Chapter 13 -Bipolar [EXAM 2]

Question 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
b. Vegetative signs and poor grooming
c. Poor judgment and hyperactivity
d. Cognitive deficits and paranoia

Answer 1

c. Poor judgment and hyperactivity

Question 2

A client diagnosed with bipolar disorder is dressed in a red leotard and bright scarves. The client twirls and shadow boxes. The client says gaily, “Do you like my scarves? Here they are my gift to you.” How should the nurse document the client’s mood?

a. Euphoric
b. Irritable
c. Suspicious
d. Confident

Answer 2

a. Euphoric

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 client’s plan of care?

a. Insulting, aggressive behavior
b. Pressured speech and grandiosity
c. Hyperactivity; not eating and sleeping
d. Poor concentration and decision making

Answer 3

c. Hyperactivity; not eating and sleeping

Question 4

A client 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

Answer 4

a. Risk for injury

Question 5

A client diagnosed with bipolar disorder becomes hyperactive after discontinuing lithium. The client threatens to hit another client. 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?”

Answer 5

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

Question 6

This nursing diagnosis applies to a client experiencing 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. What is an appropriate outcome for this client?

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

Answer 6

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

Question 7

A client demonstrating characteristics of acute mania relapsed after discontinuing lithium. New orders are written to resume lithium twice daily and begin olanzapine. What is the rationale for the addition of olanzapine to the medication regimen?

a. To minimize the side effects of lithium.
b. To bring hyperactivity under rapid control.
c. To enhance the antimanic actions of lithium.
d. To be used for long-term control of hyperactivity.

Answer 7

b. To bring hyperactivity under rapid control.

Question 8

A client 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
b. clonidine
c. risperidone
d. carbamazepine

Answer 8

d. carbamazepine

Question 9

While the exact cause of bipolar disorder has not been determined; however, what is consistent for most clients?

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.

Answer 9

a. several factors, including genetics, are implicated.

Question 10

The spouse of a client 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 clients with bipolar disorders are found among creative writers.”
b. “A higher rate of relatives with bipolar disorder is found among clients with bipolar disorder.”
c. “Clients 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.”

Answer 10

b. “A higher rate of relatives with bipolar disorder is found among clients with bipolar disorder.”

Question 11

A client diagnosed with bipolar disorder commands other clients, “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: “Let’s 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 clients around.”
d. Honest feedback: “Your controlling behavior is annoying others.”

Answer 11

a. Distraction: “Let’s go to the dining room for a snack.”

Question 12

The nurse receives a laboratory report indicating a client’s serum level is 1 mEq/L. The client’s last dose of lithium was 8 hours ago. What does this result indicate?

a. within therapeutic limits.
b. below therapeutic limits.
c. above therapeutic limits.
d. invalid because of the time lapse since the last dose.

Answer 12

a. within therapeutic limits.

Question 13

Consider these three anticonvulsant medications: divalproex, carbamazepine, and gabapentin. Which medication also belongs to this classification?

a. clonazepam
b. risperidone
c. lamotrigine
d. aripiprazole

Answer 13

c. lamotrigine

Question 14

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

a. Allow the client to act out feelings.
b. Set limits on client behavior as necessary.
c. Provide verbal instructions to the client to remain calm.
d. Restrain the client to reduce hyperactivity and aggression.

Answer 14

b. Set limits on client behavior as necessary.

Question 15

At a unit meeting, the staff discusses decor for a special room for clients 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

Answer 15

b. Neutral walls with pale, simple accessories

Question 16

A client 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 client.
b. Hold a staff meeting to discuss consistency and limit-setting approaches.
c. Conduct a meeting with all staff and clients to discuss the behavior.
d. Explain to the client that the behavior is unacceptable

Answer 16

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

Question 17

A client experiencing acute mania undresses in the group room and dances. How should the nurse intervene initially?

a. quietly asking the client, “Why don’t you put your clothes on?”
b. firmly telling the client, “Stop dancing and put on your clothing.”
c. putting a blanket around the client and walking with the client to a quiet room.
d. letting the client stay in the group room and moving the other clients to a different

Answer 17

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

Question 18

A client 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.” What is the nurse’s appropriate intervention?

a. suggesting the client have a friend do the shopping and bring purchases to the unit.
b. inviting the client to sit together and look at new fashion magazines.
c. telling the client computer use is not allowed until self-control improves.
d. asking whether the client has enough money to pay for the purchases.

Answer 18

b. inviting the client to sit together and look at new fashion magazines.

Question 19

A client diagnosed with bipolar disorder who takes lithium carbonate 300 mg three times daily reports nausea. To reduce the nausea most effectively, the nurse suggests that the lithium be taken with what?

a. food.
b. an antacid.
c. an antiemetic.
d. a large glass of juice.

Answer 19

a. food.

Question 20

A health teaching plan for a client taking lithium should include which instructions?

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.

Answer 20

a. maintain normal salt and fluids in the diet.

Question 21

Which nursing diagnosis would most likely apply to a client diagnosed with major depressive disorder as well as one experiencing acute mania?

a. Deficient diversional activity
b. Disturbed sleep pattern
c. Fluid volume excess
d. Defensive coping

Answer 21

b. Disturbed sleep pattern

Question 22

Which dinner menu is best suited for a client 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

Answer 22

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

Question 23

Outcome identification for the treatment plan of a client experiencing grandiose thinking associated with acute mania will focus on what?

a. developing an optimistic outlook.
b. distorted thought self-control.
c. interest in the environment.
d. sleep pattern stabilization

Answer 23

b. distorted thought self-control.

Question 24

Which documentation indicates that the treatment plan for a client 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.”

Answer 24

a. “Converses with few interruptions; clothing matches; participates in activities.”

Question 25

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

a. Monitor physiological functioning.
b. Provide a subdued environment.
c. Supervise personal hygiene.
d. Observe for mood changes.

Answer 25

b. Provide a subdued environment.

Question 26

A client 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 client’s behavior?

a. Educate the client about the proper ways to perform personal hygiene and coordinate clothing.
b. Continue to monitor and document the client’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 client may not be swallowing medications.

Answer 26

d. Consider the need to check the lithium level. The client may not be swallowing medications.

Question 27

A client diagnosed with acute mania has disrobed in the hall three times in 2 hours. What intervention should the nurse implement?

a. direct the client to wear clothes at all times.
b. ask if the client finds clothes bothersome.
c. tell the client that others feel embarrassed.
d. arrange for one-on-one supervision.

Answer 27

d. arrange for one-on-one supervision.

Question 28

A client experiencing acute mania is dancing atop a pool table in the recreation room. The client waves a cue in one hand and says, “I’ll throw the pool balls if anyone comes near me.” To best assure safety, what is the nurse’s first intervention?

a. tell the client, “You need to be secluded.”
b. clear the room of all other clients.
c. help the client down from the table.
d. assemble a show of force.

Answer 28

b. clear the room of all other clients.

Question 29

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

a. Attending psychoeducation sessions
b. Decreasing physical activity
c. Increasing food and fluids
d. Meeting self-care needs

Answer 29

a. Attending psychoeducation sessions

Question 30

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

a. Pharyngitis, mydriasis, and dystonia
b. Alopecia, purpura, and drowsiness
c. Diaphoresis, weakness, and nausea
d. Ascites, dyspnea, and edema

Answer 30

c. Diaphoresis, weakness, and nausea

Question 31

A client diagnosed with bipolar disorder is in the maintenance phase of treatment. The client asks, “Do I have to keep taking this lithium even though my mood is stable now?” What is the nurse’s most 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. “Most clients take medication for approximately 6 months after discharge.”
d. “It’s unusual that the health care provider hasn’t already stopped your medication.”

Answer 31

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

Question 32

A client diagnosed with bipolar disorder is prescribed lithium. The client telephones the nurse to say, “I’ve 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?” What advise will they give to the client?

a. restrict food and fluids for 24 hours and stay in bed.
b. have someone bring the client 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.

Answer 32

b. have someone bring the client to the clinic immediately.

Question 33

A client newly diagnosed with bipolar disorder is prescribed lithium. Which information from the client’s medical history indicates that monitoring of serum concentrations of the drug will be challenging and critical?

a. Arthritis
b. Epilepsy
c. Psoriasis
d. Heart failure

Answer 33

d. Heart failure

Question 34

Four new clients were admitted to the behavioral health unit in the past 12 hours. The nurse directs a psychiatric technician to monitor these clients for safety. Which client diagnosis will need the most watchful supervision?

a. bipolar I disorder.
b. bipolar II disorder.
c. dysthymic disorder.
d. cyclothymic disorder

Answer 34

a. bipolar I disorder.

Question 35

Which suggestions are appropriate for the family of a client 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. Supervise medication administration.
e. Monitor the client’s sleep patterns.

Answer 35

a. Limit credit card access.
b. Provide a structured environment.
d. Supervise medication administration.
e. Monitor the client’s sleep patterns.

Question 36

A nurse prepares the plan of care for a client experiencing an acute manic episode. Which nursing diagnoses are most likely? (Select all that apply.)

a. Imbalanced nutrition: more than body requirements
b. Impaired mood regulation
c. Sleep deprivation
d. Chronic confusion
e. Social isolation

Answer 36

b. Impaired mood regulation
c. Sleep deprivation

Question 37

A client tells the nurse, “I’m ashamed of being bipolar. When I’m manic, my behavior embarrasses everyone. Even if I take my medication, there are no guarantees. I’m 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

Answer 37

a. Powerlessness
c. Chronic low self-esteem

Question 38

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

a. Touch the client to provide reassurance.
b. Invite the client to lead a community meeting.
c. Provide a structured environment for the client.
d. Ensure that the client’s nutritional needs are met.
e. Design activities that require the client’s concentration.

Answer 38

c. Provide a structured environment for the client.
d. Ensure that the client’s nutritional needs are met.