Deck 13: Bipolar and Related Disorders

Question 1

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

Answer 1

Euphoric

Question 2

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 behavior?"

Answer 2

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

Question 3

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 behavior as necessary.
C) Provide verbal instructions to the patient to remain calm.
D) Restrain the patient to reduce hyperactivity and aggression.

Answer 3

Set limits on patient behavior as necessary.

Question 4

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 5

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 behavior 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 behavior is annoying others."

Question 6

A patient demonstrating characteristics of acute mania relapsed after discontinuing lithium. New orders are written to resume lithium twice daily and begin olanzapine. What is the rationale for the addition of olanzapine to the medication regimen? It 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 7

A patient experiencing acute mania undresses in the group room and dances. The nurse intervenes initially by

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 8

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 colored walls and print drapes
D) Deep colors for walls and upholstery

Question 9

This nursing diagnosis applies to a patient experiencing 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. 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 meal time within 1 week.
D) consistently wear appropriate attire for age and sex within 1 week while on the psychiatric unit.

Question 10

The nurse receives a laboratory report indicating a patient's serum level is 1 mEq/L. The patient's last dose of lithium was 8 hours ago. This result is

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

Question 11

The exact cause of bipolar disorder has not been determined; however, for most patients

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 12

A person was online continuously for over 24 hours, posting rhymes on official government websites 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 judgment and hyperactivity
D) Cognitive deficits and paranoia

Question 13

A patient demonstrating behaviors 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 behavior.
D) Explain to the patient that the behavior is unacceptable.

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

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

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

Question 16

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 fluid.
C) double the lithium dose if diarrhea or vomiting occurs.
D) avoid eating aged cheese, processed meats, and red wine.

Question 17

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 behavior
B) Pressured speech and grandiosity
C) Hyperactivity; not eating and sleeping
D) Poor concentration and decision making

Question 18

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
B) clonidine
C) risperidone
D) carbamazepine

Question 19

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 four pairs of shoes." Select the nurse's appropriate intervention. The nurse

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

Question 20

Consider these three anticonvulsant medications: divalproex, carbamazepine, and gabapentin. Which medication also belongs to this classification?

A) clonazepam
B) risperidone
C) lamotrigine
D) aripiprazole

Question 21

Which nursing diagnosis would most likely apply to a patient diagnosed with major depressive disorder as well as one experiencing acute mania?

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

Question 22

Outcome identification for the treatment plan of a patient experiencing 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) sleep pattern stabilization.

Question 23

The plan of care for a patient in the manic state of bipolar disorder should include which 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 24

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) "Most 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 25

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

A) bipolar I disorder.
B) bipolar II disorder.
C) dysthymic disorder.
D) cyclothymic disorder.

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 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 28

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 29

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) Diaphoresis, weakness, and nausea
D) Ascites, dyspnea, and edema

Question 30

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 behavior?

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 31

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) Impaired mood regulation
C) Sleep deprivation
D) Chronic confusion
E) Social isolation

Question 32

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) Supervise medication administration.
E) Monitor the patient's sleep patterns.

Question 33

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 34

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

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 35

A patient tells the nurse, "I'm ashamed of being bipolar. When I'm manic, my behavior 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 behavior

Question 36

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 37

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 flavored gelatin with whipped cream

Question 38

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

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.