Bipolar Disorders NCLEX

Define Fasciculation

Brief, uncoordinated twitching

What is the BRAND NAME for BENZTROPINE?

Cogentin (antiparkinson)

What is the BRAND NAME for ZIPRASIDONE?

Geodon (atypical antipsychotic)

What is the BRAND NAME for CARBAMAZEPINE?

Tegretol (anticonvulsant tricyclic)

Define teratogen

any factor that can cause a birth defect

DEFINE: mydriasis

dilation of the pupil

DEFINE: Diaphoresis

profuse sweating

What is the BRAND NAME for QUETIAPINE?

Seroquel (atypical antipsychotic)

What is the BRAND NAME for Bupropion?

Wellbutrin, Zyban (antidepressant)

Define dysgeusia

distorted sense of taste

List the CATEGORIES of BIPOLAR DISORDER according to DSM-V

- bipolar 1 - bipolar 2 - cyclothymic disorder - substance induced bipolar - bipolar induced by another medical condition - unclassified bipolar

LIST the SIDE EFFECTS from LITHIUM

- Headache - Lethargy - Recent Memory Loss - Nausea & Vomiting - Anorexia - Abdominal pain - Fine Hand Tremors - Leukocytosis

LIST anticonvulsants used as MOOD STABILIZING agents

- Neurontin - Topamax - Trileptal - Lamictal

LIST the SIDE EFFECTS of Valproic acid

- Pancreatitis - Liver failure - Weight gain - Sedation - Loss of hair - Rashes - Constipation - Irregular menses

LIST some NURSING DIAGNOSES for BIPOLAR DISORDER patients

- Risk for other-directed violence - Risk for injury - Imbalanced nutrition: less than body requirements - Ineffective coping - Noncompliance - Ineffective role performance - Self-care deficit - Chronic low self-esteem - Disturbed sleep pattern

A client is diagnosed with bipolar disorder: manic episode. Which nursing intervention would be implemented to achieve the outcome of Client will gain 2 lb by the end of the week? 1. Provide client with high-calorie finger foods throughout the day. 2. Accompany client to cafeteria to encourage adequate dietary consumption. 3. Initiate total parenteral nutrition to meet dietary needs. 4. Teach the importance of a varied diet to meet nutritional needs.

1 ~ The nurse should provide the client with high-calorie finger foods throughout the day to help the client achieve the outcome of gaining 2 lb by the end of the week. Because of the hyperactive state, the client will have difficulty sitting still to consume large meals.

A client diagnosed with bipolar disorder: depressive episode intentionally overdoses on sertraline (Zoloft). Family members report that the client has experienced anorexia, insomnia, and recent job loss. Which nursing diagnosis should a nurse prioritize? 1. Risk for suicide R/T hopelessness 2. Anxiety: severe R/T hyperactivity 3. Imbalanced nutrition: less than body requirements R/T refusal to eat 4. Dysfunctional grieving R/T loss of employment

1 ~ The priority nursing diagnosis for this client should be risk for suicide R/T hopelessness. The nurse should always prioritize client safety. This client is at risk for suicide because of his or her recent suicide attempt.

LIST the characteristics of a MANIC EPISODE.

1) Elated & Happy or Irritable & Angry 2) Racing thougts 3) Flight of Ideas 4) Increased talking 5) Pressurized speech 6) Increasing goal-directed activity 7) Grandiose plans 8) Unrealistic belief in one's ability 9) Risk taking 10) Impulsive, high-risk behaviors 11) Decreased sleep w/o fatigue

Which of the following rationales by a nurse explain to parents why is it difficult to diagnose a child or adolescent exhibiting symptoms of bipolar disorder? (SATA) 1. Bipolar symptoms mimic attention deficit-hyperactivity disorder symptoms. 2. Children are naturally active, energetic & spontaneous. 3. Neurotransmitter levels vary considerably in accordance with age. 4. The diagnosis of bipolar disorder cannot be assigned prior to the age of 18. 5. Genetic predisposition is not a reliable diagnostic determinant.

1, 2 ~ It is difficult to diagnose a child or adolescent with bipolar disorder, because bipolar symptoms mimic attention deficit-hyperactivity disorder symptoms & because children are naturally active, energetic, and spontaneous. Symptoms may also be comorbid with other childhood disorders, such as conduct disorder.

Which of the following instructions regarding lithium therapy should be included in a nurses discharge teaching? (SATA) 1. Avoid excessive use of beverages containing caffeine. 2. Maintain a consistent sodium intake. 3. Consume at least 2,500 to 3,000 mL of fluid per day. 4. Restrict sodium content. 5. Restrict fluids to 1,500 mL per day.

1, 2, 3 ~ The nurse should instruct the client taking lithium to avoid excessive use of caffeine, maintain a consistent sodium intake & consume at least 2,500 to 3,000 mL of fluid per day. The risk of developing lithium toxicity is high because of the narrow margin between therapeutic doses & toxic levels. Fluid or sodium restriction can impact lithium levels.

A client has been diagnosed with major depressive episode. After treatment with fluoxetine (Prozac), the client exhibits pressured speech & flight of ideas. Based on this symptom change, which physician action would the nurse anticipate? 1. Increase the dosage of fluoxetine. 2. Discontinue the fluoxetine and rethink the clients diagnosis. 3. Order benztropine (Cogentin) to address extrapyramidal symptoms. 4. Order olanzapine (Zyprexa) to address altered thoughts.

2 ~ A full manic episode emerging during antidepressant treatment (medication, electroconvulsive therapy, etc.), but persisting beyond the physiological effect of that treatment is sufficient evidence for a manic episode & therefore a Bipolar I diagnosis.

Which is the basic premise of a recovery model used to treat clients diagnosed with bipolar disorder? 1. Medication adherence 2. Empowerment of the consumer 3. Total absence of symptoms 4. Improved psychosocial relationships

2 ~ The basic premise of a recovery model is empowerment of the consumer. The recovery model is designed to allow consumers primary control over decisions about their own care & to enable a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential.

A client diagnosed with bipolar I disorder: manic episode refuses to take lithium carbonate (Lithobid) because of excessive weight gain. In order to increase adherence, which medication should a nurse anticipate that a physician may prescribe? 1. Sertraline (Zoloft) 2. Valproic acid (Depakote) 3. Trazodone (Desyrel) 4. Paroxetine (Paxil)

2 ~ The nurse should anticipate that the physician may prescribe valproic acid in order to increase this clients medication adherence. Valproic acid is an anticonvulsant medication that can be used to treat bipolar disorder. One of the side effects of this medication is weight loss.

A client diagnosed with bipolar disorder is distraught over insomnia experienced over the last 3 nights & a 12-pound weight loss over the past 2 weeks. Which should be this clients priority nursing diagnosis? 1. Knowledge deficit R/T bipolar disorder AEB concern about symptoms 2. Altered nutrition: less than body requirements R/T hyperactivity AEB weight loss 3. Risk for suicide R/T powerlessness AEB insomnia & anorexia 4. Altered sleep patterns R/T mania AEB insomnia for the past 3 nights

2 ~ The nurse should identify that the priority nursing diagnosis for this client is altered nutrition: less than body requirements R/T hyperactivity AEB weight loss. Because of the clients rapid weight loss, the nurse should prioritize interventions to ensure proper nutrition & physical health.

What tool should a nurse use to differentiate occasional spontaneous behaviors of children from behaviors associated with bipolar disorder? 1. Risky Activity tool 2. FIND tool 3. Consensus Committee tool 4. Monotherapy tool

2 ~ The nurse should use the FIND tool to differentiate occasional spontaneous behaviors of children from behaviors associated with bipolar disorder. FIND is an acronym that stands for Frequency, Intensity, Number & Duration & is used to assess behaviors in children.

A client began taking lithium carbonate (Lithobid) for the treatment of bipolar disorder approximately 1 month ago. The client asks if it is normal to have gained 12 pounds in this time frame. Which is the appropriate nursing response? 1. Thats strange. Weight loss is the typical pattern. 2. What have you been eating? Weight gain is not usually associated with lithium. 3. Weight gain is a common, but troubling, side effect. 4. Weight gain only occurs during the first month of treatment with this drug.

3 ~ The nurse should explain to the client that weight gain is a common side effect of lithium carbonate. The nurse should educate the client on the importance of medication adherence & discuss concerns with the prescribing physician if the client does not wish to continue taking the medication.

A nurse is planning care for a client diagnosed with bipolar disorder: manic episode. In which order should the nurse prioritize the client outcomes in the exhibit? Client Outcomes: 1. Maintains nutritional status 2. Interacts appropriately with peers 3. Remains free from injury 4. Sleeps 6 to 8 hours a night 1. 2, 1, 3, 4 2. 4, 1, 2, 3 3. 3, 1, 4, 2 4. 1, 4, 2, 3

3 ~ The nurse should order client outcomes based on priority in the following order: Remains free of injury, maintains nutritional status, sleeps 6 to 8 hours a night, and interacts appropriately with peers. The nurse should prioritize the clients safety & physical health as most important.

A nursing instructor is teaching about bipolar disorders. Which statement differentiates the DSM-5 diagnostic criteria of a manic episode from a hypomanic episode? 1. During a manic episode, clients may experience an inflated self-esteem or grandiosity & these symptoms are absent in hypomania. 2. During a manic episode, clients may experience a decreased need for sleep & this symptom is absent in hypomania. 3. During a manic episode, clients may experience psychosis & this symptom is absent in hypomania. 4. During a manic episode, clients may experience flight of ideas & racing thoughts & these symptoms are absent in hypomania.

3 ~ Three or more of the following symptoms may be experienced in both hypomanic & manic episodes: Inflated self-esteem or grandiosity, decreased need for sleep (e.g., feels rested after only 3 hours of sleep), more talkative than usual or pressure to keep talking, flight of ideas and racing thoughts, distractibility, increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation, excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., the person engages in unrestrained buying sprees, sexual indiscretions, or foolish business investments). If there are psychotic features, the episode is, by definition, manic.

A patient experiencing mania has not eaten or slept for 3 days. Which nursing diagnosis has priority? a. Risk for injury b. Ineffective coping c. Impaired social interaction d. Ineffective therapeutic regimen management

A ~ Although each of the nursing diagnoses listed is appropriate for a patient having a manic episode, the priority lies with the patient's physiologic safety. Hyperactivity & poor judgment place the patient at risk for injury.

The cause of bipolar disorder has not been determined, but: a. several factors, including genetics, are implicated. b. brain structures were altered by stresses early in life. c. excess norepinephrine is probably a major factor. d. excess sensitivity in dopamine receptors may exist.

A ~ At this time, the interplay of complex independent variables is most likely the best explanation of the cause for bipolar disorder. Various theories implicate genetics, endocrine imbalance, early stress, and neurotransmitter imbalances.

A highly agitated client paces the unit & states, I could buy & sell this place. The clients mood fluctuates from fits of laughter to outbursts of anger. Which is the most accurate documentation of this clients behavior? 1. Rates mood 8/10. Exhibiting looseness of association. Euphoric. 2. Mood euthymic. Exhibiting magical thinking. Restless. 3. Mood labile. Exhibiting delusions of reference. Hyperactive. 4. Agitated & pacing. Exhibiting grandiosity. Mood labile.

4 ~ The nurse should document that this clients behavior is Agitated & pacing. Exhibiting grandiosity. Mood labile. The client is exhibiting mood swings from euphoria to irritability. Grandiosity refers to the attitude that ones abilities are better than everyone else's.

A client diagnosed with bipolar I disorder is exhibiting severe manic behaviors. A physician prescribes lithium carbonate (Eskalith) & olanzapine (Zyprexa). The clients spouse questions the Zyprexa order. Which is the appropriate nursing response? 1. Zyprexa in combination with Eskalith cures manic symptoms. 2. Zyprexa prevents extrapyramidal side effects. 3. Zyprexa increases the effectiveness of the immune system. 4. Zyprexa calms hyperactivity until the Eskalith takes effect.

4 ~ The nurse should explain to the clients spouse that olanzapine can calm hyperactivity until the lithium carbonate takes effect. Lithium carbonate may take 1 to 3 weeks to begin to decrease hyperactivity. Monotherapy with the traditional mood stabilizers like lithium carbonate, or atypical antipsychotics like olanzapine, has been determined to be the first-line treatment for bipolar I disorder.

A client diagnosed with bipolar disorder has been taking lithium carbonate (Lithobid) for one year. The client presents in an emergency department with a temperature of 101F (38C), severe diarrhea, blurred vision, and tinnitus. How should the nurse interpret these symptoms? 1. Symptoms indicate consumption of foods high in tyramine. 2. Symptoms indicate lithium carbonate discontinuation syndrome. 3. Symptoms indicate the development of lithium carbonate tolerance. 4. Symptoms indicate lithium carbonate toxicity.

4 ~ The nurse should interpret that the clients symptoms indicate lithium carbonate toxicity. The initial signs of toxicity include ataxia, blurred vision, severe diarrhea, nausea & vomiting & tinnitus. Lithium levels should be monitored monthly with maintenance therapy to ensure proper dosage.

A nursing instructor is discussing various challenges in the treatment of clients diagnosed with bipolar disorder. Which student statement demonstrates an understanding of the most critical challenge in the care of these clients? 1. Treatment is compromised when clients can't sleep. 2. Treatment is compromised when irritability interferes with social interactions. 3. Treatment is compromised when clients have no insight into their problems. 4. Treatment is compromised when clients choose not to take their medications.

4 ~ The nursing student is accurate when stating that the most critical challenge in the care of clients diagnosed with bipolar disorder is that treatment is often compromised when clients choose not to take their medications. Clients diagnosed with bipolar disorder feel most productive & creative during manic episodes. This may lead to purposeful medication nonadherence. Symptoms of bipolar disorder will reemerge if medication is stopped.

A nurse is assessing an adolescent client diagnosed with cyclothymic disorder. Which of the following DSM-5 diagnostic criteria would the nurse expect this client to meet? (SATA) 1. Symptoms lasting for a minimum of two years 2. Numerous periods with manic symptoms 3. Possible comorbid diagnosis of a delusional disorder 4. Symptoms cause clinically significant impairment in important areas of functioning 5. Depressive symptoms that do not meet the criteria for major depressive episode

4, 5 ~ The following are selected criteria for the diagnosis of cyclothymic disorder. For at least one year in children & adolescents there have been numerous periods with hypomanic, not manic symptoms that do not meet criteria for hypomanic episode & numerous periods with depressive symptoms that do not meet the criteria for a major depressive episode. The symptoms are not better accounted for by schizoaffective disorder & are not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or psychotic disorder not elsewhere classified. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

A health teaching plan for a patient taking lithium should include instructions to: a. maintain normal salt & fluids in the diet. b. drink twice the usual daily amount of fluids. c. double the lithium dose if diarrhea or vomiting occurs. d. avoid eating aged cheese, processed meats & red wine.

A ~ Sodium depletion & dehydration increase the chance for developing lithium toxicity. The incorrect options offer inappropriate information.

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: a. meals. b. an antacid. c. a large glass of juice. d. an antiemetic medication.

A ~ Some patients find that taking lithium with meals diminishes nausea. The incorrect options are less helpful.

Which documentation indicates that the treatment plan for a patient experiencing acute mania has been effective? a. Converses without interrupting; clothing matches; participates in activities. b. Irritable, suggestible, distractible; napped for 10 minutes in afternoon. c. Attention span short; writing copious notes; intrudes in conversations. d. Heavy makeup; seductive toward staff; pressured speech.

A ~ The descriptors given indicate the patient is functioning at an optimal level, using appropriate behavior, and thinking without becoming overstimulated by unit activities. The incorrect options reflect manic behavior.

A patient diagnosed with bipolar disorder commands other patients, "Get me a book. Take this stuff out of here," & other similar demands. The nurse wants to interrupt this behavior without entering into a power struggle. Select the best initial approach by the nurse. a. Distraction: Lets go to the dining room for a snack. b. Humor: How much are you paying servants these days? c. Limit setting: You must stop ordering other patients around. d. Honest feedback: Your controlling behavior is annoying others.

A ~ The distractibility characteristic of manic episodes can assist the nurse to direct the patient toward more appropriate, constructive activities without entering into a power struggle. Humor usually backfires by either encouraging the patient or inciting anger. Limit setting and honest feedback may seem heavy-handed to a labile patient & may incite anger.

A nurse receives this laboratory result for a patient diagnosed with bipolar disorder: lithium level 1 mEq/L. This result is: a. within therapeutic limits b. below therapeutic limits c. above therapeutic limits d. incorrect because of inaccurate testing

A ~ The normal range for a blood sample taken 8 to 12 hours after the last dose of lithium is 0.4 to 1 mEq/L.

A patient diagnosed with bipolar disorder is dressed in a red leotard & brightly colored scarves. The patient says, "I'll punch you, munch you, crunch you" while twirling & shadowboxing. Then the patient says gaily, Do you like my scarves? Here, they are my gift to you. How should the nurse document the patients mood? a. Labile and euphoric b. Irritable and belligerent c. Highly suspicious and arrogant d. Excessively happy and confident

A ~ The patient has demonstrated angry behavior & pleasant, happy behavior within seconds of each other. Excessive happiness indicates euphoria. Mood swings are often rapid & seemingly without understandable reason in patients who are manic. These swings are documented as labile. Irritability, belligerence, excessive happiness & confidence are not entirely correct terms for the patient's mood. A high level of suspicion is not evident.

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? (SATA) a. Provide structure b. Limit credit card access c. Encourage group social interaction d. Limit work to half days e. Monitor the patients sleep patterns

A, B, E ~ A patient with hypomania is expansive, grandiose, and labile; uses poor judgment; spends inappropriately; and is overstimulated by a busy environment. Providing structure helps the patient maintain appropriate behavior. Financial irresponsibility may be avoided by limiting access to cash and credit cards. Continued decline in sleep patterns may indicate the condition has evolved to full mania. Group socialization should be kept to a minimum to reduce stimulation. A full leave of absence from work is necessary to limit stimuli and to prevent problems associated with poor judgment and the inappropriate decision making that accompany hypomania.

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? (SATA) a. Powerlessness b. Defensive coping c. Chronic low self-esteem d. Impaired social interaction e. Risk-prone health behavior

A, C ~ Chronic low self-esteem and powerlessness are interwoven in the patients statements. No data support the other diagnoses.

What is the BRAND NAME for ARIPIPRAZOLE?

Abilify (atypical antipsychotic; dopamine system stabilizer)

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? a. Monitor physiologic functioning b. Provide a subdued environment c. Supervise personal hygiene d. Observe for mood changes

B ~ All the options are reasonable interventions with a patient with acute mania, but providing a subdued environment directly relates to the outcome of energy conservation by decreasing stimulation and helping balance activity and rest.

The spouse of a patient diagnosed with bipolar disorder asks what evidence supports the possibility of genetic transmission of bipolar disorders. Select the nurses best response. a. A high proportion of patients diagnosed with bipolar disorders are found among creative writers. b. A higher rate of relatives diagnosed with bipolar disorder is found among patients with bipolar disorder. c. Patients diagnosed with bipolar disorder have higher rates of relatives who respond in an exaggerated way to daily stresses. d. More individuals diagnosed with bipolar disorder come from high socioeconomic & educational backgrounds.

B ~ Evidence of genetic transmission is supported when twins or relatives of patients with a particular disorder also show an incidence of the disorder that is higher than the incidence in the general public. The incorrect options do not support the theory of genetic transmission of bipolar disorder.

This nursing diagnosis applies to a patient experiencing mania: Imbalanced nutrition: less than body requirements, related to insufficient caloric intake & hyperactivity as evidenced by 5-pound weight loss in 4 days. Select the most appropriate outcome. The patient will: a. ask staff for assistance with feeding within 4 days. b. drink six servings of a high-calorie, high-protein drink each day. c. consistently sit with others for at least 30 minutes at mealtime within 1 week. d. consistently wear appropriate attire for age and sex within 1 week while in the psychiatric unit.

B ~ High-calorie, high-protein food supplements will provide the additional calories needed to offset the patients extreme hyperactivity. Sitting with others or asking for assistance does not mean the patient will eat or drink. Appropriate attire is unrelated to the nursing diagnosis.

A patient develops mania after discontinuing lithium. New prescriptions are written to resume lithium twice daily & begin olanzapine (Zyprexa). The addition of olanzapine to the medication regimen will: a. minimize the side effects of lithium. b. bring hyperactivity under rapid control. c. enhance the antimanic actions of lithium. d. provide long-term control of hyperactivity.

B ~ Manic symptoms are controlled by lithium only after a therapeutic serum level is attained. Because this takes several days to accomplish, a drug with rapid onset is necessary to reduce the hyperactivity initially. Antipsychotic drugs neither enhance lithiums antimanic activity nor minimize the side effects. Lithium is used for long-term control.

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 nurses most appropriate response. a. You will be able to stop the medication in approximately 1 month. b. Taking the medication every day helps prevent relapses and recurrences. c. Usually patients take this medication for approximately 6 months after discharge. d. Its unusual that the health care provider has not already stopped your medication.

B ~ Patients diagnosed with bipolar disorder may be indefinitely maintained on lithium to prevent recurrences. Helping the patient understand this need promotes medication compliance. The incorrect options offer incorrect or misleading information.

Which nursing diagnosis would most likely apply to both a patient diagnosed with major depressive disorder (MDD) as well as one experiencing acute mania? a. Deficient diversional activity b. Disturbed sleep pattern c. Fluid volume excess d. Defensive coping

B ~ Patients diagnosed with mood disorders, both depression and mania, experience sleep pattern disturbances. Assessment data should be routinely gathered about this possible problem. Deficient diversional activity is more relevant for patients diagnosed with MDD. Defensive coping is more relevant for patients experiencing mania. Fluid volume excess is less relevant for patients diagnosed with mood disorders than is deficient fluid volume.

A patient experiencing acute mania waves a newspaper & says, "I must have my credit card & use the computer right now. A store is having a big sale & I need to order 10 dresses & 4 pairs of shoes." Select the nurses most appropriate intervention. a. Suggest to the patient to ask a friend do the shopping & bring purchases to the unit. b. Invite the patient to sit with the nurse & look at new fashion magazines. c. Tell the patient that computer use is not allowed until self-control improves. d. Ask whether the patient has enough money to pay for the purchases.

B ~ Situations such as this offer an opportunity to use the patients distractibility to the staff's advantage. Patients become frustrated when staff members deny requests that the patient sees as entirely reasonable. Distracting the patient can avoid power struggles. Suggesting that a friend do the shopping would not satisfy the patients need for immediacy & would ultimately result in the extravagant expenditure. Asking whether the patient has enough money would likely precipitate an angry response.

At a unit meeting, staff members discuss the decor for a special room for patients experiencing mania. Select the best option. a. Extra-large window with a view of the street b. Neutral walls with pale, simple accessories c. Brightly colored walls and print drapes d. Deep colors for walls and upholstery

B ~ The environment for a patient experiencing mania should be as simple & as nonstimulating as possible. Patients experiencing mania are highly sensitive to environmental distractions & stimulation. Draperies present a risk for injury.

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: a. Restrict oral fluids for 24 hours and stay in bed. b. Have someone bring you to the clinic immediately. c. Drink a large glass of water with 1 teaspoon of salt added. d. Take an over-the-counter antidiarrheal medication hourly until the diarrhea subsides.

B ~ The symptoms described suggest lithium toxicity. The patient should have a lithium level drawn and may require further treatment. Because neurologic symptoms are present, the patient should not drive and should be accompanied by another person. The incorrect options will not address the patients symptoms. Restricting oral fluids will make the situation worse.

When a hyperactive patient experiencing acute mania is hospitalized, what initial nursing intervention is a priority? a. Allow the patient to act out his or her feelings. b. Set limits on the patients behavior as necessary. c. Provide verbal instructions to the patient to remain calm. d. Restrain the patient to reduce hyperactivity & aggression.

B ~ This intervention provides support through the nurses presence & provides structure as necessary while the patients control is tenuous. Acting out may lead to the loss of behavioral control. The patient will probably be unable to focus on instructions and comply. Restraint is used only after other interventions have proved ineffective.

A patient experiencing acute mania has exhausted the staff members by noon. The patient has joked, manipulated, insulted & fought all morning. Staff members are feeling defensive & fatigued. Which is the best action? a. Confer with the health care provider regarding use of seclusion for this patient. b. Hold a staff meeting to discuss consistency & limit-setting approaches. c. Conduct a meeting with all patients to discuss the behavior. d. Explain to the patient that the behavior is unacceptable.

B ~ When staff members are overwhelmed, the patient has succeeded in keeping the environment unsettled & avoided outside controls on behavior. Staff meetings can help minimize staff splitting & feelings of anger, helplessness, confusion & frustration. Criteria for seclusion have not been met.

A nurse prepares the plan of care for a patient having a manic episode. Which nursing diagnoses are most likely? (SATA) a. Imbalanced nutrition: more than body requirements b. Disturbed thought processes c. Sleep deprivation d. Chronic confusion e. Social isolation

B, C ~ People with mania are hyperactive and often do not take the time to eat and drink properly. Their high levels of activity consume calories; therefore deficits in nutrition may occur. Sleep is reduced. Their socialization is impaired but not isolated. Confusion may be acute but not chronic.

What is the BRAND NAME for DIPHENHYDAMINE HCL?

BENADRYL (centrally acting cholinergic antagonist; antihistamine)

A patient receiving lithium should be assessed for which evidence of complications? a. Pharyngitis, mydriasis, and dystonia b. Alopecia, purpura, and drowsiness c. Diaphoresis, weakness, and nausea d. Ascites, dyspnea, and edema

C ~ Diaphoresis, weakness, and nausea are early signs of lithium toxicity. Problems mentioned in the incorrect options are unrelated to lithium therapy.

A person is directing traffic on a busy street while shouting & making obscene gestures at passing cars. The person has not slept or eaten for 3 days. What features of mania are evident? a. Increased muscle tension and anxiety b. Vegetative signs and poor grooming c. Poor judgment and hyperactivity d. Cognitive deficit and sad mood

C ~ Hyperactivity (directing traffic) & poor judgment (putting self in a dangerous position) are characteristic of manic episodes. The distractors do not specifically apply to mania.

A patient experiencing acute mania undresses in the group room & dances. The nurses first intervention would be to: a. quietly ask the patient, Why don't you put on your clothes? b. firmly tell the patient, Stop dancing & put on your clothing. c. put a blanket around the patient & walk with the patient to a quiet room. d. allow the patient stay in the group room. Move the other patients to a different area.

C ~ Patients must be protected from the embarrassing consequences of their poor judgment whenever possible. Protecting the patient from public exposure by matter-of-factly covering the patient & removing her from the area with a sufficient number of staff members to avoid argument & provide control is an effective approach.

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, Ill throw the pool balls if anyone comes near me. The nurses first intervention is to: a. tell the patient, You need to be secluded. b. help the patient down from the table. c. clear the room of all other patients. d. assemble a show of force.

C ~ Safety is of primary importance. Once other patients are out of the room, a plan for managing this patient can be implemented. A show of force is likely to frighten the patient and increase this risk for violence.

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? a. phenytoin (Dilantin) b. clonidine (Catapres) c. carbamazepine (Tegretol) d. chlorpromazine (Thorazine)

C ~ Some patients with bipolar disorder, especially those who have only short periods between episodes, have a favorable response to the anticonvulsants carbamazepine & valproate. Phenytoin is also an anticonvulsant but is not used for mood stabilization. Carbamazepine seems to work better in patients with rapid cycling & in severely paranoid, angry patients with manic episodes.

Which dinner menu is best suited for the patient diagnosed with bipolar disorder experiencing acute mania? a. Spaghetti and meatballs, salad, a banana b. Beef and vegetable stew, a roll, chocolate pudding c. Broiled chicken breast on a roll, an ear of corn, apple d. Chicken casserole, green beans, flavored gelatin with whipped cream

C ~ The correct foods provide adequate nutrition but, more importantly, are finger foods that the hyperactive patient could eat on the run. The foods in the incorrect options cannot be eaten without utensils.

Outcome identification for the treatment plan of a patient with grandiose thinking associated with acute mania focuses on: a. maintaining an interest in the environment. b. developing an optimistic outlook. c. self-control of distorted thinking. d. stabilizing the sleep pattern.

C ~ The desired outcome is that the patient will be able to control the grandiose thinking associated with acute mania as evidenced by making realistic comments about self, abilities, and plans. Patients with acute mania are already unduly optimistic as a result of their use of denial, and they are overly interested in their environment. Sleep stability is a desired outcome but is not related to distorted thought processes.

Consider these three drugs: divalproex (Depakote), carbamazepine (Tegretol) & gabapentin (Neurontin). Which drug also belongs to this group? a. clonazepam (Klonopin) b. risperidone (Risperdal) c. lamotrigine (Lamictal) d. aripiprazole (Abilify)

C ~ The three drugs in the stem of this question are all anticonvulsants. Lamotrigine is also an anticonvulsant. Clonazepam is an anxiolytic; aripiprazole & risperidone are antipsychotic drugs.

A patient diagnosed with bipolar disorder is hyperactive & manic after discontinuing lithium. The patient threatens to hit another patient. Which comment by the nurse is appropriate? a. Stop that! No one did anything to provoke an attack by you. b. If you do that one more time, you will be secluded immediately. c. Do not hit anyone. If you are unable to control yourself, we will help you. d. You know we will not let you hit anyone. Why do you continue this behavior?

C ~ When the patient is unable to control her behavior & violates or threatens to violate the rights of others, limits must be set in an effort to de-escalate the situation. Limits should be set in simple, concrete terms. The incorrect responses do not offer appropriate assistance to the patient & threaten the patient with seclusion as punishment. Asking why does not provide for environmental safety.

A patient experiencing acute mania has disrobed in the hall three times in 2 hours. The nurse should: a. direct the patient to wear clothes at all times. b. ask if the patient finds clothes bothersome. c. tell the patient that others feel embarrassed. d. arrange for one-on-one supervision.

D ~ A patient who repeatedly disrobes, despite verbal limit setting, needs more structure. One-on-one supervision may provide the necessary structure. Directing the patient to wear clothes at all times has not proved successful, considering the behavior has continued. Asking whether the patient is bothered by clothing serves no purpose. Telling the patient that others are embarrassed will not make a difference to the patient whose grasp of social behaviors is impaired by the illness.

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 patients family? a. Decreasing physical activity b. Increasing food and fluids c. Meeting self-care needs d. Psychoeducation

D ~ During the continuation phase of treatment for bipolar disorder, the physical needs of the patient are not as important an issue as they were during the acute episode. After hospital discharge, the treatment focuses on maintaining medication compliance and preventing a relapse, both of which are fostered by ongoing psychoeducation.

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 nurses best intervention? a. Educate the patient about the proper ways to perform personal hygiene and coordinate clothing. b. Continue to monitor and document the patients speech patterns and motor activity. c. Ask the health care provider to prescribe an increased dose and frequency of lithium. d. Consider the need to check the lithium level. The patient may not be swallowing medications.

D ~ The patient is continuing to exhibit manic symptoms. The lithium level may be low as a result of cheeking the medication. The prescribed dose is high, so one would not expect a need for the dose to be increased.

Lithium is prescribed for a new patient. Which information from the patients history indicates that monitoring serum concentrations of the drug will be especially challenging and critical? a. Arthritis b. Epilepsy c. Psoriasis d. Congestive heart failure

D ~ The patient with congestive heart failure will likely need diuretic drugs, which will complicate the maintenance of the fluid balance necessary to avoid lithium toxicity. Arthritis, epilepsy, and psoriasis do not directly involve fluid balance and kidney function.

What is the BRAND NAME for VALPROIC ACID?

Depakote (anticonvulsant; GABA inhibitor)

DEFINE: dystonia

Dystonia is a disorder characterized by involuntary muscle contractions that cause slow repetitive movements or abnormal postures. The movements may be painful, and some individuals with dystonia may have a tremor or other neurologic features. There are several different forms of dystonia that may affect only one muscle, groups of muscles, or muscles throughout the body. Some forms of dystonia are genetic but the cause for the majority of cases is not known. a state of abnormal muscle tone resulting in muscular spasm and abnormal posture, typically due to neurological disease or a side effect of drug therapy.

What is the BRAND NAME for HALOPERIDOL?

Haldol (antipsychotic, butyrophenone)

What is the BRAND NAME for LAMOTRIGINE?

Lamictal (anticonvulsant)

What is the BRAND NAME for LITHIUM CARBONATE?

Lithonate, Lithotabs, Lithobid (antipsychotic; mood stabilizer)

What is the THERAPEUTIC WINDOW for LITHIUM?

Maintenance: 0.6-1.2 mEq/L Acute Mania: 1.0-1.5 mEq/L Toxicity level: 2.0-2.5 mEq/L

Fill-in-the-Blank ___________________________ is an alteration in mood that is expressed by feelings of elation, inflated self-esteem, grandiosity, hyperactivity, agitation & accelerated thinking and speaking.

Mania ~ Rationale: Mania is an alteration in mood that is expressed by feelings of elation, inflated self-esteem, grandiosity, hyperactivity, agitation & accelerated thinking & speaking. Mania can occur as a biological (organic) or psychological disorder, or as a response to substance use or a general medical condition.

What is the BRAND NAME for PAROXETINE?

PAXIL (SSRI antidepressant)

What is the BRAND NAME for FLUOXETINE HCL?

PROZAC (SSRI; antidepressant)

DESCRIBE the TREATMENT for BIPOLAR DISORDER

PSYCHOTROPIC AGENTS: lifetime regimen of Lithium, Mood Stabilizers & Antipsychotic agents (if needed)

What is the BRAND NAME for RISPERIDONE?

Risperdal (atypical antipsychotic)

Where salt goes .. lithium follows

Where salt goes .. lithium follows

What is the BRAND NAME for OLANZAPINE?

Zyprexa (atypical antipsychotic)

DEFINE: purpura

a rash of purple spots on the skin caused by internal bleeding from small blood vessels