Deck 14: Bipolar Disorders

Question 1

During a manic episode,a patient is hyperactive,restless,and disorganized.The patient goes to the dining room and begins to throw food and dishes.Verbal intervention is ineffective.The patient's behavior poses a substantial risk of harm to others.Staff escorts the patient to the patient's room to dine alone.What is the rationale for this action?

A) Prevent other patients from observing the behavior.
B) Reduce environmental stimuli that negatively affect the patient.
C) Protect the patient's biological integrity until medication takes effect.
D) Reinforce limit setting,enabling the patient to learn to follow unit rules.

Answer 1

Reduce environmental stimuli that negatively affect the patient.

Question 2

A patient with bipolar disorder is hyperactive and has not slept for 3 days.Mood and behavior are labile.The patient threatens to hit another patient.Which response by the nurse is appropriate?

A) "Stop that now.No one did anything to provoke an attack by you."
B) "If you try that again,you will be placed in seclusion 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?"

Answer 2

"Do not hit anyone.If you are unable to control yourself,we will help you."

Question 3

A patient with bipolar disorder has rapid cycles.To prepare teaching materials,the nurse anticipates which medication will be prescribed?

A) Clonidine (Catapres)
B) Phenytoin (Dilantin)
C) Carbamazepine (Tegretol)
D) Chlorpromazine (Thorazine)

Answer 3

Carbamazepine (Tegretol)

Question 4

A patient with bipolar disorder commands another patient,"Change the television channel.Get me something to drink…," and so forth.The nurse wants to interrupt this behavior without entering into a power struggle with the patient.Select the nurse's best approach.

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 behavior is annoying other patients."

Question 5

A patient with acute mania has exhausted staff by noon after joking,manipulating,and insulting all morning.Staff members feel defensive and fatigued.Select the best action.

A) Call the health care provider to evaluate the patient.
B) Hold a staff meeting to discuss consistency and limit-setting approaches.
C) Seclude the patient,and then call the health care provider to write an order.
D) Explain to the patient that the behavior is unacceptable.Ask the patient to be more cooperative.

Question 6

Laboratory results show a patient's lithium level is 1.0 mEq/L.Select the correct analysis.

A) Within therapeutic limits
B) Below therapeutic limits
C) Above therapeutic limits
D) Incorrect.Lithium levels are reported as mEq/dL

Question 7

A patient with bipolar disorder,mania,relapsed after discontinuing lithium.The health care provider prescribes lithium 600 mg BID and olanzapine (Zyprexa)10 mg BID.What is the rationale for addition of olanzapine to the lithium regime? It will:

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

Question 8

At a unit meeting,staff discusses interior decoration for a special room for patients in acute mania.Select the best suggestion.

A) An extra-large window with a view of the street.
B) Neutral walls with pale,coordinated accessories.
C) Brightly colored walls and print drapes.
D) A rocking chair.

Question 9

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

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

Question 10

The nursing diagnosis for a patient with mania is Imbalanced nutrition: less than body requirements related to caloric intake insufficient to balance with hyperactivity as evidenced by 5 lb weight loss in 4 days.Select the most appropriate outcome.The patient will:

A) reduce hyperactivity within 1 week.
B) drink four high-calorie,high-protein supplements per day.
C) consistently wear appropriate attire for age and sex within 1 week.
D) display consistently nonviolent behavior toward others within 1 week.

Question 11

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) Ineffective management of therapeutic regime
D) Imbalanced nutrition,less than body requirements

Question 12

A 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 fluid.
C) have regular laboratory studies of liver function.
D) avoid eating aged cheese,processed meats,and red wine.

Question 13

Police bring a patient to the mental health unit.The patient was directing traffic and shouting rhymes on a busy city street.The patient's spouse reports that the patient has not slept or eaten for 3 days.Which assessment findings have priority concern for this patient's plan of care?

A) Pressured speech and grandiosity
B) Hyperactivity;not eating and sleeping
C) Poor concentration and decision making
D) Insulting,provocative behavior directed at staff

Question 14

Which initial nursing intervention should be planned for a newly admitted patient with acute mania?

A) Allow the patient to act out suppressed feelings because the environment is safe.
B) Provide verbal instructions to the patient to remain calm and cooperative.
C) Be accessible to set limits on the patient's behavior as necessary.
D) Restrain the patient to reduce hyperactivity and aggression.

Question 15

A patient with acute mania approaches the nurse,waves a newspaper,and says,"I want the phone right now.I need to call this store while their sale is going on.I need ten dresses and four pairs of shoes." Select the nurse's best intervention.

A) Suggest the patient ask 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 phone use is not allowed until self-control is improved.
D) Ask whether the patient has enough money to pay for the purchases.

Question 16

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) "Higher rates of relatives of patients with bipolar disorder respond in an exaggerated way to daily stress."
D) "More individuals with bipolar disorder come from higher socioeconomic and educational backgrounds."

Question 17

A outpatient with bipolar disorder takes lithium carbonate 600 mg BID.The patient complains of nausea.To lessen the nausea,the nurse can suggest taking the lithium with:

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

Question 18

A newly admitted patient is dressed in a satin nightgown and jeweled headband.While dancing in the room and shadow boxing,the patient chants,"I'll punch you,munch you,crunch you." Then the patient says gaily,"I am so beautiful.The entire world worships me." How should the nurse document the patient's mood?

A) Excessively happy and confident
B) Highly suspicious and arrogant
C) Unstable and unpredictable
D) Irritable and belligerent

Question 19

Prior to admission,a patient was directing traffic,shouting "to work,you jerk,for perks," and making obscene gestures at cars.The patient's spouse reports noncompliance with lithium therapy for 3 weeks and not sleeping for 3 days,saying,"I'm too busy." Features characteristic of bipolar disorder the nurse can identify are:

A) increased muscle tension and anxiety.
B) vegetative signs and poor grooming.
C) poor judgment and hyperactivity.
D) cognitive deficits and low mood.

Question 20

A patient with acute mania undresses in the day room and dances about.Select the best intervention.

A) Quietly ask the patient,"Are you embarrassed? Don't you think you should put your clothes on?"
B) Let the patient stay in the day room.Move other patients to a different area.
C) Cover the patient with a blanket and walk with the patient to a quiet room.
D) Tell the patient firmly,"Stop dancing and put on your clothing."

Question 21

Treatment planning for a patient with grandiose thinking associated with acute mania will focus on:

A) developing an optimistic outlook.
B) distorted thought self-control.
C) interest in the environment.
D) body image.

Question 22

During the maintenance phase of treatment,a patient with bipolar disorder asks,"Do I have to keep taking lithium even though my mood is stable now?" Select the nurse's best response.

A) "Do you feel you are ready to stop taking it?"
B) "Taking the medication daily helps prevent future relapses and recurrences."
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 23

A patient with acute mania dances atop a pool table,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,"We are taking you to seclusion."
B) remove the patient from the pool table.
C) clear the room of all other patients.
D) assemble a show of force.

Question 24

Which nursing diagnosis is a priority for 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 25

A patient tells the nurse,"I am ashamed of having bipolar disorder.When I am manic,my behavior embarrasses my family.Even though I take my medication every day,there is no guarantee that I will not have a relapse.I am a burden to my family." These statements support which nursing diagnoses? (Select all that apply. )

A) Impaired social interaction
B) Chronic low self-esteem
C) Impaired adjustment
D) Defensive coping
E) Powerlessness

Question 26

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

A) "Converses without interrupting;clothing matched;participates in activities."
B) "Irritable;suggestible;distractible;napped for 10 minutes in afternoon."
C) "Attention span 1 to 3 minutes;journals frequently about unit activities."
D) "Heavy makeup;seductive toward staff;pressured speech."

Question 27

A patient with bipolar disorder was hospitalized 5 days ago and has received lithium 600 mg TID.The staff now observes agitation,pressured speech,poor personal hygiene,hyperactivity,and bizarre clothing.Select the nurse's best action.

A) Consider the need to measure the serum lithium level.The patient may not be swallowing the medication.
B) Include the patient in psychoeducational groups about personal hygiene,dressing,and grooming.
C) Ask the health care provider to prescribe an increased dose and frequency of lithium.
D) Continue to monitor and document the patient's speech patterns and motor activity.

Question 28

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

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

Question 29

A patient with bipolar disorder has taken lamotrigine (Lamictal)for 3 months with an excellent response.Which complaint from the patient necessitates the nurse's priority attention?

A) "I have a rash on my chest and abdomen."
B) "I experience occasional nausea."
C) "I have a little hand tremor."
D) "My nose is stuffy."

Question 30

Appropriate suggestions for the family of a patient with bipolar disorder being treated as an outpatient during a hypomanic episode include: (Select all that apply. )

A) providing structure.
B) limiting credit card access.
C) encouraging group social interaction.
D) suggesting limiting work to half days.
E) monitoring the patient's sleep patterns.

Question 31

After hospital discharge,a priority intervention for a patient with bipolar disorder who is taking antimanic medication is:

A) decreasing physical activity.
B) increasing food and fluids.
C) meeting self-care needs.
D) psychoeducation.

Question 32

Which assessment findings would be expected for a patient diagnosed with bipolar I disorder?

A) Rapid cycling
B) Major depression and acute mania
C) Major depression and/or hypomania
D) Hypomania and/or minor depression

Question 33

A patient with acute mania has been verbally abusive to staff since admission 3 hours ago.The patient says,"I can't believe you have a nursing license.I am not answering your stupid questions.You should pick another career." Select the nurse's best response.

A) "I will return in a few minutes to continue the interview."
B) "Your behavior is unacceptable.I expect an apology from you."
C) "I will have to report your behavior to the health care provider."
D) "I have a license to practice nursing,and I am entirely competent."

Question 34

A patient takes lithium daily.The nurse should monitor the patient for:

A) pharyngitis,mydriasis,and dystonia.
B) alopecia,purpura,and drowsiness.
C) diaphoresis,weakness,and nausea.
D) ascites,dyspnea,and edema.

Question 35

A patient who takes lithium phones the nurse at the clinic to say,"I've had diarrhea for 4 days.I feel weak and unsteady when I walk.My usual hand tremor has gotten worse.What should I do?" Which instruction by the nurse is appropriate?

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

Question 36

Lithium is prescribed for a new patient.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

Which factors play a dominant role in the etiology of bipolar disorder? (Select all that apply. )

A) Polygenics
B) Substance abuse
C) Variations in neurotransmission
D) Birth injuries or alternations in prenatal development
E) Dysregulation of the hypothalamic-pituitary-thyroid-adrenal (HPTA)axis

Question 38

A nurse prepares the plan of care for a patient having a manic episode.Which nursing diagnoses will are most likely to relate this patient's care? (Select all that apply. )

A) Imbalanced nutrition,more than body requirements
B) Disturbed thought processes
C) Disturbed sleep pattern
D) Chronic confusion
E) Social isolation

Question 39

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

A) Roast beef,green beans,pudding with whipped cream
B) Broiled chicken breast on a roll,ear of corn,apple
C) Beef and vegetable stew,roll,strawberry gelatin
D) Spaghetti and meatballs,salad,banana

Question 40

A patient with acute mania has disrobed in the hall 3 times in 2 hours.The nurse should:

A) direct the patient to wear clothes at all times.
B) tell the patient that others feel embarrassed.
C) provide a hospital gown for the patient.
D) arrange one-on-one supervision.