Question 1

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?

Accepted Answer

During a manic episode the client's mood is elevated,expansive,and irritable.Providing a safe environment should be prioritized to protect the client and staff from potential injury.

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?

Accepted Answer

The nurse should identify that the priority nursing diagnosis for this client is altered nutrition: less than body requirements R/T hyperactivity AEB weight loss.Due to the client's rapid weight loss,the nurse should prioritize interventions to ensure proper nutrition and health.

Question 3

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?

Accepted Answer

Although lithium is a prototype drug in the treatment of bipolar disorders,anticonvulsants such as valproic acid also have demonstrated efficacy for mood stabilization.

Question 4

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?

Accepted Answer

The nurse should explain to the client's spouse that Zyprexa can calm hyperactivity until the Eskalith takes effect.Eskalith may take 1 to 3 weeks to begin to decrease hyperactivity.Zyprexa is classified as an antipsychotic and can be used to immediately to reduce hyperactive symptoms in acute manic episodes.

Question 5

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

Accepted Answer

The Consensus Group recommends that clinicians use the FIND tool to differentiate occasional spontaneous behaviors of children from behaviors associated with bipolar disorder.FIND is an acronym that stands for frequency,intensity,number,and duration and is used to assess behaviors in children.

Question 6

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?

Accepted Answer

The nurse should interpret that the client's symptoms indicate lithium carbonate toxicity.The initial signs of toxicity include ataxia,blurred vision,severe diarrhea,nausea and vomiting,and tinnitus.Lithium levels should be monitored monthly during maintenance therapy to ensure proper dosage.

Question 7

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

Accepted Answer

The initial signs of lithium toxicity include ataxia,blurred vision,severe diarrhea,persistent nausea and vomiting,and tinnitus.

Question 8

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

Accepted Answer

The essential feature of cyclothymic disorder is a chronic mood disturbance of at least 2 years' duration,involving numerous episodes of hypomania and depressed mood of insufficient severity or duration to meet the criteria for bipolar I or II disorder.

Question 9

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?"

Accepted Answer

The nurse should provide the client with high-calorie finger foods throughout the day to help the client achieve the outcome of gaining 2 pounds by the end of the week.Because of hyperactivity,the client will have difficulty sitting still to consume large meals.

Question 10

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?

Accepted Answer

The patient who is experiencing psychosis (in this case,delusions of grandeur)may be benefited by the addition of an antipsychotic medication (risperidone)to the mood stabilizer (lithium).In addition,since lithium does not immediately reach therapeutic levels,the sedative properties of an antipsychotic may be useful in reducing agitation,hyperactivity,and/or insomnia.

Question 11

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?

Accepted Answer

The nursing student should understand that the most critical challenge in the care of clients diagnosed with bipolar disorder is that treatment is often compromised when clients choose to not take their medications.Symptoms of bipolar disorder will reemerge if medication is stopped.

Question 12

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?

Accepted Answer

The recommended dose of lamotrigine for treatment of bipolar disorder in adult clients should not exceed 400 mg daily.

Question 13

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?

Accepted Answer

The nurse should explain to the client that weight gain is a common side effect of lithium carbonate.The nurse should educate the client on the importance of medication compliance and discuss concerns with the prescribing physician if the client does not wish to continue taking the medication.

Question 14

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

Accepted Answer

The nursing student is accurate when stating that bipolar disorder is more prevalent in higher socioeconomic groups.Theories consider both hereditary and environmental factors in the etiology of bipolar disorder.

Question 15

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?

Accepted Answer

The therapeutic level of lithium carbonate is 1.0 to 1.5 mEq/L for acute mania and 0.6 to 1.2 mEq/L for maintenance therapy.There is a narrow margin between the therapeutic and toxic levels.The symptoms presented in the question can be correlated with a lithium level of 1.7 mEq/L.Levels of 2.3 mEq/L and 3.7 mEq/L would produce more extreme symptoms of intensified toxicity,eventually leading to death.

Question 16

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?

Accepted Answer

The priority nursing diagnosis for this client should be risk for suicide R/T hopelessness.The nurse should prioritize diagnoses on the basis of physical and safety needs.This client continues to be at risk for suicide related to an intentional Zoloft overdose.

Question 17

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

Accepted Answer

A client diagnosed with bipolar disorder is at risk for injury in either pole of this disorder.In the manic phase the client is hyperactive and can injure self inadvertently,and in the depressive phase the client can be at risk for suicide.

Question 18

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?

Accepted Answer

The nurse should document that this client's behavior is "Agitated and pacing.Exhibiting grandiosity.Mood labile." The client is exhibiting signs of irritation accompanied by aggressive behavior.Grandiosity refers to an exaggerated sense of power,importance,knowledge,or identity.

Question 19

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.

Accepted Answer

The nurse should order client outcomes based on priority in the following order: Remains free of injury,maintains nutritional status,sleeps 6 to 8 hours a night,and interacts appropriately with peers.The nurse should prioritize the client's physical and safety needs.

Question 20

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?

Accepted Answer

Some signs and symptoms of mania include manic excitement,delusional thinking,and hallucinations,which may predispose the client to aggressive behavior.Nurses should be alert to the risk for self or other directed violence and intervene immediately at the first signs of agitation or aggression.

Quiz 26: Bipolar and Related Disorders