Chapter 13 : Bipolar and Related Disorders
A 33-year-old female diagnosed with bipolar I disorder has been functioning well on lithium for 11 months. At her most recent checkup, the psychiatric nurse practitioner states, "You are ready to enter the maintenance therapy stage, so at this time I am going to adjust your dosage by prescribing.":
A lower dosage
Which statement made by the patient demonstrates an understanding of the effective use of newly prescribed lithium to manage bipolar mania? Select all that apply.
A) "I have to keep reminding myself to consistently drink six 12-ounce glasses of fluid every day." B) "I discussed the diuretic my cardiologist prescribed with my psychiatric care provider." E) "I've already made arrangements for my monthly lab work."
Which nursing response demonstrates accurate information that should be discussed with the female patient diagnosed with bipolar & her support system? Select all that apply.
A) "Remember that alcohol & caffeine can trigger a relapse of your symptoms." C) "It's critical to let your healthcare provider know immediately if you aren't sleeping well." D) "Is your family prepared to be actively involved in helping manage this disorder?" E) "The symptoms tend to come & go & so you need to be able to recognize the early signs."
Which intervention should the nurse implement when caring for a patient demonstrating manic behavior? Select all that apply.
A) Monitor the patient's vital signs frequently.C) Provide the patient with frequent milkshakes & protein drinks.D) Reduce the volume on the television & dim bright lights in the environment.E) Use a firm but calm voice to give specific concise directions to the patient.
Substance abuse is often present in people diagnosed with bipolar disorder. Laura, a 28-year-old with a diagnosis of bipolar disorder, drinks alcohol instead of taking her prescribed medications. The nurse caring for this patient recognizes that:
Alcohol ingestion is a form of self-medication.
Tatiana has been hospitalized for an acute manic episode. On admission the nurse suspects lithium toxicity. What assessment findings would indicate the nurse's suspicion as correct?
Ataxia, severe hypotension, large volume of dilute urine
he nurse is providing medication education to a patient who has been prescribed lithium to stabilize mood. Which early signs & symptoms of toxicity should the nurse stress to the patient?Select all that apply.
D) An upset stomach for no apparent reason E) Shaky hands that make holding a cup difficult
Which of the following describe the symptoms of the manic phase of bipolar disorder? Select all that apply. a. Excessive energy b. Fatigue and increased sleep c. Low self-esteem d. Pressured speech e. Purposeless movement f. Racing thoughts g. Withdrawal from environment h. Distractibility
a. Excessive energy d. Pressured speech e. Purposeless movement f. Racing thoughts h. Distractibility Rationale All these options describe mania. The other options more aptly describe the opposite of what happens in mania.DIF: Cognitive Level: Apply (Application)REF: page 3TOP: Nursing Process: AssessmentMSC: NCLEX: Psychosocial Integrity
Which side effects of lithium can be expected at therapeutic levels? a. Fine hand tremor and polyuria b. Nausea and thirst c. Coarse hand tremor and gastrointestinal upset d. Ataxia and hypotension
a. Fine hand tremor and polyuria Rationale The fact that fine hand tremor and polyuria are present at therapeutic levels is quite annoying to some clients. These and other side effects are factors in noncompliance.REF: 234; Table 13-4
Which behavior would be characteristic of a client during a manic episode? a. Going rapidly from one activity to another b. Taking frequent rest periods and naps during the day c. Being unwilling to leave home to see other people d. Watching others intently and talking little
a. Going rapidly from one activity to another Rationale Hyperactivity and distractibility are basic to manic episodes. None of the other options demonstrate such characteristics.REF: 223
What is the first-line drug used to treat mania? a. Lithium carbonate b. Carbamazepine c. Lamotrigine d. Clonazepam
a. Lithium carbonate Rationale Lithium, a mood stabilizer, is the first-line drug for use in treating bipolar disorder. The other options are prescribed to manage other related symptoms of bipolar disorder.REF: 233
What is the priority nursing diagnosis for a hyperactive manic client during the acute phase of treatment? a. Risk for injury b. Ineffective role performance c. Risk for other-directed violence d. Impaired verbal communication
a. Risk for injury Rationale Risk for injury is high, related to the client's hyperactivity and poor judgment. Safety is always the priority when considering client care.REF: 236-237
What action should the nurse take on learning that a manic client's serum lithium level is 1.8 mEq/L? a. Withhold medication and notify the physician. b. Continue to administer medication as ordered. c. Advise the client to limit fluids for 12 hours. d. Advise the client to curtail salt intake for 24 hours.
a. Withhold medication and notify the physician. Rationale The client's lithium level has exceeded desirable limits. Additional doses of the medication should be withheld and the physician notified. None of the other options are accurate interventions.REF: 234; Table 13-4
An acute phase nursing intervention aimed at reducing hyperactivity is demonstrated by which intervention? a. Writing in a diary b. Exercising in the gym c. Directing unit activities d. Orienting a new client to the unit
a. Writing in a diary Rationale Manic clients often respond well to the invitation to write. They will fill reams of paper. While writing they are less physically active. None of the remaining options presents this opportunity to reduce physical activity.REF: 229
What is a desired outcome for the maintenance phase of treatment for a manic client? a. Exhibit optimistic, energetic, playful behavior. b. Adhere to follow-up medical appointments. c. Take medication more than 50% of the time. d. Use alcohol to moderate occasional mood "highs."
b. Adhere to follow-up medical appointments. Rationale The client would be living in the community during the maintenance phase. Keeping follow-up appointments is highly desirable. None of the other options are accurate.REF: 238
The nurse can expect a client demonstrating typical manic behavior to be attired in clothing that includes with characteristics? a. Dark colored and modest b. Colorful and outlandish c. Compulsively neat and clean d. Ill-fitted and ragged
b. Colorful and outlandish Rationale Manic clients often manage to dress and apply makeup in ways that create a colorful, even bizarre, appearance. None of the remaining options meet that criteria.REF: 228
A male patient calls to tell the nurse that his monthly lithium level is 1.7 mEq/L. Which nursing intervention will the nurse implement initially?ns.
b. Instruct the patient to hold the next dose of medication & contact the prescriber.
Which of the following is true of the relationship between bipolar disorder and suicide? a. Patients need to be monitored only in the depressed phase because this is when suicides occur. b. Suicide is a serious risk because nearly 20% of those diagnosed with bipolar disorder commit suicide. c. Patients with bipolar disorder are not considered high risk for suicide. d. As long as patients with bipolar disorder adhere to their medication regimen, there is little risk for suicide.
b. Suicide is a serious risk because nearly 20% of those diagnosed with bipolar disorder commit suicide. Rationale Mortality rates for bipolar disorder are severe because substantial numbers of individuals with bipolar disorder will make a suicide attempt at least once in their lifetime. Suicides occur in both the depressed and the manic phase. Bipolar patients are always considered high risk for suicide because of impulsivity while in the manic phase and hopelessness when in the depressed phase. Although staying on medications may decrease risk, there is no evidence to suggest that only patients who stop medications commit suicide.DIF: Cognitive Level: Apply (Application)REF: page 2TOP: Nursing Process: PlanningMSC: NCLEX: Safe and Effective Care Environment
When a client reports that lithium causes an upset stomach, the nurse should make which suggestion associated with taking the medication? a. With meals b. With an antacid c. 30 minutes before meals d. 2 hours after meals
b. With meals Rationale Many clients find that taking lithium with or shortly after meals minimizes gastric distress. None of the other options present accurate information.REF: 235; Box 13-1
When a hyperactive manic client expresses the intent to strike another client, the initial nursing intervention would be to a. question the client's motive. b. set verbal limits. c. initiate physical confrontation. d. prepare the client for seclusion.
b. set verbal limits. Rationale Verbal limit setting should always precede more restrictive measures. Questioning motives does not address the safety issue that exists.REF: 232-233
Which room placement would be best for a client experiencing a manic episode? a. A shared room with a client with dementia b. A single room near the unit activities area c. A single room near the nurses' station d. A shared room away from the unit entrance
c. A single room near the nurses' station Rationale The room placement that provides a nonstimulating environment is best. Nearness to the nurses' station means close supervision can be provided. None of the other options provide low stimulation.REF: 232-233
What term is used to identify the condition demonstrated by a person who has numerous hypomanic and dysthymic episodes over a two-year period? a. Bipolar II disorder. b. Bipolar I disorder. c. Cyclothymia. d. Seasonal affective disorder.
c. Cyclothymia. Rationale Cyclothymia refers to mood swings involving hypomania and dysthymia of 2 years duration. The mood swings are not severe enough to prompt hospitalization. None of the other options meet that criteria.REF: 224
A manic client tells a nurse "Bud. Crud. Dud. I'm a real stud! You'd like what I have to offer. Let's go to my room." What is the best initial approach to managing this behavior? a. Reprimand the client by stating, "What an offensive thing to suggest!" b. Clarifying the nurse-client relationship by stating, "I don't have sex with clients." c. Distracting the client by suggesting, "It's time to work on your art project." d. Enforcing consequences by responding, "Let's walk down to the seclusion room."
c. Distracting the client by suggesting, "It's time to work on your art project." Rationale Distractibility works as the nurse's friend. Rather than discuss the invitation, the nurse may be more effective by redirecting the client. This intervention is both therapeutic and less restrictive.REF: 231; Table 13-3
A 31-year-old patient admitted with acute mania tells the staff and the other patients that he is on a secret mission for the President of the United States. He states, "I am the only one he trusts, because I am the best!" What term will the nurse use when documenting this behavior? a. Unpredictability b. Rapid cycling c. Grandiosity d. Flight of ideas
c. Grandiosity Rationale Grandiosity is inflated self-regard. People with mania may exaggerate their achievements or importance, state that they know famous people, or believe they have great powers. Although patients with mania are unpredictable, the scenario does not describe unpredictability: rapid cycling is switching between mania and depression in a given time period. The scenario does not describe flight of ideas, which means a continuous flow of speech with abrupt topic changes.DIF: Cognitive Level: Apply (Application)REF: page 12TOP: Nursing Process: DiagnosisMSC: NCLEX: Psychosocial Integrity
A client hospitalized for a psychotic relapse is being discharged home to family. Which topic is important to address when teaching both the patient and the family to recognize possible signs of impending mania? a. Increased appetite b. Decreased social interaction c. Increased attention to bodily functions d. Decreased sleep
d. Decreased sleep Rationale Changes in sleep patterns are especially important because they usually precede mania. Even a single night of unexplainable sleep loss can be taken as an early warning of impending mania. The other options do not indicate impending mania.DIF: Cognitive Level: Apply (Application)REF: page 6TOP: Nursing Process: ImplementationMSC: NCLEX: Physiological Integrity
A bipolar client tells the nurse, "I have the finest tenor voice in the world. The three tenors who do all those TV concerts are going to retire because they can't compete with me." What term should the nurse use to identify this behavior? a. Flight of ideas b. Distractibility c. Limit testing d. Grandiosity
d. Grandiosity Rationale Exaggerated belief in one's own importance, identity, or capabilities is seen with grandiosity. None of the other options are associated with this behavior.REF: 223
When a client experiences four or more mood episodes in a 12-month period, which term is used to describe this behavior? a. Dyssynchronous b. Incongruent c. Cyclothymic d. Rapid cycling
d. Rapid cycling Rationale Rapid cycling implies four or more mood episodes in a 12-month period, as well as more severe symptomatology. None of the other options are associated with this characteristic behavior.REF: 224
When the wife of a manic client asks about genetic transmission of bipolar disorder, the nurse's answer should be predicated on which information? a. No research exists to suggest genetic transmission. b. Much depends on the socioeconomic class of the individuals. c. Highly creative people tend toward development of the disorder. d. The rate of bipolar disorder is higher in relatives of people with bipolar disorder.
d. The rate of bipolar disorder is higher in relatives of people with bipolar disorder. Rationale This understanding will allow the nurse to directly address the question. Responses based on the other statements would be tangential or untrue.REF: Page 225
Ted, a former executive, is now unemployed due to manic episodes at work. He was diagnosed with bipolar 18 years ago. Ted has a history of IV drug abuse, which resulted in hepatitis C. He is taking his lithium exactly as scheduled, a fact that both Ted's wife & his blood tests confirm. To reduce Ted's mania the psychiatric nurse practitioner recommends:
ect
Luc's family comes home one evening to find him extremely agitated & they suspect in a full manic episode. The family calls emergency medical services. While one medic is talking with Luc & his family, the other medic is counting something on his desk. What is the medic most likely counting?
energy drink containers
