Mood disorders Prep U Chapter 17

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 1.6 mEq/L 2.0 mEq/L 2.6 mEq/L

1.0 mEq/L Serum plasma lithium levels should range from 0.6 to 1.2 mEq/L. Levels above that suggest toxicity (moderate toxicity for levels 1.5 to 2.5 mEq/L; severe toxicity for levels greater than 2.5 mEq/L).

Which client is most likely to benefit from electroconvulsive therapy (ECT)? A client with bipolar disorder who is not compliant with the blood testing necessary for lithium therapy A client with a diagnosis of bipolar II disorder who has recently begun experiencing a manic episode A client whose major depression has not responded appreciably to antidepressants A client whose recent strange behavior has been attributed to cyclothymic disorder

A client whose major depression has not responded appreciably to antidepressants

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 Lithium Carbamazepine Methyldopa

Carbamazepine

To confirm that a client is experiencing a manic episode, the nurse must eliminate the possibility that the client's symptoms are related to which problem? Substance use Inflated self-esteem or grandiosity Insomnia Overexcitment

Substance use

The nurse is seeing a 26-year-old client and the client's family. The client's family describes the client as being "very, very different." The family describes a history of periods of unpredictable behavior and disregard for consequences occurring a few times each year. The client has recently been diagnosed with bipolar I disorder, a condition that is characterized by what? The presence of objective signs of depression without the presence of anhedonia An elevated mood that lasts for at least 1 week Failure to respond to conventional pharmacological treatments for mood disorders The client's admission of a mood disorder

An elevated mood that lasts for at least 1 week

Which is an anticonvulsant used as a mood stabilizer? Divalproex Venlafaxine Bupropion Phenelzine

Divalproex

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? Point out that each time the client stops taking medication, the client becomes manic again. During stabilization, discuss the client's individual signs, symptoms, and consequences of relapse. Ensure that a family member takes responsibility for administering medications. Remind the client that the client owes it to the client's spouse and children to stay well.

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

A client diagnosed with bipolar disorder is admitted to an inpatient psychiatric facility with acute mania and threats of attacking others in the household. Which would be the priority? Ensuring safety Administering mood stabilizers Removing the client to a quiet environment Challenging the client's behavior

Ensuring safety

A nurse is reviewing a bipolar client's serum lithium level, which is 1.8 mEq/L. What is the nurse's best action? Inform the prescriber and monitor for GI and CNS effects Inform the prescriber and perform a focused respiratory assessment Contact the prescriber and request a supplementary dose of lithium Facilitate a transfer to the intensive care unit

Inform the prescriber and monitor for GI and CNS effects Therapeutic serum lithium levels range from 0.6 to 1.2 mEq/L. A level of 1.8 mEq/L would be considered toxic, but would be unlikely to warrant admission to intensive care. The nurse should report the finding and assess for common adverse effects of toxicity, which include GI and CNS effects more often than respiratory effects.

Which is considered the first-line treatment for bipolar disorder? Lithium Haloperidol Olanzapine Thioridazine

Lithium

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 Thyroid level White blood cell (WBC) count Cardiac enzymes

Liver function

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

Mood stabilizers

Which is a true statement regarding depressive disorders? They are more prevalent in men than women. Depression in older adults is easier to diagnosis. Norepinephrine, dopamine, and serotonin have been implicated. It is the leading cause of U.S. disability in clients older than 44 years of age.

Norepinephrine, dopamine, and serotonin have been implicated.

Which would be the priority diagnosis for the client in the manic phase of bipolar disorder who is exhibiting aggressive behavior? Ineffective health maintenance Risk for other-directed violence Disturbed thought processes Impaired social interaction

Risk for other-directed violence

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 Sleep disruption Dehydration Weight loss

Self-injury

A client with major depression is scheduled to receive electroconvulsive therapy. The nurse understands that this treatment is typically used in which situation? The client is tolerating the initial drug therapy. The level of depression is mild to moderate. The client is experiencing catatonia. Suicidality is of little concern.

The client is experiencing catatonia.

Which is a true statement regarding depressive disorders? They are more prevalent in men than women. Depression in older adults is easier to diagnose. The neurotransmitters norepinephrine, dopamine, and serotonin have been implicated. It is the fourth leading cause of years lost because of disability.

The neurotransmitters norepinephrine, dopamine, and serotonin have been implicated.

The genetic theory, when applied to the occurrence of depression, supports that the psychiatric nurse should ... assess for depression in the client's family history. prepare the client for diagnostic genetic testing to confirm the diagnosis. educate the client regarding the symptoms of related physical disorders. encourage the client to seek genetic counseling before considering a pregnancy.

assess for depression in the client's family history.

The nurse is caring for a child who has been hospitalized repeatedly at multiple hospitals. There is no clear medical diagnosis and the mother is threatening to leave the hospital against medical advice. The nurse suspects what issue? caregiver-fabricated illness (formerly Munchausen syndrome by proxy) bipolar disorder anxiety disorder sexual abuse

caregiver-fabricated illness (formerly Munchausen syndrome by proxy)

A female client 25 years of age has begun taking lithium for treatment of bipolar disorder. Which statement indicates that the client needs further instruction? "I will need to come to the clinic regularly for blood tests." "I will need to stop taking my birth control pills while I take lithium." "My lithium dose may change depending on the results of my blood tests." "I will call the health care provider if I experience diarrhea."

"I will need to stop taking my birth control pills while I take lithium." Women of childbearing age are often prescribed contraceptives during lithium therapy because lithium is a pregnancy category D and is contraindicated during pregnancy and lactation

A client has just been diagnosed with bipolar disorder and is upset with the diagnosis. The client tells the nurse, "It is probably my mother's fault, she has bipolar too." Which is the best response by the nurse? "Bipolar disorders have not been found to be genetic." "While bipolar disorders are genetic, there are other causes as well." "While bipolar disorders are genetic, the gene can only be passed on by a father." "Genetics are a minor factor in bipolar; it is more heavily influenced by psychological factors."

"While bipolar disorders are genetic, there are other causes as well."

A client has bipolar disorder and has just begun a regimen of lithium, 600 mg tid. Which is the most critical management issue for the client during the first 2 weeks of treatment? Ascertaining that the client is taking a full dose daily Ensuring the client's blood levels reach a therapeutic and safe dose Educating the client about the side effects of lithium Monitoring the client's cardiac status

Ensuring the client's blood levels reach a therapeutic and safe dose Lithium has few side effects if maintained within a therapeutic range. Adverse reactions begin to occur with toxic levels.

A client in the clinic appears to have elevated self-esteem, is more talkative than usual, and is easily distracted. This client is exhibiting symptoms of what? Anorexia Grandiosity Anxiety Depression

Grandiosity

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? Psychomotor retardation, fatigue, and apathy Pressured speech, combative behavior, and impaired judgment Catatonic excitement, loose associations, and recurrent illusions Self-destructive behavior, overidealization, and devaluation

Pressured speech, combative behavior, and impaired judgment

A client taking lithium for bipolar disorder is having mild diarrhea. The nurse informs the client that this is an example of what? Toxic effect Side effect Desired effect Therapeutic effect

Side effect