Chapter 17 - Mental Health_Bipolar Disorders

Which symptoms does the nurse expect to appear in the client whose serum concentration of lithium is 1.8 mEq/L?

Persistent vomiting Rationale: The serum level of 1.5 to 2.0 mEq/L of lithium in the client indicates the presence of lithium toxicity. Persistent vomiting, nausea, and blurred vision are some of the symptoms that occur with this lithium concentration.

A client with mania who is extremely hyperactive and intensely agitated is admitted into the psychiatric ward. During client care, the nurse instructs the client to perform slow exercises. Which risks does the nurse intend to prevent in the client?

Risk of physical injury Rationale: The client with intense agitation and extreme hyperactivity is at risk for injury. Providing the client calming physical activities or exercises will help reduce agitation in the client. Therefore, the nurse tries to prevent the risk of physical injury.

Which stage of mania is associated with the behavior of manipulating others to fulfill the client's wishes?

Acute mania Rationale: The client with acute mania may sometimes try to manipulate others to fulfill their own desires and wishes.

A client with mania reports an inability to sleep. Which appropriate actions does the nurse take to help the client sleep better? Select all that apply.

Administer sedative agents as prescribed Rationale: The client with mania suffers from sleep deprivation due to hyperactivity. Administering sedative agents helps the client achieve sleep until a normal sleep pattern is restored. Reduce lighting in the room Rationale: Reducing lighting in the room can promote sleep. Provide tea or coffee before sleep Rationale: The client must be provided decaffeinated drinks because caffeine or tea may interfere with sleep. Help perform relaxation exercises before sleep Rationale: The manic client must be provided frequent periods of rest to prevent sleep deprivation. Helping the client perform relaxation exercises before sleep contributes to a more calming environment conducive to sleep.

A client with bipolar disorder is diagnosed with migraine. Which medication is effective when the primary health-care provider prefers a single medication for the treatment of both the conditions?

Chlorpromazine Rationale: Chlorpromazine is useful for treatment of migraine and bipolar disorder. Therefore, this medication is effective in the treatment of both conditions.

The nurse is caring for a client with mania who is on lithium carbonate therapy. The nurse monitors the client's skin turgor daily. Which sign or symptom observed in the client supports this nursing intervention?

Dehydration Rationale: Lithium carbonate is an antimanic agent that causes dehydration as a side effect. Therefore, the nurse monitors the client's skin turgor daily.

Which findings may be present in a client with a depressive episode of bipolar disorder?

Increased levels of acetylcholine Rationale: Bipolar disorder will occur due to an imbalance between biogenic amines and acetylcholine. Cholinergic transmission will be excessive during depressive moods of the client due to increased levels of acetylcholine.

Which intervention would the nurse perform to prevent drowsiness and dizziness in a client who is on verapamil therapy?

Instruct the client not to operate heavy machinery Rationale: A client who is on verapamil therapy will be drowsy and dizzy. The nurse would advise the client not to operate heavy machinery.

A client with bipolar disorder is at high risk of self-harm. The nurse finds that the client perceives actions of others as threatening. What does the nurse do to ensure the safety of this client? Select all that apply.

Places the client on 1-1 precautions Rationale: If a patient may self-harm, it may be necessary to assign a nurse for one-on-one client care. This intervention is not necessary if mechanical restraints are not used to control the actions of the client. Maintains a low level of stimuli in the client environment Rationale: Maintaining low levels of stimuli, such as low lighting and low noise levels, will reduce the perception of threats in the client; anxiety will rise with a high level of stimuli.

Which action of the nurse is said to be effective while using mechanical restraints on a child with a manic episode of bipolar disorder?

Providing assistance while positioning the child Rationale: When the nurse uses mechanical restraints on the child, the child is unable to position himself or herself. Therefore, the nurse would assist the child while positioning in order to prevent aspiration and to facilitate comfort.

The nurse is caring for a client with impaired social interaction. The nurse sets limits on the manipulative behavior of the client. Which outcome in the client does the nurse expect from this intervention?

The client develops appropriate interaction skills. Rationale: Setting of limits on the manipulative behavior of the client will help the client eliminate manipulative behavior and develop appropriate interaction behavior.

The mother of an adolescent client says, "My child keeps talking about calling the U.S. President to give him suggestions." The nurse also finds that the client has increased libido. Which does the nurse interpret from these findings?

The client is experiencing hypomania. Rationale: A client experiencing hypomania has exalted self-perception and engages in inappropriate behaviors, such as phoning the President of the United States. Increased libido is also common in a hypomanic client.

Which medication regulates the influx and outflow of calcium from the cells through the expression of CACNA1C protein?

Verapamil Rationale: Calcium channel blocking agents such as verapamil regulate influx and outflow of calcium from the cells through the expression of CACNA1C protein.

The nurse is caring for a client who is at high risk for violence. While caring, the nurse offers an empathetic response to the client's feelings. Which outcome does the nurse expect from this intervention?

The client develops trust. Rationale: When the nurse offers an empathetic response to the client's feelings, the client develops trust in the nurse. This is because the client feels that the nurse has an understanding nature.

The nurse is caring for a client who is diagnosed with hypomania. Which behavior does the nurse find in the client? Select all that apply.

The client is cheerful and expansive with an underlying irritability. Rationale: Social and occupational functioning are not severely affected in a client with hypomania. Therefore, the mood of a hypomanic client is cheerful and expansive with an underlying irritability. The client talks and laughs very loudly while communicating with the nurse. Rationale: The client with hypomania talks and laughs, typically very loudly, and often inappropriately.