Question 1

A client asks the nurse whether the client needs to alter any of the client's activities because the client is taking lithium carbonate. Which response would be most appropriate?&#10;A) &#34;Increase your salt intake if an activity causes you to perspire heavily.&#34;&#10;B) &#34;Wear sunscreen when you are going to be outdoors in the summer.&#34;&#10;C) &#34;Drink less fluid than usual now that you are taking this drug.&#34;&#10;D) &#34;No changes are necessary for strenuous activities you do outdoors.&#34;

Accepted Answer

If body fluid decreases significantly because of a hot climate, strenuous exercise, vomiting, diarrhea, or a drastic reduction in fluid intake, then lithium levels can rise sharply, causing an increase in side effects with progression to lethal lithium toxicity. Clients should increase salt intake during periods of perspiration, increased exercise, and dehydration.

Question 2

A nurse is assessing a client with bipolar disorder who is experiencing mania. The client states, "I'm just so beautiful. Everyone just stops and stares at how gorgeous I am. People constantly want to have sex with me." The nurse interprets these statements as indicative of which type of mood?

A) Irritable
B) Elevated
C) Expansive
D) Euphoric

Expansive

Accepted Answer

The client's statements reflect an expansive mood, which is characterized by lack of restraint in expressing feelings, an overvalued sense of self-importance, and a constant and indiscriminate enthusiasm for interpersonal, sexual, or occupational interactions. An irritable mood is characterized by easy annoyance and provocation to anger, particularly when wishes are challenged or thwarted. An elevated mood can be expressed as euphoria (exaggerated feelings of well-being) or elation (feeling high), "ecstatic," "on top of the world," or "up in the clouds."

Question 3

A nurse is reviewing the medical record of a client diagnosed with bipolar disorder. The nurse would most likely expect to find a history of which condition?&#10;A) Panic disorder&#10;B) Schizophrenia&#10;C) Delusional disorder&#10;D) Posttraumatic stress disorder

Accepted Answer

The two most common comorbid conditions associated with bipolar disorder are anxiety disorders (panic disorder and social phobia are most prevalent) and substance use, most commonly alcohol and marijuana. Schizophrenia and delusional disorder are not associated comorbidities. Although posttraumatic stress disorder is an anxiety disorder, it is not as common as panic disorder and social phobia.

Question 4

A nurse is developing a presentation for families who have members diagnosed with bipolar disorders. When describing this condition to the group, which would the nurse most likely include?&#10;A) As the person ages, the episodes tend to decrease.&#10;B) Environmental stressors are a key cause of these disorders.&#10;C) The risk for suicide is high with either depression or mania.&#10;D) Risk-taking behaviors are more common during a depressive episode.

Accepted Answer

The risk of suicide is always present for those having a depressive or manic episode. During a depressive episode, the client may feel that life is not worth living. During a manic episode, the client may believe that he or she has supernatural powers, such as the ability to fly. As clients recover from a manic episode, they may be so devastated by the consequences of their impulsive behavior and poor judgment that suicide seems like the only option. Manic or depressive episodes tend to accelerate over time, with each episode leaving a trace and increasing the person's vulnerability (or sensitizing the person to have another episode with less stimulation). Environmental conditions contribute to the timing of an episode of the illness but are not a cause of the illness. During a manic episode, poor judgment and impulsivity lead to risk-taking behaviors.

Question 5

A client diagnosed with bipolar disorder is prescribed lithium. The nurse is reviewing the client's medication history for drugs that could interact with lithium. The nurse would monitor the client's serum lithium concentrations closely for toxicity if the client's history included use of which medication? Select all that apply.

A) Captopril
B) Fluoxetine
C) Hydrochlorothiazide
D) Mannitol
E) Isosorbide

Accepted Answer

Optimal blood concentrations seem to be in the range of 50 to 150 ng/mL. Thus, anything outside this range would indicate the need for a change in drug dosage.

Question 6

A client diagnosed with bipolar disorder is prescribed lithium. The nurse is reviewing the client's medication history for drugs that could interact with lithium. The nurse would monitor the client's serum lithium concentrations closely for toxicity if the client's history included use of which medication? Select all that apply.

A) Captopril
B) Fluoxetine
C) Hydrochlorothiazide
D) Mannitol
E) Isosorbide

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Accepted Answer

Lamotrigine has a boxed warning for skin rash, which should be reported immediately if it develops. In most cases, the rash is benign, but it is not possible to predict whether the rash is benign or serious (Stevens-Johnson syndrome). Blood testing is needed for other mood stabilizers, such as lithium, divalproex, and carbamazepine. Salt is a concern with lithium therapy. Liver function can be affected by carbamazepine.

Question 7

A nurse is preparing to administer medications to a client diagnosed with bipolar disorder who is experiencing acute mania. Which action would be most appropriate for the nurse to take?&#10;A) Tell the client firmly that medication compliance is vital.&#10;B) Allow the client to participate in the treatment decision.&#10;C) Restrain the client before administering the medication.&#10;D) Notify the primary care provider about the client's refusal of the medication.

Accepted Answer

Even during the most acute episodes, it is important for clients to have a sense of empowerment and participation in treatment. Therefore, the nurse would allow the client to participate in treatment decisions. Telling the client firmly that he or she must take the medication or restraining the client would be inappropriate. Notifying the primary care provider would be appropriate only if the client continued to refuse to take the medication after allowing her to participate in the decisions.

Question 8

A client who is prescribed lithium comes to the clinic for an evaluation. During the visit, the client reports a fine hand tremor. Which action by the nurse would be most appropriate?&#10;A) Immediately obtain a specimen to determine the client's blood drug concentration.&#10;B) Suggest that the client take the medication with meals or snacks.&#10;C) Assist the client in minimizing exposure to stressors.&#10;D) Encourage the client to elevate the affected hand on a pillow.

Accepted Answer

Fine hand tremor is a side effect of lithium therapy that can worsen with anxiety and intentional movement. Therefore, the nurse would provide support and reassurance, and encourage the client to minimize his or her exposure to stressors. The nurse would notify the prescriber if the tremor interferes with the client's work and if compliance will be an issue. There is no need to obtain a drug concentration because this tremor is not an indication of toxicity. Taking the medication with meals or snacks would be helpful if the client was experiencing diarrhea, nausea, or abdominal discomfort. Elevating the hand on a pillow would have no effect on the tremor. Elevating would be appropriate for edema of the hands or feet.

Question 9

A client's blood concentration of carbamazepine is increased. When reviewing the client's medication history, use of which medication would alert the nurse to a possible interaction?&#10;A) Phenobarbital&#10;B) Primidone&#10;C) Phenytoin&#10;D) Diltiazem

Accepted Answer

Diltiazem interacts with carbamazepine, causing increased carbamazepine concentrations. Phenobarbital, primidone, and phenytoin interact with carbamazepine, leading to decreased carbamazepine concentrations.

Question 10

A client diagnosed with bipolar disorder is prescribed lithium. The nurse is reviewing the client's medication history for drugs that could interact with lithium. The nurse would monitor the client's serum lithium concentrations closely for toxicity if the client's history included use of which medication? Select all that apply.

A) Captopril
B) Fluoxetine
C) Hydrochlorothiazide
D) Mannitol
E) Isosorbide

Accepted Answer

Emphasizing the recovery concept of hope will support the person who has had multiple episodes and is frustrated with the impact of several episodes. Recovery is promoted through engaging the client in partnership and empowering the person to make decisions in setting overall goals of care. Shared decision-making has been shown to improve outcomes.

Question 11

A client prescribed lithium therapy has a plasma blood concentration of 2.2 mEq/L. Which would the nurse expect to assess with moderate toxicity?&#10;A) Confusion&#10;B) Fine resting hand tremor&#10;C) Loose stools&#10;D) Muscular weakness

Accepted Answer

The answer of A client prescribed lithium therapy has a...

Question 12

When caring for a client who is demonstrating mania, which assessment would the nurse make?&#10;A) Unusual self-confidence&#10;B) Slow, repetitive speech&#10;C) Logical thinking&#10;D) Narrowed focus

Accepted Answer

The answer of When caring for a client who is...

Question 13

A client is exhibiting signs of a manic episode manifested by an elevated mood. Which expression would the nurse expect to assess?&#10;A) Feelings of being on top of the world&#10;B) Lack of restraint with feelings&#10;C) Overvalued sense of self-importance&#10;D) Indiscriminate enthusiasm for interactions

Accepted Answer

The answer of A client is exhibiting signs of a...

Question 14

After educating a class on the etiology of bipolar disorders, a nursing instructor determines that the education was successful when the class uses which description for the kindling theory?&#10;A) A dysregulation in the circadian rhythm, leading to sleep disturbance&#10;B) A single gene or sequence of genes causing pathologic changes&#10;C) Exposure to repetitive sub-threshold stressors at vulnerable times&#10;D) &#34;Wear and tear&#34; on the body from mood episodes leading to increased problems

Accepted Answer

The answer of After educating a class on the etiology...

Question 15

A client is prescribed lithium therapy as part of the treatment plan for bipolar disorder. When reviewing the client's medication history, which agents would alert the nurse to the possibility that a decrease in the lithium dosage may be needed? Select all that apply.

A) Lisinopril
B) Hydrochlorothiazide
C) Indomethacin
D) Caffeine
E) Aspirin

Accepted Answer

The answer of A client is prescribed lithium therapy as...

Question 16

A client is brought to the emergency department by a sibling. The client has a history of bipolar disorder and is prescribed valproate. The sibling reports the client took the medication about 2 hours ago and recently became very disoriented and agitated. The nurse suspects toxicity based on which assessment? Select all that apply.

A) Tachypnea
B) Bradycardia
C) Hypotension
D) Dizziness
E) Respiratory depression

Accepted Answer

The answer of A client is brought to the emergency...

Question 17

A client diagnosed with bipolar disorder is prescribed lithium. The nurse is reviewing the client's medication history for drugs that could interact with lithium. The nurse would monitor the client's serum lithium concentrations closely for toxicity if the client's history included use of which medication? Select all that apply.

A) Captopril
B) Fluoxetine
C) Hydrochlorothiazide
D) Mannitol
E) Isosorbide

Accepted Answer

The answer of A client diagnosed with bipolar disorder has...

Question 18

A nurse is preparing an education plan for the family members of a client who has been diagnosed with bipolar disorder. After teaching them about potential indicators for relapse, the nurse determines that the education was effective when the family members identify which indicator as suggesting mania? Select all that apply.

A) Avoiding people
B) Sleeping more than usual
C) Talking faster than usual
D) Being hungry all the time
E) Reading several books at once

Accepted Answer

The answer of A nurse is preparing an education plan...

Question 19

A client is diagnosed with bipolar I disorder. When assessing the client, the nurse would be alert for other signs of which comorbidities? Select all that apply.&#10;A) Panic disorder&#10;B) Social phobia&#10;C) Antisocial personality disorder&#10;D) Delirium&#10;E) Somatoform disorder

Accepted Answer

The answer of A client is diagnosed with bipolar I...

Question 20

A client diagnosed with bipolar disorder is prescribed lithium. The nurse is reviewing the client's medication history for drugs that could interact with lithium. The nurse would monitor the client's serum lithium concentrations closely for toxicity if the client's history included use of which medication? Select all that apply.

A) Captopril
B) Fluoxetine
C) Hydrochlorothiazide
D) Mannitol
E) Isosorbide

Accepted Answer

The answer of A client diagnosed with bipolar disorder is...

Deck 26: Bipolar Disorders: Nursing Care of Person With Mood Lability