Question 1

Which documentation indicates that the treatment plan for a patient experiencing 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."

Accepted Answer

The descriptors given indicate the patient is functioning at an optimal level, using appropriate behavior, and thinking without becoming overstimulated by unit activities. The incorrect options reflect manic behavior.

Question 2

A patient diagnosed with bipolar disorder is being treated as an outpatient during a hypomanic episode. Which suggestions should the nurse provide to the family? (Select all that apply.)
A) Provide structure
B) Limit credit card access
C) Encourage group social interaction
D) Limit work to half days
E) Monitor the patient's sleep patterns

Accepted Answer

A patient with hypomania is expansive, grandiose, and labile; uses poor judgment; spends inappropriately; and is overstimulated by a busy environment. Providing structure helps the patient maintain appropriate behavior. Financial irresponsibility may be avoided by limiting access to cash and credit cards. Continued decline in sleep patterns may indicate the condition has evolved to full mania. Group socialization should be kept to a minimum to reduce stimulation. A full leave of absence from work is necessary to limit stimuli and to prevent problems associated with poor judgment and the inappropriate decision making that accompany hypomania.

Question 3

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

Accepted Answer

Diaphoresis, weakness, and nausea are early signs of lithium toxicity. Problems mentioned in the incorrect options are unrelated to lithium therapy.

Question 4

Lithium is prescribed for a new patient. Which information from the patient's history indicates that monitoring serum concentrations of the drug will be especially challenging and critical?
A) Arthritis
B) Epilepsy
C) Psoriasis
D) Congestive heart failure

Accepted Answer

The patient with congestive heart failure will likely need diuretic drugs, which will complicate the maintenance of the fluid balance necessary to avoid lithium toxicity. Arthritis, epilepsy, and psoriasis do not directly involve fluid balance and kidney function.

Question 5

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 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 has not already stopped your medication."

Accepted Answer

Patients diagnosed with bipolar disorder may be indefinitely maintained on lithium to prevent recurrences. Helping the patient understand this need promotes medication compliance. The incorrect options offer incorrect or misleading information.

Question 6

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

Accepted Answer

People with mania are hyperactive and often do not take the time to eat and drink properly. Their high levels of activity consume calories; therefore deficits in nutrition may occur. Sleep is reduced. Their socialization is impaired but not isolated. Confusion may be acute but not chronic.

Question 7

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

Accepted Answer

Chronic low self-esteem and powerlessness are interwoven in the patient's statements. No data support the other diagnoses.

Question 8

Which dinner menu is best suited for the patient diagnosed with bipolar disorder experiencing acute mania?
A) Spaghetti and meatballs, salad, a banana
B) Beef and vegetable stew, a roll, chocolate pudding
C) Broiled chicken breast on a roll, an ear of corn, apple
D) Chicken casserole, green beans, flavored gelatin with whipped cream

Accepted Answer

The correct foods provide adequate nutrition but, more importantly, are finger foods that the hyperactive patient could "eat on the run." The foods in the incorrect options cannot be eaten without utensils.

Question 9

Outcome identification for the treatment plan of a patient with grandiose thinking associated with acute mania focuses on:
A) maintaining an interest in the environment.
B) developing an optimistic outlook.
C) self-control of distorted thinking.
D) stabilizing the sleep pattern.

Accepted Answer

The desired outcome is that the patient will be able to control the grandiose thinking associated with acute mania as evidenced by making realistic comments about self, abilities, and plans. Patients with acute mania are already unduly optimistic as a result of their use of denial, and they are overly interested in their environment. Sleep stability is a desired outcome but is not related to distorted thought processes.

Question 10

A patient experiencing 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) help the patient down from the table.
C) clear the room of all other patients.
D) assemble a show of force.

Accepted Answer

Safety is of primary importance. Once other patients are out of the room, a plan for managing this patient can be implemented. A show of force is likely to frighten the patient and increase this risk for violence.

Question 11

A patient experiencing 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

Accepted Answer

All the options are reasonable interventions with a patient with acute mania, but providing a subdued environment directly relates to the outcome of energy conservation by decreasing stimulation and helping balance activity and rest.

Question 12

A patient experiencing 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.

Accepted Answer

A patient who repeatedly disrobes, despite verbal limit setting, needs more structure. One-on-one supervision may provide the necessary structure. Directing the patient to wear clothes at all times has not proved successful, considering the behavior has continued. Asking whether the patient is bothered by clothing serves no purpose. Telling the patient that others are embarrassed will not make a difference to the patient whose grasp of social behaviors is impaired by the illness.

Question 13

After hospital discharge, what is the priority intervention for a patient diagnosed with bipolar disorder who is taking antimanic medication, as well as for the patient's family?
A) Decreasing physical activity
B) Increasing food and fluids
C) Meeting self-care needs
D) Psychoeducation

Accepted Answer

During the continuation phase of treatment for bipolar disorder, the physical needs of the patient are not as important an issue as they were during the acute episode. After hospital discharge, the treatment focuses on maintaining medication compliance and preventing a relapse, both of which are fostered by ongoing psychoeducation.

Question 14

A patient diagnosed with bipolar disorder has been hospitalized for 7 days and has taken 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.

Accepted Answer

The patient is continuing to exhibit manic symptoms. The lithium level may be low as a result of "cheeking" the medication. The prescribed dose is high, so one would not expect a need for the dose to be increased.

Question 15

A patient diagnosed with bipolar disorder and who takes lithium telephones the nurse at the clinic to say, "I've had severe diarrhea 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 oral 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."

Accepted Answer

The symptoms described suggest lithium toxicity. The patient should have a lithium level drawn and may require further treatment. Because neurologic symptoms are present, the patient should not drive and should be accompanied by another person. The incorrect options will not address the patient's symptoms. Restricting oral fluids will make the situation worse.

Quiz 16: Bipolar Spectrum Disorders

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

A patient diagnosed with bipolar disorder is being treated as an outpatient during a hypomanic episode. Which suggestions should the nurse provide to the family? (Select all that apply.)

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

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

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 most appropriate response.

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 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.)

Which dinner menu is best suited for the patient diagnosed with bipolar disorder experiencing acute mania?

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

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

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

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

A patient diagnosed with bipolar disorder has been hospitalized for 7 days and has taken 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 patient diagnosed with bipolar disorder and who takes lithium telephones the nurse at the clinic to say, "I've had severe diarrhea 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: