Deck 15: Bipolar Disorders

Question 1

A health teaching plan for a patient taking lithium should include instructions to do which of the following?

A) Maintain normal salt and fluids in the diet
B) Drink twice the usual daily amount of fluid
C) Double the lithium dose if diarrhea or vomiting occurs
D) Avoid eating aged cheese, processed meats, and red wine

Answer 1

Maintain normal salt and fluids in the diet

Question 2

The nurse receives a laboratory report indicating a patient's serum lithium level is 1 mEq/L. The patient's last dose of lithium was 8 hours ago. How should the nurse interpret this result?

A) This result is within therapeutic limits.
B) This result is below therapeutic limits.
C) This result is above therapeutic limits.
D) This result is invalid because of the time lapse since the last dose.

Answer 2

This result is within therapeutic limits.

Question 3

A person was directing traffic on a busy street, rapidly shouting, "To work, you jerk, for perks" and making obscene gestures at cars. The person has not slept or eaten for 3 days. Which assessment findings will have priority concern for this patient's plan of care?

A) Insulting, aggressive behaviour
B) Pressured speech and grandiosity
C) Hyperactivity; not eating and sleeping
D) Poor concentration and decision making

Answer 3

Hyperactivity; not eating and sleeping

Question 4

When a hyperactive patient diagnosed with acute mania is hospitalized, what is the initial nursing intervention?

A) Allow the patient to act out feelings.
B) Set limits on patient behaviour as necessary.
C) Provide verbal instructions to the patient to remain calm.
D) Restrain the patient to reduce hyperactivity and aggression.

Question 5

Consider these three anticonvulsant medications used in mood stabilization: divalproex sodium (Epival), carbamazepine (Tegretol), and gabapentin (Neurontin). Which of the following medications also belongs to this classification?

A) Clonazepam (Rivotril)
B) Risperidone (Risperdal)
C) Lamotrigine (Lamictal)
D) Aripiprazole (Abilify)

Question 6

A patient diagnosed with bipolar disorder becomes hyperactive after discontinuing lithium. The patient threatens to hit another patient. Which comment by the nurse is appropriate?

A) "Stop that! No one did anything to provoke an attack by you."
B) "If you do that one more time, you will be secluded immediately."
C) "Do not hit anyone. If you are unable to control yourself, we will help you."
D) "You know we will not let you hit anyone. Why do you continue this behaviour?"

Question 7

A patient diagnosed with bipolar disorder is dressed in a red leotard and bright scarves. The patient twirls and shadow boxes. The patient says gaily, "Do you like my scarves? Here; they are my gift to you." How should the nurse document the patient's mood?

A) Euphoric
B) Irritable
C) Suspicious
D) Confident

Question 8

The exact cause of bipolar disorder has not been determined; however, for most patients, which of the following is true?

A) Several factors, including genetics, are implicated.
B) Brain structures were altered by stress early in life.
C) Excess sensitivity in dopamine receptors may trigger episodes.
D) Inadequate norepinephrine reuptake disturbs circadian rhythms.

Question 9

A patient diagnosed with acute mania has distributed pamphlets about a new business venture on a street corner for 2 days. Which nursing diagnosis has priority?

A) Risk for injury
B) Ineffective coping
C) Impaired social interaction
D) Ineffective therapeutic regimen management

Question 10

This nursing diagnosis applies to a patient with acute mania: Imbalanced nutrition: less than body requirements related to insufficient caloric intake and hyperactivity as evidenced by 5-pound weight loss in 4 days. Select an appropriate outcome.

A) The patient will ask staff for assistance with feeding within 4 days.
B) The patient will drink six servings of a high-calorie, high-protein drink each day.
C) The patient will consistently sit with others for at least 30 minutes at meal time within 1 week.
D) The patient will consistently wear appropriate attire for age and sex within 1 week while on the psychiatric unit.

Question 11

A patient diagnosed with bipolar disorder has rapidly changing mood cycles. The health care provider prescribes an anticonvulsant medication. To prepare teaching materials, which drug should the nurse anticipate will be prescribed?

A) Phenytoin (Dilantin)
B) Gabapentin (Neurontin)
C) Risperidone (Risperdal)
D) Carbamazepine (Tegretol)

Question 12

An outpatient diagnosed with bipolar disorder takes lithium carbonate 300 mg three times daily. The patient reports nausea. To reduce the nausea most effectively, the nurse suggests that the lithium be taken with which of the following?

A) Meals
B) An antacid
C) An antiemetic
D) A large glass of juice

Question 13

At a unit meeting, the staff discusses decor for a special room for patients with acute mania. Which suggestion is appropriate?

A) An extra-large window with a view of the street
B) Neutral walls with pale, simple accessories
C) Brightly coloured walls and print drapes
D) Deep colours for walls and upholstery

Question 14

The spouse of a patient diagnosed with bipolar disorder asks what evidence supports the possibility of genetic transmission of bipolar disorders. Which response should the nurse provide?

A) "A high proportion of patients with bipolar disorders are found among creative writers."
B) "A higher rate of relatives with bipolar disorder is found among patients with bipolar disorder."
C) "Patients with bipolar disorder have higher rates of relatives who respond in an exaggerated way to daily stress."
D) "More individuals with bipolar disorder come from high socioeconomic and educational backgrounds."

Question 15

A patient demonstrating characteristics of acute mania relapsed after discontinuing lithium. New orders are written to resume lithium twice daily and begin olanzapine (Zyprexa). What is the rationale for the addition of olanzapine to the medication regimen?

A) It minimizes the side effects of lithium.
B) It brings hyperactivity under rapid control.
C) It enhances the antimanic actions of lithium.
D) It is used for long-term control of hyperactivity.

Question 16

A patient experiencing acute mania undresses in the group room and dances. The nurse intervenes initially by doing which of the following?

A) Quietly asking the patient, "Why don't you put your clothes on?"
B) Firmly telling the patient, "Stop dancing and put on your clothing."
C) Putting a blanket around the patient and walking with the patient to a quiet room
D) Letting the patient stay in the group room and moving the other patients to a different area

Question 17

A person was online continuously for over 24 hours, posting rhymes on official government Web sites and inviting politicians to join social networks. The person has not slept or eaten for 3 days. What features of mania are evident?

A) Increased muscle tension and anxiety
B) Vegetative signs and poor grooming
C) Poor judgement and hyperactivity
D) Cognitive deficits and paranoia

Question 18

A patient waves a newspaper and says, "I must have my credit card and use the computer right now. A store is having a big sale, and I need to order 10 dresses and 4 pairs of shoes." Select the nurse's appropriate intervention.

A) Suggest the patient have a friend do the shopping and bring purchases to the unit
B) Invite the patient to sit together and look at new fashion magazines
C) Tell the patient computer use is not allowed until self-control improves
D) Ask whether the patient has enough money to pay for the purchases

Question 19

A patient demonstrating behaviours associated with acute mania has exhausted the staff by noon. Staff members are feeling defensive and fatigued. Which action will the staff take initially?

A) Confer with the health care provider to consider use of seclusion for this patient.
B) Hold a staff meeting to discuss consistency and limit-setting approaches.
C) Conduct a meeting with all staff and patients to discuss the behaviour.
D) Explain to the patient that the behaviour is unacceptable.

Question 20

A patient diagnosed with bipolar disorder commands other patients, "Get me a book. Take this stuff out of here," and other similar demands. The nurse wants to interrupt this behaviour without entering into a power struggle. Which initial approach should the nurse select?

A) Distraction: "Let's go to the dining room for a snack."
B) Humor: "How much are you paying servants these days?"
C) Limit setting: "You must stop ordering other patients around."
D) Honest feedback: "Your controlling behaviour is annoying others."

Question 21

A patient diagnosed with bipolar disorder will be discharged tomorrow. The patient is taking a mood stabilizing medication. What is the priority nursing intervention for the patient as well as the patient's family during this phase of treatment?

A) Attending psychoeducation sessions
B) Decreasing physical activity
C) Increasing food and fluids
D) Meeting self-care needs

Question 22

A patient experiencing acute mania dances around the unit, seldom sits, monopolizes conversations, interrupts, and intrudes. Which nursing intervention will best assist the patient with energy conservation?

A) Monitor physiological functioning.
B) Provide a subdued environment.
C) Supervise personal hygiene.
D) Observe for mood changes.

Question 23

Which nursing diagnosis would most likely apply to both a patient diagnosed with major depression and one experiencing acute mania?

A) Deficient diversional activity
B) Disturbed sleep pattern
C) Fluid volume excess
D) Defensive coping

Question 24

Outcome identification for the treatment plan of a patient experiencing grandiose thinking associated with acute mania will focus on which of the following?

A) Development of an optimistic outlook
B) Distorted thought self-control
C) Interest in the environment
D) Sleep pattern stabilization

Question 25

A patient experiencing acute mania is dancing atop a pool table in the recreation room. The patient waves a cue in one hand and says, "I'll throw the pool balls if anyone comes near me." To best assure safety, the nurse's first intervention is to do which of the following?

A) Tell the patient, "You need to be secluded."
B) Clear the room of all other patients.
C) Help the patient down from the table.
D) Assemble a show of force.

Question 26

The plan of care for a patient in the manic state of bipolar disorder should include which of the following interventions? Select all that apply.

A) Touch the patient to provide reassurance.
B) Invite the patient to lead a community meeting.
C) Provide a structured environment for the patient.
D) Ensure that the patient's nutritional needs are met.
E) Design activities that require the patient's concentration.

Question 27

A nurse assesses a patient who takes lithium. Which findings demonstrate evidence of complications?

A) Pharyngitis, mydriasis, and dystonia
B) Alopecia, purpura, and drowsiness
C) Polyuria, weakness, and nausea
D) Ascites, dyspnea, and edema

Question 28

Which documentation indicates that the treatment plan for a patient diagnosed with acute mania has been effective?

A) "Converses with few interruptions; clothing matches; participates in activities."
B) "Irritable, suggestible, distractible; napped for 10 minutes in afternoon."
C) "Attention span short; writing copious notes; intrudes in conversations."
D) "Heavy makeup; seductive toward staff; pressured speech."

Question 29

Which dinner menu is best suited for a patient with acute mania?

A) Spaghetti and meatballs, salad, and a banana
B) Beef and vegetable stew, a roll, and chocolate pudding
C) Broiled chicken breast on a roll, an ear of corn, and an apple
D) Chicken casserole, green beans, and flavoured gelatin with whipped cream

Question 30

Four new patients were admitted to the behavioural health unit in the past 12 hours. The nurse directs a psychiatric technician to monitor these patients for safety. A patient with which of the following diagnoses will need the most watchful supervision?

A) Bipolar I disorder
B) Bipolar II disorder
C) Dysthymic disorder
D) Cyclothymic disorder

Question 31

A patient with acute mania has disrobed in the hall three times in 2 hours. Which of the following should the nurse do?

A) Direct the patient to wear clothes at all times.
B) Ask if the patient finds clothes bothersome.
C) Tell the patient that others feel embarrassed.
D) Arrange for one-on-one supervision.

Question 32

An outpatient diagnosed with bipolar disorder is prescribed lithium. The patient telephones the nurse to say, "I've had severe diarrhea for 4 days. I feel very weak and unsteady when I walk. My usual hand tremor has gotten worse. What should I do?" The nurse will advise the patient to which of the following?

A) Restrict food and fluids for 24 hours and stay in bed
B) Have someone bring the patient to the clinic immediately
C) Drink a large glass of water with 1 teaspoon of salt added
D) Take one dose of an over-the-counter antidiarrheal medication now

Question 33

A nurse prepares the plan of care for a patient experiencing an acute manic episode. Which nursing diagnoses are most likely? Select all that apply.

A) Imbalanced nutrition: more than body requirements
B) Disturbed thought processes
C) Sleep deprivation
D) Chronic confusion
E) Social isolation

Question 34

A patient tells the nurse, "I'm ashamed of being bipolar. When I'm manic, my behaviour embarrasses everyone. Even if I take my medication, there are no guarantees. I'm a burden to my family." These statements support which nursing diagnoses? Select all that apply.

A) Powerlessness
B) Defensive coping
C) Chronic low self-esteem
D) Impaired social interaction
E) Risk-prone health behaviour

Question 35

A patient with diagnosed bipolar disorder was hospitalized 7 days ago and has been taking lithium 600 mg tid. Staff observes increased agitation, pressured speech, poor personal hygiene, and hyperactivity. Which action demonstrates that the nurse understands the most likely cause of the patient's behaviour?

A) Educate the patient about the proper ways to perform personal hygiene and
Coordinate clothing.
B) Continue to monitor and document the patient's speech patterns and motor
Activity.
C) Ask the health care provider to prescribe an increased dose and frequency of
Lithium.
D) Consider the need to check the lithium level. The patient may not be swallowing medications.

Question 36

A newly diagnosed patient is prescribed lithium. Which information from the patient's history indicates that monitoring of serum concentrations of the drug will be challenging and critical?

A) Arthritis
B) Epilepsy
C) Psoriasis
D) Heart failure

Question 37

A patient diagnosed with bipolar disorder is in the maintenance phase of treatment. The patient asks, "Do I have to keep taking this lithium even though my mood is stable now?" Select the nurse's appropriate response.

A) "You will be able to stop the medication in about 1 month."
B) "Taking the medication every day helps reduce the risk of a relapse."
C) "Usually patients take medication for approximately 6 months after discharge."
D) "It's unusual that the health care provider hasn't already stopped your medication."

Question 38

Which suggestions are appropriate for the family of a patient diagnosed with bipolar disorder who is being treated as an outpatient during a hypomanic episode? Select all that apply.

A) Limit credit card access.
B) Provide a structured environment.
C) Encourage group social interaction.
D) Suggest limiting work to half-days.
E) Monitor the patient's sleep patterns.