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?

Accepted Answer

A)  "Rates mood 8/10.Exhibiting looseness of association.Euphoric."
B)  "Mood euthymic.Exhibiting magical thinking.Restless."
C)  "Mood labile.Exhibiting delusions of reference.Hyperactive."
D)  "Agitated and pacing.Exhibiting grandiosity.Mood labile." D

Question 2

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

Accepted Answer

A)  "This dosage is within the recommended dosage range."
B)  "This dosage is lower than the recommended dosage range."
C)  "This dosage is more than twice the recommended dosage range."
D)  "This dosage is four times higher than the recommended dosage range." C

Question 3

A client and nurse therapist are developing a treatment plan that includes strategies to manage bipolar disorder.Which should be included? Select all that apply.

Accepted Answer

A)  Maintain a consistent sleep schedule.
B)  Become an expert on mental health.
C)  Create a daily medication schedule.
D)  Set a time frame to achieve remission.
E)  Develop an emergency plan. A,B,C,E

Question 4

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.Which should be the nurse's initial intervention?

Accepted Answer

A)  Ask the group to take a vote on alternative weekend events.
B)  Remind the client to quiet down or leave the dayroom.
C)  Assist the client to move to a calmer location.
D)  Discuss with the client impulse control problems.

Question 5

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

Accepted Answer

A)  Risky Activity tool
B)  FIND tool
C)  Consensus Committee tool
D)  Monotherapy tool

Question 6

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

A)  Ineffective individual coping R/T hospitalization AEB alcohol abuse
B)  Altered nutrition: less than body requirements R/T mania AEB 10-pound weight loss
C)  Risk for violence: directed toward others R/T agitation and hyperactivity
D)  Sleep pattern disturbance R/T flight of ideas AEB sleeps 1 to 2 hours per night

Question 7

A client is diagnosed with Bipolar I Disorder: Manic Episode.Which nursing intervention should be implemented to achieve the outcome of "Client will gain 2 pounds by the end of the week?"

Accepted Answer

A)  Provide client with high-calorie finger foods throughout the day.
B)  Accompany client to cafeteria to encourage adequate dietary consumption.
C)  Initiate total parenteral nutrition to meet dietary needs.
D)  Teach the importance of a varied diet to meet nutritional needs.

Question 8

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

A)  Knowledge deficit R/T bipolar disorder AEB concern about symptoms
B)  Altered nutrition: less than body requirements R/T hyperactivity AEB weight loss
C)  Risk for suicide R/T powerlessness AEB insomnia and anorexia
D)  Altered sleep patterns R/T mania AEB insomnia for the past 3 nights

Question 9

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?

Accepted Answer

A)  Rooms should contain extra-large windows with views of the street.
B)  Rooms should contain brightly colored walls with printed drapes.
C)  Rooms should be painted deep colors and located close to the nurse's station.
D)  Rooms should be painted with neutral colors and contain pale-colored accessories.

Question 10

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

A)  "That's strange.Weight loss is the typical pattern."
B)  "What have you been eating? Weight gain is not usually associated with lithium."
C)  "Weight gain is a common but troubling side effect."
D)  "Weight gain occurs only during the first month of treatment with this drug."

Question 11

A client is diagnosed with Cyclothymic Disorder.Which client behaviors should the nurse expect to assess?

Accepted Answer

A)  The client expresses "feeling blue most of the time."
B)  The client has endured periods of elation and dysphoria lasting for more than 2 years.
C)  The client fixates on hopelessness and thoughts of suicide continually.
D)  The client has labile moods with periods of acute mania.

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?

Accepted Answer

A)  "Treatment is compromised when clients can't sleep."
B)  "Treatment is compromised when irritability interferes with social interactions."
C)  "Treatment is compromised when clients have no insight into their problems."
D)  "Treatment is compromised when clients choose not to take their medications."

Question 13

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." Which is the priority nursing action?

Accepted Answer

A)  Assess the client's vital signs.
B)  Offer to have the dietitian discuss food preferences.
C)  Encourage the client to lead the exercise program in the community meeting.
D)  Acknowledge the client briefly and then walk away.

Question 14

After teaching a client about lithium carbonate (Lithane),the nurse would conclude teaching was successful based on which client statement?

Accepted Answer

A)  "I should expect to feel better in a couple of days."
B)  "I'll call my doctor immediately if I experience any diarrhea or ringing in my ears."
C)  "If I forget a dose,I can double the dose the next time I take this drug."
D)  "I need to restrict my intake of any food containing salt."

Question 15

The 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

A)  To provide self and client with a safe environment
B)  To redirect the client to the needed assessment information
C)  To provide high-calorie finger foods to meet nutritional needs
D)  To reorient the client to person,place,time,and situation

Question 16

Which client statement indicates to the nurse that the client understands dietary teaching related to lithium carbonate (Lithobid)treatment?

Accepted Answer

A)  "I will limit my intake of fluids daily."
B)  "I will maintain normal salt intake."
C)  "I will take Lithobid on an empty stomach."
D)  "I will increase my caloric intake to prevent weight loss."

Question 17

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

A)  "Zyprexa in combination with Eskalith cures manic symptoms."
B)  "Zyprexa prevents extrapyramidal side effects."
C)  "Zyprexa ensures a good night's sleep."
D)  "Zyprexa calms hyperactivity until the Eskalith takes effect."

Question 18

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

Accepted Answer

A)  Symptoms of bipolar disorder are similar to those of attention deficit-hyperactivity disorder.
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.

Question 19

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

Accepted Answer

A)  "This disorder is more prevalent in lower socioeconomic groups."
B)  "This disorder is more prevalent in higher socioeconomic groups."
C)  "This disorder is equally prevalent in all socioeconomic groups."
D)  "This disorder's prevalence cannot be evaluated on the basis of socioeconomic groups."

Question 20

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

Accepted Answer

A)  "I can't stop my sexual urges.They have led me to numerous affairs."
B)  "I'm the world's most perceptive attorney."
C)  "My wife is distraught about my overspending."
D)  "The FBI is out to get me."

Exam 26: Bipolar and Related Disorders