Question 1

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 2

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 3

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.

Accepted Answer

A)  Imbalanced nutrition: more than body requirements 
B)  Disturbed thought processes 
C)  Sleep deprivation 
D)  Chronic confusion 
E)  Social isolation

Question 4

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 5

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.

Question 6

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 which of the following?

Accepted Answer

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

Question 7

An outpatient diagnosed with bipolar disorder takes lithium carbonate 300 mg three times daily. The patient reports nausea. To reduce the nausea most effectively, the nurse suggests that the lithium be taken with which of the following?

Accepted Answer

A)  Meals 
B)  An antacid 
C)  An antiemetic 
D)  A large glass of juice

Question 8

A patient diagnosed with bipolar disorder has rapidly changing mood cycles. The health care provider prescribes an anticonvulsant medication. To prepare teaching materials, which drug should the nurse anticipate will be prescribed?

Accepted Answer

A)  Phenytoin (Dilantin) 
B)  Gabapentin (Neurontin) 
C)  Risperidone (Risperdal) 
D)  Carbamazepine (Tegretol)

Question 9

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."

Question 10

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 11

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 do which of the following?

Accepted Answer

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.

Question 12

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?

Accepted Answer

A)  Monitor physiological functioning. 
B)  Provide a subdued environment. 
C)  Supervise personal hygiene. 
D)  Observe for mood changes.

Question 13

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?

Accepted Answer

A)  Attending psychoeducation sessions 
B)  Decreasing physical activity 
C)  Increasing food and fluids 
D)  Meeting self-care needs

Question 14

The plan of care for a patient in the manic state of bipolar disorder should include which of the following interventions? Select all that apply.

Accepted Answer

A)  Touch the patient to provide reassurance. 
B)  Invite the patient to lead a community meeting. 
C)  Provide a structured environment for the patient. 
D)  Ensure that the patient's nutritional needs are met. 
E)  Design activities that require the patient's concentration.

Question 15

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

Question 16

When a hyperactive patient diagnosed with acute mania is hospitalized, what is the initial nursing intervention?

Accepted Answer

A)  Allow the patient to act out feelings. 
B)  Set limits on patient behaviour as necessary. 
C)  Provide verbal instructions to the patient to remain calm. 
D)  Restrain the patient to reduce hyperactivity and aggression.

Question 17

A health teaching plan for a patient taking lithium should include instructions to do which of the following?

Accepted Answer

A)  Maintain normal salt and fluids in the diet 
B)  Drink twice the usual daily amount of fluid 
C)  Double the lithium dose if diarrhea or vomiting occurs 
D)  Avoid eating aged cheese, processed meats, and red wine

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.

Exam 15: Bipolar Disorders