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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 nurse’s presence and provides structure as necessary while the patient’s 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: Pages 13-18, 19, 46 (Table 13-3) | Page 13-19 (Case Study and Nursing Care Plan)

TOP: Nursing Process: Planning

MSC: Client Needs: Safe, Effective Care Environment 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

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

ANS: B

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

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: Implementation MSC: Client Needs: Psychosocial Integrity 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.

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?

ANS: B

When staff members are exhausted, 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: Pages 13-30, 31

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 don’t 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. eBay: testbanks_and_xanax

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: Pages 13-18, 19, 46 (Table 13-3) 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 nurse’s 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 patient’s distractibility to staff’s 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 patient’s 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: Pages 13-18, 19, 46 (Table 13-3) | Page 13-19 (Case Study and Nursing Care Plan)

TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity b. an antacid. c. an antiemetic. d. a large glass of juice.

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.

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 13-53 (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. eBay: testbanks_and_xanax 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 13-53 (Box 13-1) TOP: Nursing Process: Planning

MSC: Client Needs: Physiological Integrity a. Deficient diversional activity b. Disturbed sleep pattern c. Fluid volume excess d. Defensive coping

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

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: Pages 13-12, 19, 44 (Table 13-2) | Page 13-14; also incorporates content from Chapter 14 TOP: Nursing Process: Diagnosis/Analysis

MSC: Client Needs: Psychosocial Integrity 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

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

ANS: C

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

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: Implementation MSC: Client Needs: Physiological Integrity