N3511 Ch. 13 Bipolar Disorders

What critical information should the nurse provide about the use of lithium? 1. "You will still have hypersexual tendencies, so be certain to use protection when engaging in intercourse." 2. "Lithium will help you to only feel the euphoria of mania but not the anxiety." 3. "It will take 1 to 2 weeks and maybe longer for this medication to start working fully." 4. "This medication is a cure for bipolar disorder."

"It will take 1 to 2 weeks and maybe longer for this medication to start working fully."

Early sign of Lithium Toxicity

Nausea, vomiting, diarrhea, thirst, polyuria, lethargy, slurred speech, muscle weakness, and fine hand tremor

Maintenance Level of Lithium

0.4 to 1.3 mEq/L

A manic client 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 A. "What an offensive thing to suggest!" B. "I don't have sex with clients." C. "It's time to work on your art project." D. "Let's walk down to the seclusion room."

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

Therapeutic Level of Lithium

0.8 to 1.4 mEq/L

What action should the nurse take on learning that a manic client's serum lithium level is 1.8 mEq/L? A. Withhold medication and notify the physician B. Continue to administer medication as ordered C. Advise the client to limit fluids for 12 hours D. Advise the client to curtail salt intake for 24 hours

Withhold medication and notify the physician

Early Toxic Level of Lithium

1.5 to 2.0 mEq/L

Which of the following describe the symptoms of the manic phase of bipolar disorder? (select all that apply): A Excessive energy B Fatigue and increased sleep C Low self-esteem D Pressured speech E Purposeless movement F Racing thoughts G Withdrawal from environment H Distractibility

ADEFH All these options describe mania. The other options more aptly describe the opposite of what happens in mania. Cognitive Level: Apply (Application) Nursing Process: Assessment NCLEX: Psychosocial Integrity Text page: 228

Which room placement would be best for a client experiencing a manic episode? A. A shared room with a client with dementia B. A single room near the unit activities area C. A single room near the nurse's station D. A shared room away from the unit entrance

A single room near the nurse's station

Advanced signs of Lithium Toxicity

Coarse hand tremor, persistent gastrointestinal upset, mental confusion, muscle hyperirritability, electroencephalographic changes, incoordination, sedation

lamotrigine (Lamictal)

Anticonvulsant First line treatment for bipolar depression and is approved for acute and maintenance therapy. A potential life-threatening rash may occur.

carbamazepine (Tegretol)

Anticonvulsant that works better in patients w/ rapid cycling and severely paranoid, angry, patients experiencing manias than euphoric, overactive, over-friendly patients experiencing manias.

valproate (depakote)

Anticonvulsant useful in treatment in lithium non-responders who are in acute mania, experience rapid cycles, are in dysphoric mania, or have not responded to cabamazepine; also helpful in prevention of future manic episodes

Severe signs of Lithium Toxicity

Ataxia, confusion, large output of dilute urine, serious electroencephalographic changes, blurred vision, clonic movements, seizures, stupor, severe hypotension, coma; death is usually secondary to pulmonary complications.

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

B Mortality rates for bipolar disorder are severe because 25% to 60% of individuals with bipolar disorder will make a suicide attempt at least once in their lifetime, and nearly 20% of all deaths among this population are from suicide. Suicides occur in both the depressed and the manic phase. Bipolar patients are always considered high risk for suicide because of impulsivity while in the manic phase and hopelessness when in the depressed phase. Although staying on medications may decrease risk, there is no evidence to suggest that only patients who stop medications commit suicide. Cognitive Level: Apply (Application) Nursing Process: Planning NCLEX: Safe and Effective Care Environment Text page: 228

What are the 4 characteristics of mania?

mood, behavior, thought process and speech patterns, and cognitive function.

Tyler is a 31-year-old patient admitted with acute mania. He tells the staff and the other patients that he is on a secret mission given to him by the President of the United States to monitor citizens for terrorist activity. He states, "I am the only one he trusts, because I am the best!" For documentation purposes you know that this behavior is referred to as: A unpredictability. B rapid cycling. C grandiosity. D flight of ideas.

C Grandiosity is inflated self-regard. People with mania may exaggerate their achievements or importance, state that they know famous people, or believe they have great powers. Although patients with mania are unpredictable, the scenario does not describe unpredictability: Rapid cycling is switching between mania and depression in a given time period. The scenario does not describe flight of ideas, which means a continuous flow of speech with abrupt topic changes. Cognitive Level: Apply (Application) Nursing Process: Diagnosis NCLEX: Psychosocial Integrity Text page: 233

Tyler is being discharged home to his family. Which of the following is important teaching to include for the patient and the family to recognize possible signs of impending mania? A Increased appetite B Decreased social interaction C Increased attention to bodily functions D Decreased sleep

D Changes in sleep patterns are especially important because they usually precede mania. Even a single night of unexplainable sleep loss can be taken as an early warning of impending mania. The other options do not indicate impending mania. Cognitive Level: Apply (Application) Nursing Process: Implementation NCLEX: Physiological Integrity Text page: 245

Anticonvulsant for mood disorders

Depakote tegretol lamictal

mood stabilizers

Drugs used to control mood swings in patients with bipolar mood disorders.

Which side effects of lithium can be expected at therapeutic levels? A. Fine hand tremor and polyuria B. Nausea and thirst C. Coarse hand tremor and gastrointestinal upset D. Ataxia and hypotension

Fine hand tremor and polyuria

Which behavior would be most characteristic of a client during a manic episode? A. Going rapidly from one activity to another B. Taking frequent rest periods and naps during the day C. Being unwilling to leave home to see other people D. Watching others intently and talking little

Going rapidly from one activity to another

Which behavior exhibited by a patient with mania should the nurse choose to address first? 1. Indiscriminate sexual relations 2. Excessive spending of money 3. Declaration of "being at one with the world" 4. Demonstration of flight of ideas

Indiscriminate sexual relations

A manic client in the acute phase is verbally and physically aggressive to himself. The nursing diagnosis Defensive coping related to biochemical changes as evidenced by aggressive verbal and physical behaviors has been identified. A desirable short-term goal would be that the client will A. Making no attempts at self harm within 12 hrs of admission. B. sleep soundly for 12 of the next 24 hours. C. willingly take prescribed medication as offered by staff within 24 hours of admission. D. develop psychomotor retardation associated with sedation from prescribed medication within 6 hours of admission.

Making no attempts at self harm within 12 hrs of admission.

The nurse has provided education for a patient in the continuation phase after discharge from the hospital. What indicates that the plan of care has been successful? Select all that apply. 1. Patient identifies three signs and symptoms of relapse. 2. Patient states, "My wife doesn't mind if I still drink a little." 3. Patient describes the purpose of each medication he has been prescribed. 4. Patient states, "I no longer have a disease." 5. Patient identifies two ways to problem-solve a specific situation.

Patient identifies three signs and symptoms of relapse. Patient describes the purpose of each medication he has been prescribed. Patient identifies two ways to problem-solve a specific situation.

The nurse is planning care for a patient experiencing the acute phase of mania. Which is the priority intervention? 1. Prevent injury. 2. Maintain stable cardiac status. 3. Get the patient to demonstrate thought self-control. 4. Ensure that the patient gets sufficient sleep and rest.

Prevent injury.

The nurse is caring for a patient experiencing mania. Which is the most appropriate nursing intervention? 1. Provide consistency among staff members when working with the patient. 2. Negotiate limits so the patient has a voice in the plan of care. 3. Allow only certain staff members to interact with the patient. 4. Attempt to control the patient's emotions.

Provide consistency among staff members when working with the patient.

What intervention can the nurse suggest when a client reports that lithium gives him an upset stomach? A. Take it with meals B. Take it with an antacid C. Take it 30 minutes before meals D. Take it 2 hours after meals

Take it with meals

may become noncompliant with medication. Which factor would be of least concern to the nurse developing a psychoeducation plan to foster compliance? A. The side-effects are unpleasant B. The voices tell the client to stop taking it C. The client prefers to feel "high" and energetic D. The client feels well and denies the possibility of recurrence

The voices tell the client to stop taking it

A desired outcome for the maintenance phase of treatment for a manic client would be that the client will A. exhibit optimistic, energetic, playful behavior. B. adhere to follow-up medical appointments. C. take medication more than 50% of the time. D. use alcohol to moderate occasional mood "highs."

adhere to follow-up medical appointments.

Clonazepam (klonopin) and lorazepam (Ativan)

antianxiety drugs useful in treatment of acute mania in some patients who resist other treatments; also help to manage psychomotor agitation seen in mania.

lithium and lamotrigine (Lamictal)

are the first line therapy for bipolar disorder.

olanzapine (Zyprexa) and risperidone (Risperdal)

atypical antipsychotics that help w/ insomnia, anxiety, agitation and mood stabilizing properties. At times may be more effective in treatment than lithium.

The physician tells the nurse "Mrs. G's appearance is that of a typical manic client." The nurse can expect Mrs. G to be attired in clothing that is A. dark colored and modest. B. colorful and outlandish. C. compulsively neat and clean. D. ill-fitted and ragged.

colorful and outlandish.

full-blown mania

constantly go from one activity, place, or project to another; many projects may be started, but few if any are finished.

A person who has numerous hypomanic and dysthymic episodes can be assessed as having A. bipolar II disorder. B. bipolar I disorder. C. cyclothymia. D. seasonal affective disorder.

cyclothymia.

A bipolar client tells the nurse "I have the finest tenor voice in the world. The three tenors who do all those TV concerts are going to retire because they can't compete with me." The nurse would make the assessment that the client is displaying A. flight of ideas. B. distractibility. C. limit testing. D. grandiosity.

grandiosity.

hypomania

have an increased appetite for social engagement, spending, and activity, even indiscriminate sex; constant activity prevents restful sleep. some may stay up for days.

cognitive-behavioral therapy (CBT)

involves identifying maladaptive cognition and behaviors that may be barriers to a person's recovery and ongoing mood stability. Focuses on medication adherence, early detection and intervention for manic or depressive episodes.

An outcome for a manic client during the acute phase that would indicate that his treatment plan was successful would be that the client A. reports racing thoughts. B. is free of injury. C. is highly distractible. D. ignores food and fluid.

is free of injury.

hypothyroidism

is known to be associated w/ depressed moods, and is seen in some patients experiencing rapid cycling.

lithium carbonate

is used to treat some forms of depression and manic episodes of manic-depressive disorder

what is the main theme to keep the patient from staff splitting?

limit-setting (consistency among staff is imperative if the limit setting is to be carried out effectively)

The first-line drug used to treat mania is A. lithium. B. carbamazepine. C. lamotrigine D. clonazepam.

lithium.

what is the number one reason relapse usually occurs?

medication non-adherence

anterior limbic regions of the brain

the areas most deeply affected by bipolar disorder are the areas associated w/ emotion, motivation, memory and fear. What region of the brain is this associated w/

When a client experiences 4 or more mood episodes in a 12 month period, the client is said to be: A. dysynchronous. B. incongruent. C. cyclothymic. D. rapid cycling.

rapid cycling.

The priority nursing diagnosis for a hyperactive manic client during the acute phase is A. risk for injury. B. ineffective role performance. C. risk for other-directed violence. D. impaired verbal communication.

risk for injury.

To plan care for a manic client the nurse must consider that lithium cannot be started until A. the physical examination and laboratory tests are analyzed. B. the initial doses of antipsychotic medication have brought behavior under control. C. seclusion has proven ineffective as a means of controlling assaultive behavior. D. electroconvulsive therapy can be scheduled to coincide with lithium administration.

the physical examination and laboratory tests are analyzed.

When the wife of a manic client asks about genetic transmission of bipolar disorder, the nurse's answer should be predicated on the knowledge that A. no research exists to suggest genetic transmission. B. much depends on the socioeconomic class of the individuals. C. highly creative people tend toward development of the disorder. D. the rate of bipolar disorder is higher in relatives of people with bipolar disorder.

the rate of bipolar disorder is higher in relatives of people with bipolar disorder.

interpersonal and social rhythm therapy

treatment for patients during the maintenance phase of bipolar illness. this therapy addresses the variables that relate to recurrence of s/s, esp non-adherence w/ medication, stress management, and maintenance of social supports.

When a hyperactive manic client expresses the intent to strike another client, the initial nursing intervention should be A. questioning client motive. B. verbal limit setting. C. physical confrontation. D. seclusion.

verbal limit setting.

An acute phase nursing intervention aimed at reducing hyperactivity is redirecting the client to A. write. B. exercise. C. direct unit activities. D. orient a new client to the unit.

write.