Ch. 26, Bipolar and related disorders

The primary health-care provider prescribes lithium carbonate therapy to a client with mania. Which instruction should the nurse provide to the client to prevent adverse effects associated with the medication?

"Drink 6 to 8 large glasses of water each day."

Which interventions should the nurse implement while caring for a client with mania who is on lithium carbonate therapy? Select all that apply.

- Draw blood samples 12hours after the last dose. - Notify the primary health-care provider if the serum lithium level reaches 1.5 mEq/L.

A client with bipolar disorder is at high risk of self-harm. The nurse finds that the client perceives actions of others as threatening. What does the nurse do to ensure safety of this client? Select all that apply.

- Place the client on 1-1 precautions. - Maintains low level of stimuli in the client environment

The nurse is caring for a client who is diagnosed with hypomania. Which behavior does the nurse find in the client? Select all that apply.

- The client is cheerful and expansive with an underlying irritability. - The client talks and laughs very loudly while communicating with the nurse.

Which side effect in the client who is on lithium carbonate therapy prompts the primary health-care provider to decrease the dose of the medication? Select all that apply.

- arrhythmia - fine hand tremors

Which conditions can be effectively treated using topiramate? Select all that apply.

- epilepsy - migraine

A client with rapid cycling manic symptoms is on olanzapine (Zyprexa) therapy. Which adverse effects should the nurse report on chronic administration of the drug? Select all that apply.

- frequent periods of sleep - changes in electrocardiogram - manifestation of EPS

The nurse finds verapamil on the medication list of a client with a history of two manic episodes. Which side effects does the nurse expect in the client? Select all that apply.

- persistent headache - pronounced dizziness - profound mood swings

The nurse is caring for a client with mania who is on aripiprazole therapy. Which signs or symptoms does the nurse observe in the client? Select all that apply.

- polyuria - polydipsia - polyphagia

What are the characteristic cognitive symptoms observed in a client with delirious mania? Select all that apply.

- stupor - confusion - disorientation

Which category of drugs has the potential for initiating a manic episode? Select all that apply.

- sulfonamides - antiulcer agents - antihypertensive agents

A client is admitted to the psychiatric ward with a history of two manic episodes. On interaction, the nurse learns that the client has acute symptoms of mania. Which interventions should the nurse include in the acute phase treatment plan for this client? Select all that apply.

- take measures to alleviate insomnia in the client - assist the client in performing personal hygiene and grooming - remove dangerous objects from the client's environment

Which medications decrease the effects of oral contraceptives in a client with bipolar disorder? Select all that apply

- topiramate - oxacarbazepine

What is the normal therapeutic serum concentration in a client with acute mania receiving lithium therapy?

1.0 mEq/L

A nurse caring for a manic client observes that the client has persistent gastrointestinal upset and blurred vision. After reviewing the laboratory reports, the nurse finds that the client has signs of lithium toxicity. What concentration of lithium does the nurse find in the client's blood serum?

1.8 mEq/L

What is the daily dose range of lithium carbonate?

1800 to 2400 mg

While caring for a client with psychotic disorder, the nurse infers that he is at risk of being violent with other individuals. Which symptom enabled the nurse to reach this conclusion?

Manic excitement

Which finding indicates mania in the client, according to the frequency, intensity, number, and duration (FIND) strategy?

Manic symptoms severely disturb the client and interfere with the client's work.

Which signs does the nurse expect to appear in the client whose serum concentration of lithium is 1.8 mEq/L?

Persistent vomiting

A client diagnosed with bipolar I disorder is on divalproex therapy. During the follow-up visit, the nurse finds elevated mood swings in the client. Which intervention of the primary health-care provider is beneficial in this situation?

Switching the client to olanzapine therapy

The nurse is caring for a client with impaired social interaction. The nurse sets limits on the behavior of the client. Which outcome in the client does the nurse expect from this intervention?

The client develops an appropriate interaction behavior.

The nurse is caring for a client who is at high risk for violence. While caring, the nurse offers an empathetic response to the client's feelings. Which outcome does the nurse expect from this intervention?

The client develops trust.

A client is admitted into the psychiatric unit with symptoms of hypomania. The client's history indicates that the client has never experienced a full manic episode. What should the nurse infer from these findings?

The client has bipolar II disorder.

While interacting with a client, the nurse suspects that the client is having a manic episode of bipolar disorder. Which statement supports the nurse's suspicion?

The client has elevated or irritable mood.

The mother of an adolescent client says, "My child keeps talking about calling the U.S. President to give him suggestions." The nurse also finds that the client has increased libido. What does the nurse interpret from these findings?

The client is experiencing hypomania.

Which signs and symptoms indicate that the client has altered sensory perception? Select all that apply.

- Disorientation - Auditory hallucinations

While communicating with a client, the nurse suspects that the client has a manic episode of bipolar disorder. Which statement of the client supports the nurse's suspicion?

"I communicate better than anyone else.

A client with mania has shown progressive improvement with lithium therapy. After successful treatment, the client is discharged. What suggestions should the nurse give to the client? Select all that apply.

- "Notify the primary health-care provider if pregnancy is planned or suspected." - "Contact the primary health-care provider if you have excessive vomiting."

The primary health-care provider prescribes propanolol to a client with mania to counteract a side effect associated with lithium carbonate. Which side effect might have occurred in the client prior to this change in medication?

Hypotension

After assessing a child, the nurse suspects the child has cyclothymic disorder. Which statement of the child's mother supports the nurse's assumption?

"My child has had periods of elevated moods from the age of 5 years. These episodes are more frequent since she turned 8 years old."

Which statement of the client with bipolar mania indicates personalizing thought?

"My sister is this happy only when she's with me."

A nurse is preparing a diet plan for a client with mania who is on lithium therapy. Which instruction should be included in the diet plan?

"Take lithium after meals."

Which statement of the client indicates an automatic thought that occurs spontaneously in a client with bipolar mania?

"The mistakes I've made are not really important."

The registered nurse is teaching a group of student nurses about cognitive therapy. Which statement made by a student nurse requires correction?

- "Cognitive therapy describes depression as a triad of negative distortions."

The nurse is caring for a client diagnosed with bipolar disorder. On interaction with the client, the nurse suspects that the client is in the delirious mania stage. Which statement of the client supports the nurse's conclusion? Select all that apply.

- "Go away! leave me alone" - "I don't want to go into that bathroom because somebody is in there and is planning to kill me." - "I saw a demon standing in front me."

A client with mania reports an inability to sleep. What appropriate actions does the nurse take to help the client sleep better? Select all that apply.

- Administer sedative agents as prescribed. - Provide a warm bath before sleep. - Help to perform relaxation exercises before sleep.

Which stage of mania is associated with the behavior of manipulating others to fulfill the client's wishes?

Acute mania

Which condition can be effectively treated using a combination of olanzapine and fluoxetine?

Bipolar disorder with depressive episodes

Which medication indicated for attention-deficit/hyperactivity disorder (ADHD) induces mania?

Bupropion

The nurse is caring for a client with depression who reports burning and stabbing muscle pains due to nerve damage. The medical reports indicate that the client has herpes zoster infection. Which medication would be most beneficial for the client?

Carbamazepine

What should the nurse do before administering lithium carbonate to a client for the first time?

Check for a history of seizures.

A client with bipolar disorder is diagnosed with migraine. Which medication is effective when the primary health-care provider prefers a single medication for the treatment of both the conditions?

Chlorpromazine

Which medication causes extrapyramidal symptoms as a side effect?

Chlorpromazine

Which medication, when coadministered with clonazepam, increases its effects?

Cimetidine

The nurse is reviewing the medical history of four clients diagnosed with bipolar disorder who are receiving olanzapine. Which client does the nurse expect to have decreased effects of olazanpine?

Client 1

The nurse is collecting data on four clients diagnosed with bipolar disorder and bulimia nervosa. Which client is receiving effective monotherapy?

Client A; lithium carbonate

What should the nurse advise for a client with bipolar disorder who is on lithium carbonate therapy to prevent persistent vomiting and diarrhea?

Consume a diet with adequate sodium

The nurse is caring for a client with mania who is on lithium carbonate therapy. The nurse monitors the client's skin turgor daily. Which sign or symptom observed in the client supports this nursing intervention?

Dehydration

Which symptom displayed by the client may indicate hypomanic episodes of bipolar disorder?

Distractibility

Which therapy might be helpful to the client with bipolar II disorder who is not responding to lithium therapy?

Electroconvulsive therapy

Which finding may be observed in the diagnostic reports of a client with bipolar disorder?

Enlarged third ventricles

A client with mania refuses to cooperate with peers during group activity. The nurse observes that the client has inaccurate interpretation of the environment. Which intervention should the nurse include after effective treatment?

Evaluate the client's communication skills.

A client with bipolar mania is on verapamil therapy. What should the nurse instruct the client to include in his or her diet?

Fibrous foods

A research nurse finds that a client participating in a clinical trial is experiencing an episode of euphoria, elevated energy, irritable mood, and distractibility. What should the nurse suspect is occurring with the client?

Imbalance between biogenic amines and acetylcholine

The nurse is caring for a client with bipolar mania who is prescribed gabapentin. While communicating, the nurse finds that the client is receiving treatment for peptic ulcer. Which intervention of the primary health-care provider is beneficial in this situation?

Increase the dose of gabapentin.

Which findings may be present in a client with a depressive episode of bipolar disorder?

Increased levels of acetylcholine

Which behavioral characteristics does the nurse observe in a client with hypomania?

Increased perception of environment

Which intervention should the nurse perform to prevent drowsiness and dizziness in the client who is on verapamil therapy?

Instruct the client not to operate heavy machinery.

What effect does the nurse notice by the concurrent administration of carbamazepine and selegiline?

Life-threatening hypertensive reaction

A client gave birth to a stillborn baby and is diagnosed with psychosis. Which treatment would be most beneficial for this client?

Lithium carbonate

A client with bipolar disorder has been in an accident and has severe traumatic brain injury. Which medication is contraindicated in this client for the treatment of bipolar disorder?

Lithium carbonate

Which medication binds to the ANK3 (ankyrin G) protein to prevent manic episodes of bipolar disorder?

Lithium carbonate

Which treatment strategy would be most beneficial for the client with bipolar disorder who is experiencing severe symptoms of corticosteroid-induced psychosis?

Lithium carbonate

A client is diagnosed with bipolar II disorder with delirious symptoms of mania. Which interventions should the nurse include in the client's care plan?

Provide information about support groups

The nurse is caring for a client who is experiencing very frequent manic episodes. Which intervention by the nurse may help the client to reduce the manic episodes of bipolar disorder?

Providing a private room in a quiet unit

Which actions by the nurse will help a hyperactive client to achieve much-needed rest?

Providing a structured schedule of activities for the client

A client who is experiencing frequent manic episodes has a delusional thought process and low self-esteem. The nurse finds that the client is trying to manipulate others for self-gratification. Which interventions included in the client's care plan should the nurse expect to improve the client's self-esteem?

Reinforcing acceptable behaviors in the client

Which medication decreases the effects of clonazepam?

Rifampin

After assessing a manic child in the pediatric unit, the nurse concludes that the child is experiencing euphoria. Which behavior of the child supports the nurse's conclusion?

Silly and giddy

While caring for the client with extreme hyperactivity associated with mania, the nurse engages the client in physical activities. Which outcome does the nurse expect from this intervention?

The client releases pent-up tension.

What does the nurse expect in a client who shows hypomanic episodes of bipolar disorder?

The client shows manic symptoms that last for at least 4 consecutive days.

The nurse is reviewing the medical reports of four clients. Which client does the nurse expect to have complications associated with the medication prescribed?

client 2;

A client who has undergone surgery for left ventricular dysfunction is receiving treatment for bipolar mania. Which medication may increase the risk of cardiac complications in the client?

Verapamil

Which client may have effective treatment with the administration of carbamazepine?

client 4, restless leg syndrome

A client with bipolar disorder is diagnosed with glaucoma. Which medication is contraindicated in this client for the treatment of bipolar disorder?

clonazepam

The nurse is caring for a client who is undergoing treatment for mania. The nurse instructs the client to undergo blood tests regularly. Which category of medications might require this type of monitoring?

anticonvulsant

Which side effect is suspected in the client who is on verapamil therapy?

bradycardia

After reviewing the medication list of a client with bipolar mania, the nurse advises the client to increase intake of fluid and fiber in the diet. Which medication is the nurse likely to find among the client's prescriptions?

chlorpromazine

The nurse is providing education to four clients with mania who are placed on different medications. Which client does the nurse instruct to report symptoms of muscle twitching, excessive hunger, and pale stools?

client 1; antipsychotics

On reviewing the laboratory reports of a client who is on valproic acid therapy, the nurse finds that the client has an increased risk of bleeding. Which findings enable the nurse to reach this conclusion?

decreased platelet count

The primary health-care provider prescribes olazanpine to a client who is experiencing acute mania. Which condition in the health history of the client indicates the risk for complications?

diabetes mellitus

Which findings may be noticed in a client with a manic episode of bipolar disorder?

enlargement of subcortical white matter

Which behavior of a client made the nurse implement keeping juices and snacks on the unit at all times?

hyperactivity

Which medication's effects are increased by the administration of carbamazepine?

lithium

While communicating with a client, the nurse suspects bipolar mania. The nurse also finds a decreased neutrophil count in the laboratory reports of the client. Which medication would be most beneficial for this client?

lithium

A client with multiple sclerosis who is on steroid therapy is admitted to the psychiatric ward. Which symptoms does the nurse observe in the client?

mania

A client with mania who is extremely hyperactive and intensely agitated is admitted into the psychiatric ward. During client care, the nurse instructs the client to perform slow exercises. Which risks does the nurse intend to prevent in the client?

risk of physical injury

Which medication would be beneficial to a client with autism?

risperidone

Which medication for treating mania has a risk of spontaneous bleeding and bruising?

valproic acid

Which medication regulates the influx and outflow of calcium from the cells through the expression of CACNA1C protein?

verapamil