NCLEX review book
A client admitted to the nursing unit with bipolar disorder, manic phase, is accompanied by his wife. The wife states that her husband has been overly energetic and happy, talking constantly, purchasing many unneeded items, and sleeping about 4 hours a night for the past 5 days. When completing the client's daily assessment, the nurse should be especially alert for which of the following findings? A. Exhaustion. B. Vertigo. C. Gastritis. D. Bradycardia.
A
The husband of a client who is experiencing acute mania and is swearing and using profanity apologizes to the nurse for his wife's behavior. Which of the following replies by the nurse is most therapeutic? A. "This must be difficult for you." B. "It's okay. We've heard worse." C. "How long has she been like this?" D. "She needs some medication."
A
After the nurse administers haloperidol (Haldol) 5 mg PO to a client with acute mania. the client refuses to lie down on her bed, runs out on the unit, pushes clients in her vicinity out of the way, and screams threatening remarks to the staff. Which of the following should the nurse do next A. Follow the client and ask her to calm down. B. Tell the client to lie down on the sofa in the community room. C. Seclude the client and use restraints if necessary. D. Tell the staff to ignore the client's remarks.
C
After the nurse teaches a client about bipolar disorder, which of the following statements indicates that the client has developed insight about the diagnosis? A. "I enjoy feeling high. I don't need much sleep then and get really creative." B. "My medicine really helped me. I know I won't need it in about another week." C. "I'm cured now. I was really wild for a while even though I got into trouble." D. "I know I'm getting sick when I don't need
D
The client with mania is skipping up and down the hallway practically running into other clients. The nurse should include which of the following activities in the client's plan of care? A. Leading a group activity. B. Watching television. C. Reading the newspaper. D. Cleaning the dayroom tables.
D
A client diagnosed with bipolar disorder and experiencing acute mania states to the nurse, "Where is my son? | love Lucy. Rain, rain go away. Dogs eat dirt." Another client approaches the nurse and says, "Man, is he ever nuts! He's driving me crazy with all his weird talk." Which response by the nurse to the second client is most appropriate? A. "I agree. He's a little hard to take sometimes." B. "Just walk away and leave him alone. There is nothing else you can do." C. "I realize his behavior bothers you, but he can't control it right now." D. "I'll give him some medication so he won't bother you."
C
A client states to a nurse, "Hey sweetie, you're looking good today." Which of the following responses by the nurse is best? A. "Thank you for being so kind and thoughtful." B. "I know you are only teasing me." C. "My name is Molly, and I am a nurse on the unit today." D. "I am not here to receive compliments from clients."
C
The client with acute mania is prescribed 600 mg of lithium (lithium carbonate) PO three times per day. The primary health care provider also prescribes 5 mg of haloperidol (Haldol) PO at bedtime. Which action should the nurse take? A. Administer the medication as prescribed. B. Question the primary health care provider about the prescription. C. Administer the Haldol, but not the lithium. D. Consult with the nursing supervisor before administering the medications.
A
A health care provider has prescribed valproic acid for a client with bipolar disorder who has achieved limited success with lithium carbonate. The nurse should instruct the client about which of the following? A. Follow-up blood tests are necessary while on this medication. B. The extended-release tablet can be crushed if necessary for ease of swallowing. C. Tachycardia and upset stomach are common side effects. D. Consumption of a moderate amount of alcohol is safe if the medication is taken in the morning.
A Valproic acid can cause hepatotoxicity, so regular liver function tests are needed. Other side effects include nausea and drowsiness. Extended-release tablets should not be split or crushed; doing so changes their absorption. Alcohol should never be mixed with this medication. There will be medication in the client's body at all times.
Which milieu activity should the nurse rec ommend to a client with acute mania? Select all that apply. A. Scheduled rest periods. B. Relaxation exercises. C. Listening to soft music. D. Watching television. E. Aerobic exercises.
A, B, C, E
The client with bipolar disorder, manic phase, has a valproic acid level of 15 mg/mL( 104umol/L). Which of the following client behaviors should the nurse judge to be due to this level of valproic acid. Select all that apply. A. Irritability. B. Grandiosity. C. Anhedonia. D. Hypersomnia. E. Flight of ideas.
A, B, E
A client diagnosed with bipolar disorder asks the nurse why it is necessary to have a serum lithium level drawn every 3 to 4 months. The nurse's response should be based on which of the following? A. To monitor compliance with the medication B. To prevent toxicity related to the drugs there peutic range. C. To monitor the client's white blood cell count. D. To comply with the drug manufacturer's requirements.
B
A client with bipolar disorder, manic phase, is scheduled for a chest radiograph. Before taking the client to the radiology department, the nurse should: A. Give a thorough explanation of the procedure. B. Explain the procedure in simple terms. C. Call security to be on standby for possible problems. D. Cancel the appointment until the client can go unescorted.
B
After the nurse teaches a client with bipolar disorder about lithium therapy, which of the following client statements indicates the need for additional teaching? A. "It's important to keep using a regular amount of salt in my diet." B. "It's okay to double my next dose of lithium if I forget a dose." C. "I should drink about 8 to 10 eight-ounce glasses (240 to 300 mL) of water each day." D. "I need to take my medicine at the same time each day."
B
A client with acute mania fails to respond to a nurse's interventions to decrease his agitation. The nurse has attempted to defuse the client's anger, but the client refuses to participate in interventions that would lower anxiety. Which action should the nurse take next? A. Seclude the client. B. Restrain the client. C. Medicate the client. D. Control the client.
C
A nurse is assessing a client experiencing hypomania who wants to stop her mood stabilizing medication because she is "feeling good," has a high energy level, and thinks she is productive at work. Which response by the nurse is most appropriate? A. "Maybe you really don't need your medication anymore." B. "If you stop your medication, your behavior will quickly spiral out of control." C. "I believe you were hospitalized the last time you stopped your medication." D. "Why don't you cut your medication dosage in half for a while and see how you
C
The client with acute mania has been admitted to the inpatient unit voluntarily. The nurse approaches the client with medication to be taken orally as prescribed by the primary health care provider. The client states. "I don't need that stuff." Which response by the nurse is best? A. "You can't refuse to take this medication." B. "If you don't take it orally, I'll give you a shot." C. "The medication will help you feel calmer." D. "TIl get you some written information about the medication."
C The nurse should first attempt a collaborative approach to increasing adherence to the prescribed medication regimen. Giving written medication information to a client with acute mania is poor nursing judgment, because a client with acute mania cannot benefit from written information as a result of impaired ability to focus and concentrate.
A client with acute mania is to receive lithium carbonate 600 mg PO three times daily and 2 mg of haloperidol (Haldol) PO at bedtime. The nurse should: A. Refuse to give the medications as prescribed. B. Give the lithium only. C. Request a decreased dosage of lithium. D. Give the medications as prescribed.
D
The client is laughing and telling jokes to a group of clients. Suddenly, the client is crying and talking about a death in the family. A moment later, the client is laughing and joking again. The nurse should: A. Call the psychiatrist for a prescription for lorazepam (Ativan) as needed. B. Place the client in seclusion and call the psychiatrist for a prescription for the seclusion. C. Ignore the client's behavior in order not to give the client too much attention. D. Ask the client to come to a quiet area to talk to the nurse individually.
D
The client with mania is irritable and insulting to a nursing assistant. The nursing assistant states, "I can't believe Mark is so rude. Shouldn't he be overly happy?" Which of the following responses by the nurse should help the nursing assistant understand the client's behavior? A. "It's our responsibility to listen to him eve though we might not like what he's saying B. "We must reprimand Mark for doing that because there is no reason for him to behave like that." C. "I will go and speak to him about his bedani and make sure he understands that he med to control what he is saying." D. "I know it's difficult but Mark is a client whose irritable mood is a symptom of his mania."
D
The client with rapid-cycling bipolar disorder who is about to receive his 5pm dose of carbamazepine (Tegretol) tells the nurse he has a sure throat and chills. Which of the following should the nurse do next? A. Administer the prescribed dose of carbamazepine. B. First, give the client acetaminophen (Tylenol) as prescribed PRN. C. Report the symptoms to the primary health care provider in the morning. D. Call the primary health care provider to report the symptoms.
D
89. A client experiencing a manic episode has been talking loudly, pacing the unit and trying to draw other clients into debates about the value of self-determination. Arrange in order the steps a nurse should take to help calm this client. 1. Use oral medication to decrease anxiety and increase appropriate social interaction. 2. Talk with the client about the anxiety and stress the client is feeling. 3. Take client to a quiet area, such as his or her room, to decrease stimuli. 4. Teach the client coping strategies to deal with stressors.
3 —> 1 —> 2 —> 4
A client with acute mania oxhibits euphoria, pressured speech, and flight of ideas. The client has been talking to the nurse nonstop for 5 minutes and lunch has arrived on the unit. Which of the following should the nurse do next? A. Excuse self while telling the client to come to the dining room for lunch. B. Tell the client he needs to stop talking because it's time to eat lunch. C. Do not interrupt the client but wait for him to finish talking. D. Walk away and approach the client in a few minutes before the food gets cold.
A
During morning community meeting, a client with bipolar disorder, manic phase, interrupts others to the point where no one can finish their statements. The nurse should tell the client: A. "Please stop interrupting others. You can speak when it's your turn." B. "Stop talking. It's time for you to leave the meeting." C. "If you can't control yourself, we'll have to take action." D. "Please behave like an adult. Your behavior is childish."
A
A client will be discharged on lithium carbonate 600 mg three times daily. When teaching the client and his family about lithium therapy, .the nurse determines that teaching has been effective if the client and family state that they will notify the prescribing health care provider immediately if which of the following occur? Select all that apply A. Nausea. B. Muscle weakness. C. Vertigo. D. Fine hand tremor. E. Vomiting. F. Anorexia.
B, C, E
The client with bipolar disorder, manic phase, states, "You're looking good. I'm taking you out to dinner." Which of the following replies by the nurse is most therapeutic? A. "I don't want to go out to dinner." B. "I can't go out to dinner with you." C. "It doesn't matter how I look, the answer is по." D. "I'm Chris Smith, a nurse working on this unit."
D
A client's wife states, "I don't know what to do sometimes. It's so hard having a husband with a mental illness like bipolar disorder." After talking with the client's wife about her feelings and difficulties, which of the following actions is most appropriate? A. Suggest that the wife see her primary health care provider. B. Give the wife information about a support group. C. Recommend that the wife talk with her close friend. D. Have the wife share her feelings with her husband.
B
A young adult client diagnosed with bipolar disorder has been managing the disorder effectively with medication and treatment for several years. The client suddenly becomes manic. The nurse reviews the client's medication record. Which of the following medications may have contributed to the development of his manic state? Medication Record Amitriptyline 50 mg PO daily at bedtime Prednisone 20 mg PO daily Buspirone HCI 5 mg PO three times a day Gabapentin 300 mg PO three times a day• A. Amitriptyline. B. Prednisone. C. Buspirone. D. Gabapentin.
B The use of prednisone or other steroids can initiate a manic state in a bipolar client even if he is well controlled on medication. The other medications would decrease the client's depression, mood swings, and anxiety, making him calmer rather than more agitated.
The client with bipolar disorder is approaching discharge after being hospitalized with her first episode of acute mania. The client's husband asks the nurse what he can do to help her. Which of the following recommendations for the husband should the nurse anticipate including in the teaching plan? A. Help the client to be free from worry and anxiety. B. Communicate openly and offer support. C. Relieve the client of all responsibilities. D. Remind the client to control her symptoms.
B
In a pre-discharge program to educate clients with bipolar disorder and their family members, the nurse emphasizes that the most significant indicators for the onset of relapse include which of the following symptoms? A. A sense of pleasure and motivation for new endeavors. B. Decreased need for sleep and racing thoughts. C. Self-concern about increase in energy. D. Leaving a good job to start a new business.
B Decreased need fue sleep and racing thoughts are the most prominent ballmarks of mania. Feelings of pleasure, motivation, and increased energy. within reason, are desired experi ences. Also leaving a job to start a new business is not. in itself, a sign of impending illness
A nurse observes a male client who is hyperactive and intrusive sitting very close to a female client with his arm around her shoulders. The nurse hears the male client tell a sexually explicit joke.The nurse approaches the client and asks him to walk down the hallway. Which of the following statements by the nurse should benefit the client? A. "She will not want to be around you with that kind of talk." B. "Telling sexual jokes and touching others is not permitted here." C. "You need to be careful about what you say to other people." D. "I think a time-out in your room would be appropriate now."
B The nurse clearly informs the client about behavior that is unacceptable on the unit, such as voicing jokes with sexual content and touching others. Setting limits on behavior provides safety and security to the client and conveys to the client that he is worthy of help. Saying "she will not want to be around you with that kind of talk" and "you need to be careful about what you say to others" does not clearly inform the client about behaviors that are unacceptable and implies that the client can control behaviors if he chooses. A time-out in the client's room does not inform the client about the inappropriateness of his behaviors and could be interpreted by the client as punitive as well as diminishing his self-esteem.
A female client with acute manin bras six suitcases and three shopping bags of personal belongings on admission to the unit. When informed that some of the suitcases and bags need to be returned home with her husband because of a lack of storage space, the client begins to use profanity against the nurse. Which of the following responses by the nurse is most therapeutic? A. "You're acting inappropriately." B. "I won't tolerate your talking to me like that." C. "Swearing and profanity are unacceptable here." D. "We don't want to put you in seclusion yet."
C
As the nurse is turning off the television, a client with bipolar disorder, manic phase, says, y want the television on so I can watch the late show. I'm not tired and you can't tell me what to do. I want it on!" The nurse should tell the client: A. "I'll let you watch television just this once. Don't tell anyone about this." B. "I'll turn the television off when you get sleepy. Don't ask me to do this again." C. "Television hours are from 7 pM to 10 pM. It's 10 PM, and the television goes off so everyone can sleep." D. "The television goes off at 10 pM. I've been telling you this for the past three evenings.
C
The nurse overhears a client with acute mania who is euphoric and flirtatious attempting to be sexually inappropriate with other clients by talking about a sexual exploit to a group of clients seated at a table. Which of the following should the nurse do next? A. Continue walking down the hall, ignoring the conversation. B. Speak to the client later in private while saying nothing at this time. C. Tell the client others may not want to hear about sex and invite him to play a game of ping-pong. D. Inform the client that if he continues to talk about sex no one will want to be around him.
C
The primary health care provider prescribes determination of the serum lithium level tomorrow for a client with bipolar disorder, manic phase, who has been receiving lithium 300 mg PO three time daily for the past 5 days. At which of the following times should the nurse plan to have the blood specimen obtained? A. Before bedtime. B. After lunch. C. Before breakfast. D. During the afternoon.
C
The primary health care provider prescribes valproic acid for a client with bipolar disorder who has achieved limited success with lithium car-bonate. Which of the following should the nurse include in the client's medication teaching plan? A. Follow-up blood tests are unnecessary. B. The tablet can be crushed if necessary. C. Drowsiness and upset stomach are common side effects. D. Consumption of a moderate amount of alcohol is safe.
C
The wife of a client with bipolar disorder, manic phase, states to the nurse, "He's acting so crazy. What did he do to get this way?" The nurse bases the response on the understanding of which d the following about this disorder? A. It is caused by underlying psychological difficulties. B. It is caused by disturbed family dynamics in the client's early life. C. It is the result of an imbalance of chemicals b the brain. D. It is the result of a genetic inheritance from someone in the family.
C
A young woman comes to the mental health clinic for her routine medication follow-up. She has been married for 2 years and reports that she and her husband are ready to start a familv. She has a diagnosis of bipolar I disorder and has been well managed on divalproex sodium (Depakote) for at least 3 years. What is the most essential counsel for the nurse to give her? A. "Schedule an appointment for a complete gynecological exam if vou have not had one in the past vear." B. "Pay careful attention to eating healthy from this point on in order to maximize the health of both mother and baby." C. "Check with your prescriber today as Depakote carries an increased risk for birth defects, especially during the first 3 months of pregnancy." D. "It is very important for you to take steps to reduce your stress and this will help you to stay in balance during your pregnancy and reduce your chances of developing post-partum depression."
C All of these options need to be addressed. However, it is vital that this young woman receive counseling about the serious birth defects that have an increased incidence with the taking of Depakote during the first trimester of pregnancy. These problems include craniofacial abnormalities (cleft palate), organ malformations (holes in the heart and urinary tract problems), limb deficiencies, and developmental delays. The chances of preeclampsia and premature labor are also increased.
The client with acute mania states to the nurse, "I'm the prince of peace and can save the world. Those against me will find me and take me to another world. They will come. I know it." The client is beginning to scan the room and starts to repeat his delusion. Which of the following responses by the nurse is most therapeutic? A. "Describe the people who will come." B. "The staff and I will protect vou." C. "You are not the prince of peace. Your name is Joe." D. "Let's walk around the unit for a while."
D
The client with an Axis I diagnosis of bipolar disorder, manic phase, states to the nurse, "I'm the Queen of England. Bow before me." The nurse interprets this statement as important to document as which of the following areas of the mental status examination? A. Psychomotor behavior. B. Mood and affect. C. Attitude toward the nurse. D. Thought content.
D
The client with bipolar disorder, manic phase, appears at the nurse's station wearing a transparent shirt, miniskirt, high heels, 10 bracelets, and eight necklaces. Her makeup is overdone, and she is not wearing underwear. A pair of inverted underpants is on her head. The nurse should: A. Tell the client to dress appropriately while out of her room. B. Ask the client to put on hospital pajamas until she can dress appropriately. C. Instruct the client to go to her room and change clothes. D. Escort the client to her room and assist with choosing appropriate attire.
D
A client comes to the mental health clinic saying that he feels so down and lacking in energy with "loss of interest in everything." He tells the nurse that he received some samples of a new medication from his primary care physician last week to relieve his depression . The nurse recalls that this client has a history of bipolar I disorder with hospitalization for a significant manic episode. With this knowledge, the nurse would have special concern if he is taking which of the following categories of medication? A. Atypical antipsychotics. B. Mood stabilizers/ antimanics. C. Antianxiety agents (benzodiazepines). D. Selective serotonin reuptake inhibitor (SSRI) antidepressant.
D The most urgent consideration for intervention and for teaching is the fact that for individuals with a history of bipolar disorder. antidepressants when taken alone can push the person into mania. Antipsychotics are sometimes prescribed for clients with bipolar disorder and would not pose a special concern. Individuals with bipolar disorder are typically treated with mood sta-bilizers, and benzodiazepines are sometimes used in the short term to give a client relief before the mood stabilizers can take effect.
A client has just been admitted to the hospital for medication adjustment after outpatient treatment failure of his bipolar disorder and returning mania. He tells his primary nurse about his medications and treatment. Which of his following statements would raise the most urgent need for more medication instruction about his lithium therapy? A. "My doctor tells mo that my lithium level is 1.0 so I don't have to worry about my levels." B. "I've been getting a lot of good exercise playing on a local soccer team." C. "I'm trying hard to watch my diet and eat healthy." D. "I have learned to take my lithium even when I'm not feeling well, like when I had the stomach flu,"
D The therapeutic serum level for lithium is 06 to 1.2 mEg/L (0.6 to 1.2 mmol/LL Levels due factuate with taid intake and output, bowever. Thereforv., the most ungent matter for teuching is the client's comment about taking his lithium during excessive loss of Bluids during an episode of "stom-ach fu" with diarrbea. Evercising is only concerg-ing if the client becomes dehydrated. A healthy diet is indicated while taking lithium.
