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23. Outcome identification for the treatment plan of a patient experiencing grandiose thinking associated with acute mania will focus on a. developing an optimistic outlook. b. distorted thought self-control. c. interest in the environment. d. sleep pattern stabilization.

ANS: B

The desired outcome is that the patient will be able to control the grandiose thinking associated with acute mania as evidenced by making realistic comments about self, abilities, and plans. Patients with acute mania are already unduly optimistic as a result of their use of denial, and they are overly interested in their environment. Sleep stability is a desired outcome but is not related to distorted thought processes.

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

REF: Page 13-18 TOP: Nursing Process: Outcomes Identification

MSC: Client Needs: Psychosocial Integrity 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.”

24. Which documentation indicates that the treatment plan for a patient diagnosed with acute mania has been effective?

ANS: A

The descriptors given indicate the patient is functioning at an optimal level, using appropriate behavior, and thinking without becoming overstimulated by unit activities. The incorrect options reflect manic behavior.

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

REF: Pages 13-18, 19 (Case Study and Nursing Care Plan), 34

TOP: Nursing Process: Evaluation MSC: Client Needs: Psychosocial Integrity a. Monitor physiological functioning. b. Provide a subdued environment. c. Supervise personal hygiene. d. Observe for mood changes.

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

ANS: B

All the options are reasonable interventions for a patient with acute mania, but providing a subdued environment directly relates to the outcome of energy conservation by decreasing stimulation and helping to balance activity and rest.

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

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

TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity a. Educate the patient about the proper ways to perform personal hygiene and coordinate clothing. eBay: testbanks_and_xanax b. Continue to monitor and document the patient’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 patient may not be swallowing medications.

26. A patient 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 patient’s behavior?

ANS: D

The patient continues to exhibit manic symptoms. Nonadherence to the medication regime is a common problem for patients diagnosed with bipolar disorder. The lithium level should be approaching a therapeutic range after 7 days but may be low from “cheeking” (not swallowing) the medication. The prescribed dose is high, so one would not expect a need for the dose to be increased. Monitoring the patient does not address the problem.

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

REF: Pages 13-19, 25, 32, 49 (Table 13-4)

TOP: Nursing Process: Evaluation MSC: Client Needs: Physiological Integrity

27. A patient with acute mania has disrobed in the hall three times in 2 hours. The nurse should a. direct the patient to wear clothes at all times. b. ask if the patient finds clothes bothersome. c. tell the patient that others feel embarrassed. d. arrange for one-on-one supervision.

ANS: D

A patient who repeatedly disrobes despite verbal limit setting needs more structure. One-on-one supervision may provide the necessary structure. Directing the patient to wear clothes at all times has not proven successful, considering the behavior has continued. Asking if the patient is bothered by clothing serves no purpose. Telling the patient that others are embarrassed will not make a difference to the patient whose grasp of social behaviors is impaired by the illness.

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: Safe, Effective Care Environment

28. A patient experiencing acute mania is dancing atop a pool table in the recreation room. The patient waves a cue in one hand and says, “I’ll throw the pool balls if anyone comes near me.” To best assure safety, the nurse’s first intervention is to a. tell the patient, “You need to be secluded.” b. clear the room of all other patients. c. help the patient down from the table. d. assemble a show of force.

ANS: B

The patient’s behavior demonstrates a clear risk of dangerousness to others. Safety is of primary importance. Once other patients are out of the room, a plan for managing this patient can be implemented. Threatening the patient or assembling a show of force is likely to exacerbate the tension.

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

REF: Pages 13-30, 31 TOP: Nursing Process: Planning

MSC: Client Needs: Safe, Effective Care Environment a. Attending psychoeducation sessions b. Decreasing physical activity c. Increasing food and fluids d. Meeting self-care needs

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

ANS: A

During the continuation phase of treatment for bipolar disorder, the physical needs of the patient are not as important an issue as they were during the acute episode. After hospital discharge, treatment focuses on maintaining medication compliance and preventing relapse, both of which are fostered by ongoing psychoeducation.

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

REF: Pages 13-19 (Case Study and Nursing Care Plan), 32, 34, 55 (Box 13-2)

TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity a. Pharyngitis, mydriasis, and dystonia b. Alopecia, purpura, and drowsiness c. Diaphoresis, weakness, and nausea d. Ascites, dyspnea, and edema

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

ANS: C

Diaphoresis, weakness, and nausea are early signs of lithium toxicity. Problems mentioned in the incorrect options are unrelated to lithium therapy.

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

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

MSC: Client Needs: Physiological Integrity

TOP: Nursing Process: Assessment 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 patients take medication for approximately 6 months after discharge.” d. “It’s unusual that the health care provider hasn’t already stopped your medication.”

31. A patient diagnosed with bipolar disorder is in the maintenance phase of treatment. The patient asks, “Do I have to keep taking this lithium even though my mood is stable now?” Select the nurse’s appropriate response.

ANS: B

Patients diagnosed with bipolar disorder may be maintained on lithium indefinitely to prevent recurrences. Helping the patient understand this need will promote medication adherence.

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

REF: Pages 13-25, 26, 53 (Box 13-1) TOP: Nursing Process: Implementation

MSC: Client Needs: Physiological Integrity

32. An outpatient diagnosed with bipolar disorder is prescribed lithium. The patient 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?” The nurse will advise the patient to a. restrict food and fluids for 24 hours and stay in bed. b. have someone bring the patient 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.

ANS: B

The symptoms described suggest lithium toxicity. The patient should have a lithium level drawn and may require further treatment. Because neurological symptoms are present, the patient should not drive and should be accompanied by another person. The incorrect options will not ameliorate the patient’s symptoms.

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

REF: Pages 13-26, 49 (Table 13-4) TOP: Nursing Process: Implementation

MSC: Client Needs: Physiological Integrity a. Arthritis b. Epilepsy c. Psoriasis d. Heart failure

33. A newly diagnosed patient is prescribed lithium. Which information from the patient’s history indicates that monitoring of serum concentrations of the drug will be challenging and critical?

ANS: D

The patient with heart failure will likely need diuretic drugs, which will complicate the maintenance of the fluid balance necessary to avoid lithium toxicity.

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

REF: Pages 13-26, 27, 49 (Table 13-4) TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity

34. Four new patients were admitted to the behavioral health unit in the past 12 hours. The nurse directs a psychiatric technician to monitor these patients for safety. Which patient will need the most watchful supervision? A patient diagnosed with a. bipolar I disorder. b. bipolar II disorder. c. dysthymic disorder. d. cyclothymic disorder.

ANS: A

Bipolar I is a mood disorder characterized by excessive activity and energy. Psychosis (hallucinations, delusions, and dramatically disturbed thoughts) may occur during manic episodes. A patient with bipolar I disorder is more unstable than a patient diagnosed with bipolar II, cyclothymic disorder, or dysthymic disorder.

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

REF: Pages 13-2 to 5; also incorporates content from Chapter 14.

TOP: Nursing Process: Assessment

MSC: Client Needs: Safe, Effective Care Environment

Multiple Response

1. Which suggestions are appropriate for the family of a patient 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 patient’s sleep patterns.

ANS: A, B, D, E

A patient with hypomania is expansive, grandiose, and labile; uses poor judgment; spends inappropriately; and is over-stimulated by a busy environment. Providing structure helps the patient maintain appropriate behavior. Financial irresponsibility may be avoided by limiting access to cash and credit cards. Continued decline in sleep patterns may indicate the condition has evolved to full mania. Group socialization should be kept to a minimum to reduce stimulation. The family should supervise medication administration to prevent deterioration to a full manic episode and because the patient is at risk to omit medications.

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

REF: Pages 13-32, 55 (Box 13-2) TOP: Nursing Process: Planning

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

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

ANS: B, C