Chapter 13: Bipolar and Related Disorders

The priority nursing diagnosis for a hyperactive manic patient during the acute phase is 1 Risk for injury 2 Ineffective role performance 3 Risk for other-directed violence 4 Impaired verbal communication

1 Risk for injury

Which behaviors describe the symptoms of the manic phase of bipolar disorder? Select all that apply. 1 Distractibility 2 Low self-esteem 3 Racing thoughts 4 Excessive energy 5 Pressured speech 6 Purposeless movement 7 Fatigue and increased sleep 8 Withdrawal from environment

1 Distractibility 3 Racing thoughts 4 Excessive energy 5 Pressured speech 6 Purposeless movement

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

3 Instruct the patient to perform slow exercises.

Which is an advanced sign of lithium toxicity? 1 Sedation 2 Polyuria 3 Mild thirst 4 Blurred vision

4 Blurred vision

A patient with mania says to a nurse, "I will not talk with you, the nurse in the night shift advised me to stay away from you." What appropriate action does the nurse take? 1 The nurse secludes the patient. 2 The nurse asks the reason for avoiding. 3 The nurse stops interacting with the patient. 4 The nurse reports the patient's behavior in the staff meeting.

4 The nurse reports the patient's behavior in the staff meeting.

When a patient reports that lithium causes an upset stomach, the nurse suggests taking the medication 1 With meals 2 With an antacid 3 30 minutes before meals 4 2 hours after meals

1 With meals

Which food should be incorporated in the diet of patients with bipolar disorder that would also help in mood regulation? 1 Cereals 2 Chocolates 3 Cod liver oil 4 Milk products

3 Cod liver oil Integrative therapy for bipolar disorder may involve the use of foods rich in omega-3 fatty acids because those help with mood regulation and improve attention. Cod liver oil is a rich source of omega-3 fatty acids; hence it can be included in a patient's diet. Milk products can be included, but they do not help in mood regulation but rather as a source of protein. Chocolate must be avoided for patients with bipolar disorder because chocolate contains cocoa, which has caffeine. Caffeine causes central nervous system stimulation and can cause anxiety. Cereals are a source of carbohydrates. They do not contain high amounts of omega-3 fatty acids, so they do not cause mood regulation.

A patient diagnosed with bipolar disorder was hospitalized 15 days ago and has been receiving lithium. Current assessment findings include increased restlessness, pressured speech, and flight of ideas. The patient sleeps 2 hours per night. What is the nurse's best intervention? 1 Continue to monitor the patient's symptoms until the lithium begins to take effect. 2 Discourage the patient from attending groups because of the likelihood of disruptive behavior. 3 Offer the patient opportunities to practice concentration and ways to increase attention span. 4 Consider the need to obtain a lithium level. The patient may not be swallowing the medication.

4 Consider the need to obtain a lithium level. The patient may not be swallowing the medication.

A patient diagnosed with bipolar disorder has taken lithium for 1 year with good results. Today, the patient phones the nurse with these complaints. Which complaint should receive the nurse's priority attention? 1 I've had very bad diarrhea for 3 days." 2 "I notice my hand trembling occasionally." 3 "In the past 6 months, I have gained 8 pounds." 4 "I have been putting a little extra salt on my food."

1 "I've had very bad diarrhea for 3 days."

An outcome for a manic patient during the acute phase that would indicate that the treatment plan was successful would be that the patient 1 Is free of injury 2 Is highly distractible 3 Ignores food and fluid 4 Reports racing thoughts

1 Is free of injury

A patient displays a period of intense mood disturbance with persistent elevation, expansiveness, irritability, and extremely goal-directed activity. What is the term for the patient's behavior? 1 Mania 2 Hypomania 3 Flight of ideas 4 Loose associations

1 Mania

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

1 Provide step-by-step instructions for dressing. 3 Provide simple clothes and hygiene tasks to the patient. 5 Provide repeated reminders to finish tasks if necessary.

Which body system is most at risk for decompensation during the acute phase of a severe manic episode? 1 Renal 2 Cardiac 3 Endocrine 4 Pulmonary

2 Cardiac

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 patient for risks to his or her safety. What factor makes this intervention especially appropriate for this patient? 1 Such a patient is abused easily by other aggressive patients. 2 Mania can result in irresponsible and physically risky behaviors. 3 The manic phase will be followed by a phase of severe depression. 4 Older adults experience physical conditions that greatly increase the potential for injury.

2 Mania can result in irresponsible and physically risky behaviors.

The plan of care for a patient who takes lithium should include 1 Dietary teaching to restrict daily sodium intake 2 Periodic laboratory monitoring of renal and thyroid function 3 The requirement for laboratory tests to monitor serum potassium level 4 The importance of discontinuing the medication if fine hand tremors occur

2 Periodic laboratory monitoring of renal and thyroid function

A nurse prepares the plan of care for a person 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

2 Sleep deprivation 3 Disturbed thought processes 4 Risk for deficient fluid volume

The patient 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 Check the patient's blood lithium level. 4 Report to the primary health care provider.

3 Check the patient's blood lithium level

Which symptom related to communication is likely to be present in a patient experiencing mania? 1 Mutism 2 Poverty of ideas 3 Clang associations 4 Psychomotor retardation

3 Clang associations are the stringing together of words because of their rhyming sounds, without regard to their meaning. This communication style occurs commonly in persons experiencing mania. Mutism, poverty of ideas, and psychomotor retardation are assessment findings usually associated with depression.

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

3 Fine hand tremor and polyuria

Which patients can be safely prescribed lithium therapy to treat bipolar disorder? 1 Patients with renal diseases 2 Patients with thyroid disorder 3 Patients with myasthenia gravis 4 Patients with erectile dysfunction

4 Patients with erectile dysfunction Patients with erectile dysfunction can be prescribed lithium therapy because lithium does not interfere with sexual function. Lithium therapy must be avoided in patients with myasthenia gravis because it causes ataxia and severe muscle weakness. Lithium causes hypothyroidism by reducing the levels of thyroxine hormone. It should not be prescribed to patients with thyroid disorder. Lithium causes impairment in kidney functioning. It should not be prescribed to patients with renal diseases.

A person who has numerous hypomanic and dysthymic episodes can be assessed as demonstrating characteristics of 1 Cyclothymia 2 Bipolar I disorder 3 Bipolar II disorder 4 Seasonal affective disorder

1 Cyclothymia Cyclothymia refers to mood swings involving hypomania and dysthymia of 2 years' duration. The mood swings are not severe enough to prompt hospitalization.

Which behavior is important to include for the patient and the family to recognize possible signs of impending mania? 1 Decreased sleep 2 Increased appetite 3 Decreased social interaction 4 Increased attention to body functions

1 Decreased sleep

Which action should the nurse take when managing a hospitalized patient experiencing acute mania? 1 Encouraging frequent naps 2 Advising the patient to avoid frequent toilet visits 3 Giving the patient well-cooked three-course meals 4 Allowing the patient to dress and groom unassisted

1 Encouraging frequent naps

The nurse can expect a patient demonstrating typical manic behavior to be attired in clothing that is 1 ll-fitted and ragged 2 Colorful and outlandish 3 Dark-colored and modest 4 Compulsively neat and clean

2 Colorful and outlandish

The nurse is assessing a patient receiving chronic lithium therapy. Which assessment finding is an expected side effect of the therapy? 1 Ataxia 2 Goiter 3 Incoordination 4 Blurred vision

2 Goiter Expected side effects of chronic lithium therapy include goiter, renal toxicity, and hypothyroidism. Therefore, patients receiving lithium therapy should have renal function and thyroid levels check before therapy begins and then on an annual basis. Incoordination, ataxia, and blurred vision are unsafe signs of toxicity that must be reported to the physician immediately.

The nurse cares for a patient in the acute phase of bipolar disorder who has mania. This patient annoys other patients, loudly engages in power struggles with staff, and gives orders to the housekeeping employees about how to clean. Which nursing diagnosis is most applicable? 1 Defensive coping 2 Ineffective coping 3 Impaired social interaction 4 Impaired verbal communication

3 Impaired social interaction

The nurse is writing a plan of care for a patient in the manic phase of bipolar I disorder. What is the most important outcome for the patient? 1 Decreasing food intake 2 Increasing physical activity 3 Sleeping for 8 to 10 hours a night 4 Maintaining a stable cardiac status

4 Maintaining a stable cardiac status

A patient who is treated with lithium carbonate shows no improvement and often gets agitated and depressed. Which drug would the nurse expect the primary health care provider to prescribe to the patient? 1 Valproate 2 Phenytoin 3 Gabapentin 4 Phenobarbital

1 Valproate Valproate, carbamazepine, and lamotrigine are the three anticonvulsants that can be used in treating bipolar disorders. Anticonvulsants are used when the patient is not responding to lithium therapy. They are also used in dysphoric mania characterized by mixed state, or when the patient often gets agitated and depressed. The other anticonvulsants such as phenobarbital, gabapentin, and phenytoin are not effective in bipolar disorders because they may worsen the patient's condition.

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

2 Going rapidly from one activity to another

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

2 Suicide is a serious risk because nearly 20% of those diagnosed with bipolar disorder commit suicide.

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

3 Use a calm, firm approach

A patient with bipolar disorder takes lithium. After playing soccer on a hot summer day, the patient complains of nausea, vomiting, diarrhea, and thirst. The patient's hands begin to tremble and the gait becomes unsteady. What is the priority nursing intervention? Select all that apply. 1 Administer an antiemetic medication to the patient. 2 Collaborate with the health care provider regarding increasing the daily lithium dose. 3 Instruct the patient not to take any more lithium until directed by the health care provider. 4 Collaborate with the health care provider about drawing a serum lithium level immediately. 5 Complete an abnormal involuntary movement scale (AIMS) evaluation on this patient immediately.

3 Instruct the patient not to take any more lithium until directed by the health care provider. 4 Collaborate with the health care provider about drawing a serum lithium level immediately. The patient likely became dehydrated by the high activity in the summer heat. Lithium toxicity probably has developed. The lithium must be held, and a serum lithium level needs to be drawn. It is the nurse's responsibility to discuss possible toxicity with the health care provider.

Which antianxiety medication should be prescribed to patients with acute mania? 1 Citalopram (Celexa) 2 Propranolol (Inderal) 3 Labetalol (Normodyne) 4 Clonazepam (Klonopin)

4 Clonazepam (Klonopin) Antianxiety medications are prescribed to patients with acute mania who are resistant to lithium therapy. They are prescribed to reduce the psychomotor agitation in the patients. Clonazepam is a benzodiazepine class of drug and usually is prescribed to patients with mania because of its efficacy and fewer side effects. Citalopram belongs to the class of medications known as selective serotonin reuptake inhibitor. These medications are not prescribed because they produce side effects like nervousness and agitation. Labetalol is a beta blocker medication that is usually prescribed to reduce the blood pressure. Propranolol (Inderal) is a beta blocker used for the treatment of hypertension in the patients with anxiety. It is not prescribed for patients with acute mania.

Which symptom may be seen in patients with bipolar II disorder (hypomania)? 1 Hallucinations 2 Disturbed thoughts 3 Impaired social functioning 4 Hyperactivity and high energy

4 Hyperactivity and high energy The patients with bipolar II disorder (hypomania) are hyperactive and have high energy. These patients do not have impaired social functioning. Psychosis symptoms such as hallucinations are seen in patients with bipolar I disorder. Disturbed thoughts are seen in patients with bipolar disorder I but not in bipolar disorder II (hypomania).

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

4 Redirecting the patient's energy into alternate channels

When the wife of a manic patient asks about genetic transmission of bipolar disorder, the nurse's answer should be predicated on the knowledge that 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 relatives of people with bipolar disorder

4 The rate of bipolar disorder is higher in relatives of people with bipolar disorder

Which room placement would be best for a patient experiencing a manic episode? 1 A single room near the nurses' station 2 A single room near the unit activities area 3 A shared room with a patient with dementia 4 A shared room away from the unit entrance

1 A single room near the nurses' station

A manic patient tells a nurse "Bud. Crud. Dud. I'm a real stud! You'd like what I have to offer. Let's go to my room." The best approach for the nurse to use would be to say, 1 "I don't have sex with patients." 2 "It's time to work on your art project." 3 "What an offensive thing to suggest!" 4 "Let's walk down to the seclusion room."

2 "It's time to work on your art project."

What is the usual age of onset for cyclothymic disorders? 1 Childhood 2 Adolescence 3 Middle adulthood 4 Late adulthood

2 Adolescence

When a patient experiences four or more mood episodes in a 12-month period, the patient is said to be 1 Incongruent 2 Cyclothymic 3 Rapid cycling 4 Dyssynchronous

3 Rapid cycling

What action should the nurse take on learning that a manic patient's serum lithium level is 1.8 mEq/L? 1 Advise the patient to limit fluids for 12 hours. 2 Continue to administer medication as prescribed. 3 Advise the patient to curtail salt intake for 24 hours. 4 Withhold medication and notify the health care provider

4 Withhold medication and notify the health care provider

A manic patient showed progressive improvement with continued lithium therapy. After successful treatment, the patient is discharged from the hospital. What appropriate suggestions should the nurse make to the patient and his or her family during discharge? Select all that apply. 1 Water pills or diuretics will help with lithium side effects. 2 You can reduce the lithium dose if there is an excessive weight gain. 3 Over-the-counter medications are safe if taken as instructed on the box. 4 Schedule regular checkups to test the function of your thyroid and kidney. 5 Contact the primary health care provider if there is any excessive vomiting.

4 Schedule regular checkups to test the function of your thyroid and kidney. 5 Contact the primary health care provider if there is any excessive vomiting.

To plan care for a manic patient the nurse must consider that lithium cannot be started until 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 assaultive behavior 4 Electroconvulsive therapy can be scheduled to coincide with lithium administration

1 The physical examination and laboratory tests are analyzed Lithium should not be given to patients with impaired renal or thyroid function. A thorough physical examination and various laboratory tests are necessary to rule out other organic causes for the behavior and to ensure that the lithium can be excreted normally.

A desirable short-term goal for the nursing diagnosis of defensive coping, related to biochemical changes as evidenced by aggressive verbal and physical behaviors, would be 1 Sleeping soundly for 12 of the next 24 hours 2 Making no attempts at self-harm within 12 hours of admission 3 Willingly taking prescribed medication as offered by staff within 24 hours of admission 4 Demonstrating psychomotor retardation associated with sedation from prescribed medication within 6 hours of admission

2 Making no attempts at self-harm within 12 hours of admission

A patient experiencing mania has not slept for three days and states, "I am not tired. I have so much energy!" What is the best way for the nurse to assure the patient is getting adequate rest? 1 Keep patient stimulated during daylight hours. 2 Recommend frequent rest periods during the day. 3 Suggest the patient remain awake during the day. 4 Encourage hot tea at bedtime to promote relaxation

2 Recommend frequent rest periods during the day.