MH Module 4 Bipolar Spectrum Disorders

A patient diagnosed with Bipolar Disorder is hyperactive and manic after discontinuing Lithium. The patient threatens to hit another patient. Which comment by the nurse is appropriate? "Stop that! No one did anything to provoke an attack by you." "If you do that one more time, you will be secluded immediately." "Do not hit anyone. If you're unable to control yourself, we'll help you." "You know we will not let you hit anyone. Why do you continue this behavior?"

"Do not hit anyone. If you're unable to control yourself, we'll help you."

A person was directing traffic on a busy street rapidly shouting, "To work, you jerk, for perks" and making obscene gestures at cars. The person has not slept or eaten for 3 days. Which assessment finding will have priority concern for this patient's plan of care? A. Insulting, aggressive behavior B. Pressured speech and grandiosity C. Hyperactivity; not eating and sleeping D.Poor concentration and decision making

Hyperactivity; not eating and sleeping

Stevens-Johnson Syndrome is a severe and potentially fatal syndrome that is indicated by a rash and flu-like symptoms. It sometimes is caused by which medication? Clozaril (clozapine) Geodon (ziprasidone) Lamotrigine (lamictal) Neurontin (gabapentin)

Lamotrigine (lamictal)

A patient has been diagnosed as having mania. The nurse anticipates that the physician will most likely prescribe: Klonopin (clonazepam) Ativan (lorazepam) Tofranil (imipramine) Lithium

Lithium

A person is directing traffic on a busy street and making obscene gestures at passing cars. The individual has not eaten or slept for three days. What features of mania are evident? Increased muscle tension and anxiety Vegetative signs and poor grooming Poor judgment and hyperactivity Cognitive deficit and sad mood

Poor judgment and hyperactivity

A female patient is under evaluation for imminent suicide risk. Which information given by her would be most significant? At least a two-year history of feeling depressed more days than not Divorced from spouse six months ago Feeling loss of energy and appetite Reference to suicide as the best solution to her problems

Reference to suicide as the best solution to her problems

Wandering off topic and eventually getting back to the original topic

Tangential thinking

A patient experiencing acute mania is dancing atop the pool table in the recreation room. The patient waves a cue in one hand and says, "I'll throw the pool balls if anyone comes near me!" The nurse's first intervention is to: Tell the patient, "You need to be secluded." Help the patient down from the table Clear the room of all other patients Ignore the behavior

Clear the room of all other patients

When a hyperactive patient diagnosed with acute mania is hospitalized, what is the initial nursing intervention? Allow the patient to ventilate and express self Provide verbal direction to the client to set limits of patient behavior as necessary remain calm Restrain the patient to reduce hyperactivity and aggression.

Provide verbal direction to the client to set limits of patient behavior as necessary

Which statement by a patient demonstrates an understanding of the effective use of Lithium to manage bipolar mania? Select all that apply. "I have to keep reminding myself to consistently drink six 12-ounce glasses of fluid every day." "I discussed with my psychiatric care provider the diuretic my cardiologist prescribed." "Lithium may help me lose the extra pounds I tend to carry around." "I take my Lithium on an empty stomach to help with absorption." "I've already made arrangements for my monthly lab work."

"I have to keep reminding myself to consistently drink six 12-ounce glasses of fluid every day." "I discussed with my psychiatric care provider the diuretic my cardiologist prescribed." "I've already made arrangements for my monthly lab work."

A 33-year-old female diagnosed with Bipolar Disorder Type I has been functioning well on Lithium for 11 months. At her last checkup the psychiatric nurse practitioner states, "You're ready now to enter maintenance therapy stage, so at this time I'm going to adjust your dosage by prescribing": A higher dosage Once-a-week dosing A lower dosage A different medication

A lower dosage

After the nurse administers Haldol 5mg PO to a client with acute mania, the client refuses to lie down on her bed, runs out on the unit, pushes other clients out of the way, and screams threatening remarks to the staff. Which of the following should the nurse do next? A. Follow the client and ask her to calm down B. Tell the client to lie down on the sofa in the day room C. Seclude the client and use restraints if necessary D. Tell the patients and staff to ignore the client

A. Follow the client and ask her to calm down

Which suggestions are appropriate for the family of a patient diagnosed with bipolar disorder who is being treated as an outpatient during a hypomanic episode? Select all that apply: A. Limit credit card access B. Provide a structured environment C. Encourage group social interaction D. Monitor the patient's sleep patterns E. Give the antianxiety agent leftover from last hypomanic episode

A. Limit credit card access B. Provide a structured environment D. Monitor the patient's sleep patterns

Which nursing response demonstrates accurate information that should be discussed with a female patient diagnosed with Bipolar Disorder and with her support system. Select all that apply. A."Remember that alcohol and caffeine can trigger a relapse of your symptoms." B. "Due to the risk of a manic episode, antidepressant therapy is never used with Bipolar Disorder." 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. "Because symptoms tend to come and go, you need to be able to recognize the early signs."

A."Remember that alcohol and 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. "Because symptoms tend to come and go, you need to be able to recognize the early signs."

A patient with bipolar disorder was hospitalized 7 days ago and has been taking lithium 600 mg tid. Staff observes increased agitation, pressured speech, poor personal hygiene and hyperactivity. Which action demonstrates that the nurse understands the most likely cause of the patient's behavior? A. Educate the patient about the proper ways to perform personal hygiene and coordinate clothing. B. Continue to monitor and document the patient's speech patterns and motor activity. C. Ask the health care provider to prescribe an increased dose of lithium. D. Consider the need to check the lithium level. The patient may not be swallowing the meds.

Consider the need to check the lithium level. The patient may not be swallowing the meds.

Hypomania with mild to moderate depression

Cyclothymic Disorder

False ideas not based on reality

Delusion

Mood-congruent psychotic features in depressed patients may include all but: Nihilistic delusions Delusion of guilt Delusion of poverty Delusion of grandeur

Delusion of grandeur

Speech pattern with rapid transition from topic to topic

Flight of ideas (occurs frequently during manic phase)

Exaggerated sense of one's importance/power

Grandiosity

A patient diagnosed with Bipolar Disorder has rapid cycles. The health care provider prescribes an anticonvulsant. To prepare teaching materials, which drug should the nurse anticipate will be prescribed? Dilantin (phenytoin) Catapres (clonidine) Tegretol (carbamazepine) Thorazine (chlorpromazine)

Tegretol (carbamazepine)

Substance abuse is often present in people diagnosed with bipolar disorder. A 28-year-old female with a diagnosis of Bipolar Disorder drinks alcohol instead of taking her prescribed medications. A nurse caring for this patient would recognize that: Anxiety may be present. Alcohol ingestion is a form of self-medication. The patient lacks a sufficient number of neurotransmitters. The patient is using alcohol because she is depressed.

Alcohol ingestion is a form of self-medication.

A patient is admitted to the hospital with a diagnosis of Bipolar Disorder. He has been taking Lithium for several years, but it is no longer effective in managing his acute manic episodes. Which type of medication is likely to be prescribed now? Antianxiety Antiparkinson Antidepressant Anticonvulsant

Anticonvulsant

A patient experiencing acute mania has disrobed in the hall three times in two hours. The nurse should: Direct the patient to wear clothes at all times Ask if the patient finds clothes to be bothersome Tell the patient that others feel embarrassed Arrange for one-on-one supervision

Arrange for one-on-one supervision

A female patient has been admitted following an acute manic episode. The admitting nurse suspects Lithium toxicity. What assessment findings would confirm the nurse's suspicion? Shortness of breath, gastrointestinal distress, chronic cough Ataxia, severe hypotension, large volume of dilute urine Gastrointestinal distress, thirst, nystagmus Electroencephalographic changes, chest pain, dizziness2

Ataxia, severe hypotension, large volume of dilute urine

An outpatient with bipolar disorder is prescribed lithium. The patient telephones the nurse to say, "I've had severe diarrhea for 4 days. I feel very weak and unsteady when I walk. My usual hand tremor has gotten worse. What should I do?" The nurse will advise the patient to: A. Restrict food and fluids for 24 hours and rest. B. Have someone bring the client to the clinic immediately. C. Drink a large glass of water with 1 teaspoon salt and see if that helps the symptoms. D. Take one dose of OTC antidiarrheal medication now and call back in 3 hours.

B. Have someone bring the client to the clinic immediately.

Which is the most severe form of Bipolar Disorder? Bipolar Disorder Type I Bipolar Disorder Type II Cyclothymia Mixed episodes

Bipolar Disorder Type I

Full blown mania with severe depression

Bipolar I

Lower level mania alternating with serious depression is what?

Bipolar II

A patient develops mania after discontinuing lithium. New medications are written to resume lithium twice daily and begin Zyprexa (olanzapine). The addition of olanzapine to the medication regimen will: Minimize the side effects of lithium Bring hyperactivity under rapid control Enhance the antimanic actions of Lithium Provide long-term control of hyperactivity

Bring hyperactivity under rapid control

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: A. Place the client on one to one observation to prevent injury B. Ask the physician for a psychiatric consultation C. Assess vital signs, and complete a physical assessment D. Reinforce relaxation techniques to decrease anxiety

C. Assess vital signs, and complete a physical assessment Rationale: Since the stem of the question does not indicate the patient has bipolar mania, it is not known what is causing the irritability and other symptoms. We would answer A. if there were indicates the patient was harm to self or others.

The primary health care provider prescribes a serum lithium level tomorrow for a client receiving lithium 300 mg PO three times daily for the past 5 days. At which of the following times should the nurse plan to have the blood specimen obtained? (Ideally blood work for lithium levels is 10-14 hours after last dose). A. Before bedtime B. After lunch C. Before breakfast D. During the afternoon

C. Before breakfast

A nurse prepares to lead a psycho-educational group for patients who take anticonvulsants to manage bipolar disorder. The nurse should invite patients who take which drugs? Select all that apply: A. Lithium B. Aripiprazole (Abilify) C. Lamotrigine (Lamictal) D. Carbamazepine (Tegretol) E. lorazepam (Ativan)

C. Lamotrigine (Lamictal) D. Carbamazepine (Tegretol)

Which nursing chart entry is documentation of a behavioral symptom of mania? A. Thoughts fragmented, flight of ideas noted B. Mood euphoric and expansive; Rates mood a 10/10 C. Pacing halls throughout the day. Exhibits poor impulse control D. Easily distracted, unable to focus on goals

C. Pacing halls throughout the day. Exhibits poor impulse control

Giving all manner of extraneous detail when answering a simple question

Circumstantial thinking

A patient who has been on Depakote (valproate) for bipolar disorder for two weeks continues to be manic. The serum valproate level is 25 mcg/mL. Which of the following applies? This is below the therapeutic range, so the dose needs to be increased. This is a potentially toxic level, and the medication should be stopped immediately. This within the therapeutic range, but it may take up to two more weeks for the patient to fully respond, so the medication will be continued at current dose. This is above the therapeutic range for bipolar disorder, so the patient is nonresponsive to this medication and will need to be changed to a different medication.

This is below the therapeutic range, so the dose needs to be increased.

A manic patient announces to everyone in the dayroom that a stripper is coming to perform this evening. When the nurse firmly states that this will not happen, the manic patient becomes verbally abusive and threatens the nurse with physical violence. The most appropriate action by the nurse would be: With assistance, escort the manic patient to his/her room and offer Haldol (haloperidol) Tell the patient that smoking privileges are revoked for 24 hours Orient the client to time, person, and place Tell the client that the behavior is not appropriate

With assistance, escort the manic patient to his/her room and offer Haldol (haloperidol)

A nurse is planning activities for a patient who has Bipolar Disorder with aggressive social behavior. Which activity would be most appropriate for this patient? Ping Pong Writing Chess Shooting baskets

Writing

A patient with acute mania has disrobed in the hall three times in 2 hours. The nurse should: A. direct the patient to wear clothes at all times. B. ask if the patient finds clothes bothersome. C. tell the patient that others feel embarrassed. D. arrange for one-on-one supervision.

arrange for one-on-one supervision.

A patient with rapid-cycling bipolar disorder is not responding to lithium therapy. At the next multidisciplinary team meeting, the nurse should point out that many rapid-cycling patients have been effectively treated using: A. sertraline (Zoloft). B. phenytoin (Dilantin). C. benztropine (Cogentin). D. divalproex (Depakote).

divalproex (Depakote).