Ch 24: bipolar questions
Which client statement would the nurse recognize as indicating that the client understands dietary teaching related to lithium carbonate (Lithobid) treatment?
"I will maintain normal salt intake."
An adult client diagnosed with bipolar I disorder is prescribed lamotrigine (Lamictal), 400 mg three times a day, for mood stabilization. Which is a true statement about this medication order?
This dosage is more than twice the recommended dosage range.
A highly agitated client paces the unit and states, "I could buy and sell this place." The client's mood fluctuates from fits of laughter to outbursts of anger. Which is the most accurate documentation of this client's behavior?
"Agitated and pacing. Exhibiting grandiosity. Mood labile."
What tool should a nurse use to differentiate occasional spontaneous behaviors of children from behaviors associated with bipolar disorder?
"FIND" tool
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?
"Treatment is compromised when clients choose not to take their medications."
A client is diagnosed with cyclothymic disorder. What client behaviors should the nurse expect to assess?
The client has endured periods of elation and dysphoria lasting for more than 2 years.
A client is admitted in a manic episode of bipolar I disorder. Which nursing intervention should be most therapeutic for this client?
Using a calm, unemotional approach during client interactions
A client began taking lithium 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 reply?
"Weight gain is a common but troubling side effect."
A client's spouse asks, "What evidence supports the possibility of genetic transmission of bipolar disorder?" Which is the best nursing reply?
"Higher rates of relatives diagnosed with bipolar disorder are found in families of clients diagnosed with this disorder."
A client diagnosed with bipolar I disorder is distraught over insomnia experienced over the last 3 nights and a 12-pound weight loss over the past 2 weeks. Which should be this client's priority nursing diagnosis?
Altered nutrition: less than body requirements R/T hyperactivity AEB weight loss
The clinic nurse is reviewing the medication list of a client diagnosed with Medication-Induced Bipolar Disorder. The nurse recognizes which may have precipitated the client's mood disturbance? Select all that apply. A. Oral contraceptives B. Antihypertensives C. Dopamine agonist D. Corticosteroids E. Alpha-adrenergics
A. Oral contraceptives B. Antihypertensives D. Corticosteroids
A client on an inpatient unit is diagnosed with Bipolar Disorder: Manic Episode. During a discussion in the dayroom about weekend activities, the client raises his voice, becomes irritable, and insists that plans change. Which should be the nurse's initial intervention? A. Ask the group to take a vote on alternative weekend events. B. Remind the client to quiet down or leave the dayroom. C. Assist the client to move to a calmer location. D. Discuss with the client impulse control problems.
Assist the client to move to a calmer location.
A client who has been diagnosed with Bipolar I Disorder states, "God has taught me how to decode the Bible." The nurse should anticipate which combination of medications would be ordered to address this client's symptoms? A. Lithium carbonate (Lithobid) and risperidone (Risperdal) B. Lithium carbonate (Lithobid) and carbamazepine (Tegretol) C. Valproic acid (Depakote) and sertraline (Zoloft) D. Valproic acid (Depakote) and lamotrigine (Lamictal)
Lithium carbonate (Lithobid) and risperidone (Risperdal)
A nurse begins the intake assessment of a client diagnosed with bipolar I disorder. The client shouts, "You can't do this to me. Do you know who I am?" Which is the priority nursing action in this situation?
To provide self and client with a safe environment
Which client statement indicates to the nurse that the client understands dietary teaching related to lithium carbonate (Lithobid) treatment? A. "I will limit my intake of fluids daily." B. "I will maintain normal salt intake." C. "I will take Lithobid on an empty stomach." D. "I will increase my caloric intake to prevent weight loss."
"I will maintain normal salt intake."
A client diagnosed with bipolar disorder, who has taken lithium carbonate (Lithane) for 1 year, presents in an emergency department with severe diarrhea, blurred vision, and tinnitus. How should the nurse interpret these symptoms?
Symptoms indicate lithium carbonate toxicity.
A client is diagnosed with Bipolar Disorder and admitted to an inpatient psychiatric unit. Which is the priority outcome for this client? A. The client will accomplish activities of daily living independently by discharge. B. The client will verbalize feelings during group sessions by discharge. C. The client will remain safe throughout hospitalization. D. The client will use problem-solving to cope adequately after discharge.
The client will remain safe throughout hospitalization.
A client diagnosed with Bipolar I Disorder is exhibiting severe manic behaviors. A physician prescribes lithium carbonate (Eskalith) and olanzapine (Zyprexa). The client's spouse questions the Zyprexa order. Which is the appropriate nursing reply? A. "Zyprexa in combination with Eskalith cures manic symptoms." B. "Zyprexa prevents extrapyramidal side effects." C. "Zyprexa ensures a good night's sleep." D. "Zyprexa calms hyperactivity until the Eskalith takes effect."
"Zyprexa calms hyperactivity until the Eskalith takes effect."
Which carries a warning label stating that the use of the medication increases risk for suicidal thoughts and behaviors? A. Antipsychotics B. Antiepileptics C. Mood stabilizers D. Anxiolytics
Anxiolytics
Which of the following explanations should a nurse include when teaching parents why is it difficult to diagnose a child or adolescent exhibiting symptoms of bipolar disorder? Select all that apply.
Bipolar symptoms are similar to attention deficit-hyperactivity disorder symptoms. Children are naturally active, energetic, and spontaneous.
A client is diagnosed with bipolar disorder and admitted to an inpatient psychiatric unit. Which is the priority outcome for this client?
The client will remain safe throughout hospitalization.
A client diagnosed with bipolar I disorder: manic episode refuses to take lithium carbonate because he complains that it makes him feel sick. Which of the following medications might be alternatively prescribed for mood stabilization in bipolar disorders?
Valproic acid (Depakote)
The mental health nurse is providing discharge teaching for a client diagnosed with Bipolar Disorder. Which statement indicates that the nurse's teaching is effective? A. "I shouldn't take my lithium when I have the flu." B. "I am looking forward to having real coffee in the morning." C. "I can get off medication in 5 years if I am stable." D. "I'll be the designated driver since I shouldn't have alcohol with lamotrigine."
"I'll be the designated driver since I shouldn't have alcohol with lamotrigine."
After teaching a client about lithium carbonate (Lithane), a nurse would consider the teaching successful on the basis of which client statement?
"I'll call my doctor immediately if I experience any diarrhea or ringing in my ears."
A nursing instructor is teaching about the prevalence of bipolar disorder. Which student statement indicates learning has occurred? A. "This disorder is more prevalent in lower socioeconomic groups." B. "This disorder is more prevalent in higher socioeconomic groups." C. "This disorder is equally prevalent in all socioeconomic groups." D. "This disorder's prevalence cannot be evaluated on the basis of socioeconomic groups."
"This disorder is more prevalent in higher socioeconomic groups."
A nursing instructor is teaching about the prevalence of bipolar disorder. Which student statement indicates that learning has occurred?
"This disorder is more prevalent in the higher socioeconomic groups."
An adult client diagnosed with Bipolar I Disorder is prescribed lamotrigine (Lamictal), 400 mg three times a day, for mood stabilization. Which statement about this medication order is true? A. "This dosage is within the recommended dosage range." B. "This dosage is lower than the recommended dosage range." C. "This dosage is more than twice the recommended dosage range." D. "This dosage is four times higher than the recommended dosage range."
"This dosage is more than twice the recommended dosage range."
A client diagnosed with bipolar I disorder is exhibiting severe manic behaviors. A physician prescribes lithium carbonate (Eskalith) and olanzapine (Zyprexa). The client's spouse questions the Zyprexa order. Which is the appropriate nursing reply?
"Zyprexa calms hyperactivity until the Eskalith takes effect."
A client has been taking lithium for several years with good symptom control. The client presents in the emergency department with blurred vision, tinnitus, and severe diarrhea. The nurse should correlate these symptoms with which lithium level?
1.7 mEq/L
A client has been taking lithium for several years with good symptom control. The client presents in the emergency department with blurred vision, tinnitus, and severe diarrhea. Which lithium level should the nurse correlate with these symptoms? A. 1.3 mEq/L B. 1.7 mEq/L C. 2.3 mEq/L D. 3.7 mEq/L
1.7 mEq/L
Which of the following instructions regarding lithium therapy should be included in the nurse's discharge teaching? Select all that apply. A. Avoid excessive use of beverages containing caffeine. B. Maintain a consistent sodium intake. C. Consume at least 2500 to 3000 mL of fluid per day. D. Restrict sodium content. E. Restrict fluids to 1500 mL per day.
A. Avoid excessive use of beverages containing caffeine. B. Maintain a consistent sodium intake. C. Consume at least 2500 to 3000 mL of fluid per day.
A client and nurse therapist are developing a treatment plan that includes strategies to manage bipolar disorder. Which should be included? Select all that apply. A. Maintain a consistent sleep schedule. B. Become an expert on mental health. C. Create a daily medication schedule. D. Set a time frame to achieve remission. E. Develop an emergency plan.
A. Maintain a consistent sleep schedule. B. Become an expert on mental health. C. Create a daily medication schedule. E. Develop an emergency plan.
Which of the following explanations should the nurse include when teaching parents why it is difficult to diagnose a child or adolescent exhibiting symptoms of bipolar disorder? Select all that apply. A. Symptoms of bipolar disorder are similar to those of attention deficit-hyperactivity disorder. B. Children are naturally active, energetic, and spontaneous. C. Neurotransmitter levels vary considerably in accordance with age. D. The diagnosis of Bipolar Disorder cannot be assigned prior to the age of 18. E. Genetic predisposition is not a reliable diagnostic determinant.
A. Symptoms of bipolar disorder are similar to those of attention deficit-hyperactivity disorder. B. Children are naturally active, energetic, and spontaneous.
A client diagnosed with Bipolar I Disorder is distraught over insomnia experienced over the last 3 nights and a 12-pound weight loss over the past 2 weeks. Which should be this client's priority nursing diagnosis? A. Knowledge deficit R/T bipolar disorder AEB concern about symptoms B. Altered nutrition: less than body requirements R/T hyperactivity AEB weight loss C. Risk for suicide R/T powerlessness AEB insomnia and anorexia D. Altered sleep patterns R/T mania AEB insomnia for the past 3 nights
Altered nutrition: less than body requirements R/T hyperactivity AEB weight loss
A client diagnosed with Bipolar Disorder states, "I hate oatmeal. Let's get everybody together to do exercises. I'm thirsty and I'm burning up. Get out of my way; I have to see that guy." Which is the priority nursing action? A. Assess the client's vital signs. B. Offer to have the dietitian discuss food preferences. C. Encourage the client to lead the exercise program in the community meeting. D. Acknowledge the client briefly and then walk away.
Assess the client's vital signs.
A client diagnosed with bipolar disorder states, "I hate oatmeal. Let's get everybody together to do exercises. I'm thirsty and I'm burning up. Get out of my way; I have to see that guy." What should be the priority nursing action?
Assess the client's vital signs.
Which tool should the nurse use to differentiate occasional spontaneous behaviors of children from behaviors associated with bipolar disorder? A. Risky Activity tool B. FIND tool C. Consensus Committee tool D. Monotherapy tool
FIND tool
A newly admitted client is diagnosed with Bipolar Disorder: Manic Episode. Which symptom related to altered thought is the nurse most likely to assess? A. Pacing B. Flight of ideas C. Lability of mood D. Irritability
Flight of ideas
A newly admitted client is diagnosed with bipolar disorder: manic episode. Which symptom related to altered thought is the nurse most likely to assess?
Flight of ideas
As clients are leaving the dayroom following a group therapy session, the nurse notices a client admitted for acute mania is clenching and unclenching both fists, swearing, and glaring at a staff member. Which action should the nurse take first? A. Calmly ask the client to go to the "quiet room." B. Instruct clients to return to the dayroom. C. Prepare to administer a sedative medication. D. Ask a staff member to call hospital security.
Instruct clients to return to the dayroom.
A client who has been diagnosed with bipolar I disorder states, "God has taught me how to decode the Bible." A nurse should anticipate that which combination of medications would be ordered to address this client's symptoms?
Lithium carbonate (Lithobid) and risperidone (Risperdal)
A client diagnosed with Bipolar Disorder, who has taken lithium carbonate (Lithane) for 1 year, presents in an emergency department with severe diarrhea, blurred vision, and tinnitus. The nurse should interpret these symptoms to be indicative of which of the following? A. Consumption of foods high in tyramine B. Lithium carbonate discontinuation syndrome C. Development of lithium carbonate tolerance D. Lithium carbonate toxicity
Lithium carbonate toxicity
A client is diagnosed with Bipolar I Disorder: Manic Episode. Which nursing intervention should be implemented to achieve the outcome of "Client will gain 2 pounds by the end of the week?" A. Provide client with high-calorie finger foods throughout the day. B. Accompany client to cafeteria to encourage adequate dietary consumption. C. Initiate total parenteral nutrition to meet dietary needs. D. Teach the importance of a varied diet to meet nutritional needs.
Provide client with high-calorie finger foods throughout the day.
The nurse is planning care for a client diagnosed with Bipolar Disorder: Manic Episode. Which should be the first priority of the listed client outcomes? A. Maintains nutritional status B. Interacts appropriately with peers C. Remains free from injury D. Sleeps 6 to 8 hours a night
Remains free from injury
A nurse is planning care for a client diagnosed with bipolar disorder: manic episode. In which order should the nurse prioritize the listed client outcomes?
Remains free from injury. Maintains nutritional status. Sleeps 6 to 8 hours a night. Interacts appropriately with peers.
A client diagnosed with Bipolar Disorder: Depressive Episode intentionally overdoses on sertraline (Zoloft). Family reports that the client has experienced anorexia, insomnia, and recent job loss. Which should be the priority nursing diagnosis for this client? A. Risk for suicide R/T hopelessness B. Anxiety: severe R/T hyperactivity C. Imbalanced nutrition: less than body requirements R/T refusal to eat D. Dysfunctional grieving R/T loss of employment
Risk for suicide R/T hopelessness
A newly admitted client is experiencing a manic episode of bipolar I disorder and presents as very agitated. The nurse should assign which priority nursing diagnosis to this client?
Risk for violence: directed toward others R/T agitation and hyperactivity
The nurse begins the intake assessment of a client diagnosed with Bipolar I Disorder. The client shouts, "You can't do this to me. Do you know who I am?" Which is the priority nursing action in this situation? A. To provide self and client with a safe environment B. To redirect the client to the needed assessment information C. To provide high-calorie finger foods to meet nutritional needs D. To reorient the client to person, place, time, and situation
To provide self and client with a safe environment
A client is admitted in a manic episode of bipolar I disorder. Which nursing intervention is most therapeutic for this client? A. Use a calm, unemotional approach during client interactions. B. Focus primarily on enforcing limits. C. Limit interactions to decrease external stimuli. D. Encourage the client to establish social relationships with peers.
Use a calm, unemotional approach during client interactions.
A client diagnosed with Bipolar I Disorder: Manic Episode refuses to take lithium carbonate because he complains that it makes him feel sick. Which of the following medications might be alternatively prescribed for mood stabilization in bipolar disorders? A. Sertraline (Zoloft) B. Valproic acid (Depakote) C. Trazodone (Desyrel) D. Paroxetine (Paxil)
Valproic acid (Depakote)
A highly agitated client paces the unit and states, "I could buy and sell this place." The client's mood fluctuates from fits of laughter to outbursts of anger. Which is the most accurate documentation of this client's behavior? A. "Rates mood 8/10. Exhibiting looseness of association. Euphoric." B. "Mood euthymic. Exhibiting magical thinking. Restless." C. "Mood labile. Exhibiting delusions of reference. Hyperactive." D. "Agitated and pacing. Exhibiting grandiosity. Mood labile."
"Agitated and pacing. Exhibiting grandiosity. Mood labile."
A client's spouse asks, "What evidence supports the possibility of genetic transmission of bipolar disorder?" Which is the best nursing reply? A. "Clients diagnosed with Bipolar Disorders have alterations in neurochemicals that affect behaviors." B. "Higher rates of relatives diagnosed with Bipolar Disorder are found in families of clients diagnosed with this disorder." C. "Higher rates of relatives of clients diagnosed with Bipolar Disorder respond in an exaggerated way to daily stress." D. "More individuals diagnosed with Bipolar Disorder come from higher socioeconomic and educational backgrounds."
"Higher rates of relatives diagnosed with Bipolar Disorder are found in families of clients diagnosed with this disorder."
After teaching a client about lithium carbonate (Lithane), the nurse would conclude teaching was successful based on which client statement? A. "I should expect to feel better in a couple of days." B. "I'll call my doctor immediately if I experience any diarrhea or ringing in my ears." C. "If I forget a dose, I can double the dose the next time I take this drug." D. "I need to restrict my intake of any food containing salt."
"I'll call my doctor immediately if I experience any diarrhea or ringing in my ears."
A nurse learns at report that a newly admitted client experiencing mania is demonstrating grandiose delusions. The nurse should recognize that which client statement would provide supportive evidence of this symptom?
"I'm the world's most perceptive attorney."
The nurse learns at report that a newly admitted client experiencing mania is demonstrating grandiose delusions. The nurse should recognize that which client statement provides supportive evidence of this symptom? A. "I can't stop my sexual urges. They have led me to numerous affairs." B. "I'm the world's most perceptive attorney." C. "My wife is distraught about my overspending." D. "The FBI is out to get me."
"I'm the world's most perceptive attorney."
A client began taking lithium 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 reply? A. "That's strange. Weight loss is the typical pattern." B. "What have you been eating? Weight gain is not usually associated with lithium." C. "Weight gain is a common but troubling side effect." D. "Weight gain occurs only during the first month of treatment with this drug."
"Weight gain is a common but troubling side effect."
A newly admitted client is experiencing a manic episode of bipolar I disorder and presents as very agitated. The nurse should assign which priority nursing diagnosis to this client? A. Ineffective individual coping R/T hospitalization AEB alcohol abuse B. Altered nutrition: less than body requirements R/T mania AEB 10-pound weight loss C. Risk for violence: directed toward others R/T agitation and hyperactivity D. Sleep pattern disturbance R/T flight of ideas AEB sleeps 1 to 2 hours per night
Risk for violence: directed toward others R/T agitation and hyperactivity
The inpatient psychiatric unit is being redecorated. At a unit meeting, staff discusses bedroom décor for clients experiencing mania. The nurse manager evaluates which suggestion as most appropriate?
Rooms should be painted with neutral colors and contain pale-colored accessories.
A client on an inpatient unit is diagnosed with bipolar disorder: manic episode. During a discussion in the dayroom about weekend activities, the client raises his voice, becomes irritable, and insists that plans change. What should be the nurse's initial intervention?
Assist the client to move to a calmer location.
Which of the following instructions regarding lithium therapy should be included in a nurse's discharge teaching? Select all that apply.
Avoid excessive use of beverages containing caffeine. Maintain a consistent sodium intake. Consume at least 2,500 to 3,000 mL of fluid per day.
A client is diagnosed with bipolar I disorder: manic episode. Which nursing intervention would be implemented to achieve the outcome of "Client will gain 2 pounds by the end of the week?"
Provide client with high-calorie finger foods throughout the day.
The inpatient psychiatric unit is being redecorated. At a unit meeting, staff discusses bedroom décor for clients experiencing mania. The nurse manager evaluates which suggestion as most appropriate? A. Rooms should contain extra-large windows with views of the street. B. Rooms should contain brightly colored walls with printed drapes. C. Rooms should be painted deep colors and located close to the nurse's station. D. Rooms should be painted with neutral colors and contain pale-colored accessories.
Rooms should be painted with neutral colors and contain pale-colored accessories.
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? A. "Treatment is compromised when clients can't sleep." B. "Treatment is compromised when irritability interferes with social interactions." C. "Treatment is compromised when clients have no insight into their problems." D. "Treatment is compromised when clients choose not to take their medications."
"Treatment is compromised when clients choose not to take their medications."
A client diagnosed with bipolar disorder: depressive episode intentionally overdoses on sertraline (Zoloft). Family reports that the client has experienced anorexia, insomnia, and recent job loss. What should be the priority nursing diagnosis for this client?
Risk for suicide R/T hopelessness
A client is diagnosed with Cyclothymic Disorder. Which client behaviors should the nurse expect to assess? A. The client expresses "feeling blue most of the time." B. The client has endured periods of elation and dysphoria lasting for more than 2 years. C. The client fixates on hopelessness and thoughts of suicide continually. D. The client has labile moods with periods of acute mania.
The client has endured periods of elation and dysphoria lasting for more than 2 years.
