Chapter 22 Bipolar

A client with bipolar disorder I is experiencing a depressive episode. Which of the following would the nurse expect to be prescribed? Valproate Lamotrigine Lithium Carbamazepine

lamotrigine

During report, the nurse learns that a client with mania has not slept since admission 2 days ago. On entering the day room, the nurse finds this client dancing to loud music. Which would be the most appropriate statement by the nurse? "How are you ever going to get any rest if you keep that music on?" "Turn the radio down so we can hear ourselves talk." "Let's go to the conference room and talk for a while." "Do you think you could sit still for a few minutes so we can talk?"

"Let's go to the conference room and talk for a while."

A client is prescribed carbamazepine as part of the treatment plan for bipolar disorder. The nurse obtains a complete blood count and differential before initiating therapy. The nurse would instruct the client to return to the outpatient facility for repeat blood testing at which time? 6 months 1 month 3 months 12 months

1 month

Which sleep pattern is suggestive of a manic episode? A client experiences day-night reversal, sleeping until late in the afternoon and going to bed near dawn. A client reports having fitful sleep that is characterized by frequent awakenings and nightmares. A client stays awake for several days and nights before "crashing" and sleeping for a long period. A client takes multiple short naps at varied times throughout the day and night.

A client stays awake for several days and nights before "crashing" and sleeping for a long period.

A nurse is providing psycho-education to a client who has been admitted to the inpatient mental health unit for a manic episode. In order to ensure the teaching is effective, the nurse must first determine which regarding the client? Interest in learning about the disorder Ability to concentrate and process the information Cognitive awareness and intellectual abilities Likelihood to assume responsibility for self-care

Ability to concentrate and process the information

A client with mania is demonstrating hypersexual behavior by blowing kisses to other clients, making suggestive remarks, and removing some articles of clothing. Which nursing intervention would be most appropriate at this time? Put the client in seclusion for his or her own protection. Accompany the client to his or her room to get dressed. Tell the client that the behaviors have to stop right now. Tell other clients to ignore the behavior because it is harmless.

Accompany the client to his or her room to get dressed

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? 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 The presence of objective signs of depression without the presence of anhedonia

An elevated mood that lasts for at least 1 week

When teaching a client who is recently diagnosed bipolar I disorder, the nurse correctly tells the client that the difference between bipolar I disorder and bipolar II disorder is what? Bipolar I disorder more often effects women. Bipolar I disorder is often more disruptive than bipolar II disorder. Bipolar I disorder involves altered moods of anger and paranoia. Bipolar I disorder is characterized by hypomanic episodes.

Bipolar I disorder is often more disruptive than bipolar II disorder.

Which meal would the nurse provide to best meet the nutritional needs of a client who is manic? Peanut butter sandwich, chips, cola Spaghetti, garlic bread, salad, tea Fried chicken, mashed potatoes, milk Ham sandwich, cheese slices, milk

Ham sandwich, cheese slices, milk

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

Mood stabilizers

A client with bipolar disorder has been taking lithium, and today the client's serum lithium level is 2.0 mEq/L. What effects would the nurse expect to see? Constipation and postural hypotension Fever, muscle rigidity, and disorientation Nausea, diarrhea, and confusion None; the serum level is in therapeutic range

Nausea, diarrhea, and confusion

Both valproate and carbamazepine may be lethal if high doses are ingested. Toxic symptoms appear in 1 to 3 hours and include what? Neuromuscular disturbances Tinnitus Urinary frequency Bradycardia

Neuromuscular disturbances

A client with mania is in the dining room at lunchtime and is observed taking food from other clients' trays. The nurse's intervention should be based on which rationale? Other clients need to be protected from the intrusive behavior. The client needs food and fluids in any way possible. As soon as lunch is over, the client will calm down. The client's behavior is not an imminent threat to anyone's physical safety.

Other clients need to be protected from the intrusive behavior.

A nurse who works primarily with clients who have bipolar disorder identifies which group of clients as not being candidates to take lithium as treatment? Patients who drink decaffeinated coffee Patients who take bronchodilators Patients with diabetes who take oral antidiabetic agents Patients who take ACE inhibitors

Patients who take ACE inhibitors

A nurse who works primarily with clients who have bipolar disorder identifies which group of clients as not being candidates to take lithium as treatment? Patients who drink decaffeinated coffee Patients with diabetes who take oral antidiabetic agents Patients who take bronchodilators Patients who take ACE inhibitors

Patients who take ACE inhibitors

Police officers bring a client to the mental health unit for admission. The client had been directing traffic on a busy city street, shouting rhymes such as "to work, you jerk, for perks" and making obscene gestures at cars that came close to the client. When the client's spouse is contacted at work, the spouse reports that the client stopped taking lithium 3 weeks ago and has not slept or eaten for 3 days. With which two features characteristic of the manic phase of bipolar disorder can the nurse identify? Increased muscle tension and anxiety Poor judgment and hyperactivity Disinhibition and elevated mood Vegetative signs and poor grooming

Poor judgment and hyperactivity

A nurse is preparing to administer pharmacotherapy as part of the treatment plan for a client with bipolar disorder. The nurse understands that this therapy is designed to achieve which goal? Select all that apply.

Rapid control of symptoms Decreased frequency of manic episodes Prevention of future episodes Decreased severity of manic episodes

lithium toxicity

Serum lithium levels of less than 0.5 mEq/L are rarely therapeutic, and levels of more than 1.5 mEq/L are usually considered toxic. The client would show signs of toxicity with a lithium level of 2.0 mEq/L. Toxic effects of lithium are severe diarrhea, vomiting, drowsiness, muscle weakness, and lack of coordination.

A nurse is assessing a client who is brought to the emergency department. The nurse suspects that the client is experiencing mania. Which finding would support the nurse's suspicion? Select all that apply. Slowness of speech Statements of self-importance Easily distractible Flight of ideas Sleepiness

Statements of self-importance Flight of ideas Easily distractible

A client who has just been prescribed lithium for bipolar disorder is being given education from the nurse about this medication. Which is important for the nurse to include in teaching? Changes in diet will not affect lithium levels. Lithium has few interactions with other drugs. The higher the potassium level, the lower the lithium level will be. The higher the sodium level, the lower the lithium level will be.

The higher the sodium level, the lower the lithium level will be.

The spouse of a client with bipolar disorder calls the nurse expressing distress about recent spending patterns of the client. The nurse suggests the spouse implement the limit-setting skills the spouse has learned in family therapy. In this instance, the nurse's action would be considered ... appropriate; the spouse is responsible for the client's actions since the client has a mental illness. inappropriate; the nurse should not give advice to the spouse. inappropriate; the client has the legal right to spend personal money. appropriate; the spouse needs support in setting boundaries.

appropriate; the spouse needs support in setting boundaries.

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

divalproex

A nursing student learning about mood disorders correctly identifies which of the following to mean exaggerated feelings of well-being? Euphoria Expansiveness Irritability Paranoia

euphoria

On admission to the psychiatric unit, a client is dressed in a red leotard and exercise bra, with an assortment of chains and brightly colored scarves on the client's head, waist, wrists, and ankles. The client's first words to the nurse are, "I'll punch you, munch you, crunch you," as the client dances into the room, shadow boxing. The client shakes the nurse's hand and says cheerfully, "We need to become better acquainted. I have the world's greatest intellect, and you are probably an intellectual midget." How can the nurse document the client's mood? Expansive and grandiose. Anxious and unpredictable. Suspicious and paranoid. Belligerent and blunted.

expansive and grandiose

A psychiatric-mental health nurse is preparing a review class for a group of nurses at the community mental health center. The topic is mood-stabilizing drugs. After teaching the class about the different drugs that may be prescribed, the nurse determines that the teaching was successful when the group identifies which drug as being prescribed most often? Lamotrigine Lithium Divalproex Carbamazepine

lithium

A client is prescribed lithium to treat mania. The client also has a history of hypertension for which the client takes lisinopril and hydrocholorothiazide. When monitoring this client, the nurse would be especially alert for signs and symptoms of which condition? Hypernatremia Hypertensive crisis Lithium toxicity Hypokalemia

lithium toxicity

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? White blood cell (WBC) count Cardiac enzymes Thyroid level Liver function

liver function

Which of the following is an adverse effect of lithium?

n/d

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 Weight loss Dehydration

self injury

Administration of lithium affects which of the following electrolytes? Chloride Sodium Magnesium Potassium

sodium