Question 1

A hyperactive, aggressive patient diagnosed with bipolar disorder threatens to physically assault another patient. What initial nursing intervention should be implemented?

Accepted Answer

Providing firm verbal limits is the initial nursing intervention as it can help to de-escalate the situation and prevent physical assault. It is important to set clear boundaries and communicate consequences for aggressive behavior. Seclusion should only be used as a last resort if the patient continues to pose a threat to others or themselves. Asking why the patient is angry or distracting them with activities may not address the immediate safety concern.

Question 2

A newly admitted patient experiencing a manic episode is verbally and physically aggressive. The plan for care should include which interventions to minimize the risk of injury and manage the milieu effectively?

Accepted Answer

Setting clear limits on aggressive behavior can help protect staff and other patients from harm. Providing a quiet environment can help reduce stimulation that can exacerbate the manic episode. Limiting activities can also help reduce stimulation and provide structure to the patient's day.

Question 3

A medication teaching plan for a patient receiving lithium should include which instruction?

Accepted Answer

Lithium is a medication used to treat bipolar disorder, and it works by changing the levels of certain chemicals in the brain. Lithium levels in the blood have to be monitored regularly, and compliance with scheduled laboratory testing is essential for a patient receiving lithium. Eating bananas or limiting sodium intake is not specifically related to lithium therapy, and restricting fluid intake to 1000 mL would not be appropriate, as adequate hydration is important for overall health.

Question 4

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?

Accepted Answer

The patient's mood is rapidly shifting from one extreme to another, indicating mood instability, which is described as labile. Incongruent mood refers to a mood that doesn't correspond to the situation, inappropriate mood is not suitable to the situation, and blunted mood refers to a lack of emotion.

Question 5

A patient has been diagnosed with cyclothymic disorder. Which assessment data provided by the patient support this diagnosis? (Select all that apply.)

Accepted Answer

Cyclothymic disorder is a milder form of bipolar disorder, characterized by fluctuating mood swings that alternate between hypomania and depression. Option A is correct because patients with cyclothymic disorder experience hypomanic episodes. Option B is correct because the symptoms of cyclothymic disorder last for at least two years in adults and one year in children and adolescents, and the patient's symptoms have been present for four years. Option C is incorrect because patients with cyclothymic disorder do not typically require hospitalization, as their symptoms are not severe enough to warrant this level of care. Option D is incorrect because seasonality is not typically associated with cyclothymic disorder. Option E is correct because patients with cyclothymic disorder experience periods of mild to moderate depression.

Question 6

A nurse presents a psychoeducational program to patients diagnosed with bipolar disorder and their families. Information about which collection of signs associated with an impending relapse of mania should be included?

Accepted Answer

Sleep disturbances and racing thoughts are common signs associated with an impending relapse of mania. Patients with bipolar disorder may require education regarding recognizing these signs as an early warning of a manic episode, and seeking help immediately to prevent a full-blown episode from occurring. The other signs listed may also be present in individuals with bipolar disorder, but they are not typically associated with the early stages of a manic episode.

Question 7

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?

Accepted Answer

Interrupting the patient by stating the need to take vital signs is a direct yet respectful approach that allows the nurse to perform the necessary assessment without escalating the situation or waiting indefinitely for the patient to become quieter.

Question 8

A nurse assesses a new patient experiencing a manic episode. Which behavior is most likely to have occurred before hospitalization?

Accepted Answer

Going rapidly from one activity to another is a common symptom of a manic episode. This behavior is often seen as impulsive and may have led to the need for hospitalization due to the increased risk of harm to the individual. The other options do not necessarily indicate a manic episode.

Question 9

During community lunch, a manic patient tells another patient, "Push yourself away from the table. You're too fat for your own good!" Which intervention demonstrates the nurse's best ability to manage the milieu?

Accepted Answer

Option C demonstrates the nurse's ability to manage the milieu by calmly setting limits while also acknowledging the rule that insulting others is not permitted. This approach helps to maintain a therapeutic environment and encourages appropriate behavior without resorting to punishment or ignoring the behavior altogether. Option A involves giving the patient an ultimatum, which may not be effective in changing behavior in the long-term, while option B is too harsh and does not allow the patient to learn from their mistake. Option D is not recommended as it may reinforce the behavior by not addressing it.

Question 10

Which principle is most useful and effective when interacting with a patient experiencing a manic episode?

Accepted Answer

When interacting with a patient experiencing a manic episode, it is important to use a calm, matter-of-fact approach. This can help to reduce the patient's agitation and prevent escalation of their behavior. Encouraging the patient to freely express their feelings, not interrupting them, or frequently using silence may not be as effective in managing their manic symptoms.

Question 11

A nurse presents a psychoeducational program to patients diagnosed with bipolar disorder and their families. Information about which collection of signs associated with an impending relapse of depressive episode should be included?

Accepted Answer

C) Decreased libido, anhedonia (loss of interest or pleasure in almost all activities), and inertia (lack of energy or motivation) are classic signs of a depressive episode, which can indicate an impending relapse in patients with bipolar disorder.

Question 12

Which indicator of disordered communication is the nurse most likely to assess in a patient having a manic episode?

Accepted Answer

Flight of ideas is a common sign of disordered communication in patients with manic episodes. It is characterized by a rapid shift in conversation topics and ideas, and can be difficult for others to understand and follow. Loose associations may also be present, but are less specific to manic episodes and can be seen in other disorders such as schizophrenia. Echolalia involves repeating words or phrases spoken by others, and mutism refers to a complete lack of speech, neither of which are typically associated with manic episodes.

Question 13

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.)

Accepted Answer

Manic behavior can be influenced by metabolic imbalances, substance use, and thyroid dysfunction. Elevated calcium levels can cause psychiatric symptoms, including mania. Drug screens are essential to rule out substance-induced mania. Thyroid function tests are critical since hyperthyroidism can present with symptoms similar to mania.

Question 14

A patient offers to lead the next medication group session stating, "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?

Accepted Answer

This behavior is an example of grandiosity, where the patient overestimates their ability or knowledge, in this case, believing they are qualified to lead a medication group session based on internet research.

Question 15

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.)

Accepted Answer

Passivity, psychomotor retardation, and preoccupation with death are common depressive symptoms in bipolar disorder. Aggression and hyperactivity are more commonly associated with manic episodes.

Question 16

Within a 15-minute period, a patient having a manic episode states, "Dinner was cold and the solarium is too hot. I have a sore throat and there is no clean towel for my shower." What action should the nurse take to address the patient's concerns?

Accepted Answer

The nurse should first assess the patient's sore throat to determine if further intervention is needed. Additionally, showing the patient where clean linen is stored can help address the concern about the lack of towels. The other options do not directly address the patient's concerns and do not provide immediate solutions.

Question 17

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 to address the spouse's concern?

Accepted Answer

Directing the couple to seek genetic counseling is the most appropriate action as it can provide them with information about the risk of passing on bipolar disorder to their children and help them make informed decisions about family planning. The nurse may also offer educational resources about bipolar disorder and its heritability as a supplement to genetic counseling. Encouraging adoption or discussing options with a spiritual advisor may not fully address the couple's concerns about passing on bipolar disorder, and educating the spouse about environmental determinants alone may not fully address the genetic aspects of the disorder.

Question 18

What are the best menu selections for lunch for a hyperactive patient during a manic episode? (Select all that apply.)

Accepted Answer

It is important for a hyperactive patient during a manic episode to consume foods that are high in protein, fiber, and complex carbohydrates which can promote stable blood sugar levels and reduce mood swings. A banana and a roast beef sandwich on whole-grain bread are good choices because they provide a combination of protein, fiber, and complex carbohydrates. Cherry pie and macaroni and cheese are not recommended as they are high in sugar and simple carbohydrates which can cause a spike in blood sugar levels and worsen mood swings. The tossed salad with ranch dressing may also not be the best choice as the dressing can be high in fat and calories, and the salad alone may not provide enough sustenance for a hyperactive patient during a manic episode.

Quiz 26: Bipolar Disorders