Question 1

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

Accepted Answer

Neutral walls with pale, simple accessories are calming and non-stimulating, which is appropriate for patients with acute mania who may be sensitive to overstimulation.

Question 2

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?

Accepted Answer

Lamotrigine (Lamictal) is an anticonvulsant medication that is also used as a mood stabilizer, similar to divalproex sodium, carbamazepine, and gabapentin.

Question 3

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?

Accepted Answer

Distraction is a non-confrontational approach that can redirect the patient's behavior without escalating the situation or entering into a power struggle.

Question 4

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?

Accepted Answer

The patient's behavior of twirling, shadow boxing, and offering gifts, along with the use of "gaily" suggests a euphoric mood. The bright clothing and willingness to give gifts also align with manic symptoms commonly seen in bipolar disorder.

Question 5

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?

Accepted Answer

Taking lithium with meals can help reduce gastrointestinal side effects like nausea.

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?

Accepted Answer

The nurse's comment in option C is appropriate as it sets clear boundaries and offers support to help the patient control their behavior, which is essential in managing patients with bipolar disorder.

Question 7

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

Accepted Answer

Setting limits on patient behavior is crucial to ensure safety and structure, which helps manage the patient's hyperactivity and impulsivity in a therapeutic manner.

Question 8

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.

Accepted Answer

The outcome focuses on addressing the nutritional imbalance by ensuring the patient consumes sufficient calories and protein, which directly relates to the diagnosis of imbalanced nutrition.

Question 9

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?

Accepted Answer

The priority concern is the patient's hyperactivity and lack of eating and sleeping, as these can lead to severe physical exhaustion and potential medical complications.

Question 10

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

Accepted Answer

Several factors, including genetics, are implicated in the development of bipolar disorder, suggesting a multifactorial cause rather than a single identifiable factor.

Question 11

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?

Accepted Answer

The therapeutic range for serum lithium levels is typically 0.6 to 1.2 mEq/L. A level of 1 mEq/L is within this therapeutic range.

Question 12

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?

Accepted Answer

Distributing pamphlets on a street corner for 2 days puts the patient at risk for injury, as they may not be aware of their surroundings and potential hazards. This nursing diagnosis takes priority over the others as it addresses the patient's immediate safety.

Question 13

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?

Accepted Answer

Olanzapine is added to bring hyperactivity under rapid control, as it acts faster than lithium, which takes time to reach therapeutic levels.

Question 14

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

Accepted Answer

The nurse should prioritize the patient's dignity and privacy by covering them with a blanket and escorting them to a quieter area, which helps manage the situation without causing further embarrassment or distress.

Question 15

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?

Accepted Answer

The features of mania evident in the scenario include poor judgment, as seen in the inappropriate posting on government websites, and hyperactivity, indicated by being online continuously for over 24 hours without sleep or food.

Question 16

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?

Accepted Answer

Research has shown that bipolar disorders have a strong genetic component. Studies of families with bipolar disorder have found that individuals with a family history of the illness are more likely to develop bipolar disorder themselves. The risk is higher in first-degree relatives such as siblings and children, and the risk is even higher if more than one family member has the disorder.

Question 17

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?

Accepted Answer

Holding a staff meeting to discuss consistency and limit-setting approaches is the initial action to ensure all staff members are aligned in their approach to managing the patient's behavior, which can help reduce staff fatigue and defensiveness.

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.

Accepted Answer

The nurse should redirect the patient's attention to a less stimulating activity, such as looking at fashion magazines, which can help manage impulsive behavior without confrontation.

Question 19

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

Accepted Answer

Lithium can affect the balance of fluids and salts in the body, so it is important for patients to maintain a normal intake of salt and fluids to prevent lithium toxicity or subtherapeutic levels.

Question 20

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?

Accepted Answer

Carbamazepine (Tegretol) is an anticonvulsant that is often used as a mood stabilizer in the treatment of bipolar disorder, particularly for patients with rapid cycling mood changes.

Quiz 14: Bipolar Disorders