Question 1

This nursing diagnosis applies to a patient with 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.

Accepted Answer

A)   The patient will ask staff for assistance with feeding within 4 days.
B)   The patient will drink six servings of a high-calorie, high-protein drink each day.
C)   The patient will consistently sit with others for at least 30 minutes at meal time within 1 week.
D)   The patient will consistently wear appropriate attire for age and sex within 1 week while on the psychiatric unit. B

Question 2

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

Accepted Answer

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." A

Question 3

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?

Accepted Answer

A)   Limit credit card access.
B)   Provide a structured environment.
C)   Encourage group social interaction.
D)   Suggest limiting work to half-days.
E)   Monitor the patient's sleep patterns. A, B, E

Question 4

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?

Accepted Answer

A)   Arthritis
B)   Epilepsy
C)   Psoriasis
D)   Heart failure

Question 5

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?

Accepted Answer

A)   Risk for injury
B)   Ineffective coping
C)   Impaired social interaction
D)   Ineffective therapeutic regimen management

Question 6

Consider these three anticonvulsant medications used in mood stabilization: divalproex sodium (Epival), carbamazepine (Tegretol), and gabapentin (Neurontin). Which of the following medications also belongs to this classification?

Accepted Answer

A)   Clonazepam (Rivotril) 
B)   Risperidone (Risperdal) 
C)   Lamotrigine (Lamictal) 
D)   Aripiprazole (Abilify)

Question 7

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 4 pairs of shoes." Select the nurse's appropriate intervention.

Accepted Answer

A)   Suggest the patient have a friend do the shopping and bring purchases to the unit
B)   Invite the patient to sit together and look at new fashion magazines
C)   Tell the patient computer use is not allowed until self-control improves
D)   Ask whether the patient has enough money to pay for the purchases

Question 8

A patient tells the nurse, "I'm ashamed of being bipolar. When I'm manic, my behaviour embarrasses everyone. Even if I take my medication, there are no guarantees. I'm a burden to my family." These statements support which nursing diagnoses?

Accepted Answer

A)   Powerlessness
B)   Defensive coping
C)   Chronic low self-esteem
D)   Impaired social interaction
E)   Risk-prone health behaviour

Question 9

A person was online continuously for over 24 hours, posting rhymes on official government Web sites and inviting politicians to join social networks. The person has not slept or eaten for 3 days. What features of mania are evident?

Accepted Answer

A)   Increased muscle tension and anxiety
B)   Vegetative signs and poor grooming
C)   Poor judgement and hyperactivity
D)   Cognitive deficits and paranoia

Question 10

A patient demonstrating characteristics of acute mania relapsed after discontinuing lithium. New orders are written to resume lithium twice daily and begin olanzapine (Zyprexa). What is the rationale for the addition of olanzapine to the medication regimen?

Accepted Answer

A)   It minimizes the side effects of lithium.
B)   It brings hyperactivity under rapid control.
C)   It enhances the antimanic actions of lithium.
D)   It is used for long-term control of hyperactivity.

Question 11

Outcome identification for the treatment plan of a patient experiencing grandiose thinking associated with acute mania will focus on which of the following?

Accepted Answer

A)   Development of an optimistic outlook
B)   Distorted thought self-control
C)   Interest in the environment
D)   Sleep pattern stabilization

Question 12

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

Accepted Answer

A)   An extra-large window with a view of the street
B)   Neutral walls with pale, simple accessories
C)   Brightly coloured walls and print drapes
D)   Deep colours for walls and upholstery

Question 13

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?

Accepted Answer

A)   Insulting, aggressive behaviour
B)   Pressured speech and grandiosity
C)   Hyperactivity; not eating and sleeping
D)   Poor concentration and decision making

Question 14

The exact cause of bipolar disorder has not been determined; however, for most patients, which of the following is true?

Accepted Answer

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.

Question 15

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?

Accepted Answer

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 behaviour?"

Question 16

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

Accepted Answer

A)   Pharyngitis, mydriasis, and dystonia
B)   Alopecia, purpura, and drowsiness
C)   Polyuria, weakness, and nausea
D)   Ascites, dyspnea, and edema

Question 17

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 behaviour without entering into a power struggle. Which initial approach should the nurse select?

Accepted Answer

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 behaviour is annoying others."

Question 18

The nurse receives a laboratory report indicating a patient's serum lithium level is 1 mEq/L. The patient's last dose of lithium was 8 hours ago. How should the nurse interpret this result?

Accepted Answer

A)   This result is within therapeutic limits.
B)   This result is below therapeutic limits.
C)   This result is above therapeutic limits.
D)   This result is invalid because of the time lapse since the last dose.

Question 19

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.

Accepted Answer

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)   "Usually patients take medication for approximately 6 months after discharge."
D)   "It's unusual that the health care provider hasn't already stopped your medication."

Question 20

Which nursing diagnosis would most likely apply to both a patient diagnosed with major depression and one experiencing acute mania?

Accepted Answer

A)   Deficient diversional activity
B)   Disturbed sleep pattern
C)   Fluid volume excess
D)   Defensive coping

Exam 14: Bipolar Disorders