Question 1

The spouse of a patient diagnosed with bipolar I disorder says, "We want to have children, but I worry they could inherit this problem. There is also bipolar disorder on my side of the family." What is the nurse's most appropriate action to address the spouse's concern?

Accepted Answer

A)   Direct the couple to seek genetic counseling.
B)   Encourage the couple to consider adopting children.
C)   Encourage the spouse to discuss options with a spiritual advisor.
D)   Educate the spouse about environmental determinants of bipolar disorder. A

Question 2

Within a 15-minute period, a patient having a manic episode states, "Dinner was cold and the solarium is too hot. I have a sore throat and there is no clean towel for my shower." What action should the nurse take to address the patient's concerns?

Accepted Answer

A)   Listen but not act on the patient's reports.
B)   Suggest the patient use the unit's suggestion box.
C)   Assess the patient's throat, and show him or her where clean linen is stored.
D)   Invite the patient to share the concerns about the food and temperature at the community meeting. C

Question 3

A patient offers to lead the next medication group session stating, "I have studied all the effects and problems with drugs on the Internet, so I can answer patients' questions." How should the nurse document this finding?

Accepted Answer

A)   Flight of ideas
B)   Distractibility
C)   Limit-testing
D)   Grandiosity D

Question 4

The nurse prepares to take vital signs for a patient experiencing mania. What is the nurse's best intervention when the patient's talking interferes with the assessment?

Accepted Answer

A)   Use a voice volume louder than the patient's to say, "Stop talking now."
B)   Interrupt by saying, "It's time to take your vital signs now."
C)   Delay taking the vital signs until the patient is quieter.
D)   Wait tolerantly for the patient to finish talking.

Question 5

A patient has been diagnosed with cyclothymic disorder. Which assessment data provided by the patient support this diagnosis? (Select all that apply.)

Accepted Answer

A)   Patient describes periods that suggest hypomanic episodes
B)   Current symptoms began 4 years ago
C)   Patient has been hospitalized for depression numerous times
D)   Patient reports depression worsens in the winter
E)   Patient reports being "moderately depressed" at times

Question 6

A medication teaching plan for a patient receiving lithium should include which instruction?

Accepted Answer

A)   Eat one or two bananas daily.
B)   To limit daily sodium intake.
C)   To restrict daily fluid intake to 1000 mL.
D)   Comply with scheduled laboratory testing of lithium level.

Question 7

A patient diagnosed with bipolar disorder is laughing and giddy one minute and seconds later is angry and sarcastic. How should the nurse document the patient's mood?

Accepted Answer

A)   Incongruent
B)   Inappropriate
C)   Blunted
D)   Labile

Question 8

A nurse teaching about bipolar disorder should inform patients and their families of possible depressive symptoms. Which symptoms should the nurse include? (Select all that apply.)

Accepted Answer

A)   Passivity
B)   Aggression
C)   Hyperactivity
D)   Psychomotor retardation
E)   Preoccupation with death

Question 9

A nurse presents a psychoeducational program to patients diagnosed with bipolar disorder and their families. Information about which collection of signs associated with an impending relapse of mania should be included?

Accepted Answer

A)   Diarrhea, thirst, and gross tremor
B)   Sleep disturbances and racing thoughts
C)   Decreased libido, anhedonia, and hypersomnia
D)   Delusional thinking, excessive guilt, and passivity

Question 10

Which indicator of disordered communication is the nurse most likely to assess in a patient having a manic episode?

Accepted Answer

A)   Loose associations
B)   Flight of ideas
C)   Echolalia
D)   Mutism

Question 11

A nurse presents a psychoeducational program to patients diagnosed with bipolar disorder and their families. Information about which collection of signs associated with an impending relapse of depressive episode should be included?

Accepted Answer

A)   Diarrhea, thirst, and gross tremor
B)   Sleep disturbances and racing thoughts
C)   Decreased libido, anhedonia, and inertia
D)   Anorexia, excessive guilt, and aggression

Question 12

Which principle is most useful and effective when interacting with a patient experiencing a manic episode?

Accepted Answer

A)   Encourage the patient to freely express feelings.
B)   Use a calm, matter-of-fact approach.
C)   Do not interrupt the patient.
D)   Frequently use silence.

Question 13

A patient is hospitalized with new onset of manic behavior. It would be important for the nurse to inspect and report results of which laboratory tests? (Select all that apply.)

Accepted Answer

A)   Calcium
B)   Creatinine
C)   Potassium
D)   Drug screens
E)   Thyroid function

Question 14

During community lunch, a manic patient tells another patient, "Push yourself away from the table. You're too fat for your own good!" Which intervention demonstrates the nurse's best ability to manage the milieu?

Accepted Answer

A)   Say to the patient, "You may remain at lunch only if you apologize."
B)   Tell the patient, "You must leave lunch and go to your room now."
C)   Calmly tell the patient that insulting others is not permitted.
D)   Extinguish the behavior by ignoring it.

Question 15

A hyperactive, aggressive patient diagnosed with bipolar disorder threatens to physically assault another patient. What initial nursing intervention should be implemented?

Accepted Answer

A)   Provide firm verbal limits.
B)   Place the patient in seclusion.
C)   Ask the patient, "Why are you so angry?"
D)   Distract the patient with diversional activities.

Question 16

A newly admitted patient experiencing a manic episode is verbally and physically aggressive. The plan for care should include which interventions to minimize the risk of injury and manage the milieu effectively?

Accepted Answer

A)   Setting clear limits, providing a quiet environment, and limiting activities
B)   Avoiding use of antipsychotic drugs for 24 hours and providing nourishment ad lib
C)   Orienting to unit activities, encouraging gross motor activity, and watching television
D)   Avoiding confrontations by not enforcing limits and encouraging physical exercise at bedtime

Question 17

A nurse assesses a new patient experiencing a manic episode. Which behavior is most likely to have occurred before hospitalization?

Accepted Answer

A)   Watching others closely but avoiding interaction
B)   Taking frequent rest periods during the day
C)   Going rapidly from one activity to another
D)   Remaining ar home for long periods

Question 18

What are the best menu selections for lunch for a hyperactive patient during a manic episode? (Select all that apply.)

Accepted Answer

A)   Cherry pie
B)   Macaroni and cheese
C)   A banana
D)   Tossed salad with ranch dressing
E)   Roast beef sandwich on whole-grain bread

Exam 26: Bipolar Disorders