Psych Chapter 20

Which sleep pattern is suggestive of a manic episode?

A client stays awake for several days and nights before "crashing" and sleeping for a long period.

A client with bipolar disorder has been ordered a medication that is classified as an anticonvulsant. Which drug does the nurse know falls within this class of medications?

Carbamazepine

The client with mania attempts to hit the nurse. Which is the best response by the nurse?

"Do not swing at me again. If you cannot control yourself, we will help you."

At 1 a.m., the client with mania rushes to the nurses' station and demands that the psychiatrist come to the unit now to write an order for a pass to go home. Which response by the nurse would be the most therapeutic?

"I can't call the psychiatrist now, but you and I can talk about your request for a pass."

A client is prescribed carbamazepine as part of the treatment plan for bipolar disorder. The nurse obtains a complete blood count and differential before initiating therapy. The nurse would instruct the client to return to the outpatient facility for repeat blood testing at which time?

1 month

A client with bipolar disorder is receiving lithium therapy. The nurse is reviewing the client's serum plasma drug levels and determines that the client's level is therapeutic based on what?

1.0 mEq/L

After educating a client with bipolar disorder on his prescribed lithium therapy, the nurse determines that additional education is needed when the client states which of the following?

"I need to cut back on my salt intake when it's really hot outside."

A nurse is reviewing information about medications used to treat bipolar disorders. The nurse demonstrates understanding by identifying which medication classification as effective in stabilizing moods in people with bipolar disorder?

Anticonvulsants

Which is an anticonvulsant used as a mood stabilizer?

Divalproex

Which behavior is the priority concern as the nurse begins a care plan for a client in the manic phase of bipolar disorder?

Hyperactivity, dismissing meals, and sleep disturbance

A client who has liver damage is receiving lithium for treatment of bipolar disorder. The nurse understands that which of the following may occur when the client is receiving lithium?

Increased plasma concentration

A nurse is working with a client diagnosed with bipolar disorder and his family on relapse prevention. Which information would the nurse encourage the family to include in their emergency plan? Select all that apply.

Information about other health problems List of emergency contacts Treatment preferences

Which of the following is the treatment setting of choice for persons who are severely psychotic?

Inpatient admission

Police officers bring a client to the mental health unit for admission. The client had been directing traffic on a busy city street, shouting rhymes such as "to work, you jerk, for perks" and making obscene gestures at cars that came close to the client. When the client's spouse is contacted at work, the spouse reports that the client stopped taking lithium 3 weeks ago and has not slept or eaten for 3 days. With which two features characteristic of the manic phase of bipolar disorder can the nurse identify?

Poor judgment and hyperactivity

A nurse is caring for a client diagnosed with bipolar disorder who has been prescribed divalproex. The nurse knows that the client should have which test completed before initiation of drug therapy?

Liver function

A patient with bipolar disorder is prescribed divalproex. Before initiating this therapy, which laboratory test would be most important for the nurse to obtain?

Liver function tests

A client with bipolar disorder takes lithium 300 mg 3 times daily. The nurse is educating the client on its use, side effects, and need for compliance. The nurse evaluates that the dose is appropriate when the client reports what?

Minimal mood swings.

Which medication classification is considered first-line drug therapy for bipolar disorder?

Mood stabilizers

A client with mania is in the dining room at lunchtime and is observed taking food from other clients' trays. The nurse's intervention should be based on which rationale?

Other clients need to be protected from the intrusive behavior.

A client is receiving lithium carbonate for the treatment of mania. The nurse would reinforce which teaching component regarding lithium treatment?

Schedule bloodwork for lithium levels.

A client with bipolar disorder has a plasma lithium concentration of 2.7 mE/L. Which finding would a nurse most likely assess in this client? Select all that apply.

Seizures Nystagmus Fasciculations

Administration of lithium affects which of the following electrolytes?

Sodium

A nurse is assessing a client who is brought to the emergency department. The nurse suspects that the client is experiencing mania. Which finding would support the nurse's suspicion? Select all that apply.

Statements of self-importance Flight of ideas Easily distractible

A concerned family member tells the nurse, "I am concerned about my sibling. My sibling has been acting very different lately." Knowing the family has a history of bipolar disorder, the nurse inquires further about this. Which behavior during the past week might indicate that the sibling has bipolar disorder?

Taking unnecessary risks

A client who has just been prescribed lithium for bipolar disorder is being given education from the nurse about this medication. Which is important for the nurse to include in teaching?

The higher the sodium level, the lower the lithium level will be.

A client with acute mania is prescribed lithium. During this time, the nurse would anticipate obtaining blood concentrations how often?

Twice weekly

A client taking lithium for bipolar disorder comes to the clinic and reports symptoms which the nurse interprets as consistent with moderate lithium toxicity. Which action should the nurse perform? Select all that apply.

Withhold additional doses of lithium. Obtain a blood sample for lithium level. Push fluids. Contact the physician.

The spouse of a client with bipolar disorder calls the nurse expressing distress about recent spending patterns of the client. The nurse suggests the spouse implement the limit-setting skills the spouse has learned in family therapy. In this instance, the nurse's action would be considered ...

appropriate; the spouse needs support in setting boundaries.

Which is a food that might be incorporated into the plan of care for a client diagnosed in the manic phase of bipolar disorder?

bananas

A client taking lithium for bipolar disorder is having mild diarrhea. The nurse informs the client that this is an example of what?

side effect