Question 1

A client diagnosed with bipolar I disorder is exhibiting severe manic behaviors. A physician prescribes lithium carbonate (Eskalith) and olanzapine (Zyprexa). The client's spouse questions the Zyprexa order. Which is the appropriate nursing reply?

Accepted Answer

Olanzapine (Zyprexa) is an atypical antipsychotic medication that can help to control manic symptoms, including hyperactivity and aggression. It is often used in combination with a mood stabilizer like lithium carbonate (Eskalith). The combination of these medications helps to calm manic symptoms quickly while the lithium takes a longer time to become effective. It is not used to cure manic symptoms, prevent extrapyramidal side effects, or ensure a good night's sleep.

Question 2

After teaching a client about lithium carbonate (Lithane), which client statement would indicate to the nurse that teaching has been successful?

Accepted Answer

This statement shows that the client understands the potential side effects of Lithane and when to seek medical attention if they occur. A is incorrect because Lithane typically takes several weeks to be effective. C is incorrect because doubling the dose is not safe and can lead to lithium toxicity. D is incorrect because while excessive salt intake can interfere with Lithane's effectiveness, clients should not restrict their salt intake but should maintain a consistent level of salt in their diet.

Question 3

A client is diagnosed with bipolar disorder: manic phase. Which nursing intervention would be implemented to achieve the outcome of "Client will gain 2 lbs by the end of the week?"

Accepted Answer

During the manic phase of bipolar disorder, the client may have decreased appetite and increased activity levels, which can lead to weight loss. Providing high-calorie finger foods throughout the day can help increase the client's calorie intake and promote weight gain. Accompanying the client to the cafeteria and initiating total parenteral nutrition may not be necessary interventions at this time. Teaching the importance of a varied diet may be appropriate but may not directly address the desired outcome of weight gain.

Question 4

A client diagnosed with bipolar disorder, who has taken lithium carbonate (Lithane) for 1 year, presents in an emergency department with severe diarrhea, blurred vision, and tinnitus. How should the nurse interpret these symptoms?

Accepted Answer

The symptoms of severe diarrhea, blurred vision, and tinnitus are indicative of lithium toxicity. The client should be evaluated for blood levels of lithium and treated accordingly to prevent further complications.

Question 5

A nursing instructor is teaching about the prevalence of bipolar disorder. Which student statement indicates that learning has occurred?

Accepted Answer

Bipolar disorder is more prevalent in higher socioeconomic groups, as studies have shown a correlation between higher socioeconomic status and the prevalence of this disorder.

Question 6

A client diagnosed with bipolar disorder: depressive phase intentionally overdoses on sertraline (Zoloft). Family reports that the client has experienced anorexia, insomnia, and recent job loss. What should be the priority nursing diagnosis for this client?

Accepted Answer

The client's intentional overdose and reported symptoms of anorexia and insomnia suggest a high risk for suicide. The nursing diagnosis of Risk for Suicide R/T hopelessness should be the priority to address the immediate safety and well-being of the client.

Question 7

A newly admitted client is experiencing the manic phase of bipolar I disorder. The nurse should assign which priority nursing diagnosis to this client?

Accepted Answer

The priority nursing diagnosis for a client in the manic phase of bipolar I disorder is always safety. A client experiencing mania may exhibit agitation, hyperactivity, and irritability, which can all lead to violent behavior directed towards self or others. The nurse must assess for potential safety risks and intervene accordingly to prevent harm to the client or others.

Question 8

A nurse is planning care for a client diagnosed with bipolar disorder: manic phase. In which order should the nurse prioritize the listed client outcomes? 
Client Outcomes:
1. Maintains nutritional status.
2. Interacts appropriately with peers.
3. Remains free from injury.
4. Sleeps 6 to 8 hours a night.

Accepted Answer

During the manic phase of bipolar disorder, the priority is to ensure the client remains safe and free from injury (3). This is followed by maintaining their nutritional status (1) and ensuring they are able to sleep 6 to 8 hours a night (4). Interacting appropriately with peers (2) is important; however, it is not as high a priority as safety and basic physiological needs.

Question 9

A client diagnosed with bipolar disorder weighs 220 lb. A physician orders lamotrigine (Lamictal) 10 mg/kg/day to a maximum of 400 mg/day for mood stabilization. Which is a true statement about this medication order?

Accepted Answer

The client's weight is 220 lb, which is approximately 100 kg. The ordered dosage is 10 mg/kg/day, which equals 1000 mg/day. This exceeds the maximum recommended dosage of 400 mg/day, making it more than twice the recommended dosage range.

Question 10

A client who has been diagnosed with bipolar I disorder states, "God has taught me how to decode the Bible." A nurse should anticipate that which combination of medications would be ordered to address this client's symptoms?

Accepted Answer

The client's statement suggests that they may be experiencing symptoms of mania/hypomania, which is common in bipolar I disorder. Lithium carbonate is a mood stabilizer frequently used to address mania and risperidone is an atypical antipsychotic that can be used to treat both manic and depressive symptoms in bipolar disorder. This combination of medications would be an appropriate choice to address the client's symptoms. It is important to note that medication choices for bipolar disorder should be tailored to each individual's specific symptoms and needs, and may require adjustments over time.

Question 11

A highly agitated client paces the unit and states, "I could buy and sell this place." The client's mood fluctuates from fits of laughter to outbursts of anger. Which is the most accurate documentation of this client's behavior?

Accepted Answer

The client is exhibiting behaviors of grandiosity and mood lability, as seen in their statement of being able to "buy and sell this place" and the fluctuation between fits of laughter and outbursts of anger. The documentation should accurately describe these behaviors, which option D does. Options A, B, and C do not fully capture the client's behavior.

Question 12

A client is diagnosed with bipolar disorder and admitted to an inpatient psychiatric unit. Which is the priority outcome for this client?

Accepted Answer

Safety is the priority outcome for a client with bipolar disorder who is admitted to an inpatient psychiatric unit. Bipolar disorder can cause symptoms that put the client at risk for harm to themselves or others, and ensuring their safety is of utmost importance during their hospitalization. While the other options are important outcomes to work towards, they are not the immediate priority.

Question 13

A client began taking lithium for the treatment of bipolar disorder approximately 1 month ago. The client asks if it is normal to have gained 12 pounds in this time frame. Which is the appropriate nursing reply?

Accepted Answer

Weight gain is a known side effect of lithium, and it can be troubling for some clients. It is important for the nurse to acknowledge the client's concerns and discuss potential strategies to manage the weight gain, such as diet and exercise. Option A is incorrect because weight gain is a potential side effect of lithium. Option B is incorrect because it could be perceived as blaming the client for the weight gain. Option D is incorrect because weight gain can occur beyond the first month of treatment.

Question 14

A nurse begins the intake assessment of a client diagnosed with bipolar I disorder. The client shouts, "You can't do this to me. Do you know who I am?" Which is the priority nursing action in this situation?

Accepted Answer

The priority nursing action is to ensure that both the nurse and the client are in a safe environment. The client's behavior is unpredictable and may become aggressive, so the nurse needs to take necessary measures to provide a safe environment. Once safety is assured, the nurse can then proceed with the assessment and potentially redirect the client to the needed information or reorient them to the situation. Meeting nutritional needs is important but does not take priority in this situation.

Question 15

A nursing instructor is discussing various challenges in the treatment of clients diagnosed with bipolar disorder. Which student statement demonstrates an understanding of the most critical challenge in the care of these clients?

Accepted Answer

Non-adherence to medication is a critical challenge in treating clients with bipolar disorder as it can lead to relapse, recurrence of symptoms, hospitalizations, and even suicide. Clients with bipolar disorder may experience mood swings that can make them feel better or worse, and this can lead them to stop taking medications. It is essential to educate clients and their families about the importance of medication adherence and provide regular follow-up and support to ensure that they continue to take their medications as prescribed.

Question 16

A client diagnosed with bipolar I disorder: manic episode refuses to take lithium carbonate due to excessive weight gain. In order to increase compliance, which medication should a nurse anticipate that a physician would prescribe?

Accepted Answer

Valproic acid (Depakote) is a mood stabilizer medication that is commonly prescribed for bipolar disorder, and it is often well-tolerated in patients who cannot take lithium due to side effects such as weight gain. Valproic acid may also be effective in treating manic episodes and preventing future episodes. The other medications listed are not appropriate choices for bipolar disorder, and may even exacerbate symptoms or increase the risk of mania.

Question 17

A client has been taking lithium for several years with good symptom control. The client presents in the emergency department with blurred vision, tinnitus, and severe diarrhea. The nurse should correlate these symptoms with which lithium level?

Accepted Answer

The therapeutic level of lithium carbonate is 1.0 to 1.5 mEq/L for acute mania and 0.6 to 1.2 mEq/L for maintenance therapy.There is a narrow margin between the therapeutic and toxic levels.The symptoms presented in the question can be correlated with a lithium level of 1.7 mEq/L.Levels of 2.3 mEq/L and 3.7 mEq/L would produce more extreme symptoms of intensified toxicity,eventually leading to death.

Question 18

A client is diagnosed with cyclothymic disorder. What client behaviors should the nurse expect to assess?

Accepted Answer

Cyclothymic disorder is characterized by periods of hypomanic and depressive symptoms that do not meet the criteria for a full manic or depressive episode. These periods must last for at least 2 years in order to fit the diagnosis. Option A is more indicative of major depressive disorder, option C suggests persistent depressive disorder, and option D describes bipolar disorder.

Question 19

What tool should a nurse use to differentiate occasional spontaneous behaviors of children from behaviors associated with bipolar disorder?

Accepted Answer

The "FIND" tool (Fostering Healthy Interactions with Novel Developmental Strides) is a screening tool specifically designed to differentiate occasional spontaneous behaviors of children from behaviors associated with bipolar disorder. It assesses behaviors along four domains: affective instability, behavioral impulsivity, sensory sensitivity, and hyperarousal. By using this tool, a nurse can better identify whether a child's behavior is within expected developmental norms or indicative of a mood disorder. The other options listed are not relevant tools for this purpose.

Question 20

A client diagnosed with bipolar disorder is distraught over insomnia experienced over the last 3 nights and a 12-pound weight loss over the past 2 weeks. Which should be this client's priority nursing diagnosis?

Accepted Answer

The priority nursing diagnosis for this client should be Altered nutrition: less than body requirements related to hyperactivity and weight loss. This is because the client has lost 12 pounds in the past 2 weeks and is experiencing hyperactivity, which may be contributing to the weight loss. Insomnia and concern about symptoms may be important, but they do not pose an immediate threat to the client's health and safety like altered nutrition does. Risk for suicide is also a concern but is not the priority in this particular case. Altered sleep patterns should be addressed but are not the priority.

Quiz 28: Mood Disorders: Bipolar Disorder

A client diagnosed with bipolar I disorder is exhibiting severe manic behaviors. A physician prescribes lithium carbonate (Eskalith) and olanzapine (Zyprexa) . The client's spouse questions the Zyprexa order. Which is the appropriate nursing reply?

After teaching a client about lithium carbonate (Lithane) , which client statement would indicate to the nurse that teaching has been successful?