Chapter 12: Bipolar Disorders My Nursing Test Banks

Chapter 12: Bipolar Disorders

Multiple Choice

Identify the choice that best completes the statement or answers the question.

____ 1. Your bipolar patient approaches you and says, I will be running this hospital someday. I know I can change everything. What is the best intervention?

A.

Orient the patient by telling her that this would require multiple educational degrees that she does not have.

B.

Ask the patient why she thinks she can do that.

C.

Redirect the patient to what is going on around her now.

D.

Contact the psychiatrist immediately.

____ 2. Your new patient admitted to the psychiatric unit is pacing and agitated. Which of the following is the most appropriate intervention?

A.

Introduce the patient to all the other patients.

B.

Direct him to a group therapy session.

C.

Place him in a quiet area away from other patients.

D.

Review the unit rules with the patient to distract him.

____ 3. Your patient in the psychiatric unit is still up at midnight playing cards. You tell him, Its time to get some sleep now. What is the purpose of this response?

A.

Limit setting

B.

Reality testing

C.

Controlling patient so other patients will respond the same way

D.

Enforcing rules

____ 4. Which statement is most likely to be from a patient in a manic episode?

A.

I dont need to sleep.

B.

I am Jesus Christ.

C.

Leave me alone while I am reading this textbook.

D.

I am worthless.

____ 5. Which diversional activity is most appropriate for a patient in a manic phase?

A.

Bridge

B.

Exercise class

C.

Cross stitch

D.

Computer game

____ 6. Lithium toxicity is most likely with which of the following patients?

A.

Elderly man with diarrhea from food poisoning

B.

Teenage girl on oral contraceptives

C.

40-year-old man who smokes marijuana on the weekend

D.

All of the above are at high risk

____ 7. Your 28-year-old patient was admitted to the psychiatric unit with a diagnosis of major depression with symptoms of withdrawal and extreme sadness. After 2 weeks on the unit, the patient suddenly becomes more talkative, sleeps only 2 hours a night, and acts seductively with the male patients. What is the most likely explanation for this change?

A.

The antidepressants are effective.

B.

The patient was diagnosed incorrectly.

C.

She is having a manic episode as part of her illness.

D.

She is recovering from her depression.

____ 8. You are working with the RN to plan short-term goals for a 28-year-old hospitalized manic client. Which is the most important goal?

A.

Protection from self-inflicted harm

B.

Meals in excess of metabolic requirement

C.

Strict participation in unit activities

D.

Enforced medication compliance

____ 9. A 30-year-old male client is admitted to the psychiatric unit with a diagnosis of bipolar disorder. His family reports that for the past 2 months he has been in constant motion, sleeping very little, spending lots of money, and has been full of ideas. During the initial assessment with the client, the nurse would expect him to exhibit which of the following?

A.

Short, polite responses to interview questions

B.

Introspection related to his present situation

C.

Exaggerated self-importance

D.

Feelings of helplessness and hopelessness

____ 10. Lithium is most commonly used to treat which of the following disorders?

A.

Dysthymia

B.

Schizophrenia

C.

Generalized anxiety disorder

D.

Bipolar disorder

____ 11. Marnie is a 16-year-old patient with bipolar disorder. She is manic right now and is in the hallway naked, making sexual requests of the staff and other patients. What is your best course of action?

A.

Quietly approach her, escort her to her room, and assist her in getting dressed.

B.

Quietly approach her, escort her to her room, and explain to her the inappropriateness of her actions.

C.

Approach her, confront her behavior as it is happening, and escort her to her room.

D.

Confront her behavior in the hall, apologize to the other patients, and escort her to her room.

____ 12. Which activity would you select as best for your patient in a manic state?

A.

Brown bag lunch at a book review group

B.

Badminton

C.

Paint by numbers class

D.

Guided imagery

____ 13. Which of the following best describes bipolar I disorder?

A.

Full manic cycles with possibility of depression.

B.

Disturbance in mood that is a direct result of physiological effects of substance abuse.

C.

Periods of mild mania followed by mild depression.

D.

Intense depression followed by normal mood.

____ 14. Which of the following would present the greatest risk to develop bipolar disorder?

A.

Use of stimulant medications as a child

B.

History of anxiety disorder as a teenager

C.

First-degree relative with the bipolar disorder diagnosis

D.

History of conduct disorder

____ 15. Toni, diagnosed with bipolar disorder, is currently in the mania stage. The staff noted that Toni has placed her lipstick on in an exaggerated way. She is currently pacing the floor and is easily angered. The duty nurse approaches in an attempt to ease some of Tonis behaviors. The most therapeutic response by the nurse would be:

A.

Would you like to watch TV?

B.

Would you like me to talk with you?

C.

Lets walk and talk

D.

Avoid giving attention to the patient by not responding to her behavior

 

____ 16. For a patient diagnosed with bipolar disorder, what would be the drug of choice?

A.

Lithium carbonate

B.

Valium

C.

Paxil

D.

Haldol

Multiple Response

Identify one or more choices that best complete the statement or answer the question.

____ 17. Which of the following are signs of mania? (Select all that apply)

A.

Pessimistic feelings

B.

Increased sexual drive

C.

Denial that anything is wrong

D.

Decreased energy

E.

Decreased need for sleep

F.

Thoughts of death or suicide

____ 18. While assessing your patient, you realize the patient is experiencing a manic episode. You will most likely expect (select all that apply):

A.

Decreased need for sleep.

B.

Extreme irritability.

C.

Extreme depression.

D.

A surge of energy.

E.

A loss of interest in ordinary activities.

Chapter 12: Bipolar Disorders

Answer Section

MULTIPLE CHOICE

1. ANS: C

Rather than challenge the patients thinking or overreacting, it is best to acknowledge what she said and then distract her to more reality-based thoughts.

PTS: 1

REF: Chapter 12: Bipolar Disorders; General Nursing Interventions for Bipolar Disorder; page 198-199

KEY: Integrated Processes: Caring | Content Area: Mental Health: Therapeutic communication | Cognitive Level: Application | Client Need: Psychosocial Integrity: Therapeutic communication

2. ANS: C

Rather than adding more information and added stimuli, you are focusing on helping him cope.

PTS: 1

REF: Chapter 12: Bipolar Disorders; General Nursing Interventions for Bipolar Disorder; page 198-199

KEY: Integrated Processes: Nursing Process: Implementation | Content Area: Mental Health: Coping | Cognitive Level: Application | Client Need: Psychosocial Integrity: Behavioral intervention

3. ANS: A

Limit setting is an important intervention that defines what is expected and what is not allowed. It is more therapeutic than just controlling or enforcing rules.

PTS: 1

REF: Chapter 12: Bipolar Disorders; General Nursing Interventions for Bipolar Disorder; page 198-199

KEY: Integrated Processes: Nursing Process: Implementation | Content Area: Mental Health: Therapeutic communication | Cognitive Level: Application | Client Need: Psychosocial Integrity: Therapeutic communication

4. ANS: A

Manic patients usually have very little need for sleep. Response B is a delusion of grandeur that may be present but is not most likely. Manic patients are unable to concentrate on reading and less likely to make depressive statements in a manic state.

PTS: 1 REF: Chapter 12: Bipolar Disorders; Manic Phase; page 193-194

KEY: Integrated Processes: Nursing Process: Assessment | Content Area: Mental Health: Mood disorders | Cognitive Level: Application | Client Need: Psychosocial Integrity: Mental health concepts

5. ANS: B

Physical activity to discharge pent-up energy can be useful. The other activities are sedentary and require concentration, which would be difficult for the manic patient.

PTS: 1 REF: Chapter 12: Bipolar Disorders; General Nursing Interventions; page 198-199

KEY: Integrated Processes: Nursing Process: Analysis

6. ANS: A

Diarrhea can precipitate dehydration, which is a common cause of lithium toxicity. Responses B and C are not indicators of high risk behaviors for toxicity.

PTS: 1 REF: Chapter 12: Bipolar Disorders; Treatment of Bipolar Disorders; page 197

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Adult health: Pharmacology | Cognitive Level: Application | Client Need: Physiological Integrity: Pharmacological and parenteral therapies: Medication administration and adverse effects/contraindications/side effects/interactions

7. ANS: C

Sudden shifts to manic behavior after depression may indicate bipolar disorder I. Responses A and D are unlikely, given the rapid change in behavior. Depression diagnosis was accurate initially related to response B.

PTS: 1 REF: Chapter 12: Bipolar Disorders; Manic Phase; page 193-194

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Mood disorders | Cognitive Level: Application | Client Need: Psychosocial Integrity: Mental health concepts

8. ANS: A

Safety is always the priority. The other goals may be part of the plan, but protection from self-inflicted harm is most important.

PTS: 1 REF: Chapter 12: Bipolar Disorders; General Nursing Interventions; page 198-199

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Mood disorders | Cognitive Level: Application | Client Need: Psychosocial Integrity

9. ANS: C

In the manic phase the client will be unable to control his response or be introspective. He will also not be in touch with feelings of helplessness or hopelessness unless he moves into the depressive phase.

Integrated process: Nursing process: Assessment | Content Area: Mental health: Mood disorder | Cognitive Level: Application | Client Need: Psychosocial integrity: Mental health concepts

PTS: 1 REF: Chapter 12: Bipolar Disorders; Manic Phase; page 193-194

KEY: Integrated Processes: Nursing Process: Assessment | Content Area: Mental Health: Mood disorder | Cognitive Level: Application

10. ANS: D

Lithium is a drug commonly used to treat bipolar disorder and is not used to treat the other disorders.

PTS: 1 REF: Chapter 12: Bipolar Disorders; Treatment of Bipolar Disorders; page 197

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Pharmacology | Cognitive Level: Knowledge | Client Need: Physiological Integrity: Pharmacological and parenteral therapies: Medication administration

11. ANS: A

With a patient in a manic state, the intervention should be calming with the emphasis on limit setting rather than confrontational and/or encouraging insight.

PTS: 1 REF: Chapter 12: Bipolar Disorders; General Nursing Interventions; page 198-199

KEY: Integrated Processes: Nursing Process: Implementation | Content Area: Mental Health: Mood disorders | Cognitive Level: Application | Client Need: Psychosocial Integrity: Therapeutic communication

12. ANS: B

Physical activity is more effective than these other activities that require concentration.

PTS: 1 REF: Chapter 12: Bipolar Disorders; General Nursing Interventions; page 199

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Mood disorders | Cognitive Level: Application | Client Need: Psychosocial Integrity: Mental health concepts

13. ANS: A

Bipolar I is a full syndrome of manic symptoms and may also have depression. Response B is bipolar disorder due to substance abuse.

PTS: 1

REF: Chapter 12: Bipolar Disorders; Table 12-1, Forms of Bipolar Disorders; page 194

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Mood disorders | Cognitive Level: Comprehension | Client Need: Psychosocial Integrity: Mental health concepts

14. ANS: C

Family history is the strongest risk factor.

PTS: 1 REF: Chapter 12: Bipolar Disorders; Etiology; page 195-196

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Mood disorders | Cognitive Level: Comprehension | Client Need: Psychosocial Integrity: Mental health concepts

15. ANS: C

To reduce the level of anger and aggression the patient may be experiencing, the nurse should encourage the patient to discharge some energy by physical activity. Talking about feelings may be difficult. The patient may not be able to concentrate.

PTS: 1 REF: Chapter 12: Bipolar Disorders; General Nursing Interventions; page 193-195

KEY: Integrated Processes: Caring | Content Area: Mental Health: Therapeutic Communication | Cognitive Level: Application | Client Need: Psychosocial Integrity: Therapeutic Communication

16. ANS: A

Lithium is one of the major drugs that assist in mood stabilizing.

PTS: 1 REF: Chapter 12: Bipolar Disorders; Pharmacology Corner; page 196

KEY: Integrated Processes: Teaching/Learning | Content Area: Mental Health: Pharmacology | Cognitive Level: Knowledge | Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies: Expected Actions/Outcomes

MULTIPLE RESPONSE

17. ANS: B, C, E

The manic patient will have increased energy and drive and not exhibit insight into the maladaptive behavior.

PTS: 1 REF: Chapter 12: Bipolar Disorders; Manic Phase; page 193

KEY: Integrated Processes: Analysis | Content Area: Mental Health: Mood disorders | Cognitive Level: Comprehension | Client Need: Psychosocial Integrity: Mental health concepts

18. ANS: A, B, D

Mania is part of the bipolar disorder. The patients moods shift from mania to depression, both in the extreme. The changes are noticeable and can be described as dramatic. During a manic episode the patient is hyperactive, irritable, reduced need for sleep without signs of depression.

PTS: 1 REF: Chapter 12: Bipolar Disorders; Manic Phase; page 193-194

KEY: Integrated Processes: Teaching/Learning | Content Area: Mental Health: Mood Disorder | Cognitive Level: Comprehension | Client Need: Psychosocial Integrity: Mental health Concepts

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