psych exam 2

- crisis hotline - individual psychotherapy - support groups - family education groups

A client diagnosed with bipolar 1 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. a. financial and legal assistance b. crisis hotline. c. individual psychotherapy d. support groups e. family education groups

a. risk for violence: other-directed R/T poor impulse control

A newly admitted client diagnosed with bipolar I disorder is experiencing a mania episode. Which nursing diagnosis is a priority at this time? a. risk for violence: other-directed R/T poor impulse control b. altered thought process R/T hallucinations c. social isolation R/T manic excitement d. Low self-esteem R/T guilt about promiscuity

c. "The client has rapid-cycle bipolar disorder; it includes quickly changing moods."

The NA comments to the nurse about the recently admitted client with bipolar disorder. "I think the new admit is faking being ill. Yesterday the client didn't say a word, and today it's nonstop talking" Which response by the nurse is most helpful? a. "Thanks for letting me know. I think the client may be looking for attention." b. "It is more appropriate to refer to the client by name and not as the new admit." c. "The client has rapid-cycle bipolar disorder; it includes quickly changing moods." d. "Some people are quiet; the client has the right to decide when and when not to talk."

c. withhold the lithium dose and notify the HCP

The nurse assesses that the client with acute mania has coarse hand tremors, and the serum lithium level is 1.8 mEq/L. What should the nurse do? a. advise the client to limit the intake of fluids b. continue to administer lithium as prescribed c. withhold the lithium dose and notify the HCP d. request a medication to treat the hand tremors

b. the signs and symptoms of drug toxicity e. the need to consistently monitor blood levels f. the expected time frame for improvements in mood

The nurse is preparing discharge instructions for a client with bipolar disorder who has been prescribed lithium. Which information is most important for the nurse to provide to this client? Select all that apply. a. the potential for addiction b. the signs and symptoms of drug toxicity c. the risk for tardive dyskinesia d. the restrictions of a low-tyramine diet e. the need to consistently monitor blood levels f. the expected time frame for improvements in mood

c. "Pacing halls throughout the day" d. "Easily distracted, unable to focus on goals." e. "Exhibits poor impulse control"

Which of the following nursing charting entries is documentation of a behavior symptom of mania? Select all that apply. a. "Thoughts fragmented, flight of ideas noted" b. mood euphoric and expansive. Rates mood as 10/10. c. "Pacing halls throughout the day" d. "Easily distracted, unable to focus on goals." e. "Exhibits poor impulse control"

d. thoughtless spending

a client with bipolar disorder tells the nurse that he has suddenly stopped taking his medication. the nurse assesses the client. what finding would indicate a manic episode? a. binge eating b. relationship avoidance c. sudden relocation d. thoughtless spending

c. "I need to have my blood counts checked periodically."

a nurse is teaching a client whith bipoalr disorder about the drug carbamazepine. The nurse determines teaching was effective when the client states: a. "My hair will fall out after I take this drug for a few months" b. " I will drink plenty of water so I don't develop kidney problems" c. "I need to have my blood counts checked periodically." d. "I can't take any other drugs while I am taking this one."

c. irritable, with an elevated mood and increased motor activity

the nurse is assessing the behavior of a client with hypomania. What behavior would the nurse expect from this client? a. on the verge of depression and the potential for a crisis b. indecisive and vacillating, with a diminished ability to think c. irritable, with an elevated mood and increased motor activity d. disorganized, tending to exhibit impaired judgement

a. obtain medication for sleep

the nurse is developing a plan of care for a newly-admitted client with bipolar disorder. What is the most important for the nurse to include in this client's plan of care? a. obtain medication for sleep b. work on solving a problem c. exercise before bedtime d. develop a sleep ritual

b. the client's kidney function should be within normal parameters

the nurse is planning care for the client diagnosed with acute mania. What situation must occur prior to initiating treatment with lithium carbonate? a. the client must have been fasting for the past 12 hours b. the client's kidney function should be within normal parameters c. the client's behavior has not been controlled with room seclusion d. .benzodiazepine use has been discontinued in the client's treatment

d. persistent gastrointestinal upset

the nurse is providing discharge teaching for a client who will be taking lithium. Which condition would necessitate a call to the client's health care provider? a. development of black tongue b. increased lacrimation c. periods of excitability d. persistent gastrointestinal upset

d. the client with distinguish reality from delusions by day 6

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

c. give the client foods to be eaten while he's active

A client who is experiencing a manic episode has been admitted to an inpatient unit. The most important intervention to ensure adequate nutrition for this client would be to: a. determine the client's metabolic rate b. make the client sit down for each meal and snack c. give the client foods to be eaten while he's active d. have the client interact with a dietician twice a week

- chicken fingers and french fries - ham and cheese sandwich

A newly admitted client is experiencing a manic episode. The client's nursing diagnosis is imbalanced nutrition, less than body requirements. Which of the following meals are most appropriate for this client? Select all that apply. a. chicken fingers and french fries b. grilled chicken and baked potato c. spaghetti and meatballs d. .chili and crackers e. ham and cheese sandwich

b. "I need to watch for signs and symptoms of drug toxicity including blurred vision and ringing in the ears" e. "I will need to consistently monitor blood levels" f. " The therapeutic effect of the medication takes time to occur"

A nurse is caring for a client displaying extreme mood swings with suicidal tendencies. A physician prescribes lithium and diagnoses the client with bipolar disorder. When teaching the client, which statements, verbalized by the client indicate a good understanding of the teaching of medication management? Select all that apply. a. "I understand that there is a potential for addiction." b. "I need to watch for signs and symptoms of drug toxicity including blurred vision and ringing in the ears" c. "I will adjust me medication depending upon my symptoms." d. "I will need to be on a low-tyramine diet" e. "I will need to consistently monitor blood levels" f. " The therapeutic effect of the medication takes time to occur"

a. placing the nurse in the role of parent c. requesting personal information from the nurse e. stating information to try to shock the nurse f. violating the nurse's personal space

A nurse is caring for a client who exhibits behaviors that test the nurse-client relationship. When discussion this behavior at a multidisciplinary team conference, which behaviors would the nurse provide as examples of this behavior? Select all that apply. a. placing the nurse in the role of parent b. dressing in a flamboyant or seductive manner c. requesting personal information from the nurse d. following the contract establish between the nurse and client e. stating information to try to shock the nurse f. violating the nurse's personal space

1. 2. Uses relevant, calm speech patterns 2. 3. shows high productivity and competitive attitude in work and leisure activities 3. 1. Has delusions of grandeur 4. 4. becomes easily irritated 5. 5. demonstrates poor judgment and impulse control

A nurse is developing a care plan for a client with acute mania. Place the following behaviors according to the order in which they progress in a client with acute mania. 1. Has delusions of grandeur 2. Uses relevant, calm speech patterns 3. shows high productivity and competitive attitude in work and leisure activities 4. becomes easily irritated 5. demonstrates poor judgment and impulse control

a. client on one-to-one status because of active suicidal ideations

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

- the client may have been misdiagnosed and may have a bipolar disorder

The client on the mental health unit is diagnosed with a major depressive disorder and was started on an antidepressant two days ago. The nurse observes that two days ago the client appeared sad and remained in bed. Now the clients is awake at 4 a.m. and planning a unit party. Which conclusion should the nurse make regarding the client's change in behavior? - the client is responding positively to the antidepressant medications - treatment was effective, and the client plans on being discharge soon - the client is more familiar with the unit and is able to be self-expressive - the client may have been misdiagnosed and may have a bipolar disorder

b. provided finger goods that client can eat while moving around the unit.

The client recently admitted to a psychiatric unit is experiencing acute mania. Which intervention should the nurse include when developing the client's plan of care? a. initiate prolonged conversations to improve the client's concentration b. provided finger foods that client can eat while moving around the unit. c. teach the client and family about community resources that are available d. instruct the family to confront the client's angry behavior, or it will escalate

Lithium toxicity - normal levels are 0.6-1.2

The client with a bipolar disorder presents to the ED with impaired consciousness, nystamus, and seizures. Client is suffering from?

1. the client exhibits no evidence of physical injury 2. the client eats 70% of all finger foods offered 4. the client is able to access available out-patient resources 3. . the client accepts responsibility for own behaviors

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 accepts responsibility for own behaviors 4. the client is able to access available out-patient resources

d. "you are frightening people. we will walk down the hall to release some energy"

a client diagnosed with bipolar disorder becomes verbally aggressive during group therapy. The client states, "I hate all of you." Which response by the nurse is best? a. "you are behaving in an unacceptable manner." b. "if you continue to talk like that, I will dismiss you from the group." c. "other people are not comfortable with you statement. Please, stop it." d. "you are frightening people. we will walk down the hall to release some energy"

b. encourage the client to use an exercise bike

a client is experiencing a manic episode. it would be MOST appropriate for the nurse to perform which of the following interventions? a. give the client materials to make a collage b. encourage the client to use an exercise bike c. encourage the client to attend a group about managing feelings d. ask the client to play a board game with other clients

c. hypomania

a client with bipolar disorder is reporting insomnia, restlessness, and clouded thinking. The nurse understands that this client is most likely experiencing: a. depression b. cyclothymia c. hypomania d. mania

d. tell the client that it is inappropriate for clients to speak to any nurse that way

a client with bipolar disorder makes a sexually inappropriate comment to the nurse. The nurse should take which of the following actions? a. ignore the comment because the client has a mental health disorder and cannot help it. b. report the comment to the nurse manager. c. ignore the comment, but tell the incoming nurse to be aware of the client's propensity to make inappropriate comments d. tell the client that it is inappropriate for clients to speak to any nurse that way

a. use of lithium usually results in serious congenital problems

a client with bipolar disorder tells the nurse that she just found out she is pregnant, and is concerned because she takes lithium. What is the most important information for the nurse to provide to this client? a. use of lithium usually results in serious congenital problems b. thyroid problems can occur in the first trimester of the pregnancy c. lithium causes severe urine retention and increased risk of toxicity d. women who take lithium are very likely to have a spontaneous abortion

b. lithium levels demonstrate whether you are taking a therapeutic dose range or the drug

a client, who is taking lithium, asks the nurse why she has to have her blood drawn for a lithium level. What is the nurse's most appropriate response? a. lithium levels are obtained to determine if you have any liver or renal damage b. lithium levels demonstrate whether you are taking a therapeutic dose range or the drug c. lithium levels indicate whether the drug has passed through your blood-brain barrier d. lithium levels are unnecessary if you commit to taking the drug as ordered

b. focus and redirect the conversation as necessary

the nurse needs to communicate with a client experiencing mania. How should the nurse address this client? a. in a light and joking manner b. focus and redirect the conversation as necessary c. allow the client to talk about several different topics d. ask only open-ended questions to facilitate conversation

d. if the intake of sodium increase, the lithium level with decrease

what is the most important information for the nurse to include when providing nutritional counseling for family members of a client with bipolar disorder? a. it sufficient roughage isn't eaten while taking lithium, bowl problems with occur b. if the intake of carbohydrates increases, the lithium level will increase c. in the intake of calories is reduced, the lithium level with increase d. if the intake of sodium increase, the lithium level with decrease