Chapter 26. Bipolar and Related Disorders

8. A client diagnosed with bipolar II disorder has a nursing diagnosis of impaired social interactions R/T egocentrism. Which short-term outcome is an appropriate expectation for this client problem? 1. The client will have an appropriate one-on-one interaction with a peer by day 4. 2. The client will exchange personal information with peers at lunchtime. 3. The client will verbalize the desire to interact with peers by day 2. 4. The client will initiate an appropriate social relationship with a peer.

1. A client's having an appropriate one-on-one interaction with a peer is a successful outcome for the nursing diagnosis of impaired social interactions. The test taker should note that this outcome is specific, client centered, positive, realistic, and measurable and includes a time frame.

10. A client experiencing mania states, "Everything I do is great." Using a cognitive approach, which nursing response would be most appropriate? 1. "Is there a time in your life when things didn't go as planned?" 2. "Everything you do is great." 3. "What are some other things you do well?" 4."Let's talk about the feelings you have about your childhood."

1. By asking, "Is there a time in your life when things didn't go as planned?" the nurse is using a cognitive approach to challenge the thought processes of the client.

11. A newly admitted client is experiencing a manic episode. The client's nursing diagnosis is imbalanced nutrition, less than body requirements. Which meal is most appropriate for this client? 1. Chicken fingers and French fries. 2. Grilled chicken and a baked potato. 3. Spaghetti and meatballs. 4. Chili and crackers.

1. Chicken fingers and French fries are finger foods, which the client would be able to eat during increased psychomotor activity, such as pacing. Because these foods are high in caloric value, they also meet the client's increased nutritional needs.

23. A client prescribed lithium carbonate (Lithium) 300 mg qam and 600 mg qhs presents in the ED with impaired consciousness, nystagmus, arrhythmias, and a history of recent seizure. Which serum lithium level would the nurse expect to assess? 1. 3.7 mEq/L. 2. 3.0 mEq/L. 3. 2.5 mEq/L. 4. 1.9 mEq/L.

1. Clients with a serum lithium level greater than 3.5 mEq/L may show signs such as impaired consciousness, nystagmus, seizures, coma, oliguria/anuria, arrhythmias, myocardial infarction, or cardiovascular collapse.

15. A client diagnosed with bipolar I disorder, most recent episode manic, is now ready for discharge. Which of the following resource services should be included in discharge teaching? Select all that apply. 1. Financial and legal assistance. 2. Crisis hotline. 3. Individual psychotherapy. 4. Support groups. 5. Family education groups.

1. During a manic episode, clients are likely to experience impulse control problems, which may lead to excessive spending. 2. Clients diagnosed with bipolar disorder can experience hyperactivity or depression, which may lead to ambivalence regarding his or her desire to live. Having access to a crisis hotline may help the client to de-escalate and make the difference between life and death decisions. 3. During a manic episode, a client most likely would have had difficulties in various aspects of interpersonal relationships, such as with family, friends, and coworkers. Individuals experiencing mania may be difficult candidates for psychotherapy because of their inability to focus. When the acute phase of the illness has passed, the client may decide to access an available resource to deal with interpersonal problems. Psychotherapy, in conjunction with medication maintenance treatment, and counseling may be useful in helping these individuals. 4. During a manic episode, a client would not be a willing candidate for any type of group therapy. However, when the acute phase of the illness has passed, this individual may want to access support groups to benefit therapeutically from peer support. 5. During a manic episode, a client may have jeopardized marriage or family functioning. Having access to a resource that would help this client restore adaptive family functioning may improve not only relationships but also noncompliance issues and dysfunctional behavioral patterns, and ultimately may reduce relapse rates. Family therapy is most effective with the combination of psychotherapeutic and pharmacotherapeutic treatment.

18. A nurse working with a client diagnosed with bipolar I disorder attempts to recognize the motivation behind the client's use of grandiosity. Which is the rationale for this nurse's action? 1. Understanding the reason behind a behavior would assist the nurse in accepting and relating to the client, not the behavior. 2. Change in behavior cannot occur until the client can accept responsibility for his or her own actions. 3. As self-esteem is increased, the client will meet individual needs without the use of manipulation. 4. Positive reinforcement would enhance self-esteem and promote desirable behaviors.

1. Grandiosity, which is defined as an exaggerated sense of self-importance, power, or status, is used by clients diagnosed with bipolar affective disorder to help reduce feelings of insecurity by increasing feelings of power and control. When the nurse understands the origin of this behavior, the nurse can better work with, and relate to, the client.

24. A client is newly prescribed lithium carbonate (Lithium). Which teaching point by the nurse takes priority? 1."Make sure your salt intake is consistent." 2. "Limit your fluid intake to 2000 mL/day." 3. "Monitor your caloric intake because of potential weight gain." 4."Get yourself in a daily routine to assist in avoiding relapse."

1. Lithium is similar in chemical structure to sodium, behaving in the body in much the same manner and competing with sodium at various sites in the body. If sodium intake is reduced, or the body is depleted of its normal sodium, lithium is reabsorbed by the kidneys, and this increases the potential for toxicity.

28. A client diagnosed with bipolar affective disorder is prescribed divalproex sodium (Depakote). Which of the following lab tests would the nurse need to monitor throughout drug therapy? Select all that apply. 1. Platelet count. 2. Aspartate aminotransferase (AST). 3. Fasting blood sugar (FBS). 4. Alanine aminotransferase (ALT). 5. Serum depakote level.

1. Platelet counts need to be monitored before and during therapy with Depakote because of the potential side effect of blood dyscrasias. 2. Aspartate aminotransferase is a liver enzyme test that needs to be monitored before and during therapy with Depakote because of the potential side effect of liver toxicity. 4. Alanine aminotransferase is a liver enzyme test that needs to be monitored before and during therapy with Depakote because of the potential side effect of liver toxicity. 5. Depakote levels need to be monitored to determine therapeutic levels and assess potential toxicity.

5. A newly admitted client diagnosed with bipolar I disorder is experiencing a manic episode. Which nursing diagnosis is a priority at this time? 1. Risk for violence: other-directed R/T poor impulse control. 2. Altered thought process R/T hallucinations. 3. Social isolation R/T manic excitement. 4. Low self-esteem R/T guilt about promiscuity.

1. Risk for violence: other-directed is defined as behaviors in which an individual demonstrates that he or she can be physically, emotionally, or sexually harmful to others. Because of poor impulse control, irritability, and hyperactive psychomotor behaviors experienced during a manic episode, this client is at risk for violence directed toward others. Keeping everyone in the milieu safe is always a nursing priority.

13. A client diagnosed with bipolar I disorder in the manic phase is yelling at another peer in the milieu. Which nursing intervention takes priority? 1. Calmly redirect and remove the client from the milieu. 2. Administer prescribed prn intramuscular injection for agitation. 3. Ask the client to lower his or her voice while in the common area. 4. Obtain an order for seclusion to help decrease external stimuli.

1. When a client experiencing mania is yelling at other peers, it is the nurse's priority to address this situation immediately. Behaviors of this type can escalate into violence toward clients and staff members. By using a calm manner, the nurse avoids generating any further hostile behaviors, and by removing the client from the milieu, the nurse protects other clients on the unit.

27. A client on an in-patient psychiatric unit is prescribed lamotrigine (Lamictal) 50 mg qd. After client teaching, which client statement reflects understanding of important information related to lamotrigine? 1. "I will call the doctor if I miss more than 5 days before restarting the medication." 2. "I will schedule an appointment for my blood to be drawn at the lab next week." 3. "I will call the doctor immediately if my temperature rises above 100°F." 4."I will stop my medication if I start having muscle rigidity of my face or neck."

1. When the medication is titrated incorrectly, the risk for Stevens-Johnson syndrome increases. Clients need to be taught the importance of taking the medication as prescribed and accurately reporting adherence.

3. A nurse on an in-patient psychiatric unit receives report at 1500 hours. Which client would need to be assessed first? 1. A client on one-to-one status because of active suicidal ideations. 2. A client pacing the hall and experiencing irritability and flight of ideas. 3. A client diagnosed with hypomania monopolizing time in the milieu. 4. A client with a history of mania who is to be discharged in the morning.

2. A client's behavior of pacing the halls and experiencing irritability should be considered emergent and warrant immediate attention. Most assaultive behavior that occurs on an in-patient unit is preceded by a period of increasing hyperactivity. Because of these symptoms, this client would need to be assessed first.

14. A client newly admitted with bipolar I disorder has a nursing diagnosis of risk for injury R/T extreme hyperactivity. Which nursing intervention is appropriate? 1. Place the client in a room with another client experiencing similar symptoms. 2. Use prn antipsychotic medications as ordered by the physician. 3. Discuss consequences of the client's behaviors with the client daily. 4. Reinforce previously learned coping skills to decrease agitation.

2. A newly admitted client experiencing an extremely hyperactive episode as the result of bipolar I disorder would benefit from an antipsychotic medication to sedate the client quickly. A mood stabilizer may be given concurrently for maintenance therapy and to prevent or diminish the intensity of subsequent manic episodes.

Which statement about the development of bipolar disorder is from a biochemical perspective? 1. Family studies have shown that if one parent is diagnosed with bipolar disorder, the risk that a child will have the disorder is about 28%. 2. In bipolar disorder, there may be possible alterations in normal electrolyte transfer across cell membranes, resulting in elevated levels of intracellular calcium and sodium. 3. Magnetic resonance imaging reveals enlarged third ventricles, subcortical white matter, and periventricular hyperintensity in those diagnosed with bipolar disorder. 4. Twin studies have indicated a concordance rate among monozygotic twins of 60% to 80%.

2. Alterations in normal electrolyte transfer across cell membranes, resulting in elevated levels of intracellular calcium and sodium, is an example of a biochemical perspective in the development of bipolar disorder.

12. A provocatively dressed client diagnosed with bipolar I disorder is observed laughing loudly with peers in the milieu. Which nursing action is a priority in this situation? 1. Join the milieu to assess the appropriateness of the laughter. 2. Redirect clients in the milieu to structured social activities, such as cards. 3. Privately discuss with the client the inappropriate provocative dress. 4. Administer prn antianxiety medication to calm the client.

3. Because dressing provocatively can precipitate sexual overtures that can be dangerous to the client, it is the priority of the nurse to discuss with the client the inappropriateness of this clothing choice.

4. A client diagnosed with cyclothymia is newly admitted to an in-patient psychiatric unit. The client has a history of irritability and grandiosity and is currently sleeping 2 hours a night. Which nursing diagnoses takes priority? 1. Altered thought processes R/T biochemical alterations. 2. Social isolation R/T grandiosity. 3. Disturbed sleep patterns R/T agitation. 4. Risk for violence: self-directed R/T depressive symptoms.

3. Disturbed sleep patterns is defined as a time-limited disruption of sleep amount and quality. Because the client is sleeping only 2 hours a night, the client is meeting the defining characteristics of the nursing diagnosis of disturbed sleep patterns. This sleep problem is usually due to excessive hyperactivity and agitation.

25. Which list contains medications that the nurse may see prescribed to treat clients diagnosed with bipolar affective disorder? 1. Lithium carbonate (Lithium), loxapine (Loxitane), and carbamazepine (Tegretol). 2. Gabapentin (Neurontin), thiothixene (Navane), and clonazepam (Klonopin). 3. Divalproex sodium (Depakote), verapamil (Calan), and olanzapine (Zyprexa). 4. Lamotrigine (Lamictal), risperidone (Risperdal), and benztropine (Cogentin).

3. Divalproex sodium (Depakote), an anticonvulsant, and verapamil (Calan), a calcium channel blocker, are used in the long-term treatment of BPAD. Olanzapine (Zyprexa), an antipsychotic, has been approved by the FDA for the treatment of acute manic episodes.

21. A client prescribed lithium carbonate (Eskalith) is experiencing an excessive output of dilute urine, tremors, and muscular irritability. These symptoms would lead the nurse to expect that the client's serum lithium level would be which of the following? 1. 0.6 mEq/L. 2. 1.5 mEq/L. 3. 2.6 mEq/L. 4. 3.5 mEq/L.

3. The client's symptoms described in the question support a serum lithium level of 2.6 mEq/L.

9. A client seen in the emergency department is experiencing irritability, pressured speech, and increased levels of anxiety. Which would be the nurse's priority intervention? 1. Place the client on a one-to-one observation to prevent injury. 2. Ask the physician for a psychiatric consultation. 3. Assess vital signs, and complete a physical assessment. 4. Reinforce relaxation techniques to decrease anxiety.

3. The nurse first should assess vital signs and complete a physical assessment to rule out a physical cause for the symptoms presented. Many physical problems manifest in symptoms that seem to be caused by psychological problems.

29. A client diagnosed with bipolar affective disorder is prescribed carbamazepine (Tegretol). The client exhibits nausea, vomiting, and anorexia. Which is an appropriate nursing intervention at this time? 1. Stop the medication, and notify the physician. 2. Hold the next dose until symptoms subside. 3. Administer the next dose with food. 4. Ask the physician for a stat carbamazepine (Tegretol) level.

3. When clients prescribed carbamazepine experience nausea, vomiting, and anorexia, it is important for the nurse to administer the medication with food to decrease these uncomfortable, but acceptable, side effects. If these side effects do not abate, other interventions may be necessary.

2. Which nursing charting entry is documentation of a behavioral symptom of mania? 1. "Thoughts fragmented, flight of ideas noted." 2. "Mood euphoric and expansive. Rates mood a 10/10." 3. "Pacing halls throughout the day. Exhibits poor impulse control." 4."Easily distracted, unable to focus on goals."

3. When the nurse documents, "Pacing halls throughout the day. Exhibits poor impulse control," the nurse is charting a behavioral symptom of mania. Psychomotor activities and uninhibited social and sexual behaviors are classified as behavioral symptoms.

16. A nursing instructor is teaching about the etiology of mood disorders. Which statement by a nursing student best indicates an understanding of the etiology of mood disorders? 1. "When clients experience loss, they learn that it is inevitable and become hopeless and helpless." 2. "There are alterations in the neurochemicals, such as serotonin, that cause the client's symptoms." 3. "Evidence continues to support multiple causations related to an individual's susceptibility to mood symptoms." 4. "Current research suggests that a genetic component affects the development of mood disorders."

3. When the student states that there is support for multiple causations related to an individual's susceptibility to mood symptoms, the student understands the content presented about the etiology of mood disorders.

6. A client diagnosed with bipolar I disorder has a nursing diagnosis of disturbed thought process R/T biochemical alterations. Based on this diagnosis, which outcome would be appropriate? 1. The client will not experience injury throughout the shift. 2. The client will interact appropriately with others by day 3. 3. The client will be compliant with prescribed medications. 4. The client will distinguish reality from delusions by day 6.

4. Distinguishing reality from delusions by day 6 is an appropriate outcome for the nursing diagnosis of disturbed thought process R/T biochemical alterations. Altered thought processes have improved when the client can distinguish reality from delusions.

19. A nursing instructor is teaching about the criteria for the diagnosis of bipolar II disorder. Which student statement indicates that learning has occurred? 1. "Clients diagnosed with bipolar II disorder experience a full syndrome of mania and have a history of symptoms of depression." 2. "Clients diagnosed with bipolar II disorder experience numerous episodes of hypomania and dysthymia for at least 2 years." 3. "Clients diagnosed with bipolar II disorder have mood disturbances that are directly associated with the physiological effects of a substance." 4."Clients diagnosed with bipolar II disorder experience recurrent bouts of depression with episodic occurrences of hypomania."

4. Recurrent bouts of depression and episodic occurrences of hypomania are diagnostic criteria for bipolar II disorder. Experiencing a full manic episode would indicate a diagnosis of bipolar I disorder and rule out a diagnosis of bipolar II disorder.

20. A client diagnosed with bipolar I disorder is experiencing auditory hallucinations and flight of ideas. Which medication combination would the nurse expect to be prescribed to treat these symptoms? 1. Amitriptyline (Elavil) and divalproex sodium (Depakote). 2. Verapamil (Calan) and topiramate (Topamax). 3. Lithium carbonate (Eskalith) and clonazepam (Klonopin). 4. Risperidone (Risperdal) and lamotrigine (Lamictal).

4. Risperidone (Risperdal), an anti - psychotic, directly addresses the auditory hallucinations experienced by the client. Lamotrigine (Lamictal), a mood stabilizer, would address the classic symptoms of bipolar I disorder.

17. A nursing instructor is teaching about the psychosocial theory related to the development of bipolar disorder. Which student statement indicates that learning has occurred? 1. "The credibility of psychosocial theories in the etiology of bipolar disorder has strengthened in recent years." 2. "Individuals are genetically predisposed to being diagnosed with bipolar disorder if a parent is mentally ill." 3. "Following steroid, antidepressant, or amphetamine use, individuals can experience manic episodes." 4."The etiology of bipolar disorder is unclear, but it is possible that biological and psychosocial factors are influential."

4. The etiology of bipolar disorder is unclear; however, research evidence shows that biological and psychosocial factors are influential in the development of the disorder.

26. The nurse is evaluating lab test results for a client prescribed lithium carbonate (Lithium). The client's lithium level is 1.9 mEq/L. Which nursing intervention takes priority? 1. Give next dose because the lithium level is normal for acute mania. 2. Hold the next dose, and continue the medication as prescribed the following day. 3. Give the next dose after assessing for signs and symptoms of lithium toxicity. 4. Immediately notify the physician, and hold the dose until instructed further.

4. The nurse needs to notify the physician immediately of the serum lithium level, which is outside the therapeutic range, to avoid any risk for further toxicity.

A newly admitted patient is experiencing a manic episode. The patient is verbally and physically aggressive. The plan for care should include: a. setting clear limits, providing a quiet environment, and limiting activities. b. avoiding use of antipsychotic drugs for 24 hours and providing nourishment ad lib. c. orienting to unit activities, encouraging gross motor activity, and watching television. d. avoiding confrontations by not enforcing limits and encouraging physical exercise at bedtime.

A Stimuli should be reduced to provide a simple, quiet, and nonstimulating environment. Clear limits should be explained in as few words as possible, and then maintained. Gross motor activity should be limited to prevent exhaustion, and exercise should not be encouraged at bedtime. Quiet activity is more conducive to initiating sleep. Intake should be monitored and food and fluids encouraged to compensate for the higher energy expenditure of the patient. Antipsychotic drugs will probably be needed to reduce activity and aggressiveness.

The spouse of a patient diagnosed with bipolar I disorder says, "We want to have children, but I worry they could inherit this problem. There is also bipolar disorder on my side of the family." What is the nurse's most appropriate action? a. Direct the couple to seek genetic counseling. b. Encourage the couple to consider adopting children. c. Encourage the spouse to discuss options with a spiritual advisor. d. Educate the spouse about environmental determinants of bipolar disorder.

A The nurse's advice should be based on knowledge that there appears to be a genetic role in the cause of bipolar disorder. Genetic counseling will provide the couple with the best possible basis for decision making. The other options will not provide the information that the couple needs to make an informed decision.

When a hyperactive, aggressive patient with bipolar disorder threatens to beat up another patient, the initial nursing intervention should be to: a. provide firm verbal limits. b. place the patient in seclusion. c. ask the patient, "Why are you so angry?" d. distract the patient with diversional activities.

A Unless a physical attack has taken place, verbal limit-setting should precede the use of more restrictive measures.

A patient is hospitalized with new onset of manic behavior. It would be important for the nurse to inspect and report results of which laboratory tests? Select all that apply. a. Calcium b. Creatinine c. Potassium d. Drug screens e. Thyroid function

A, D, E Medical conditions may cause mania, including hypercalcemia, hyperthyroidism, and selected drugs of abuse, particularly stimulants. Steroids may also produce mania.

A nurse teaching about bipolar disorder should inform patients and their families of possible depressive symptoms. Which symptoms should the nurse include? Select all that apply. a. Passivity b. Aggression c. Hyperactivity d. Psychomotor retardation e. Preoccupation with death

A, D, E The symptoms of a bipolar depressive episode are often atypical, such as those consistent with the atypical depressive symptoms of major depressive disorder. They include preoccupation with death, psychomotor retardation, and passivity.

A client is admitted in a manic episode of bipolar I disorder. Which nursing intervention should be most therapeutic for this client? A. Using a calm, unemotional approach during client interactions B. Focusing primarily on enforcing limits C. Limiting interactions to decrease external stimuli D. Encouraging the client to establish social relationships with peers

ANS: A Clients experiencing mania are subject to frequent mood variations, easily changing from irritability and anger to sadness and crying. Therefore, it is necessary to maintain a calm, unemotional approach during client interactions. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

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? 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

ANS: A During a manic episode the client's mood is elevated, expansive, and irritable. Providing a safe environment should be prioritized to protect the client and staff from potential injury. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Safe and Effective Care Environment

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?" 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.

ANS: A The nurse should provide the client with high-calorie finger foods throughout the day to help the client achieve the outcome of gaining 2 pounds by the end of the week. Because of hyperactivity, the client will have difficulty sitting still to consume large meals. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Physiological Integrity

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? 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)

ANS: A The patient who is experiencing psychosis (in this case, delusions of grandeur) may be benefited by the addition of an antipsychotic medication (risperidone) to the mood stabilizer (lithium). In addition, since lithium does not immediately reach therapeutic levels, the sedative properties of an antipsychotic may be useful in reducing agitation, hyperactivity, and/or insomnia. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies

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? 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

ANS: A The priority nursing diagnosis for this client should be risk for suicide R/T hopelessness. The nurse should prioritize diagnoses on the basis of physical and safety needs. This client continues to be at risk for suicide related to an intentional Zoloft overdose. KEY: Cognitive Level: Analysis | Integrated Process: Nursing Process: Analysis | Client Need: Safe and Effective Care Environment: Management of Care

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? 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.

ANS: A When assessing a client diagnosed with bipolar disorder, the nurse should not lose sight of the fact that co-occurring physical problems could be masked by hyperactive, manic, or both behaviors. The client's statement of "I'm thirsty and I'm burning up" could be a symptom of either infection or dehydration and must be assessed. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Safe and Effective Care Environment: Management of CareANS: A When assessing a client diagnosed with bipolar disorder, the nurse should not lose sight of the fact that co-occurring physical problems could be masked by hyperactive, manic, or both behaviors. The client's statement of "I'm thirsty and I'm burning up" could be a symptom of either infection or dehydration and must be assessed. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Safe and Effective Care Environment: Management of Care

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. A. Bipolar symptoms are similar to attention deficit-hyperactivity disorder symptoms. 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.

ANS: A, B It is difficult to diagnose a child or adolescent with bipolar disorder because bipolar symptoms are similar to attention deficit-hyperactivity disorder symptoms and because children are naturally active, energetic, and spontaneous. Symptoms may also be comorbid with other childhood disorders, such as conduct disorder. KEY: Cognitive Level: Application | Integrated Processes: Teaching/Learning | Client Need: Psychosocial Integrity

Which of the following instructions regarding lithium therapy should be included in a 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 2,500 to 3,000 mL of fluid per day. D. Restrict sodium content. E. Restrict fluids to 1,500 mL per day.

ANS: A, B, C The nurse should instruct the client taking lithium to avoid excessive use of caffeine, maintain a consistent sodium intake, and consume at least 2,500 to 3,000 mL of fluid per day. The risk of developing lithium toxicity is high due to the narrow margin between therapeutic doses and toxic levels. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies

Which client statement would the nurse recognize as indicating 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."

ANS: B A client taking Lithobid should be taught not to skimp on dietary sodium intake. He or she should take Lithobid on a full stomach to avoid gastrointestinal upset and choose lower-calorie foods to prevent weight gain. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies

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)

ANS: B Although lithium is a prototype drug in the treatment of bipolar disorders, anticonvulsants such as valproic acid also have demonstrated efficacy for mood stabilization. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Safe and Effective Care Environment

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

ANS: B Clients diagnosed with bipolar disorder: manic episode experience cognition and perception fragmentation often with psychosis during acute mania. Rapid thinking proceeds to racing and disjointed thinking (flight of ideas) and may be manifested by a continuous flow of accelerated, pressured speak with abrupt changes from topic to topic. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

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."

ANS: B Family studies have shown that if one parent is diagnosed with bipolar disorder, the risk that a child will have the disorder is around 28%. If both parents are diagnosed with the disorder, the risk is two to three times as great. KEY: Cognitive Level: Application | Integrated Processes: Teaching/Learning | Client Need: Health Promotion and Maintenance

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? 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."

ANS: B Grandiosity is defined as a belief that personal abilities are better than anyone else's. This client is experiencing delusions of grandeur, which are commonly experienced in mania. KEY: Cognitive Level: Application | Integrated Processes: Evaluation | Client Need: Psychosocial Integrity

What tool should a 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

ANS: B The Consensus Group recommends that clinicians 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, and duration and is used to assess behaviors in children. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

A client is diagnosed with cyclothymic disorder. What 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.

ANS: B The essential feature of cyclothymic disorder is a chronic mood disturbance of at least 2 years' duration, involving numerous episodes of hypomania and depressed mood of insufficient severity or duration to meet the criteria for bipolar I or II disorder. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

After teaching a client about lithium carbonate (Lithane), a nurse would consider the teaching successful on the basis of 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."

ANS: B The initial signs of lithium toxicity include ataxia, blurred vision, severe diarrhea, persistent nausea and vomiting, and tinnitus. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies

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

ANS: B 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. Due to the client's rapid weight loss, the nurse should prioritize interventions to ensure proper nutrition and health. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Analysis | Client Need: Physiological Integrity

A nursing instructor is teaching about the prevalence of bipolar disorder. Which student statement indicates that learning has occurred? A. "This disorder is more prevalent in the lower socioeconomic groups." B. "This disorder is more prevalent in the 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."

ANS: B The nursing student is accurate when stating that bipolar disorder is more prevalent in higher socioeconomic groups. Theories consider both hereditary and environmental factors in the etiology of bipolar disorder. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Health Promotion and Maintenance

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? A. 1.3 mEq/L B. 1.7 mEq/L C. 2.3 mEq/L D. 3.7 mEq/L

ANS: B The therapeutic level of lithium carbonate is 1.0 to 1.5 mEq/L for acute mania and 0.6 to 1.2 mEq/L for maintenance therapy. There is a narrow margin between the therapeutic and toxic levels. The symptoms presented in the question can be correlated with a lithium level of 1.7 mEq/L. Levels of 2.3 mEq/L and 3.7 mEq/L would produce more extreme symptoms of intensified toxicity, eventually leading to death. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies

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.

ANS: C A client diagnosed with bipolar disorder is at risk for injury in either pole of this disorder. In the manic phase the client is hyperactive and can injure self inadvertently, and in the depressive phase the client can be at risk for suicide. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Planning | Client Need: Safe and Effective Care Environment

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? 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.

ANS: C During a manic episode, the client experiences increased agitation and extreme hyperactivity that can lead to a risk for injury. Overstimulation can exacerbate these symptoms. Therefore, the nurse's initial action should focus on removing the client from the stimulating environment to a calmer location. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Safe and Effective Care Environment: Management of Care

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

ANS: C Some signs and symptoms of mania include manic excitement, delusional thinking, and hallucinations, which may predispose the client to aggressive behavior. Nurses should be alert to the risk for self or other directed violence and intervene immediately at the first signs of agitation or aggression. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Analysis | Client Need: Safe and Effective Care Environment: Management of Care

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."

ANS: C 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 compliance and discuss concerns with the prescribing physician if the client does not wish to continue taking the medication. KEY: Cognitive Level: Application | Integrated Processes: Teaching/Learning | Client Need: Health Promotion and Maintenance

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? Client Outcomes: 1. Maintains nutritional status. 2. Interacts appropriately with peers. 3. Remains free from injury. 4. Sleeps 6 to 8 hours a night. A. 2, 1, 3, 4 B. 4, 1, 2, 3 C. 3, 1, 4, 2 D. 1, 4, 2, 3

ANS: C 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 client's physical and safety needs. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Planning | Client Need: Safe and Effective Care Environment: Management of Care

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? 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.

ANS: C The recommended dose of lamotrigine for treatment of bipolar disorder in adult clients should not exceed 400 mg daily. KEY: Cognitive Level: Application | Integrated Processes: Implementation | Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies

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.

ANS: D Clients experiencing mania are subject to frequent mood variations, easily changing from irritability and anger to sadness and crying. Therefore, it is necessary to maintain low levels of stimuli in the client's environment (low lighting, few people, simple décor, low noise levels). Anxiety levels rise in a stimulating environment. Neutral colors and pale accessories are most appropriate for a client experiencing mania. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

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."

ANS: D The nurse should document that this client's behavior is "Agitated and pacing. Exhibiting grandiosity. Mood labile." The client is exhibiting signs of irritation accompanied by aggressive behavior. Grandiosity refers to an exaggerated sense of power, importance, knowledge, or identity. KEY: Cognitive Level: Application | Integrated Processes: Communication and Documentation | Client Need: Safe and Effective Care Environment

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."

ANS: D The nurse should explain to the client's spouse that Zyprexa can calm hyperactivity until the Eskalith takes effect. Eskalith may take 1 to 3 weeks to begin to decrease hyperactivity. Zyprexa is classified as an antipsychotic and can be used to immediately to reduce hyperactive symptoms in acute manic episodes. KEY: Cognitive Level: Application | Integrated Processes: Teaching/Learning | Client Need: Health Promotion and Maintenance

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? A. Symptoms indicate consumption of foods high in tyramine. B. Symptoms indicate lithium carbonate discontinuation syndrome. C. Symptoms indicate the development of lithium carbonate tolerance. D. Symptoms indicate lithium carbonate toxicity.

ANS: D The nurse should interpret that the client's symptoms indicate lithium carbonate toxicity. The initial signs of toxicity include ataxia, blurred vision, severe diarrhea, nausea and vomiting, and tinnitus. Lithium levels should be monitored monthly during maintenance therapy to ensure proper dosage. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies

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."

ANS: D The nursing student should understand that the most critical challenge in the care of clients diagnosed with bipolar disorder is that treatment is often compromised when clients choose to not take their medications. Symptoms of bipolar disorder will reemerge if medication is stopped. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies

Which principle is most useful and effective when interacting with a patient experiencing a manic episode? a. Encourage the patient to freely express feelings. b. Use a calm, matter-of-fact approach. c. Do not interrupt the patient. d. Frequently use silence.

B A calm, matter-of-fact approach minimizes the need for the patient to respond defensively and avoids power struggles. Using this approach, the nurse conveys both control of the situation and empathy. The other options are not principles related to therapeutic interactions with a patient experiencing a manic episode. The distracters allow for manipulation of the nurse and for the patient to control the interaction.

Which indicator of disordered communication is the nurse most likely to assess in a patient having a manic episode? a. Loose associations b. Flight of ideas c. Echolalia d. Mutism

B Flight of ideas is a continuous flow of speech marked by jumping from topic to topic. The other options are most likely to be assessed in patients with schizophrenia.

A nurse presents a psychoeducational program to patients with bipolar disorder and their families. Information about signs of impending relapse of mania should include: a. diarrhea, thirst, and gross tremor. b. sleep disturbances and racing thoughts. c. decreased libido, anhedonia, and hypersomnia. d. delusional thinking, excessive guilt, and passivity.

B Relapse symptoms are congruent with early symptoms of a manic episode. They include sleeping less, experiencing racing thoughts, and having boundless energy. Diarrhea, thirst, and tremor relate to lithium side effects. Libido increases. Delusional thinking may occur in an exacerbation of the illness but not usually before relapse.

The nurse prepares to take vital signs for a patient experiencing mania. What is the nurse's best intervention when the patient's talking interferes with the assessment? a. Use a voice volume louder than the patient's to say, "Stop talking now." b. Interrupt by saying, "It's time to take your vital signs now." c. Delay taking the vital signs until the patient is quieter. d. Wait tolerantly for the patient to finish talking.

B There are times when the nurse must simply, calmly, and firmly interrupt a manic patient. Waiting is counterproductive. Yelling at the patient and delaying necessary assessments are inappropriate.

A patient at the clinic describes periods of sadness and depression as well as episodes of elation over the past 3 years. The patient adds, "Fortunately, I have been able to keep my job despite these mood changes." These findings are most consistent with which disorder? a. Bipolar I b. Bipolar II c. Cyclothymic d. Seasonal affective

C Cyclothymic disorder is characterized by mood swings between hypomania and depressive symptoms, with behavior at the poles being less severe than mania or depression. The patient's ability to remain employed indicates that the periods of elation were hypomania rather than mania. The patient's description does not meet criteria for any of the other options listed.

A nurse presents a psychoeducational program to patients with bipolar disorder and their families. Information about signs of impending relapse of depressive episode should include: a. diarrhea, thirst, and gross tremor. b. sleep disturbances and racing thoughts. c. decreased libido, anhedonia, and inertia. d. anorexia, excessive guilt, and aggression.

C Relapse symptoms are congruent with early symptoms of a depressive episode. They include decreased libido, loss of pleasure, and lack of energy. Sleeping less, experiencing racing thoughts, experiencing aggression, and having boundless energy suggest impending mania. Diarrhea, thirst, and tremor relate to lithium side effects.

Within a 15-minute period, a patient having a manic episode voices these complaints. "Dinner was cold. The bath towels are rough. The solarium is too hot. I have a sore throat. Another patient needs a shower. The medication nurse is too slow." The nurse should: a. listen but ignore the patient's complaints. b. tell the patient to use the suggestion box. c. assess the patient's throat, and take vital signs. d. invite the patient to share the concerns at the community meeting.

C The hypercritical manic patient offers so many complaints that it is easy to discount his or her concerns. Legitimate complaints should always be investigated, however. By listening and ignoring complaints, the nurse might fail to intervene to provide care. Telling the patient to use the suggestion box or asking him to share his complaints at the community meeting are placating and may anger the patient.

During community lunch, a manic patient tells another patient, "Push yourself away from the table. You're too fat for your own good!" How should the nurse intervene? a. Say to the patient, "You may remain at lunch only if you apologize." b. Tell the patient, "You must leave lunch and go to your room now." c. Calmly tell the patient that insulting others is not permitted. d. Extinguish the behavior by ignoring it.

C The nurse must protect vulnerable patients and keep them from being drawn into the manic patient's angry behavior. By stating that the behavior is not permitted, the nurse sets limits and does not enter into an argument. The distracters will further anger the patient, may cause escalation, or may allow for loss of control.

A nurse assesses a new patient experiencing a manic episode. Which behavior is most likely to have occurred before hospitalization? a. Watching others closely but avoiding interaction b. Taking frequent rest periods during the day c. Going rapidly from one activity to another d. Remaining in the home for long periods

C There is increased physical and mental activity exhibited during a manic episode. Moving rapidly from one activity to another is characteristic behavior during a manic episode. The other behaviors mentioned are not consistent with what occurs during a manic episode.

What are the best menu selections for lunch for a hyperactive patient during a manic episode? Select all that apply. a. Cherry pie b. Macaroni and cheese c. Chocolate chip cookies d. Tossed salad with ranch dressing e. Roast beef sandwich on whole-grain bread

C, E A hyperactive patient experiencing a manic episode is often too overactive to sit and eat, so the nurse must provide food that can be eaten out of hand while the patient walks around. A sandwich and cookies provide protein, carbohydrates, fat, and fiber.

A patient diagnosed with bipolar I disorder says, "I will lead the next group about medications. I have studied all the effects and problems with drugs on the Internet, so I can answer patients' questions." How should the nurse document this finding? a. Flight of ideas b. Distractibility c. Limit-testing d. Grandiosity

D Grandiosity is reflected when the individual makes statements that show an inflated sense of self-worth. Flight of ideas refers to rapidly shifting topics of conversation. Limit-testing refers to attempting to override the structure of the milieu. Distractibility refers to inability to maintain concentration when environmental stimuli shift.

A patient diagnosed with bipolar disorder is laughing and giddy one minute and seconds later is angry and sarcastic. How should the nurse document the patient's mood? a. Incongruent b. Inappropriate c. Blunted d. Labile

D Lability refers to rapid mood shifts, often seemingly without provocation. This is the only term that fits the description given in the scenario.

A medication teaching plan for a patient receiving lithium should include: a. directions to eat one or two bananas daily. b. dietary teaching to limit daily sodium intake. c. the need to restrict daily fluid intake to 1000 ml. d. the importance of laboratory testing to monitor the lithium level.

D Maintaining serum lithium levels within 0.6 and 1.2 mEq/L is vital to symptom control. The patient must be made aware that frequent monitoring will foster symptom control and prevent toxicity. The other options are inappropriate in a teaching plan.

30. A client thought to be cheeking medications is prescribed Lithium syrup 900 mg bid. The syrup contains 300 mg of lithium per 5 mL. At 0800, how many milliliters would the nurse administer? _____ mL.

The nurse would administer 15 mL.

7. The nurse is reviewing expected outcomes for a client diagnosed with bipolar I disorder. Number the outcomes presented in the order in which the nurse would address them. 1. _____ The client exhibits no evidence of physical injury. 2. _____ The client eats 70% of all finger foods offered. 3. _____ The client is able to access available out-patient resources. 4. _____ The client accepts responsibility for own behaviors.

The outcomes should be numbered as follows: 1, 2, 4, 3.

The physician orders lithium carbonate 600 mg tid for a newly diagnosed client with BP 1 disorder. There is a narrow margin between the therapeutic and toxic levels of lithium. Therapeutic range for acute mania is: a. 1.0 to 1.5 mEq/L b. 10 to 15 mEq/L c. 0.5 to 1.0 mEq/L d. 5 to 10 mEq/L

a. 1.0 to 1.5 mEq/L

Although historically lithium has been the drug of choice for mania, several other drugs have been used with good results. Which of the following are used in the treatment of bipolar disorder? (Select all that apply) a. Olanzepine/Zyprexa b. Paroxetine/Paxil c. Carbamazepine/Tegretol d. Gabapentin/Neurontin e. Tranylcypromine/Parnate

a. Olanzepine/Zyprexa c. Carbamazepine/Tegretol d. Gabapentin/Neurontin

Margaret, a 68-year-old widow, is brought to the emergency department by her sister-in-law. margaret has a history of bipolar disorder and has been maintained on medication for many years. Her sister-in-law reports that margaret quit taking her medication a few months ago, thinking she didn't need it anymore. She is agitated, pacing, demanding, and speaking ver loudly. Her sister-in-law reports that margaret eats little, is losing weight, and almost never sleeps: "I'm afraid she's going to just collapse!" Margaret is admitted to the psychiatric unit. The priority nursing diagnosis for margaret is: a. Imbalance nutrition: less than body requirement related to not eating b. Risk for injury related to hyperactivity c. Disturbed sleep pattern related to agitation d. Ineffective coping related to denial of depression

b. Risk for injury related to hyperactivity

A nurse is educating a client about his lithium therapy. She is explaining signs and symptoms of lithium toxicity. For which of the following would she instruct the client to be on the alert? a. Fever, sore throat, malaise b. Tinnitus, severe diarrhea, ataxia c. Occipital head ache, palpitations, chest pain d. Skin rash, marked rise in blood pressure, bradycardia

b. Tinnitus, severe diarrhea, ataxia

Margaret, a 68-year-old widow with bipolar mania, is admitted to the psychiatric unit after being brought to the ED by her sister in law. margaret yells, "My sister in law is just jealous of me! She's trying to make it look like I'm insane!" This behavior is an example of a delusion of: A. grandeur b. persecution c. reference d. control or influence

b. persecution

Margaret, age 68, is diagnosed with Bipolar Disorder, manic episode. She is extremely hyperactive and has lost weight. One way to promote adequate nutritional intake for margaret is to: a. Sit with her during meals to ensure that she eats everything on her tray b. haver her sister-in-law bring all her food from home because she knows her likes and dislikes c. Provide high-calorie, nutritious finger foods and snacks that she can eat 'on the run' d. Tell her that she will be on room restriction until she starts gaining weight

c. Provide high-calorie, nutritious finger foods and snacks that she can eat 'on the run'

A client diagnosed with bipolar mania enters the milieu area dressed in a provocative and physically revealing outfit. Which of the following is the most appropriate intervention by the nurse? a. Tell the client she cannot wear this outfit while she is in the hospital b. Do nothing and allow her to learn from the responses of her peers c. Quietly walk with her back to her room and help her change into something more appropriate d. Explain to her that, if she wears this outfit, she must remain in her room

c. Quietly walk with her back to her room and help her change into something more appropriate

A child with bipolar disorder also has attention-deficit/hyperactivity disorder (ADHD). How would these comorbid conditions most likely be treated? a. No medication would be given for either condition b. Medication would be given for both conditions simultaneously c. The bipolar condition would be stabilized first before medication for the ADHD would be given d. The ADHD would be treated before consideration of the bipolar disorder

c. The bipolar condition would be stabilized first before medication for the ADHD would be given

The most common comorbid condition in children with bipolar disorder is: a. Schizophrenia b. Substance disorders c. Oppositional defiant disorder d. Attention-deficit/hyperactivity disorder

d. Attention-deficit/hyperactivity disorder