Question 1

The nurse is assessing a teenaged client diagnosed with cyclothymic disorder. Which DSM-5 diagnostic criteria would the nurse expect this client to meet? (Select all that apply.)&#10;A) Symptoms lasting for a minimum of two years&#10;B) Numerous periods with manic symptoms&#10;C) Possible comorbid diagnosis of a delusional disorder&#10;D) Symptoms cause clinically significant impairment in important areas of functioning&#10;E) Depressive symptoms that do not meet the criteria for major depressive episode&#10;

Accepted Answer

Symptoms cause clinically significant impairment in important areas of functioning
Depressive symptoms that do not meet the criteria for major depressive episode

Question 2

The client taking lithium carbonate (Lithobid) presents to an emergency department with a temperature of 101°F (38°C), severe diarrhea, blurred vision, and tinnitus. Which interpretation should the nurse make regarding these symptoms?

A) Symptoms indicate spending too much time outdoors without sunblock.
B) Symptoms indicate antipsychotic withdrawal syndrome.
C) Symptoms indicate the development of neutropenia.
D) Symptoms indicate lithium carbonate toxicity.

Symptoms indicate lithium carbonate toxicity.

Accepted Answer

The symptoms indicate lithium carbonate toxicity, which is a serious condition that requires immediate medical attention. The temperature, severe diarrhea, blurred vision, and tinnitus are all potential side effects of lithium toxicity. Neutropenia, antipsychotic withdrawal syndrome, and spending too much time outdoors without sunblock are not the most likely causes of these symptoms in a client taking lithium carbonate.

Question 3

The health-care provider prescribes lithium carbonate (Eskalith) and olanzapine (Zyprexa) for a client with severe manic episodes. The client's spouse asks the nurse how Zyprexa works. Which response would the nurse make?

A) "Zyprexa in combination with Eskalith cures bipolar disorder symptoms."
B) "Zyprexa prevents extrapyramidal side effects."
C) "Zyprexa increases the effectiveness of the immune system."
D) "Zyprexa calms the agitation associated with mania."

"Zyprexa calms the agitation associated with mania."

Accepted Answer

Olanzapine (Zyprexa) is an atypical antipsychotic medication that is commonly used to treat manic episodes associated with bipolar disorder. It works by blocking certain neurotransmitters in the brain, which can reduce agitation and other symptoms associated with mania. Zyprexa does not cure bipolar disorder, prevent extrapyramidal side effects, or increase the effectiveness of the immune system.

Question 4

The client diagnosed with bipolar disorder intentionally overdoses on antidepressants. Family members report that the client has experienced a relationship break-up, anorexia, and a recent job loss. Which nursing diagnosis is the priority based upon the client's signs and symptoms?

A) Risk for self-directed violence R/T multiple losses
B) Anxiety: severe R/T hyperactivity
C) Imbalanced nutrition: less than body requirements R/T refusal to eat
D) Dysfunctional grieving R/T hopelessness

Accepted Answer

Providing the client with high-calorie finger foods throughout the day would help them increase their caloric intake, facilitating weight gain. This is a practical and safe intervention to help the client achieve their goal. Accompanying the client to the cafeteria may not be practical or feasible depending on the setting, and total parenteral nutrition is a more invasive and extreme intervention that would not be indicated in this situation. Teaching about the importance of a varied diet is important but may not be sufficient to help the client achieve their weight gain goal in the short term.

Question 5

The nursing instructor is teaching about bipolar disorders. Which symptom should the instructor include that is present during a manic episode but is absent in hypomania?&#10;A) Inflated self-esteem or grandiosity&#10;B) Decreased need for sleep&#10;C) Psychosis&#10;D) Flight of ideas or racing thoughts&#10;

Accepted Answer

Psychosis is a symptom that can be present during a manic episode but is absent in hypomania. Hypomania is characterized by elevated mood and increased activity or energy that is not severe enough to cause significant impairment in social or occupational functioning or to necessitate hospitalization, and there are no psychotic features.

Question 6

____________________ is an alteration in mood that is expressed by feelings of elation, inflated self-esteem, grandiosity, hyperactivity, agitation, racing thoughts, and accelerated speech.

Accepted Answer

The answer of ____________________ is an alteration in mood that...

Question 7

Which information would the nurse include in a teaching session about predisposing factors in the development of bipolar disorder, mania episode? (Select all that apply.)&#10;A) There are excessive levels of glutamate.&#10;B) Mania has greater right-side reduction in brain activity.&#10;C) Steroids are the most common medication to trigger a manic response.&#10;D) Expression of gene ANK3 is decreased in manic episodes.&#10;E) Dopamine levels are decreased in mania.&#10;

Accepted Answer

Excessive levels of glutamate and greater right-side reduction in brain activity are associated with mania. Steroids can trigger manic episodes. Gene ANK3 expression and dopamine levels are not typically decreased in mania.

Question 8

The client diagnosed with bipolar disorder intentionally overdoses on antidepressants. Family members report that the client has experienced a relationship break-up, anorexia, and a recent job loss. Which nursing diagnosis is the priority based upon the client's signs and symptoms?

A) Risk for self-directed violence R/T multiple losses
B) Anxiety: severe R/T hyperactivity
C) Imbalanced nutrition: less than body requirements R/T refusal to eat
D) Dysfunctional grieving R/T hopelessness

Accepted Answer

The client intentionally overdosing on antidepressants is a clear indication of a suicide attempt, and therefore, the priority nursing diagnosis should be Risk for self-directed violence R/T multiple losses. The client's recent relationship break-up, anorexia, and job loss are significant losses that may contribute to the client's suicidal ideation. The other options, anxiety, imbalanced nutrition, and dysfunctional grieving, may also be present but are not as urgent as addressing the client's potential for self-harm.

Question 9

The client with bipolar disorder refuses to take lithium carbonate (Lithobid) because of excessive weight gain. In order to increase adherence, which anticonvulsant medication should the nurse be prepared to administer?

A) Sertraline (Zoloft)
B) Valproic acid (Depakote)
C) Verapamil (Calan)
D) Lurasidone (Latuda)

Accepted Answer

Valproic acid (Depakote) is an anticonvulsant medication that has been shown to be effective in treating bipolar disorder, particularly in patients who are resistant to lithium treatment. It has also been found to be effective in preventing manic and depressive episodes, and does not cause significant weight gain. Therefore, it may be a good alternative for patients who refuse lithium due to weight gain concerns.

Question 10

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 chart entry would the nurse document for this client's behavior?

A) "Rates mood 8/10. Exhibiting looseness of association. Euphoric."
B) "Mood irritability. Exhibiting magical thinking. Nervousness."
C) "Blunted affect. Exhibiting delusions of reference. Hyperactive."
D) "Agitated and pacing. Exhibiting grandiosity. Mood labile."

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Accepted Answer

The chart entry should document the client's current behavior and mood. The client is exhibiting agitation and pacing, which is noted in option D. The client is also displaying grandiosity by stating they could buy and sell the place. The mood is described as labile, as it fluctuates between laughter and anger. Options A, B, and C do not accurately describe the client's current behavior and mood.

Question 11

Which information should the nurse include when teaching parents who have children or adolescents with symptoms of bipolar disorder? (Select all that apply.)&#10;A) First-line treatment is a second-generation antipsychotic.&#10;B) In children and adolescents with bipolar disorder there is a high risk of relapse.&#10;C) There is a direct link between development of bipolar disorder and attention deficit/hyperactivity disorder.&#10;D) The diagnosis of bipolar disorder cannot be assigned prior to the age of 18.&#10;E) Genetic predisposition is not a reliable diagnostic determinant.&#10;

Accepted Answer

The answer of Which information should the nurse include when...

Question 12

Which statement by the client indicates successful teaching about taking lithium carbonate (Lithobid) for the treatment of bipolar disorder?&#10;A) &#34;I should decrease my intake of sodium.&#34;&#10;B) &#34;Drinking ten large glasses of water a day is good for me.&#34;&#10;C) &#34;Weight gain is a common, but troubling, side effect.&#34;&#10;D) &#34;Diarrhea should be expected while using this drug.&#34;&#10;

Accepted Answer

The answer of Which statement by the client indicates successful...

Question 13

The nurse presents a staff development session about the various challenges in the treatment of clients diagnosed with bipolar disorder. Which factor should the nurse include that is an essential component of relapse prevention?

A) Methods to treat insomnia
B) Inability to control irritability
C) Lack of insight
D) Medication adherence

Accepted Answer

The answer of The nurse presents a staff development session...

Question 14

A client has been diagnosed with major depressive episode. After treatment with an antidepressant, the client exhibits pressured speech and flight of ideas. Based on this symptom change, which information should the nurse share with the health-care provider?

A) Ask to increase the dosage of the antidepressant.
B) Ask that the client be reevaluated.
C) Ask to order benztropine (Cogentin) for the extrapyramidal symptoms.
D) Ask that another class of antidepressants be used.

Accepted Answer

The answer of A client has been diagnosed with major...

Question 15

Which premise is basic to the recovery model used to treat clients diagnosed with bipolar disorder?&#10;A) Medication compliance&#10;B) Independent management&#10;C) Total absence of symptoms&#10;D) Improved psychosocial relationships&#10;

Accepted Answer

The answer of Which premise is basic to the recovery...

Deck 17: Bipolar and Related Disorders