Question 1

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

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 because of their use of denial,and they are overly interested in their environment.

Question 2

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.

Accepted Answer

Bipolar patients are maintained on lithium indefinitely to prevent recurrences.Helping the patient understand this need will promote medication compliance .It is expected that the patient will take medication for a long time.

Question 3

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:

Accepted Answer

The safety of the other patients in the room is of primary importance.Once other patients are out of the room,a plan for controlling this patient can be implemented.

Question 4

Which nursing diagnosis is a priority for both a patient with depression and one with acute mania?

Accepted Answer

Physical needs of patients with mood disorders include sleep disturbances.This possible problem should be monitored consistently.While the other diagnoses may apply,sleep problems are the priority.

Question 5

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. )

Accepted Answer

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

Question 6

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

Accepted Answer

The correct response indicates the patient is functioning at an optimal level,using appropriate behavior,and thinking without overstimulation.The distracters show manic behavior.

Question 7

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.

Accepted Answer

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

Question 8

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?

Accepted Answer

All the options are reasonable interventions with a patient with acute mania,but the correct answer directly relates to the outcome of energy conservation.A subdued environment decreases stimulation,which will help balance activity and rest.

Question 9

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?

Accepted Answer

The symptoms listed in the correct response suggest a potential life-threatening dermatological reaction and warrant immediate intervention.All other problems mentioned are unrelated to problems with this drug.

Question 10

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. )

Accepted Answer

A patient with hypomania is expansive,grandiose,labile,uses poor judgment,spends inappropriately,and is overstimulated by a busy environment.Providing structure would help 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 will be necessary to limit stimuli and prevent problems associated with poor judgment and inappropriate decision making that accompany hypomania.

Question 11

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

Accepted Answer

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

Question 12

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

Accepted Answer

Bipolar I disorder is diagnosed when the patient has had one episode of mania alternating with major depression.Bipolar I disorder may or may not be rapid cycling in nature.

Question 13

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.

Accepted Answer

Angry verbal attacks against staff by patients with mania are commonplace.Staff must realize verbal attacks are part of illness behavior rather than personal in nature.Arguing,explaining,and calling for apologies are counterproductive behaviors.Remaining neutral and allowing a cooling-down period will serve the nurse well.Because the patient's mood is labile,the patient may be willing to continue the assessment when the nurse returns.

Question 14

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

Accepted Answer

The symptoms listed in the correct response are signs of lithium toxicity.All other problems mentioned are unrelated to lithium therapy.

Question 15

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?

Accepted Answer

The symptoms described suggest lithium toxicity.The patient should have a lithium level drawn and may require further treatment.Because neurological symptoms are present,the patient should not drive and should be accompanied by another person.

Question 16

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?

Accepted Answer

The patient with heart failure will likely need diuretic drugs,which will complicate the maintenance of the fluid balance necessary to avoid lithium toxicity.

Question 17

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

Accepted Answer

Bipolar disorder is most likely caused by the interplay of complex variables.Theories implicate polygenics (multiple genes),neurotransmitter imbalances,and endocrine imbalance.Neuroimaging shows changes in the frontal lobes and lateral ventricles of some patients.The cause of the disorder is not associated with substance abuse or prenatal problems.

Question 18

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. )

Accepted Answer

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

Question 19

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

Accepted Answer

These foods provide adequate nutrition and are finger foods that the hyperactive patient could "eat on the run." The foods listed in the other options cannot be eaten without utensils.

Question 20

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

Accepted Answer

A patient who repeatedly disrobes despite verbal limit setting needs more structure.One-on-one supervision may provide the necessary structure.

Quiz 14: Bipolar Disorders