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

REF: Page 12-95 (Table 12-3)

MSC: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Diagnosis/Analysis eBay: testbanks_and_xanax

Chapter 13: Bipolar and Related Disorders

Halter: Varcarolis’ Foundations of Psychiatric Mental Health Nursing: A Clinical Approach, 8th Edition

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 b. Vegetative signs and poor grooming c. Poor judgment and hyperactivity 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: Pages 13-11, 12, 15, 16, 44 (Table 13-2)

TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity a. Euphoric b. Irritable c. Suspicious d. Confident

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 patient’s mood?

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 patient’s mood. Suspiciousness is not evident.

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

REF: Pages 13-10, 11

MSC: Client Needs: Psychosocial Integrity

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

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 patient’s plan of care?

ANS: C eBay: testbanks_and_xanax

Safety and physiological needs have the highest priority. 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 patient’s life.

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

REF: Pages 13-18, 19 (Case Study and Nursing Care Plan)

TOP: Nursing Process: Planning

MSC: Client Needs: Safe, Effective Care Environment a. Risk for injury b. Ineffective coping c. Impaired social interaction d. Ineffective therapeutic regimen management

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?

ANS: A

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

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

REF: Pages 13-18, 44 (Table 13-2) | Page 13-19 (Case Study and Nursing Care Plan)

TOP: Nursing Process: Diagnosis/Analysis

MSC: Client Needs: Safe, Effective Care Environment 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?”

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?

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: Pages 13-18, 19, 30, 31, 46 (Table 13-3) | Page 13-19 (Case Study and Nursing Care Plan) TOP: Nursing Process: Implementation

MSC: Client Needs: Safe, Effective Care Environment

6. This nursing diagnosis applies to a patient 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. 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 patient’s 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: Pages 13-18, 19, 46 (Table 13-3) | Page 13-19 (Case Study and Nursing Care Plan)

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

PTS: 1

DIF: Cognitive Level: Analyze (Analysis)

REF: Pages 13-24, 28 TOP: Nursing Process: Planning

MSC: Client Needs: Physiological Integrity a. phenytoin b. clonidine c. risperidone d. carbamazepine

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?

ANS: D

Some patients diagnosed 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.

PTS: 1

DIF: Cognitive Level: Apply (Application)

REF: Pages 13-27, 51 (Table 13-5) 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: Pages 13-8 to 10 TOP: Nursing Process: Implementation

MSC: Client Needs: Health Promotion and Maintenance 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.”

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?

ANS: B

Evidence of genetic transmission is supported by lifetime prevalence statistics. 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 13-8 TOP: Nursing Process: Implementation

MSC: Client Needs: Health Promotion and Maintenance 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 patients around.” d. Honest feedback: “Your controlling behavior is annoying others.”

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?

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: Pages 13-18, 19, 25, 46 (Table 13-3) | Page 13-19 (Case Study and Nursing Care Plan) TOP: Nursing Process: Implementation

MSC: Client Needs: Psychosocial Integrity

12. The nurse receives a laboratory report indicating a patient’s serum level is 1 mEq/L. The patient’s 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 0.6 to 1.2 mEq/L.

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

REF: Pages 13-26, 27, 28, 49 (Table 13-4)

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity a. clonazepam b. risperidone c. lamotrigine d. aripiprazole

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

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.

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

REF: Pages 13-28, 51(Table 13-5)

MSC: Client Needs: Physiological Integrity

TOP: Nursing Process: Implementation a. Allow the patient to act out feelings.

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