Blood levels need to be monitored for therapeutic levels during the acute phase (1.0-1.5 mEq/L) and during longer term maintenance. Other treatments that could be expected for clients during mania include sedatives or antipsychotics. Electroconvulsive therapy, phototherapy, and monoamine oxidase inhibitors are not typically indicated during manic phases.

Which medication classification is considered first-line drug therapy for bipolar disorder? Antidepressants Anticonvulsants x Antipsychotics Mood stabilizers

Mood stabilizers

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 Weight loss Sleep disruption Dehydration

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

A client with mania is in the dining room at lunchtime and is observed taking food from other clients' trays. Which is the priority action by the nurse? Set and maintain limitations on behavior to avoid threat to others' rights. Allow the client to take the food and replace the other clients' trays. Inform the client that they will lose the privilege of eating in the dining room. Take the client out of the dining room and avoid lunch until the client calms down.

Set and maintain limitations on behavior to avoid threat to others' rights.

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 potassium level, the lower the lithium level will be. Lithium has few interactions with other drugs. The higher the sodium level, the lower the lithium level will be. Changes in diet will not affect lithium levels.

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

A client taking lithium for bipolar disorder comes to the clinic and reports symptoms which the nurse interprets as consistent with moderate lithium toxicity. Which action should the nurse perform? Select all that apply. Contact the physician. Perform a 12-lead electrocardiogram. Push fluids. Obtain a blood sample for lithium level. Withhold additional doses of lithium.

Withhold additional doses of lithium. Obtain a blood sample for lithium level. Push fluids. Contact the physician.

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. Administer an antiemetic and then proceed with the administration of lithium. Prepare the client for hemodialysis to remove the toxic amount of lithium. Augment the excretion of lithium with the administration of m

Withhold the lithium and notify the healthcare provider.