Multiple Choice
Identify the choice that best completes the statement or answers the question.
____ 1. A highly agitated client paces the unit and states, “I could buy and sell this place.” The client’s mood fluctuat
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Multiple Choice
Identify the choice that best completes the statement or answers the 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?
1. “Rates mood 8/10. Exhibiting looseness of association. Euphoric.”
2. “Mood euthymic. Exhibiting magical thinking. Restless.”
3. “Mood labile. Exhibiting delusions of reference. Hyperactive.”
4. “Agitated and pacing. Exhibiting grandiosity. Mood labile.”
____ 2. A client diagnosed with bipolar disorder is distraught over insomnia experienced over the last 3 nights and a 12-lb. weight loss over the past 2 weeks. Which should be this client’s priority nursing diagnosis?
1. Knowledge deficit R/T bipolar disorder AEB concern about symptoms
2. Altered nutrition: less than body requirements R/T hyperactivity AEB weight loss
3. Risk for suicide R/T powerlessness AEB insomnia and anorexia
4. Altered sleep patterns R/T mania AEB insomnia for the past 3 nights
____ 3. A nurse is planning care for a client diagnosed with bipolar disorder: manic episode. In which order should the nurse prioritize the client outcomes in the exhibit? The following are the outcomes: 1. Maintains nutritional status. 2. Interacts appropriately with peers. 3. Remains free from injury. 4. Sleeps 6 to 8 hours a night.
1. 2, 1, 3, 4
2. 4, 1, 2, 3
3. 3, 1, 4, 2
4. 1, 4, 2, 3
____ 4. A client diagnosed with bipolar disorder: depressive episode intentionally overdoses on sertraline (Zoloft). Family members report that the client has experienced anorexia, insomnia, and recent job loss. Which nursing diagnosis should a nurse prioritize?
1. Risk for suicide R/T hopelessness
2. Anxiety: severe R/T hyperactivity
3. Imbalanced nutrition: less than body requirements R/T refusal to eat
4. Dysfunctional grieving R/T loss of employment
____ 5. A client diagnosed with bipolar I disorder: manic episode refuses to take lithium carbonate (Lithobid) because of excessive weight gain. In order to increase adherence, which medication should a nurse anticipate that a physician may prescribe?
1. Sertraline (Zoloft)
2. Valproic acid (Depakote)
3. Trazodone (Desyrel)
4. Paroxetine (Paxil)
____ 6. 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 asks the nurse how Zyprexa works. Which is the appropriate nursing response?
1. “Zyprexa in combination with Eskalith cures manic symptoms.”
2. “Zyprexa prevents extrapyramidal side effects.”
3. “Zyprexa increases the effectiveness of the immune system.”
4. “Zyprexa calms hyperactivity until the Eskalith takes effect.”
____ 7. A client began taking lithium carbonate (Lithobid) 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 response?
1. “That’s strange. Weight loss is the typical pattern.”
2. “What have you been eating? Weight gain is not usually associated with lithium.”
3. “Weight gain is a common, but troubling, side effect.”
4. “Weight gain only occurs during the first month of treatment with this drug.”
____ 8. A client diagnosed with bipolar disorder has been taking lithium carbonate (Lithobid) for one year. The client presents in an emergency department with a temperature of 101F (38C), severe diarrhea, blurred vision, and tinnitus. How should the nurse interpret these symptoms?
1. Symptoms indicate consumption of foods high in tyramine.
2. Symptoms indicate lithium carbonate discontinuation syndrome.
3. Symptoms indicate the development of lithium carbonate tolerance.
4. Symptoms indicate lithium carbonate toxicity.
____ 9. 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?
1. “Treatment is compromised when clients can’t sleep.”
2. “Treatment is compromised when irritability interferes with social interactions.”
3. “Treatment is compromised when clients have no insight into their problems.”
4. “Treatment is compromised when clients choose not to take their medications.”
____ 10. A client is diagnosed with bipolar disorder: manic episode. Which nursing intervention would be implemented to achieve the outcome of “Client will gain 2 lbs. by the end of the week?”
1. Provide client with high-calorie finger foods throughout the day.
2. Accompany client to cafeteria to encourage adequate dietary consumption.
3. Initiate total parenteral nutrition to meet dietary needs.
4. Teach the importance of a varied diet to meet nutritional needs.
____ 11. A nursing instructor is teaching about bipolar disorders. Which statement differentiates the DSM-5 diagnostic criteria of a manic episode from a hypomanic episode?
1. During a manic episode, clients may experience an inflated self-esteem or grandiosity, and these symptoms are absent in hypomania.
2. During a manic episode, clients may experience a decreased need for sleep, and this symptom is absent in hypomania.
3. During a manic episode, clients may experience psychosis, and this symptom is absent in hypomania.
4. During a manic episode, clients may experience flight of ideas and racing thoughts, and these symptoms are absent in hypomania.
____ 12. A client has been diagnosed with major depressive episode. After treatment with fluoxetine (Prozac), the client exhibits pressured speech and flight of ideas. Based on this symptom change, which physician action would the nurse anticipate?
1. Increase the dosage of fluoxetine.
2. Discontinue the fluoxetine and rethink the client’s diagnosis.
3. Order benztropine (Cogentin) to address extrapyramidal symptoms.
4. Order olanzapine (Zyprexa) to address altered thoughts.
____ 13. Which is the basic premise of a recovery model used to treat clients diagnosed with bipolar disorder?
1. Medication adherence
2. Empowerment of the consumer
3. Total absence of symptoms
4. Improved psychosocial relationships
Multiple Response
Identify one or more choices that best complete the statement or answer the question.
____ 14. Which of the following instructions regarding lithium therapy should be included in a nurse’s discharge teaching? (Select all that apply.)
1. Avoid excessive use of beverages containing caffeine.
2. Maintain a consistent sodium intake.
3. Consume at least 2,500 to 3,000 mL of fluid per day.
4. Restrict sodium content.
5. Restrict fluids to 1,500 mL per day.
____ 15. A nurse is assessing an adolescent client diagnosed with cyclothymic disorder. Which of the following DSM-5 diagnostic criteria would the nurse expect this client to meet? (Select all that apply.)
1. Symptoms lasting for a minimum of two years
2. Numerous periods with manic symptoms
3. Possible comorbid diagnosis of a delusional disorder
4. Symptoms cause clinically significant impairment in important areas of functioning
5. Depressive symptoms that do not meet the criteria for major depressive episode
____ 16. Which of the following rationales by a nurse explain to parents why it is difficult to diagnose a child or adolescent exhibiting symptoms of bipolar disorder? (Select all that apply.)
1. Bipolar symptoms mimic attention deficit-hyperactivity disorder symptoms.
2. Children are naturally active, energetic, and spontaneous.
3. Neurotransmitter levels vary considerably in accordance with age.
4. The diagnosis of bipolar disorder cannot be assigned prior to the age of 18.
5. Genetic predisposition is not a reliable diagnostic determinant.
Completion
Complete each statement.
17. ___________________________ is an alteration in mood that is expressed by feelings of elation, inflated self-esteem, grandiosity, hyperactivity, agitation, and accelerated thinking and speaking.
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