BioPsych Bipolar - Evolve

A client with a diagnosis of bipolar I disorder, manic episode, is started on a regimen of an antipsychotic agent and lithium carbonate. The nurse explains to the client that the rationale behind this regimen is that the antipsychotic has which action? A. Potentiates the action of lithium for more effective results B. Interacts with lithium to prevent progression to the depressive phase C. Helps decrease the risk of lithium toxicity in the first week of therapy D. Acts to quiet the client while allowing time for the lithium to reach a therapeutic level

Acts to quiet the client while allowing time for the lithium to reach a therapeutic level. Antipsychotics usually are prescribed to calm agitated clients during the 3-week period it takes for the lithium to become effective. Antipsychotic drugs have a different, not a potentiating, mechanism of action. The drugs are used to control symptoms of mania, not to prevent depression. The neuroleptic drug has no effect on lithium toxicity.

A client with bipolar disorder, manic episode, has a superior, authoritative manner and constantly instructs other clients in how to dress, what to eat, and where to sit. The nurse should intervene to prevent these behaviors from causing the other clients to feel what? A. Angry B. Dependent C. Inadequate D. Ambivalent

Angry A person with a condescending, superior attitude typically evokes feelings of anger in others and will increase their anxiety. It is unlikely that a condescending, superior attitude will produce feelings of dependency, inadequacy, or ambivalence in others.

A hyperactive client with bipolar I disorder becomes loud and insulting and says to a staff member, "Get lost, you old buzzard!" How can the nurse can best handle this situation? A. Asking the client to come along on a walk B. Asking the client to explain their anger C. Pointing out that the staff member is neither old nor a buzzard. D. Telling the client that if the rude behavior does not change there will be consequences

Asking the client to come along on a walk. Rather than placing emphasis on their behavior, staff members should use the easy distractibility of these clients to redirect manic behavior to more constructive channels. A walk with the nurse provides structure and a way to expend energy safely. The client will be unable to explain the basis for the expressed anger to the nurse. Pointing out that the staff member is neither old nor a buzzard encourages the client to defend the statement; it does not foster communication about feelings. Telling the client that if the rude behavior does not change there will be consequences focuses on the behavior; it is a punitive response that does not foster communication.

A healthcare provider prescribes divalproex for a client with the diagnosis of bipolar I disorder, manic episode. What side effects of this medication might the client report during a follow-up visit? A. Dizziness, Nausea, Vomiting B. Photo sensitivity, agitation, restlessness C. Abdominal cramps, tremors, muscle weakness. D. Weight gain, drowsiness, and diminished concentration.

Dizziness, Nausea, Vomiting. Divalproex, an anticonvulsant, causes gastric irritation and should be taken with food; it is available in an enteric-coated form. It may cause nausea, vomiting, indigestion, hypersalivation, diarrhea or constipation, anorexia or increased appetite, dizziness, headache, and confusion. Photosensitivity, agitation, and restlessness are all common side effects of phenothiazines. Abdominal cramps, tremor, and muscle weakness are signs and symptoms of lithium toxicity. Weight gain, drowsiness, and diminished concentration are common side effects of tricyclic antidepressants.

A client with bipolar I disorder, manic episode, is admitted to the mental health unit of a community hospital. When developing an initial plan of care for this client, what should the nurse plan to do? A. Increase the clients gym time B. Isolate the client from peers C. Encourage increased nutritional intake D. Reinforce participation in unit programs.

Encourage increased nutritional intake. The client in a manic episode of the illness often neglects basic needs; these needs are a priority to ensure adequate nutrition, fluid, and rest. The hyperactivity of mania creates an increased need for calories. Although the client needs to expend excess energy, physical exhaustion and dehydration are real possibilities during the manic episode of the illness. Isolating the client from peers is counterproductive and punitive. The client is unable to actively participate in group activities at this time.

The nurse cares for a client with bipolar disorder who is receiving drug therapy. The laboratory report reveals that the client's serum sodium level is 132 mEq/L (132 mmol/L). Which drug might have led to this condition? A. Lithium B. Buproprion C. Fluoxetine D. Nortriptyline

Fluoxetine A serum sodium level of 132mEq/L (132 mmol/L) indicates hyponatremia. Fluoxetine is a serotonin reuptake inhibitor that may lead to hyponatremia. Lithium is a mood stabilizer used to treat bipolar disorder; it does not lead to hyponatremia. Bupropion is an atypical antidepressant that does not cause hyponatremia. Nortriptyline is a tricyclic antidepressant used to treat bipolar disorder that does not lead to hyponatremia.

A client is admitted with bipolar disorder, depressed episode. The nursing history indicates a progressive increase in depression over the past month. What should the nurse expect the client to display? A. Elated affect related to reaction formation B. Loose associations related to a thought disorder C. Physical exhaustion related to decreased physical activity. D. Paucity of verbal expression related to slowed thought processes

Paucity of verbal expression related to slowed thought processes. As depression increases, thought processes become slower and verbal expression decreases because of lack of emotional energy. Elation is associated with bipolar disorder, manic episode; the affect of a depressed person is usually one of sadness, or it may be blank. Loose associations are related to schizophrenia, not depression. Physical exhaustion is associated with bipolar disorder, manic episode; decreased physical activity does not produce physical exhaustion.

A nurse is planning care for a client admitted to the unit with a diagnosis of bipolar disorder, manic phase. In which type of room should the nurse tell the admissions clerk to place this client. A. Private B. Isolation C. Semi-private D. Negative airflow

Private The client who is manic needs a nonstimulating environment. A person who is bipolar is not contagious and does not require an isolation room. The presence of another person in the room is considered stimulating and may interfere with the rest and sleep of both clients. A client who is bipolar does not need a negative-airflow room. This type of room is appropriate for a client with a communicable disease, such as tuberculosis, that requires airborne precautions.

What is the best nursing intervention when the language of a client in the manic phase of a bipolar disorder becomes vulgar and profane? A. Stating, "We don't like that kind of talk around here." B. Ignoring it because the client is using it to gain attention C. Recognizing that the behavior is part of the illness but setting limits on it D. Responding, "We'll talk with you when you can speak in an acceptable way."

Recognizing that the behavior is part of the illness but setting limits on it. Recognizing the language as part of the illness makes it easier to tolerate, but limits must be set for the benefit of the staff and other clients. Setting limits also shows the client that the nurse cares enough to stop the behavior. "We don't like that kind of talk around here" shows little understanding or tolerance of the illness. Ignoring the behavior is a form of rejection; the client is not using the behavior for attention. Saying "We'll talk with you when you can speak in an acceptable way" demonstrates rejection of the client and little understanding of the illness.

Lithium is prescribed for a client with bipolar disorder experiencing a manic episode. When teaching the client about this medication, the nurse will emphasize which fact about lithium? A. Cannot be taken safely with any other antipsychotic medications B. Can be taken safely with diuretics if the potassium level is maintained C. Should be discontinued and the primary healthcare provider notified if depression occurs D. Should temporarily be stopped and the primary healthcare provider notified if diarrhea results

Should temporarily be stopped and the primary healthcare provider notified if diarrhea results. A decrease in serum sodium because of diarrhea decreases the excretion of lithium, which can result in a toxic level in the blood. In addition, diarrhea is a sign of lithium toxicity. It is safe to take lithium with other antipsychotics, because the client's behavior may require combination pharmacotherapy. Lithium should not be taken with diuretics, regardless of the potassium level, because diuretics decrease the sodium level, and lithium is not excreted when the sodium level is decreased. Lithium is useful in both the manic and depressive phases of a bipolar disorder.

A client with the diagnosis of bipolar disorder, manic episode, attends a mental health day treatment program. What supervised activity will be most therapeutic for this client during the early phase of treatment? A. Doing a needle point project B. Joining a brief swimming team C. Walking around the facility with a nurse D. Playing a board game with another patient

Walking around the facility with a nurse Walking around the facility with a nurse does not involve an element of competition and still allows the client to channel excess energy safely. A needlepoint project requires fine motor skills of a client who is hyperactive and whose attention span is limited. The sense of competition and added stimulation provided by a swimming competition may increase the client's anxiety. The client is too hyperactive to play a board game and may respond with distractibility or aggressiveness toward others.

The nurse is leading a relapse-prevention group for clients who experience bipolar disorder manic episodes. Which strategies should the nurse teach to help prevent or identify impending relapse? Select all that apply. A. Watch for changes in libido B. Keeping dietary changes to a minimum C. Maintain a regular sleeping schedule D. Plan multiple varied activities everyday E. Monitor self for increased irritability and mood instability

Watch for changes in Libido Keeping dietary changes to a minimum Maintain regular sleeping schedule Monitor self for increased irritability and mood instability. Increased sex drive often indicates the beginning of a manic episode. Changes in the eating pattern can trigger a manic episode. Changes in the sleeping pattern may increase anxiety and trigger a manic episode. An elevated, expansive, or irritable mood often indicates the beginning of a manic episode. Too many activities may be too stimulating and precipitate a manic episode. Simple, repetitive routines should be followed to limit change or anxiety.

A client with newly diagnosed rapid-cycling bipolar disorder will be meeting with the nurse for an educational session about the pharmacological approach that is planned. Which classification of medication does the nurse expect to discuss? A. Anti anxiety medication B. Antiparkinson medication C. Antidepressant medication D. Anticonvulsant medication

Anticonvulsant medication Anticonvulsant medications are therapeutic for clients with rapid-cycling bipolar disorder. Antianxiety medications are not primarily used for rapid-cycling bipolar disorder. Antianxiety medications may be helpful for clients with treatment-resistant mania. Antiparkinson medications are not used for rapid-cycling bipolar disorder. An antidepressant medication is not used unless the client also is taking an antipsychotic medication.

A nurse is admitting a client with a history of bipolar disorder. The nurse determines that the client is in the depressive phase of the disorder. Identify the signs and symptoms that support the nurse's conclusion. Select all that apply. A. Apathy B. Hyperactivity C. Flight of ideas D. Loss of appetite E. Sleep disturbances

Apathy Loss of Appetite Sleep disturbances When a client is depressed, the mood is sad or flat, which is manifested by apathy. Depressed people do not have an appetite or the energy to eat. Difficulty initiating or maintaining sleep or excessive sleepiness is associated with depression. Hyperactivity is a sign of the manic phase of a bipolar disorder. Flight of ideas is a sign of the manic phase of a bipolar disorder.

The primary healthcare provider suspects agranulocytosis in a client with a history of bipolar disorder (BPD). Which drug used to treat BPD is responsible for this condition? A. Clozapine B. Olanzapine C. Risperidone D. Aripiprazole

Clozapine. Atypical antipsychotics are generally used to treat clients with bipolar disorder (BPD) to control symptoms during mania and to stabilize mood. Although clozapine is highly effective in treating BPD, this drug is not preferred because it may cause agranulocytosis. Olanzapine is approved for long-term use to prevent the recurrence of mood episodes. Side effects of this drug include weight gain, diabetes, and dyslipidemia. Risperidone along with mood stabilizers such as antiepileptic drugs are used to treat BPD; this drug's side effects include dizziness, somnolence, and fatigue. Aripiprazole is an approved drug for long-term use in clients with BPD. The side effects of aripiprazole include agitation, nervousness, anxiety, and insomnia.

A nurse is caring for a client with bipolar disorder, depressive episode. What should the nurse's initialobjective for this client be? A. Feeling comfortable with the nurse. B. Investigating new leisure activities C. Participating in small group activities D. Initiating conversations about feelings

Feeling comfortable with the nurse. Before therapy can begin, a trusting relationship must be developed. A client with major depression will not have the impetus or energy to investigate new leisure activities. Participating in small group activities is not appropriate initially; the client does not have the physical or emotional energy to interact with a small group of people. Initiating conversations about feelings will not be successful unless the client develops a trusting, comfortable relationship with the nurse.

A man with bipolar disorder, manic episode, has been traveling around the country, dating multiple women, and buying his dates expensive gifts. He is admitted to the hospital when he becomes exhausted and runs out of money. The nurse anticipates that during a manic episode the client is most likely experiencing feelings of what? A. Guilt B. Grandeur C. Worthlessness D. Self-depreciation

Grandeur During a manic episode a client has an inflated self-esteem that replaces feelings with which the client cannot cope. Feelings of guilt, worthlessness, and self-deprecation are not associated with bipolar disorder, manic episode.

A nurse is planning an educational program for family members of clients with bipolar disorder. What clinical manifestations indicating the beginning of an episode of mania should the nurse include? Select all that apply. A. insomnia B. Irritability C. Excessive eating D. Decreased libido E. Financial responsibility

Insomnia Irritability Financial responsibility During a manic episode there is a decreased need for sleep and clients do not feel tired. During a manic episode the primary mood is irritability; the emotions often fluctuate between euphoria and anger. During a manic episode impulsivity, impaired judgment, and involvement in pleasurable activities may result in spending sprees that can have negative consequences. During a manic episode there is a decrease in appetite. The client's increased activity and inability to sit still interfere with the ability to eat and drink. Hypersexuality, rather than decreased libido, is common during a manic episode.

A nurse is caring for a client with bipolar I disorder. What should the plan of care for this client include? Select all that apply. A. Touching the client to provide reassurance B. Providing a structured environment for the client C. Ensuring that the client's nutritional needs are met D. Engaging the client in conversation about current affairs E. Designing activities that require the client to maintain contact with reality

Providing a structured environment for the client Ensuring that the client's nutritional needs are met. Structure tends to decrease agitation and anxiety and to increase the client's feelings of security. Whether the individual is experiencing mania or depression, nutritional needs must be met. The hyperactivity associated with mania interferes with the ability to sit still long enough to eat; hyperactivity requires an increase in the intake of calories for the energy expended. Touching can be threatening for many clients and should not be used indiscriminately. Conversations should be kept simple. The client with a bipolar disorder, either depressed or manic phase, may have difficulty following involved conversations about current affairs. Clients with bipolar disorders are in contact with reality, so designing activities that require the client to maintain such contact will serve little purpose.

A 32-year-old client is hospitalized with a diagnosis of a bipolar disorder, manic episode. The client becomes loud and vulgar and disturbs the other clients. What is the best reaction by the nurse to this situation? A. Telling the client that the behavior is bothering the other clients B. Ignoring the vulgar talk because it is part of the illness C. Segregating the client until this phase of the illness passes D. Commenting that this kind of talk is not appreciated on the unit

Segregating the client until this phase of the illness passes During the manic phase, when clients are unable to control their behavior, they should be protected from embarrassing themselves or harming others. These clients are unable to deal with others' feelings; the client's own feelings are primary at this time. Also, simply telling the client that the behavior is bothersome is too general to communicate which behaviors are dysfunctional. The client's behavior cannot be ignored, because the client or others may be hurt if limits are not set. Stating that talk such as the client's is not welcome on the unit is critical of the client, who is unable to respond differently at this time.