Chapter 13: Bipolar and Related Disorders My Nursing Test Banks

Chapter 13: Bipolar and Related Disorders

MULTIPLE CHOICE

1. A person was online continuously for over 24 hours, posting rhymes on official government websites and inviting politicians to join social networks. The person has not slept or eaten for 3 days. What features of mania are evident?

a.

Increased muscle tension and anxiety

c.

Poor judgment and hyperactivity

b.

Vegetative signs and poor grooming

d.

Cognitive deficits and paranoia

ANS: C

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

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Page 228-229 TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity

2. 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 patients mood?

a.

Euphoric

c.

Suspicious

b.

Irritable

d.

Confident

ANS: A

The patient has demonstrated clang associations and pleasant, happy behavior. Excessive happiness indicates euphoria. Irritability, belligerence, excessive happiness, and confidence are not the best terms for the patients mood. Suspiciousness is not evident.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 228-230 TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity

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 patients plan of care?

a.

Insulting, aggressive behavior

b.

Pressured speech and grandiosity

c.

Hyperactivity; not eating and sleeping

d.

Poor concentration and decision making

ANS: C

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

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 234-236 (Case Study and Nursing Care Plan 13-1) TOP: Nursing Process: Planning

MSC: Client Needs: Safe, Effective Care Environment

4. 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?

a.

Risk for injury

b.

Ineffective coping

c.

Impaired social interaction

d.

Ineffective therapeutic regimen management

ANS: A

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

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 234-235 (Table 13-1) | Page 236 (Case Study and Nursing Care Plan 13-1)

TOP: Nursing Process: Diagnosis/Analysis

MSC: Client Needs: Safe, Effective Care Environment

5. 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?

a.

Stop that! No one did anything to provoke an attack by you.

b.

If you do that one more time, you will be secluded immediately.

c.

Do not hit anyone. If you are unable to control yourself, we will help you.

d.

You know we will not let you hit anyone. Why do you continue this behavior?

ANS: C

When the patient is unable to control his or her behavior 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.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 233-234 | Page 238-239 (Table 13-2) | Page 236 (Case Study and Nursing Care Plan 13-1)

TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment

6. 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. The patient will:

a.

ask staff for assistance with feeding within 4 days.

b.

drink six servings of a high-calorie, high-protein drink each day.

c.

consistently sit with others for at least 30 minutes at meal time within 1 week.

d.

consistently wear appropriate attire for age and sex within 1 week while on the psychiatric unit.

ANS: B

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

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 238-239 (Table 13-2) | Page 236 (Case Study and Nursing Care Plan 13-1)

TOP: Nursing Process: Outcomes Identification

MSC: Client Needs: Physiological Integrity

7. 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? It will:

a.

minimize the side effects of lithium.

b.

bring hyperactivity under rapid control.

c.

enhance the antimanic actions of lithium.

d.

be used for long-term control of hyperactivity.

ANS: B

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 lithiums antimanic activity nor minimize the side effects. Lithium will be used for long-term control.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Page 239-240 | Page 242 TOP: Nursing Process: Planning

MSC: Client Needs: Physiological Integrity

8. 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?

a.

phenytoin (Dilantin)

c.

risperidone (Risperdal)

b.

clonidine (Catapres)

d.

carbamazepine (Tegretol)

ANS: D

Some patients with bipolar disorder, especially those who have only short periods between episodes, have a favorable 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. See relationship to audience response question.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 241-244 (Table 13-4) TOP: Nursing Process: Planning

MSC: Client Needs: Physiological Integrity

9. The exact cause of bipolar disorder has not been determined; however, for most patients:

a.

several factors, including genetics, are implicated.

b.

brain structures were altered by stress early in life.

c.

excess sensitivity in dopamine receptors may trigger episodes.

d.

inadequate norepinephrine reuptake disturbs circadian rhythms.

ANS: A

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.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Page 229-231 TOP: Nursing Process: Implementation

MSC: Client Needs: Health Promotion and Maintenance

10. 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?

a.

A high proportion of patients with bipolar disorders are found among creative writers.

b.

A higher rate of relatives with bipolar disorder is found among patients with bipolar disorder.

c.

Patients with bipolar disorder have higher rates of relatives who respond in an exaggerated way to daily stress.

d.

More individuals with bipolar disorder come from high socioeconomic and educational backgrounds.

ANS: B

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.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 229-230 TOP: Nursing Process: Implementation

MSC: Client Needs: Health Promotion and Maintenance

11. 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 behavior without entering into a power struggle. Which initial approach should the nurse select?

a.

Distraction: Lets go to the dining room for a snack.

b.

Humor: How much are you paying servants these days?

c.

Limit setting: You must stop ordering other patients around.

d.

Honest feedback: Your controlling behavior is annoying others.

ANS: A

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.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 238-239 (Table 13-2) | Page 236 (Case Study and Nursing Care Plan 13-1)

TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

12. The nurse receives a laboratory report indicating a patients serum level is 1 mEq/L. The patients last dose of lithium was 8 hours ago. This result is:

a.

within therapeutic limits.

b.

below therapeutic limits.

c.

above therapeutic limits.

d.

invalid because of the time lapse since the last dose.

ANS: A

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

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Page 240 | Page 243-244 (Table 13-4)

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

13. Consider these three anticonvulsant medications: divalproex (Depakote), carbamazepine (Tegretol), and gabapentin (Neurontin). Which medication also belongs to this classification?

a.

clonazepam (Klonopin)

c.

lamotrigine (Lamictal)

b.

risperidone (Risperdal)

d.

aripiprazole (Abilify)

ANS: C

The three drugs in the stem of the question are all anticonvulsants. Lamotrigine is also an anticonvulsant. Clonazepam is an anxiolytic; aripiprazole and risperidone are antipsychotic drugs. See relationship to audience response question.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Page 243-244 (Table 13-4) TOP: Nursing Process: Implementation

MSC: Client Needs: Physiological Integrity

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

a.

Allow the patient to act out feelings.

b.

Set limits on patient behavior as necessary.

c.

Provide verbal instructions to the patient to remain calm.

d.

Restrain the patient to reduce hyperactivity and aggression.

ANS: B

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

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 233-234 | Page 238-239 (Table 13-2) | Page 236 (Case Study and Nursing Care Plan 13-1)

TOP: Nursing Process: Planning MSC: Client Needs: Safe, Effective Care Environment

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

a.

An extra-large window with a view of the street

b.

Neutral walls with pale, simple accessories

c.

Brightly colored walls and print drapes

d.

Deep colors for walls and upholstery

ANS: B

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

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 238-239 (Table 13-2) | Page 236 (Case Study and Nursing Care Plan 13-1)

TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

16. A patient demonstrating behaviors associated with acute mania has exhausted the staff by noon. Staff members are feeling defensive and fatigued. Which action will the staff take initially?

a.

Confer with the health care provider to consider use of seclusion for this patient.

b.

Hold a staff meeting to discuss consistency and limit-setting approaches.

c.

Conduct a meeting with all staff and patients to discuss the behavior.

d.

Explain to the patient that the behavior is unacceptable.

ANS: B

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

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Page 233-234 TOP: Nursing Process: Implementation

MSC: Client Needs: Safe, Effective Care Environment

17. A patient experiencing acute mania undresses in the group room and dances. The nurse intervenes initially by:

a.

quietly asking the patient, Why dont you put your clothes on?

b.

firmly telling the patient, Stop dancing and put on your clothing.

c.

putting a blanket around the patient and walking with the patient to a quiet room.

d.

letting the patient stay in the group room and moving the other patients to a different area.

ANS: C

Patients must be protected from the embarrassing consequences of their poor judgment 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.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 234 | Page 238-239 (Table 13-2)

TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

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 four pairs of shoes. Select the nurses appropriate intervention. The nurse:

a.

suggests the patient have a friend do the shopping and bring purchases to the unit.

b.

invites the patient to sit together and look at new fashion magazines.

c.

tells the patient computer use is not allowed until self-control improves.

d.

asks whether the patient has enough money to pay for the purchases.

ANS: B

Situations such as this offer an opportunity to use the patients distractibility to staffs 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 patients need for immediacy and would ultimately result in the extravagant expenditure. Asking whether the patient has enough money would likely precipitate an angry response.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 234 | Page 238-239 (Table 13-2) | Page 236 (Case Study and Nursing Care Plan 13-1)

TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

19. 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:

a.

meals.

c.

an antiemetic.

b.

an antacid.

d.

a large glass of juice.

ANS: A

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

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 241 (Box 13-1) TOP: Nursing Process: Implementation

MSC: Client Needs: Physiological Integrity

20. A health teaching plan for a patient taking lithium should include instructions to:

a.

maintain normal salt and fluids in the diet.

b.

drink twice the usual daily amount of fluid.

c.

double the lithium dose if diarrhea or vomiting occurs.

d.

avoid eating aged cheese, processed meats, and red wine.

ANS: A

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

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 241 (Box 13-1) TOP: Nursing Process: Planning

MSC: Client Needs: Physiological Integrity

21. Which nursing diagnosis would most likely apply to both a patient diagnosed with major depression as well as one experiencing acute mania?

a.

Deficient diversional activity

c.

Fluid volume excess

b.

Disturbed sleep pattern

d.

Defensive coping

ANS: B

Patients with mood disorders, both depression and mania, experience sleep pattern disturbances. Assessment data should be routinely gathered about this possible problem. Deficient diversional activity is more relevant for patients with depression. Defensive coping is more relevant for patients with mania. Fluid volume excess is less relevant for patients with mood disorders than is deficient fluid volume.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Page 234-235 (Table 13-1) | Page 245; also incorporates content from Chapter 14.

TOP: Nursing Process: Diagnosis/Analysis

MSC: Client Needs: Psychosocial Integrity

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

a.

Spaghetti and meatballs, salad, and a banana

b.

Beef and vegetable stew, a roll, and chocolate pudding

c.

Broiled chicken breast on a roll, an ear of corn, and an apple

d.

Chicken casserole, green beans, and flavored gelatin with whipped cream

ANS: C

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

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 238-239 (Table 13-2) | Page 236 (Case Study and Nursing Care Plan 13-1)

TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity

23. Outcome identification for the treatment plan of a patient experiencing grandiose thinking associated with acute mania will focus on:

a.

developing an optimistic outlook.

c.

interest in the environment.

b.

distorted thought self-control.

d.

sleep pattern stabilization.

ANS: B

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.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 234 TOP: Nursing Process: Outcomes Identification

MSC: Client Needs: Psychosocial Integrity

24. Which documentation indicates that the treatment plan for a patient diagnosed with acute mania has been effective?

a.

Converses with few interruptions; 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.

ANS: A

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.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 245-246 TOP: Nursing Process: Evaluation

MSC: Client Needs: Psychosocial Integrity

25. A patient experiencing acute 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 physiological functioning.

c.

Supervise personal hygiene.

b.

Provide a subdued environment.

d.

Observe for mood changes.

ANS: B

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 to balance activity and rest.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 238-239 (Table 13-2) | Page 236 (Case Study and Nursing Care Plan 13-1)

TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity

26. A patient with diagnosed bipolar disorder was hospitalized 7 days ago and has been taking lithium 600 mg tid. Staff observes increased agitation, pressured speech, poor personal hygiene, and hyperactivity. Which action demonstrates that the nurse understands the most likely cause of the patients behavior?

a.

Educate the patient about the proper ways to perform personal hygiene and coordinate clothing.

b.

Continue to monitor and document the patients 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.

ANS: D

The patient is continuing to exhibit manic symptoms. The lithium level may be low from cheeking (not swallowing) the medication. The prescribed dose is high, so one would not expect a need for the dose to be increased. Monitoring the patient does not address the problem.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Page 235 | Page 238-239 (Table 13-2) TOP: Nursing Process: Evaluation

MSC: Client Needs: Physiological Integrity

27. A patient with 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.

ANS: D

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 proven successful, considering the behavior has continued. Asking if 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.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 233-234 | Page 238-239 (Table 13-2) | Page 236 (Case Study and Nursing Care Plan 13-1)

TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment

28. A patient experiencing acute mania is dancing atop a pool table in the recreation room. The patient waves a cue in one hand and says, Ill throw the pool balls if anyone comes near me. To best assure safety, the nurses first intervention is to:

a.

tell the patient, You need to be secluded.

b.

clear the room of all other patients.

c.

help the patient down from the table.

d.

assemble a show of force.

ANS: B

Safety is of primary importance. Once other patients are out of the room, a plan for managing this patient can be implemented.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 244-245 TOP: Nursing Process: Planning

MSC: Client Needs: Safe, Effective Care Environment

29. A patient diagnosed with bipolar disorder will be discharged tomorrow. The patient is taking a mood stabilizing medication. What is the priority nursing intervention for the patient as well as the patients family during this phase of treatment?

a.

Attending psychoeducation sessions

c.

Increasing food and fluids

b.

Decreasing physical activity

d.

Meeting self-care needs

ANS: A

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, treatment focuses on maintaining medication compliance and preventing relapse, both of which are fostered by ongoing psychoeducation.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 234-235 | Page 245 (Box 13-2) TOP: Nursing Process: Planning

MSC: Client Needs: Psychosocial Integrity

30. A nurse assesses a patient who takes lithium. Which findings demonstrate evidence of complications?

a.

Pharyngitis, mydriasis, and dystonia

c.

Diaphoresis, weakness, and nausea

b.

Alopecia, purpura, and drowsiness

d.

Ascites, dyspnea, and edema

ANS: C

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

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Page 240 (Table 13-3) | Page 241 (Box 13-1)

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

31. 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 nurses appropriate response.

a.

You will be able to stop the medication in about 1 month.

b.

Taking the medication every day helps reduce the risk of a relapse.

c.

Usually patients take medication for approximately 6 months after discharge.

d.

Its unusual that the health care provider hasnt already stopped your medication.

ANS: B

Patients diagnosed with bipolar disorder may be maintained on lithium indefinitely to prevent recurrences. Helping the patient understand this need will promote medication compliance.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 241 (Box 13-1) TOP: Nursing Process: Implementation

MSC: Client Needs: Physiological Integrity

32. An outpatient diagnosed with bipolar disorder is prescribed lithium. The patient telephones the nurse to say, Ive had severe diarrhea for 4 days. I feel very weak and unsteady when I walk. My usual hand tremor has gotten worse. What should I do? The nurse will advise the patient to:

a.

restrict food and fluids for 24 hours and stay in bed.

b.

have someone bring the patient to the clinic immediately.

c.

drink a large glass of water with 1 teaspoon of salt added.

d.

take one dose of an over-the-counter antidiarrheal medication now.

ANS: B

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. The incorrect options will not ameliorate the patients symptoms.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 240 (Table 13-3) | Page 241 (Box 13-1)

TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity

33. A newly diagnosed patient is prescribed lithium. Which information from the patients history indicates that monitoring of serum concentrations of the drug will be challenging and critical?

a.

Arthritis

c.

Psoriasis

b.

Epilepsy

d.

Heart failure

ANS: D

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.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Page 240 (Table 13-3) | Page 241 (Box 13-1)

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

34. Four new patients were admitted to the behavioral health unit in the past 12 hours. The nurse directs a psychiatric technician to monitor these patients for safety. Which patient will need the most watchful supervision? A patient diagnosed with:

a.

bipolar I disorder.

c.

dysthymic disorder

b.

bipolar II disorder.

d.

cyclothymic disorder.

ANS: A

Bipolar I is a mood disorder characterized by excessive activity and energy. Psychosis (hallucinations, delusions, and dramatically disturbed thoughts) may occur during manic episodes. A patient with bipolar I disorder is more unstable than a patient diagnosed with bipolar II, cyclothymic disorder, or dysthymic disorder.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Page 228-230; also incorporates content from Chapter 14.

TOP: Nursing Process: Assessment MSC: Client Needs: Safe, Effective Care Environment

MULTIPLE RESPONSE

1. Which suggestions are appropriate for the family of a patient diagnosed with bipolar disorder who is being treated as an outpatient during a hypomanic episode? Select all that apply.

a.

Limit credit card access.

b.

Provide a structured environment.

c.

Encourage group social interaction.

d.

Suggest limiting work to half-days.

e.

Monitor the patients sleep patterns.

ANS: A, B, E

A patient with hypomania is expansive, grandiose, and labile; uses poor judgment; spends inappropriately; and is over-stimulated 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.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 228-232 | Page 245 (Box 13-2) TOP: Nursing Process: Planning

MSC: Client Needs: Psychosocial Integrity

2. A nurse prepares the plan of care for a patient experiencing an acute 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

ANS: B, C

People 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. Confusion may be acute but not chronic.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 234-235 (Table 13-1) TOP: Nursing Process: Diagnosis/Analysis

MSC: Client Needs: Psychosocial Integrity

3. A patient tells the nurse, Im ashamed of being bipolar. When Im manic, my behavior embarrasses everyone. Even if I take my medication, there are no guarantees. Im 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

ANS: A, C

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

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Page 234-235 (Table 13-1) TOP: Nursing Process: Diagnosis/Analysis

MSC: Client Needs: Psychosocial Integrity

4. The plan of care for a patient in the manic state of bipolar disorder should include which interventions? Select all that apply.

a.

Touch the patient to provide reassurance.

b.

Invite the patient to lead a community meeting.

c.

Provide a structured environment for the patient.

d.

Ensure that the patients nutritional needs are met.

e.

Design activities that require the patients concentration.

ANS: C, D

People with mania are hyperactive, grandiose, and distractible. Its most important to ensure the patient receives adequate nutrition. Structure will support a safe environment. Touching the patient may precipitate aggressive behavior. Leading a community meeting would be appropriate when the patients behavior is less grandiose. Activities that require concentration will produce frustration.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 234-236 | Page 238-239 (Table 13-2) TOP: Nursing Process: Planning

MSC: Client Needs: Psychosocial Integrity

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