Bipolar Spectrum Disorders

The spouse of a patient diagnosed with bipolar disorder asks what evidence supports the possibility of genetic transmission of bipolar disorders. Select the nurse's best response.

"A higher rate of relatives diagnosed with bipolar disorder is found among patients with bipolar disorder."

Which documentation indicates that the treatment plan for a patient experiencing acute mania has been effective?

"Converses without interrupting; clothing matches; participates in activities."

A patient diagnosed with bipolar disorder is hyperactive and manic after discontinuing lithium. The patient threatens to hit another patient. Which comment by the nurse is appropriate?

"Do not hit anyone. If you are unable to control yourself, we will help you."

A patient diagnosed with bipolar disorder and who takes lithium telephones the nurse at the clinic to say, "I've had severe diarrhea 4 days. I feel very weak and unsteady when I walk. My usual hand tremor has gotten worse. What should I do?" The nurse should advise the patient:

"Have someone bring you to the clinic immediately."

A patient diagnosed with bipolar disorder is in the maintenance phase of treatment. The patient asks, "Do I have to keep taking this lithium even though my mood is stable now?" Select the nurse's most appropriate response.

"Taking the medication every day helps prevent relapses and recurrences."

Which dinner menu is best suited for the patient diagnosed with bipolar disorder experiencing acute mania?

Broiled chicken breast on a roll, an ear of corn, apple

Lithium is prescribed for a new patient. Which information from the patient's history indicates that monitoring serum concentrations of the drug will be especially challenging and critical?

Congestive heart failure

A patient diagnosed with bipolar disorder has been hospitalized for 7 days and has taken lithium 600 mg three times daily. Staff members observe increased agitation, pressured speech, poor personal hygiene, hyperactivity, and bizarre clothing. What is the nurse's best intervention?

Consider the need to check the lithium level. The patient may not be swallowing medications

A patient receiving lithium should be assessed for which evidence of complications?

Diaphoresis, weakness, and nausea

A patient diagnosed with bipolar disorder commands other patients, "Get me a book. Take this stuff out of here," and other similar demands. The nurse wants to interrupt this behavior without entering into a power struggle. Select the best initial approach by the nurse.

Distraction: "Let's go to the dining room for a snack."

Which nursing diagnosis would most likely apply to both a patient diagnosed with major depressive disorder (MDD) as well as one experiencing acute mania?

Disturbed sleep pattern

A nurse prepares the plan of care for a patient having a manic episode. Which nursing diagnoses are most likely? Select all that apply.

Disturbed thought processes Sleep deprivation

A patient experiencing acute mania has exhausted the staff members by noon. The patient has joked, manipulated, insulted, and fought all morning. Staff members are feeling defensive and fatigued. Which is the best action?

Hold a staff meeting to discuss consistency and limit-setting approaches

A patient experiencing acute mania waves a newspaper and says, "I must have my credit card and use the computer right now. A store is having a big sale and I need to order 10 dresses and four pairs of shoes." Select the nurse's most appropriate intervention.

Invite the patient to sit with the nurse and look at new fashion magazines

A patient diagnosed with bipolar disorder is dressed in a red leotard and brightly colored scarves. The patient says, "I'll punch you, munch you, crunch you," while twirling and shadowboxing. Then the patient says gaily, "Do you like my scarves? Here...they are my gift to you." How should the nurse document the patient's mood?

Labile and euphoric

At a unit meeting, staff members discuss the decor for a special room for patients experiencing mania. Select the best option.

Neutral walls with pale, simple accessories

A person is directing traffic on a busy street while shouting and making obscene gestures at passing cars. The person has not slept or eaten for 3 days. What features of mania are evident?

Poor judgment and hyperactivity

A patient tells the nurse, "I am so ashamed of being bipolar. When I'm manic, my behavior embarrasses my family. Even if I take my medication, there's no guarantee I won't have a relapse. I am such a burden to my family." These statements support which nursing diagnoses? Select all that apply.

Powerlessness Chronic low self-esteem

A patient experiencing mania dances around the unit, seldom sits, monopolizes conversations, interrupts, and intrudes. Which nursing intervention will best assist the patient with energy conservation?

Provide a subdued environment

A patient diagnosed with bipolar disorder is being treated as an outpatient during a hypomanic episode. Which suggestions should the nurse provide to the family? Select all that apply.

Provide structure Limit credit card access Monitor the patient's sleep patterns

After hospital discharge, what is the priority intervention for a patient diagnosed with bipolar disorder who is taking antimanic medication, as well as for the patient's family?

Psychoeducation

A patient experiencing mania has not eaten or slept for 3 days. Which nursing diagnosis has priority?

Risk for injury

When a hyperactive patient experiencing acute mania is hospitalized, what initial nursing intervention is a priority?

Set limits on the patient's behavior as necessary

A patient experiencing acute mania has disrobed in the hall three times in 2 hours. The nurse should:

arrange for one-on-one supervision

A patient develops mania after discontinuing lithium. New prescriptions are written to resume lithium twice daily and begin olanzapine (Zyprexa). The addition of olanzapine to the medication regimen will:

bring hyperactivity under rapid control

A patient diagnosed with bipolar disorder has rapid cycles. The health care provider prescribes an anticonvulsant medication. To prepare teaching materials, which drug should the nurse anticipate will be prescribed?

carbamazepine (Tegretol)

A patient experiencing acute mania is dancing atop the pool table in the recreation room. The patient waves a cue in one hand and says, "I'll throw the pool balls if anyone comes near me." The nurse's first intervention is to:

clear the room of all other patients

This nursing diagnosis applies to a patient experiencing mania: Imbalanced nutrition: less than body requirements, related to insufficient caloric intake and hyperactivity as evidenced by 5-pound weight loss in 4 days. Select the most appropriate outcome. The patient will:

drink six servings of a high-calorie, high-protein drink each day

Consider these three drugs: divalproex (Depakote), carbamazepine (Tegretol), and gabapentin (Neurontin). Which drug also belongs to this group?

lamotrigine (Lamictal)

A health teaching plan for a patient taking lithium should include instructions to:

maintain normal salt and fluids in the diet

A patient diagnosed with bipolar disorder is being treated on an outpatient basis with lithium carbonate 300 mg three times daily. The patient complains of nausea. To reduce the nausea, the nurse can suggest that the lithium be taken with:

meals

A patient experiencing acute mania undresses in the group room and dances. The nurse's first intervention would be to:

put a blanket around the patient, and walk with the patient to a quiet room

Outcome identification for the treatment plan of a patient with grandiose thinking associated with acute mania focuses on:

self-control of distorted thinking

The cause of bipolar disorder has not been determined, but:

several factors, including genetics, are implicated

A nurse receives this laboratory result for a patient diagnosed with bipolar disorder: lithium level 1 mEq/L. This result is:

within therapeutic limits