Deck 16: Bipolar Spectrum Disorders

Question 1

A patient with mania has not eaten or slept for 3 days.Which nursing diagnosis has priority?

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

Answer 1

Risk for injury

Question 2

A patient with bipolar disorder,who is being treated on an outpatient basis,takes lithium carbonate 300 mg three times daily.The patient complains of nausea.To reduce the nausea,the nurse can suggest that the lithium be taken with:

A)meals
B)an antacid
C)an antiemetic medication
D)a large glass of juice

Answer 2

meals

Question 3

A patient with bipolar disorder is dressed in a red leotard and brightly colored scarves.The patient says,"I'll punch you,munch you,crunch you," while twirling and shadowboxing.Then 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)Labile and euphoric
B)Irritable and belligerent
C)Highly suspicious and arrogant
D)Excessively happy and confident

Answer 3

Labile and euphoric

Question 4

Consider these three drugs: divalproex (Depakote),carbamazepine (Tegretol),and gabapentin (Neurontin).Which drug also belongs to this group?

A)clonazepam (Klonopin)
B)risperidone (Risperdal)
C)lamotrigine (Lamictal)
D)aripiprazole (Abilify)

Question 5

The cause of bipolar disorder has not been determined,but:

A)several factors,including genetics,are implicated.
B)brain structures were altered by stresses early in life.
C)excess norepinephrine is probably a major factor.
D)excess sensitivity in dopamine receptors may exist.

Question 6

A patient with acute mania undresses in the group room and dances.The nurse's first intervention would be to:

A)quietly ask the patient,"Why don't you put on your clothes?"
B)firmly tell the patient,"Stop dancing,and put on your clothing."
C)put a blanket around the patient,and walk with the patient to a quiet room.
D)allow the patient stay in the group room.Move the other patients to a different area.

Question 7

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

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

Question 8

A nurse receives this laboratory result: lithium level 1 mEq/L.This result is:

A)within therapeutic limits
B)below therapeutic limits
C)above therapeutic limits
D)incorrect because of inaccurate testing

Question 9

A patient with bipolar disorder has rapid 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)clonidine (Catapres)
C)carbamazepine (Tegretol)
D)chlorpromazine (Thorazine)

Question 10

A person is directing traffic on a busy street and 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,provocative behavior
B)Pressured speech and grandiosity
C)Hyperactivity;not eating and sleeping
D)Poor concentration and decision making

Question 11

A patient with mania relapsed after discontinuing lithium.New orders are written to resume lithium twice daily and begin olanzapine (Zyprexa).The addition of olanzapine to the medication regimen will:

A)minimize the side effects of lithium.
B)bring hyperactivity under rapid control.
C)enhance the antimanic actions of lithium.
D)be used for long-term control of hyperactivity.

Question 12

The spouse of a patient with bipolar disorder asks what evidence supports the possibility of genetic transmission of bipolar disorders.Select the nurse's best response.

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 stresses."
D)"More individuals with bipolar disorder come from high socioeconomic and educational backgrounds."

Question 13

A health teaching plan for a patient taking lithium should include instructions to:

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

Question 14

A patient 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 behavior without entering into a power struggle.Select the best initial approach by the nurse.

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 behavior is annoying others."

Question 15

A patient with bipolar disorder is hyperactive after discontinuing lithium and has not slept for 3 days.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 behavior?"

Question 16

A patient with acute mania has exhausted the staff members by noon.The patient has joked,manipulated,insulted,and fought all morning.Staff members are feeling defensive and fatigued.Which is the best action?

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

Question 17

A person is directing traffic on a busy street and shouting,"To work,you jerk,for perks," and making obscene gestures at cars.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 judgment and hyperactivity
D)Cognitive deficit and sad mood

Question 18

A patient with acute mania 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 four pairs of shoes." Select the nurse's most appropriate intervention.

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

Question 19

At a unit meeting,staff members discuss the decor for a special room for patients with mania.Select the best option.

A)Extra-large window with a view of the street
B)Neutral walls with pale,simple accessories
C)Brightly colored walls and print drapes
D)Deep colors for walls and upholstery

Question 20

This nursing diagnosis applies to a patient with 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 the most appropriate outcome.The patient will:

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

Question 21

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

A)"Converses without interrupting,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 22

A patient with 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 physiologic functioning.
B)Provide a subdued environment.
C)Supervise personal hygiene.
D)Observe for mood changes.

Question 23

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

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

Question 24

A nurse prepares the plan of care for a patient having a 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 25

Outcome identification for the treatment plan of a patient with grandiose thinking associated with acute mania focuses on:

A)developing an optimistic outlook
B)self-control of distorted thinking
C)maintaining an interest in the environment
D)stabilizing the sleep pattern

Question 26

A patient with acute mania has disrobed in the hall three times in 2 hours.The nurse should:

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 27

A patient with acute mania is dancing atop the 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." The nurse's first intervention is to:

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 28

Which dinner menu is best suited for the patient with bipolar disorder experiencing 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 flavored gelatin with whipped cream

Question 29

After hospital discharge,what is the priority intervention for a patient with bipolar disorder,who is taking antimanic medication,and for the patient's family?

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

Question 30

A patient tells the nurse,"I am so ashamed of being bipolar.When I'm manic,my behavior embarrasses my family.Even if I take my medication,there's no guarantee I won't have a relapse.I am such 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 behavior

Question 31

Lithium is prescribed for a new patient.Which information from the patient's history indicates that monitoring serum concentrations of the drug will be challenging and critical?

A)Arthritis
B)Epilepsy
C)Psoriasis
D)Congestive heart failure

Question 32

A patient with bipolar disorder and who takes lithium telephones the nurse at the clinic 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 should advise the patient:

A)"Restrict food and fluids for 24 hours,and stay in bed."
B)"Have someone bring you to the clinic immediately."
C)"Drink a large glass of water with 1 teaspoon of salt added."
D)"Take an over-the-counter antidiarrheal medication hourly until the diarrhea subsides."

Question 33

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

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

Question 34

A patient 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 most appropriate response.

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

Question 35

A patient receiving lithium should be assessed for which evidence of complications?

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

Question 36

A patient with bipolar disorder was hospitalized 7 days earlier and has been taking lithium 600 mg three times daily.Staff members observe increased agitation,pressured speech,poor personal hygiene,hyperactivity,and bizarre clothing.What is the nurse's best intervention?

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.