Chapter 26

Question 1

A highly agitated client paces the unit and states, “I could buy and sell this place.” The client’s mood fluctuates from fits of laughter to outbursts of anger. Which is the most accurate documentation of this client’s behavior?

Answer 1

“Agitated and pacing. Exhibiting grandiosity. Mood labile.”

Question 2

A client diagnosed with bipolar I disorder is distraught over insomnia experienced over the last 3 nights and a 12-pound weight loss over the past 2 weeks. Which should be this client’s priority nursing diagnosis?

Answer 2

Altered nutrition: less than body requirements R/T hyperactivity AEB weight loss

Question 3

A nurse is planning care for a client diagnosed with bipolar disorder: manic episode. In which order should the nurse prioritize the listed client outcomes?
Client Outcomes:
1. Maintains nutritional status.
2. Interacts appropriately with peers.
3. Remains free from injury.
4. Sleeps 6 to 8 hours a night.

Answer 3

C. 3, 1, 4, 2

Question 4

A client diagnosed with bipolar disorder: depressive episode intentionally overdoses on sertraline (Zoloft). Family reports that the client has experienced anorexia, insomnia, and recent job loss. What should be the priority nursing diagnosis for this client?

Answer 4

Risk for suicide R/T hopelessness

Question 5

A client diagnosed with bipolar I disorder: manic episode refuses to take lithium carbonate because he complains that it makes him feel sick. Which of the following medications might be alternatively prescribed for mood stabilization in bipolar disorders?

Answer 5

Valproic acid (Depakote)

Question 6

A client diagnosed with bipolar I disorder is exhibiting severe manic behaviors. A physician prescribes lithium carbonate (Eskalith) and olanzapine (Zyprexa). The client’s spouse questions the Zyprexa order. Which is the appropriate nursing reply?

Answer 6

“Zyprexa calms hyperactivity until the Eskalith takes effect.”

Question 7

A client began taking lithium for the treatment of bipolar disorder approximately 1 month ago. The client asks if it is normal to have gained 12 pounds in this time frame. Which is the appropriate nursing reply?

Answer 7

“Weight gain is a common but troubling side effect.”

Question 8

A nursing instructor is teaching about the prevalence of bipolar disorder. Which student statement indicates that learning has occurred?

Answer 8

“This disorder is more prevalent in the higher socioeconomic groups.”

Question 9

A client diagnosed with bipolar disorder, who has taken lithium carbonate (Lithane) for 1 year, presents in an emergency department with severe diarrhea, blurred vision, and tinnitus. How should the nurse interpret these symptoms?

Answer 9

Symptoms indicate lithium carbonate toxicity.

Question 10

What tool should a nurse use to differentiate occasional spontaneous behaviors of children from behaviors associated with bipolar disorder?

Answer 10

“FIND” tool

Question 11

An adult client diagnosed with bipolar I disorder is prescribed lamotrigine (Lamictal), 400 mg three times a day, for mood stabilization. Which is a true statement about this medication order?

Answer 11

This dosage is more than twice the recommended dosage range.

Question 12

A nursing instructor is discussing various challenges in the treatment of clients diagnosed with bipolar disorder. Which student statement demonstrates an understanding of the most critical challenge in the care of these clients?

Answer 12

“Treatment is compromised when clients choose not to take their medications.”

Question 13

A client is diagnosed with bipolar I disorder: manic episode. Which nursing intervention would be implemented to achieve the outcome of “Client will gain 2 pounds by the end of the week?”

Answer 13

Provide client with high-calorie finger foods throughout the day.

Question 14

A client is diagnosed with bipolar disorder and admitted to an inpatient psychiatric unit. Which is the priority outcome for this client?

Answer 14

The client will remain safe throughout hospitalization.

Question 15

A nurse begins the intake assessment of a client diagnosed with bipolar I disorder. The client shouts, “You can’t do this to me. Do you know who I am?” Which is the priority nursing action in this situation?

Answer 15

To provide self and client with a safe environment

Question 16

A client is diagnosed with cyclothymic disorder. What client behaviors should the nurse expect to assess?

Answer 16

The client has endured periods of elation and dysphoria lasting for more than 2 years.

Question 17

After teaching a client about lithium carbonate (Lithane), a nurse would consider the teaching successful on the basis of which client statement?

Answer 17

“I’ll call my doctor immediately if I experience any diarrhea or ringing in my ears.”

Question 18

A client has been taking lithium for several years with good symptom control. The client presents in the emergency department with blurred vision, tinnitus, and severe diarrhea. The nurse should correlate these symptoms with which lithium level?

Answer 18

1.7 mEq/L

Question 19

A newly admitted client is experiencing a manic episode of bipolar I disorder and presents as very agitated. The nurse should assign which priority nursing diagnosis to this client?

Answer 19

Risk for violence: directed toward others R/T agitation and hyperactivity

Question 20

A client who has been diagnosed with bipolar I disorder states, “God has taught me how to decode the Bible.” A nurse should anticipate that which combination of medications would be ordered to address this client’s symptoms?

Answer 20

Lithium carbonate (Lithobid) and risperidone (Risperdal)

Question 21

A nurse learns at report that a newly admitted client experiencing mania is demonstrating grandiose delusions. The nurse should recognize that which client statement would provide supportive evidence of this symptom?

Answer 21

“I’m the world’s most perceptive attorney.”

Question 22

Which client statement would the nurse recognize as indicating that the client understands dietary teaching related to lithium carbonate (Lithobid) treatment?

Answer 22

“I will maintain normal salt intake.”

Question 23

A client on an inpatient unit is diagnosed with bipolar disorder: manic episode. During a discussion in the dayroom about weekend activities, the client raises his voice, becomes irritable, and insists that plans change. What should be the nurse’s initial intervention?

Answer 23

Assist the client to move to a calmer location.

Question 24

A client diagnosed with bipolar disorder states, “I hate oatmeal. Let’s get everybody together to do exercises. I’m thirsty and I’m burning up. Get out of my way; I have to see that guy.” What should be the priority nursing action?

Answer 24

Assess the client’s vital signs.

Question 25

A newly admitted client is diagnosed with bipolar disorder: manic episode. Which symptom related to altered thought is the nurse most likely to assess?

Answer 25

Flight of ideas

Question 26

The inpatient psychiatric unit is being redecorated. At a unit meeting, staff discusses bedroom décor for clients experiencing mania. The nurse manager evaluates which suggestion as most appropriate?

Answer 26

Rooms should be painted with neutral colors and contain pale-colored accessories.

Question 27

A client’s spouse asks, “What evidence supports the possibility of genetic transmission of bipolar disorder?” Which is the best nursing reply?

Answer 27

“Higher rates of relatives diagnosed with bipolar disorder are found in families of clients diagnosed with this disorder.”

Question 28

A client is admitted in a manic episode of bipolar I disorder. Which nursing intervention should be most therapeutic for this client?

Answer 28

Using a calm, unemotional approach during client interactions

Question 29

Which of the following instructions regarding lithium therapy should be included in a nurse’s discharge teaching? Select all that apply.

A. Avoid excessive use of beverages containing caffeine.
B. Maintain a consistent sodium intake.
C. Consume at least 2,500 to 3,000 mL of fluid per day.
D. Restrict sodium content.
E. Restrict fluids to 1,500 mL per day.

Answer 29

A, B, C

Question 30

Which of the following explanations should a nurse include when teaching parents why is it difficult to diagnose a child or adolescent exhibiting symptoms of bipolar disorder? Select all that apply.

A. Bipolar symptoms are similar to attention deficit-hyperactivity disorder symptoms.
B. Children are naturally active, energetic, and spontaneous.
C. Neurotransmitter levels vary considerably in accordance with age.
D. The diagnosis of bipolar disorder cannot be assigned prior to the age of 18.
E. Genetic predisposition is not a reliable diagnostic determinant.

Answer 30

A, B