Question 1

A patient diagnosed with bipolar disorder is dressed in a red leotard and bright scarves. The patient twirls and shadow boxes. The patient says gaily, "Do you like my scarves? Here; they are my gift to you." How should the nurse document the patient's mood?

Accepted Answer

A)   Euphoric
B)   Irritable
C)   Suspicious
D)   Confident A

Question 2

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 C

Question 3

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? Select all that apply.

Accepted Answer

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

Question 4

Four new patients were admitted to the behavioural health unit in the past 12 hours. The nurse directs a psychiatric technician to monitor these patients for safety. A patient with which of the following diagnoses will need the most watchful supervision?

Accepted Answer

A)   Bipolar I disorder
B)   Bipolar II disorder
C)   Dysthymic disorder
D)   Cyclothymic disorder

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

A patient with acute mania has disrobed in the hall three times in 2 hours. Which of the following should the nurse do?

Accepted Answer

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.

Question 7

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 8

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 9

The spouse of a patient diagnosed with bipolar disorder asks what evidence supports the possibility of genetic transmission of bipolar disorders. Which response should the nurse provide?

Accepted Answer

A)   "A high proportion of patients with bipolar disorders are found among creative writers."
B)   "A higher rate of relatives with bipolar disorder is found among patients with bipolar disorder."
C)   "Patients with bipolar disorder have higher rates of relatives who respond in an exaggerated way to daily stress."
D)   "More individuals with bipolar disorder come from high socioeconomic and educational backgrounds."

Question 10

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 11

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 12

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 13

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 14

A patient demonstrating behaviours associated with acute mania has exhausted the staff by noon. Staff members are feeling defensive and fatigued. Which action will the staff take initially?

Accepted Answer

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 behaviour.
D)   Explain to the patient that the behaviour is unacceptable.

Question 15

A patient experiencing acute mania undresses in the group room and dances. The nurse intervenes initially by doing which of the following?

Accepted Answer

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

Question 16

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 17

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

Accepted Answer

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 flavoured gelatin with whipped cream

Question 18

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.

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.

Question 19

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 behaviour?

Accepted Answer

A)   Educate the patient about the proper ways to perform personal hygiene andCoordinate clothing.
B)   Continue to monitor and document the patient's speech patterns and motorActivity.
C)   Ask the health care provider to prescribe an increased dose and frequency ofLithium.
D)   Consider the need to check the lithium level. The patient may not be swallowing medications.

Question 20

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

Exam 15: Bipolar Disorders