Question 1

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

Accepted Answer

Sodium depletion and dehydration increase the chance for development of lithium toxicity. The other options offer inappropriate information.

Question 2

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

Normal range for a blood sample taken 8 to 12 hours after the last dose of lithium is 0.4 to 1 mEq/L.

Question 3

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

Hyperactivity, poor nutrition, poor hydration, and not sleeping take priority in terms of the needs listed above because they threaten the physical integrity of the patient. The other behaviours are less threatening to the patient's life.

Question 4

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

Accepted Answer

This intervention provides support through the nurse's presence and provides structure as necessary while the patient's control is tenuous. Acting out may lead to loss of behavioural control. The patient will probably be unable to focus on instructions and comply. Restraint is used only after other interventions have proved ineffective.

Question 5

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

The three drugs in the question are all anticonvulsants. Lamotrigine is also an anticonvulsant. Clonazepam is an anxiolytic; aripiprazole and risperidone are antipsychotic drugs.

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

When the patient is unable to control his or her behaviour and violates or threatens to violate the rights of others, limits must be set in an effort to de-escalate the situation. Limits should be set in simple, concrete terms. The incorrect responses do not offer appropriate assistance to the patient, threaten the patient with seclusion as punishment, and ask a rhetorical question.

Question 7

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 has demonstrated clang associations and pleasant, happy behaviour. Excessive happiness indicates euphoria. Irritability and confidence are not the best terms for the patient's mood. Suspiciousness is not evident.

Question 8

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

Accepted Answer

The best explanation at this time is that bipolar disorder is most likely caused by interplay of complex independent variables. Various theories implicate genetics, endocrine imbalance, environmental stressors, and neurotransmitter imbalances.

Question 9

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

Although each of the nursing diagnoses listed is appropriate for a patient having a manic episode, the priority lies with the patient's physiological safety. Hyperactivity and poor judgement put the patient at risk for injury.

Question 10

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

High-calorie, high-protein food supplements will provide the additional calories needed to offset the patient's extreme hyperactivity. Sitting with others or asking for assistance does not mean the patient eats or drinks. The other indicator is unrelated to the nursing diagnosis.

Question 11

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

Some patients with bipolar disorder, especially those who have only short periods between episodes, have a favourable response to the anticonvulsants carbamazepine and valproate. Carbamazepine seems to work better in patients with rapid cycling and in severely paranoid, angry manic patients. Phenytoin is also an anticonvulsant but not used for mood stabilization. Risperidone is not an anticonvulsant. Gabapentin is an anticonvulsant that is used primarily for maintenance treatment of bipolar disorder.

Question 12

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

Some patients find that taking lithium with meals diminishes nausea. The incorrect options are less helpful.

Question 13

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

Accepted Answer

The environment for a manic patient should be as simple and nonstimulating as possible. Manic patients are highly sensitive to environmental distractions and stimulation.

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?

Accepted Answer

Evidence of genetic transmission is supported when twins or relatives of patients with a particular disorder also show an incidence of the disorder that is higher than the incidence in the general public. The incorrect options do not support the theory of genetic transmission and other factors involved in the etiology of bipolar disorder.

Question 15

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

Manic symptoms are controlled by lithium only after a therapeutic serum level is attained. Because this takes several days to accomplish, a drug with rapid onset is necessary to reduce the hyperactivity initially. Antipsychotic drugs neither enhance lithium's antimanic activity nor minimize the side effects. Lithium is used for long-term control.

Question 16

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

Accepted Answer

Patients must be protected from the embarrassing consequences of their poor judgement whenever possible. Protecting the patient from public exposure by matter-of-factly covering the patient and removing him or her from the area with a sufficient number of staff to avoid argument and provide control is an effective approach.

Question 17

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

Hyperactivity (activity without sleep) and poor judgement (posting rhymes on government Web sites) are characteristic of manic episodes. The distracters do not specifically apply to mania.

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

Situations such as this offer an opportunity to use the patient's distractibility to staff's advantage. Patients become frustrated when staff deny requests that the patient sees as entirely reasonable. Distracting the patient can avoid power struggles. Suggesting that a friend do the shopping would not satisfy the patient's need for immediacy and would ultimately result in the extravagant expenditure. Asking whether the patient has enough money would likely precipitate an angry response.

Question 19

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

When staff members are at their wits' end, the patient has succeeded in keeping the environment unsettled and avoided outside controls on behaviour. Staff meetings can help minimize staff splitting and feelings of anger, helplessness, confusion, and frustration.

Question 20

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

The distractibility characteristic of manic episodes can assist the nurse to direct the patient toward more appropriate, constructive activities without entering into power struggles. Humor usually backfires by either encouraging the patient or inciting anger. Limit setting and honest feedback may seem heavy-handed and may incite anger.

Quiz 15: Bipolar Disorders