BIPOLAR prepU
A client is exhibiting rapid shifts in mood. The nurse documents this as which of the following? Elevated mood Expansive mood Irritable mood Mood lability
Correct response: Mood lability Explanation: Mood lability is a term used for rapid shifts in mood that often occur with bipolar disorder. Elevated mood refers to exaggerated feelings of well-being (euphoria) or feeling ecstatic or high (elation). An expansive mood is characterized by lack of restraint in expressing feelings, an overvalued sense of self-importance, and a constant and indiscriminate enthusiasm for interpersonal, sexual or occupational interactions. An irritable mood is indicated by being easily annoyed and provoked to anger, especially when wishes are challenged or thwarted.
Which meal would the nurse provide to best meet the nutritional needs of a client who is manic? Peanut butter sandwich, chips, cola Fried chicken, mashed potatoes, milk Ham sandwich, cheese slices, milk Spaghetti, garlic bread, salad, tea
Correct response: Ham sandwich, cheese slices, milk Explanation: Finger foods, or things clients can eat while moving around, are the best options to improve nutrition. Such foods should be as high in calories and protein as possible. Sandwiches and cheese are finger foods and are calorie-dense. Chips and cola are not nutritious, even though they are high in calories. Fried chicken, potatoes and spaghetti cannot be eaten while the client is moving.
Which is a food that might be incorporated into the plan of care for a client diagnosed in the manic phase of bipolar disorder? Bananas Brocolli Spaghetti Steak
Correct response: Bananas Explanation: For a client who is unable to sit long enough to eat, snacks and high-energy foods that can be eaten while moving should be provided.
A client with bipolar disorder is experiencing acute mania. The client is unable to sit still, moving from place to place. Medication therapy has been prescribed but not yet initiated. Which would the nurse include in the plan of care to meet the client's physical needs? Instituting a sleep hygiene program Providing high energy snacks Encouraging frequent rest periods Increasing environmental stimuli
Correct response: Providing high energy snacks Explanation: For the client experiencing acute mania, the nurse would provide snacks and high energy foods because it is highly likely that the client is unable to sit long enough to eat. Sleep hygiene is a priority but may not be realistic until medications take effect. Because of the client's activity level, frequent rest periods would be unlikely. Limiting stimuli would be helpful in decreasing agitation.
A client who has a recent diagnosis of bipolar I disorder is scheduled to begin therapy with lithium. Which instruction should the nurse provide to this client? "Try to limit your fluid intake to no more than four to six glasses per day." "If you don't feel substantially different in a few days, increase your dose by 50%." "Avoid exercise at the hottest times of the day." "Try to adapt to a low-salt diet as soon as possible."
Correct response: "Avoid exercise at the hottest times of the day." Explanation: Heavy perspiration increases the possibility of adverse effects during lithium therapy. A high-fluid diet with normal levels of salt is indicated, and doses should not be independently adjusted.
Which statement by a client would indicate the need for additional education regarding a prescribed lithium treatment regimen? "I will take my medications with food." "I will have my blood drawn on schedule." "I will drink 8 to 12 glasses of liquids daily." "I will restrict my intake of processed foods high in sodium."
Correct response: "I will restrict my intake of processed foods high in sodium." Explanation: Clients taking lithium must maintain a normal sodium intake or risk symptoms of lithium toxicity. The client should have 2 to 3 liters of fluid daily. Taking lithium with food minimizes gastrointestinal side effects. Regular monitoring of lithium levels is important to prevent toxicity.
A client with bipolar disorder is receiving lithium therapy. The nurse is reviewing the client's serum plasma drug levels and determines that the client's level is therapeutic based on what? 1.0 mEq/L 1.6 mEq/L 2.0 mEq/L 2.6 mEq/L
Correct response: 1.0 mEq/L Explanation: Serum plasma lithium levels should range from 0.6 to 1.2 mEq/L. Levels above that suggest toxicity (moderate toxicity for levels 1.5 to 2.5 mEq/L; severe toxicity for levels greater than 2.5 mEq/L).
A patient with bipolar I disorder being treated with lithium is brought to the emergency department. Assessment reveals moderate ataxia, slurred speech, asymmetric deep tendon reflexes, muscle twitching and increased muscle tone. The nurse suspects moderate lithium toxicity. Which lithium blood level would support the nurse's suspicion? 1.0 mEq/L 1.4 mEq/L 2.2 mEq/L 2.8 mEq/L
Correct response: 2.2 mEq/L Explanation: Lithium levels between 1.5 to 2.5 mEq/L indicate moderate toxicity as evidenced by the client's symptoms. Levels below 1.5 mEq/L suggest mild side effects. Levels greater than 2.5 mEq/L indicate severe toxicity, which can lead to coma and death.
Which sleep pattern is suggestive of a manic episode? A client stays awake for several days and nights before "crashing" and sleeping for a long period. 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 takes multiple short naps at varied times throughout the day and night.
Correct response: A client stays awake for several days and nights before "crashing" and sleeping for a long period. Explanation: During a manic episode, an individual will typically go several nights without sleep before collapsing from exhaustion.
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? Ability to concentrate and process the information Likelihood to assume responsibility for self-care Cognitive awareness and intellectual abilities Interest in learning about the disorder
Correct response: Ability to concentrate and process the information Explanation: To best assure successful outcomes related to client education of an individual experiencing a manic episode, the nurse's initial assessment is focused on the client's 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? Accompany the client to his or her room to get dressed. Put the client in seclusion for his or her own protection. Tell other clients to ignore the behavior because it is harmless. Tell the client that the behaviors have to stop right now.
Correct response: Accompany the client to his or her room to get dressed. Explanation: Redirecting the client to appropriate behavior without confrontation is most effective. Seclusion is not an appropriate intervention for this situation. Ignoring the behavior is not indicated. The client is in the manic phase; telling him or her to stop the behavior may make the behaviors escalate.
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? The presence of objective signs of depression without the presence of anhedonia An elevated mood that lasts for at least 1 week Failure to respond to conventional pharmacological treatments for mood disorders The client's admission of a mood disorder
Correct response: An elevated mood that lasts for at least 1 week Explanation: During manic episodes that characterize bipolar disorder, the individual exhibits an abnormal, persistently elevated, or irritable mood that lasts for at least 1 week. Failure to respond to treatment, the presence of signs of depression without anhedonia, and the client's admission of a mood disorder are neither diagnostic nor typical of bipolar disorder.
A nurse is reviewing information about medications used to treat bipolar disorders. The nurse demonstrates understanding by identifying which medication classification as effective in stabilizing moods in people with bipolar disorder? Anticonvulsants Antianxiety Anticoagulants Antibiotics
Correct response: Anticonvulsants Explanation: Several anticonvulsants traditionally used to treat seizure disorders have proved helpful in stabilizing the moods of people with bipolar illness.
A nurse is reading a journal article about bipolar disorder and common comorbidities. The nurse demonstrates understanding of the article by identifying which condition as a common comorbidity? Select all that apply. Anxiety disorders Substance use Personality disorders Schizophrenia Eating disorders
Correct response: Anxiety disorders Substance use Explanation: The two most common comorbid conditions are anxiety disorders and substance use. Individuals with a comorbid anxiety disorder are more likely to experience a more severe course. A history of substance use further complicates the course of illness and results in less chance for remission and poorer treatment compliance. Personality disorders, schizophrenia, and eating disorders are not the most common comorbid conditions.
A client has just been diagnosed as having major depression. At which time would the nurse expect the client to be at highest risk for self-harm? Immediately after a family visit On the anniversary of significant life events in the client's life During the first few days after admission Approximately 2 weeks after starting antidepressant medication
Correct response: Approximately 2 weeks after starting antidepressant medication Explanation: Observe the client closely for suicide potential, especially after antidepressant medication begins to raise the client's mood. Risk for suicide increases as the client's energy level is increased by medication. The other choices are not significantly associated with increased risk for suicide.
An inappropriately dressed client has not slept for 3 days and has been making excessive long-distance phone calls. When the client can be heard singing loudly in the examining room, the nurse makes initial plans to focus on what? Setting strict limits on dress and behavior Assessing needs for food, liquids, and rest Conducting an in-depth suicide assessment Obtaining a complete psychosocial assessment
Correct response: Assessing needs for food, liquids, and rest Explanation: Clients with mania frequently ignore basic physiologic needs, as evidenced by not sleeping for 3 days and/or not eating or drinking, thus making these assessments the priority. Nutrition is another area of concern. Manic clients may be too "busy" to sit down and eat, or they may have such poor concentration that they fail to stay interested in food for very long. Limits, although appropriate to consider, are not the priority. The manic state precludes a thorough assessment initially. Suicide assessment is not a priority at this time but reckless behavior could result in personal injury.
A client is admitted to the unit in an acute manic episode. The client has had three major depressive episodes in the past 10 years and two other hospitalizations for mania. Which disorders would reflect the client's symptom profile? Bipolar II Cyclothymic disorder Bipolar I Euthymic state
Correct response: Bipolar I Explanation: Bipolar I disorder is characterized by one or more manic episodes, usually alternating with major depressive episodes.
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 is often more disruptive than bipolar II disorder. Bipolar I disorder more often effects women. Bipolar I disorder is characterized by hypomanic episodes. Bipolar I disorder involves altered moods of anger and paranoia.
Correct response: Bipolar I disorder is often more disruptive than bipolar II disorder. Explanation: Bipolar I disorder is often more severe, thus symptoms tend to create more disruption in functioning compared to bipolar II disorder. Bipolar I disorder is characterized by one or more manic or mixed episodes in which the individual experiences rapidly alternating moods accompanied by symptoms of a manic mood and a major depressive episode.
A client with bipolar disorder has been ordered a medication that is classified as an anticonvulsant. Which drug does the nurse know falls within this class of medications? Mannitol Lithium Carbamazepine Methyldopa
Correct response: Carbamazepine Explanation: Carbamazepine is an anticonvulsant with mood-stabilizing effects. Lithium is a mood stabilizer. Mannitol and methyldopa are not used in the treatment of bipolar disorder.
A client with bipolar disorder is admitted to the psychiatric unit. The client is talking loudly, walking back and forth rapidly, and exhibiting a short attention span. Which nursing intervention should occur first? Decrease the client's environmental stimuli. Give the client feedback about the client's behavior. Introduce the client to other staff on the unit. Tell the client about hospital rules and policies.
Correct response: Decrease the client's environmental stimuli. Explanation: When the client is agitated, decreasing stimuli is the priority because it is likely to reduce the client's agitation. Giving an agitated client feedback about his or her behavior may provoke confrontation. Similarly, making reference to rules and policies may make the client reactive or defensive, exacerbating the situation. Introducing the client to other staff does nothing to address the client's agitation.
Which is an anticonvulsant used as a mood stabilizer? Divalproex Venlafaxine Bupropion Phenelzine
Correct response: Divalproex Explanation: Divalproex is an anticonvulsant that may be used as a mood stabilizer. Venlafaxine, bupropion, and phenelzine are antidepressants.
A client is being discharged on lithium. The nurse encourages the client to follow which health maintenance recommendations? Select all that apply. Weigh self weekly at the same time of day. Drink a 2 L bottle of decaffeinated fluid daily. Do not alter dietary salt intake. See the doctor if the client gets the flu. Engage in strenous exercise frequently
Correct response: Drink a 2 L bottle of decaffeinated fluid daily. Do not alter dietary salt intake. See the doctor if the client gets the flu. Explanation: Clients should drink adequate water (approximately 2 L/day) and continue with the usual amount of dietary table salt. Having too much salt in the diet because of unusually salty foods or the ingestion of salt-containing antacids can reduce receptor availability for lithium and increase lithium excretion, so the lithium level will be too low. If there is too much water, lithium is diluted, and the lithium level will be too low to be therapeutic. Drinking too little water or losing fluid through excessive sweating, such as with strenuous exercise, vomiting, or diarrhea increases the lithium level, which may result in toxicity. Monitoring daily weights and the balance between intake and output and checking for dependent edema can be helpful in monitoring fluid balance. The physician should be contacted if the client has diarrhea, fever, flu, or any condition that leads to dehydration.
A 35-year-old client with bipolar disorder has a history of discontinuing medication when feeling well and then becoming manic again. During the client's last episode of mania, the client lost several thousand dollars in risky investments. Which intervention will be most helpful in achieving medication adherence? Point out that each time the client stops taking medication, the client becomes manic again. During stabilization, discuss the client's individual signs, symptoms, and consequences of relapse. Ensure that a family member takes responsibility for administering medications. Remind the client that the client owes it to the client's spouse and children to stay well.
Correct response: During stabilization, discuss the client's individual signs, symptoms, and consequences of relapse. Explanation: To help link the importance of taking medication with relapse prevention, the nurse lists target symptoms and identifies signs of imminent relapse. The nurse engages in problem solving with the client about early management of symptoms so severity does not increase.
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? Belligerent and blunted. Expansive and grandiose. Anxious and unpredictable. Suspicious and paranoid.
Correct response: Expansive and grandiose. Explanation: The client is demonstrating an expansive and grandiose mood state. Although the client also exhibits aspects of belligerence, the client does not have a blunted affect. The client is not demonstrating anxious or unpredictable behavior, suspicion, or paranoia.
A client has entered the manic phase of bipolar disorder. To maintain the client's nutrition, which of the following should be offered? Finger foods Foods of the client's choosing Large, nutritious meals Fluids only
Correct response: Finger foods Explanation: Clients in the manic phase of bipolar disorder need to have foods that are readily available and nutritious. Clients in the manic phase exhibit nonstop activity. The client would not be able to choose foods, fluids are not enough to keep up with the nonstop activity, and the client would not be able to sit still for a large nutritious meal.
A client is prescribed lithium as treatment for bipolar disorder. The nurse is reviewing the client's medication history which reveals medications that interact with lithium, increasing lithium levels. The nurse would recommend close monitoring of the client's serum lithium levels based on use of which medication? Select all that apply. Fluoxetine Furosemide Quinipril Isosorbide Methyldopa
Correct response: Fluoxetine Furosemide Quinipril Explanation: Medications such as fluoxetine, furosemide and ACE inhibitors such as quinapril increase lithium levels. Isosorbide decreases serum lithium levels. Methyldopa has no effect on lithium level but it does increase neurotoxicity.
The police bring a client to the hospital. They found the client in a hospital gown, swimming in a local creek. The client states that the client was "being baptized by Mother Nature, who loves and worships me." How would the nurse describe the client's current alterations in mental status? Visual hallucinations Grandiose delusions Neologisms Dysphoria
Correct response: Grandiose delusions Explanation: Disturbed thinking marked by expanded sense of self with false beliefs, such as religious connections or physical powers, are grandiose delusions. Visual hallucinations are perceptual disturbances. Neologisms are made-up words. Also, the client is not experiencing dysphoria (low mood) at this time.
Which behavior is the priority concern as the nurse begins a care plan for a client in the manic phase of bipolar disorder? Bizarre, colorful, inappropriate dress Grandiose thinking and poor concentration Insulting, provocative behavior directed at staff Hyperactivity, dismissing meals, and sleep disturbance
Correct response: Hyperactivity, dismissing meals, and sleep disturbance Explanation: Safety needs are always the first priority in care planning. A client who has not eaten or slept for several days and has been extremely hyperactive may be at risk for exhaustion and malnutrition and the implications of those states. Although thought disorder, expansive mood, and dress are important assessment information, priority interventions must center on the basic needs of hyperactivity, dismissing meals, and sleep disturbance.
Which of the following is the treatment setting of choice for persons who are severely psychotic? Inpatient admission Intensive outpatient programs Residential apartments Partial hospitalization
Correct response: Inpatient admission Explanation: Inpatient admission is the treatment setting of choice for clients who are severely psychotic, or who are an immediate threat to themselves or others. Intensive outpatient programs, such as partial hospitalization, and residential apartments would not be immediate options for this client.
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? Lithium Divalproex Carbamazepine Lamotrigine
Correct response: Lithium Explanation: The mainstays of pharmacotherapy are the mood-stabilizing drugs, including lithium carbonate (Lithium), divalproex sodium (Depakote), carbamazepine (Tegretol), and lamotrigine (Lamictal). Of these, lithium is the most widely used mood stabilizer.
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? Lithium toxicity Hypokalemia Hypertensive crisis Hypernatremia
Correct response: Lithium toxicity Explanation: Lisinopril is an ACE inhibitor; hydrochlorothiazide is a thiazide diuretic. Both drugs interact with lithium to increase serum lithium levels. Therefore, the nurse should be especially alert for signs and symptoms of lithium toxicity. Hypokalemia and hyponatremia are possible effects of hydrochlorothiazide when given alone but these wouldn't be as great a concern as the increased risk for lithium toxicity. Hypertensive crisis would be more commonly associated with the use of MAOIs and tyramine foods.
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? Liver function Thyroid level White blood cell (WBC) count Cardiac enzymes
Correct response: Liver function Explanation: Baseline liver function tests and a complete blood count with platelets should be obtained before starting therapy, and clients with known liver disease should not be given divalproex sodium. There is a boxed warning for hepatotoxicity. Thyroid level, WBC count, and cardiac enzymes do not have to be performed routinely before starting this medication.
A client with bipolar disorder is prescribed divalproex sodium as part of the treatment plan. Before administering the medication, which tests should be done? Select all that apply. Liver function tests Complete blood count Platelet count Urinalysis Blood glucose concentration
Correct response: Liver function tests Complete blood count Platelet count Explanation: Baseline liver function tests and a complete blood count with platelets should be obtained before starting therapy with divalproex sodium. Clients with known liver disease should not be given divalproex sodium. There is no need to obtain a urinalysis or blood glucose concentration.
A client who has been taking lithium for bipolar disorder is admitted to the hospital with the following symptoms: dry mouth, nausea and vomiting, blurred vision, dizziness, and muscle twitching. What should the nurse suspect? Common side effects of the drug Moderate lithium toxicity Interaction of lithium with another medication Need for an increased dose of medication
Correct response: Moderate lithium toxicity Explanation: Side effects associated with moderate lithium toxicity include severe diarrhea, dry mouth, nausea and vomiting, mild to moderate ataxia, lack of coordination, dizziness, slurred speech, tinnitus, blurred vision, increasing tremors, muscle rigidity, asymmetric deep tendon reflexes, and increased muscle tone.
A client in an acute manic phase is pacing the halls and talking in a loud voice with pressured speech. The client is overly involved with coclients and frequently threatens and disrupts others on the unit. After administering lithium treatment for the client, the nurse can expect the plan of care to include which additional intervention? Monitoring phototherapy response. Monitoring blood levels of the medication. Teaching the client to avoid foods with tyramine. Assessing for post-electroconvulsive therapy disorientation and confusion.
Correct response: Monitoring blood levels of the medication. Explanation: Lithium is the drug of choice for clients with bipolar illness and has a high antimanic effectiveness. Lithium decreases the intensity, frequency, and duration of manic and depressive episodes. Blood levels need to be monitored for therapeutic levels during the acute phase (1.0-1.5 mEq/L) and during longer term maintenance. Other treatments that could be expected for clients during mania include sedatives or antipsychotics. Electroconvulsive therapy, phototherapy, and monoamine oxidase inhibitors are not typically indicated during manic phases.
Which medication classification is considered first-line drug therapy for bipolar disorder? Antipsychotics Mood stabilizers Anticonvulsants Antidepressants
Correct response: Mood stabilizers Explanation: Mood stabilizers are first-line drugs for bipolar disorders. They stabilize depressive and manic cycles.
Which of the following is an adverse effect of lithium? Nausea and diarrhea Anxiety and motor retardation Constipation and insomnia Ataxia and urinary retention
Correct response: Nausea and diarrhea Explanation: Nausea and diarrhea are adverse effect of lithium.
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
Correct response: Nausea, diarrhea, and confusion Explanation: 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 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? As soon as lunch is over, the client will calm down. Other clients need to be protected from the intrusive behavior. The client's behavior is not an imminent threat to anyone's physical safety. The client needs food and fluids in any way possible.
Correct response: Other clients need to be protected from the intrusive behavior. Explanation: The nurse must set limits on this intrusive behavior because other clients have the right to be protected. The client is in the manic phase; the client may not calm down after lunch. The behavior could be an imminent threat to individual safety for many reasons, infection control included. The client's need for food and fluids does not supersede any of the other clients' needs for food and fluids.
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 take bronchodilators Patients who take ACE inhibitors Patients who drink decaffeinated coffee Patients with diabetes who take oral antidiabetic agents
Correct response: Patients who take ACE inhibitors Explanation: Lithium interacts with several different medications and foods. Clients who take ACE inhibitors should not take lithium, because the combination can increase the serum lithium level, leading to toxicity and impaired kidney function.
A client was admitted to the psychiatric unit after being picked up by police officers who found the client frantically running back and forth across the freeway. The client's spouse reports that the client stayed up all night, ate very little, and talked incessantly. Additional assessment findings that indicate a manic episode include what? Psychomotor retardation, fatigue, and apathy Pressured speech, combative behavior, and impaired judgment Catatonic excitement, loose associations, and recurrent illusions Self-destructive behavior, overidealization, and devaluation
Correct response: Pressured speech, combative behavior, and impaired judgment Explanation: A manic episode would be characterized by pressured speech, potentially combative behavior, and impaired judgment. Neither psychomotor retardation is present nor are recurrent illusions. Self-destructive behavior is not a classic symptom of mania; more often, clients may have accidents caused by their lack of judgment and psychomotor agitation.
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. Cure of the disorder Rapid control of symptoms Decreased frequency of manic episodes Prevention of future episodes Decreased severity of manic episodes
Correct response: Rapid control of symptoms Decreased frequency of manic episodes Prevention of future episodes Decreased severity of manic episodes Explanation: Pharmacotherapy is essential to the successful management of bipolar disorder to achieve the goals of rapid control of symptoms and prevention of future episodes, or, at least, reduction in their severity and frequency.
A client has been admitted to a psychiatric-mental health facility in a manic state. The client's spouse accompanies the client to the facility and informs the nurse that the client has been displaying manic symptoms for the past 2 weeks. The spouse reports that the client has not slept for the past 2 days and that the client has not eaten anything for at least 3 days. Which would be the priority nursing diagnosis for this client? Ineffective health maintenance Risk for other-directed violence Risk for imbalanced nutrition Risk for suicide
Correct response: Risk for imbalanced nutrition Explanation: A primary concern for clients with bipolar disorders is physiologic integrity and function. Mania causes hyperactivity, resulting in an inability to sit still for the time needed to eat a meal. Clients with mania often neglect nutritional and fluid needs. While all listed nursing diagnoses are appropriate for the client, restoring nutritional balance is the highest priority.
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 Dehydration Weight loss
Correct response: Self-injury Explanation: During a manic episode, client safety is a priority. Risk of suicide is always present for those having a depressive or manic episode. During a depressive episode, the client may believe that life is not worth living. During a manic episode, the client may believe that he or she has supernatural powers, such as the ability to fly. Although changes in sleep, fluid balance (such as dehydration), and inadequate nutrition manifested by weight loss would be important to assess, safety and prevention of self-injury are the priority.
Administration of lithium affects which of the following electrolytes? Chloride Magnesium Sodium Potassium
Correct response: Sodium Explanation: Clients should drink adequate water and continue with the usual amount of dietary salt. Having too much salt in the diet because of unusually salty foods or the ingestion of salt-containing antacids can reduce receptor availability for lithium and increase lithium excretion, so that the lithium level is too low to be therapeutic.
To confirm that a client is experiencing a manic episode, the nurse must eliminate the possibility that the client's symptoms are related to which problem? Substance use Inflated self-esteem or grandiosity Insomnia Overexcitment
Correct response: Substance use Explanation: The effects of illicit substance use can mimic the symptoms of mania. The use of substances must be ruled out through the use of blood and urine diagnostics. Once determined that the signs and symptoms are not the result of substances, the client can be further investigated for mania.
A client admitted to the inpatient psychiatric unit changes clothes eight or nine times a day, wears heavy eye makeup, is intrusive with other clients, and makes inappropriate sexual advances toward staff members. Which goal would be most appropriate for this client? The client will identify two trusted staff members of the opposite sex to help choose appropriate dress. The client will record the number of clothing changes per day. The client will refrain from being intrusive with others and change clothing only twice per day. The client will verbalize feelings of low self-esteem with nursing staff.
Correct response: The client will refrain from being intrusive with others and change clothing only twice per day. Explanation: The focus should be on symptom management and containment until the client recovers enough to participate in more structured nursing interventions. Small limitations relative to hugging and wardrobe changes are realistic, offer a measure of change/stability, and help decrease overall hypomanic behaviors. Recording the number of clothing changes per day is not realistic. Having staff members of the opposite sex help the client choose appropriate dress is incorrect because this behavior will encourage continued inappropriate sexual advances. The client does not have difficulties with low self-esteem.
When teaching a group of new mental health nurses about the major difference between bipolar I and bipolar II disorders, which would be most appropriate for the nurse to include? Unlike bipolar II, bipolar I disorder involves no symptoms of mania, but only depression. Bipolar II is more often recognized than bipolar I. The mania symptoms of bipolar II disorder have little effect on functioning. Both disorders are the same, except the risk for suicide is greater with bipolar I disorder.
Correct response: The mania symptoms of bipolar II disorder have little effect on functioning. Explanation: With bipolar I, at least one manic episode or mixed episode and a depressive episode have to occur. Bipolar II is not as easily recognized as bipolar I because the symptoms are less dramatic. Hypomania, a mild form of mania, is characteristic of bipolar II. A hypomanic episode is less intense, and there is little impairment in social or occupational functioning. The risk for suicide is present with both disorders.
A client is taking lithium carbonate and asks why regular blood tests are needed. The nurse explains that it is to detect lithium toxicity. The nurse can best explain lithium toxicity in what way? Too much medication in the blood serum The level at which the medication is most effective Not enough of the medication in the blood A common side effect of taking the medication
Correct response: Too much medication in the blood serum Explanation: Lithium has a very narrow range between therapeutic and toxic levels. Toxicity describes the systemic effects when excess medication is in the bloodstream. The level at which the medication is most effective (therapeutic level) is the desired state of having the correct amount of medication in the bloodstream. Common side effects result from taking the medication but do not indicate that the client has too much medication in the blood serum. The client will not achieve the therapeutic benefit of the medication with too little medication in the blood level.
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 ... inappropriate; the nurse should not give advice to the spouse. inappropriate; the client has the legal right to spend personal money. appropriate; the spouse is responsible for the client's actions since the client has a mental illness. appropriate; the spouse needs support in setting boundaries.
Correct response: appropriate; the spouse needs support in setting boundaries. Explanation: It is therapeutic and appropriate for the nurse to work with families to help the clients manage their behavior. Nurses are not prohibited from giving advice. The wife is not legally or morally responsible for her husband's action simply because he has a mental illness. The husband has the legal right to spend money, but this does not mean that the nurse is not permitted to provide interventions to address problematic behavior.
After educating a client with bipolar disorder on his prescribed lithium therapy, the nurse determines that additional education is needed when the client states which of the following? "I need to report any problems with severe diarrhea or slurred speech." "I need to avoid drinking any alcohol." "I need to cut back on my salt intake when it's really hot outside." "I can use sugarless candies to help with any metallic taste."
Correct response: "I need to cut back on my salt intake when it's really hot outside." Explanation: Clients should increase their intake of salt during periods of perspiration (e.g., when it is hot outside) and periods of increased exercise and dehydration. Severe diarrhea and slurred speech suggest moderate toxicity, which needs to be evaluated. Alcohol interacts with lithium, causing increased serum concentrations of the drug, placing the client at risk for toxicity. Sugarless candies and throat lozenges can help to combat metallic taste.
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? The higher the potassium level, the lower the lithium level will be. The higher the sodium level, the lower the lithium level will be. Changes in diet will not affect lithium levels. Lithium has few interactions with other drugs.
Correct response: The higher the sodium level, the lower the lithium level will be. Explanation: Lithium is a salt, so the interaction between lithium and sodium levels in the body and between lithium level and fluid volume in the body are crucial issues to consider. The higher the sodium levels, the lower the lithium level will be and vice versa. The other options do not represent correct information.
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 Bradycardia Urinary frequency Tinnitus
Correct response: Neuromuscular disturbances Explanation: Symptoms include neuromuscular disturbances, dizziness, stupor, agitation, disorientation, nystagmus, urinary retention, nausea and vomiting, tachycardia, hypotension or hypertension, cardiovascular shock, coma, and respiratory depression. Tinnitus does not occur with lethal doses of these drugs.
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? "Do you think you could sit still for a few minutes so we can talk?" "How are you ever going to get any rest if you keep that music on?" "Let's go to the conference room and talk for a while." "Turn the radio down so we can hear ourselves talk."
Correct response: "Let's go to the conference room and talk for a while." Explanation: Redirecting the client to a quieter, smaller room will decrease external stimuli and promote calmness so the client will eventually rest and sleep. It is more effective and therapeutic for the nurse to suggest an alternative rather than adopting a reprimanding or confrontational tone. Making a new suggestion is likely more effective than asking a client who is manic to simply stop what he or she is doing. Stating "turn down the radio" is more likely to provoke a confrontation than suggesting that they go to a different room. The client is manic, so is unlikely to respond to a reason-based argument about the need for rest.
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? 1 month 3 months 6 months 12 months
Correct response: 1 month Explanation: Liver function tests and complete blood counts with differential are minimal pretreatment laboratory tests. They should be repeated about 1 month after initiating treatment, and at 3 months, 6 months, and yearly.
The client with mania attempts to hit the nurse. Which is the best response by the nurse? "Do not swing at me again. If you cannot control yourself, we will help you." "If you do that one more time, you will be put in seclusion immediately." "Stop that. I didn't do anything to provoke an attack." "Why do you continue that kind of behavior? You know I won't let you do it."
Correct response: "Do not swing at me again. If you cannot control yourself, we will help you." Explanation: Stating, "Do not swing at me again. If you cannot control yourself, we will help you," firmly states behavioral expectations and lets the client know his behavior will be safely controlled if he is unable to do so. Arguing that the nurse does not deserve the attack provokes confrontation rather than communicating clear expectations. Stating "If you do that one more time, you will be put in seclusion immediately" is likely to be perceived as a threat rather than an assertive statement. Similarly, stating "Why do you continue that kind of behavior? You know I won't let you do it" may be perceived as a challenge or threat.
A client taking lithium for bipolar disorder is having mild diarrhea. The nurse informs the client that this is an example of what? Toxic effect Side effect Desired effect Therapeutic effect
Correct response: Side effect Explanation: Lithium has many side effects that can be handled with interventions. For diarrhea, the nurse can instruct the client to take the medication with meals and provide for fluid replacement. The nurse should tell the client to notify the prescriber if the diarrhea becomes severe—this development can be an early sign of lithium toxicity, which would warrant a change in medication. Diarrhea is not a toxic or desired effect. The therapeutic effect is the intended effect of a drug.
