Chapter 13 Bipolar and Related Disorders PDF

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Varcarolis' Foundations of Psychiatric-Mental Health Nursing 8th Edition Test Banks...

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VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

Chapter 13: Bipolar and Related Disorders Halter: Varcarolis’ Foundations of Psychiatric Mental Health Nursing: A Clinical Approach, 8th Edition

MULTIPLE CHOICE 1. A person was online continuously for over 24 hours, posting rhymes on official government websites and inviting politicians to join social networks. The person has not slept or eaten for 3 days. What features of mania are evident? a. Increased muscle tension and anxiety b. Vegetative signs and poor grooming c. Poor judgment and hyperactivity d. Cognitive deficits and paranoia ANS: C Hyperactivity (activity without sleep) and poor judgment (posting rhymes on government websites) are characteristic of manic episodes. The distracters do not specifically apply to mania. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Pages 13-11, 12, 15, 16, 44 (Table 13-2) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 2. 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 shouldNURSINGTB.COM the nurse document the patient’s mood? a. Euphoric b. Irritable c. Suspicious d. Confident ANS: A The patient has demonstrated clang associations and pleasant, happy behavior. Excessive happiness indicates euphoria. Irritability, belligerence, excessive happiness, and confidence are not the best terms for the patient’s mood. Suspiciousness is not evident. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 13-10, 11 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 3. 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? a. Insulting, aggressive behavior b. Pressured speech and grandiosity c. Hyperactivity; not eating and sleeping d. Poor concentration and decision making ANS: C

VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

Safety and physiological needs have the highest priority. Hyperactivity, poor nutrition, hydration, and not sleeping take priority in terms of the needs listed above because they threaten the physical integrity of the patient. The other behaviors are less threatening to the patient’s life. PTS: REF: TOP: MSC:

1 DIF: Cognitive Level: Analyze (Analysis) Pages 13-18, 19 (Case Study and Nursing Care Plan) Nursing Process: Planning Client Needs: Safe, Effective Care Environment

4. 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? a. Risk for injury b. Ineffective coping c. Impaired social interaction d. Ineffective therapeutic regimen management ANS: A Although each of the nursing diagnoses listed is appropriate for a patient having a manic episode, the priority lies with the patient’s physiological safety. Hyperactivity and poor judgment put the patient at risk for injury. PTS: REF: TOP: MSC:

1 DIF: Cognitive Level: Apply (Application) Pages 13-18, 44 (Table 13-2) | Page 13-19 (Case Study and Nursing Care Plan) Nursing Process: Diagnosis/Analysis Client Needs: Safe, Effective Care Environment NURSINGTB.COM

5. 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? 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 behavior?” ANS: C When the patient is unable to control his or her behavior and violates or threatens to violate the rights of others, limits must be set in an effort to de-escalate the situation. Limits should be set in simple, concrete terms. The incorrect responses do not offer appropriate assistance to the patient, threaten the patient with seclusion as punishment, and ask a rhetorical question. PTS: REF: Plan) MSC:

1 DIF: Cognitive Level: Apply (Application) Pages 13-18, 19, 30, 31, 46 (Table 13-3) | Page 13-19 (Case Study and Nursing Care TOP: Nursing Process: Implementation Client Needs: Safe, Effective Care Environment

6. This nursing diagnosis applies to a patient experiencing 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. The patient will a. ask staff for assistance with feeding within 4 days.

VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

b. drink six servings of a high-calorie, high-protein drink each day. c. consistently sit with others for at least 30 minutes at meal time within 1 week. d. consistently wear appropriate attire for age and sex within 1 week while on the psychiatric unit. ANS: B High-calorie, high-protein food supplements will provide the additional calories needed to offset the patient’s extreme hyperactivity. Sitting with others or asking for assistance does not mean the patient ate or drank. The other indicator is unrelated to the nursing diagnosis. PTS: REF: TOP: MSC:

1 DIF: Cognitive Level: Apply (Application) Pages 13-18, 19, 46 (Table 13-3) | Page 13-19 (Case Study and Nursing Care Plan) Nursing Process: Outcomes Identification Client Needs: Physiological Integrity

7. A patient demonstrating characteristics of acute mania relapsed after discontinuing lithium. New orders are written to resume lithium twice daily and begin olanzapine. What is the rationale for the addition of olanzapine to the medication regimen? It will a. minimize the side effects of lithium. b. bring hyperactivity under rapid control. c. enhance the antimanic actions of lithium. d. be used for long-term control of hyperactivity. ANS: B Manic symptoms are controlled by lithium only after a therapeutic serum level is attained. Because this takes several days to accomplish, a drug with rapid onset is necessary to reduce the hyperactivity initially. Antipsychotic drugs neither enhance lithium’s antimanic activity NURSINGTB.COM nor minimize the side effects. Lithium will be used for long-term control. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Pages 13-24, 28 TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity 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? a. phenytoin b. clonidine c. risperidone d. carbamazepine ANS: D Some patients diagnosed with bipolar disorder, especially those who have only short periods between episodes, have a favorable response to the anticonvulsants carbamazepine and valproate. Carbamazepine seems to work better in patients with rapid cycling and in severely paranoid, angry manic patients. Phenytoin is also an anticonvulsant but not used for mood stabilization. Risperidone is not an anticonvulsant. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 13-27, 51 (Table 13-5) TOP: Nursing Process: Planning

VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

MSC: Client Needs: Physiological Integrity 9. The exact cause of bipolar disorder has not been determined; however, for most patients 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. ANS: A The best explanation at this time is that bipolar disorder is most likely caused by interplay of complex independent variables. Various theories implicate genetics, endocrine imbalance, environmental stressors, and neurotransmitter imbalances. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 13-8 to 10 TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 10. 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? 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.” NURSINGTB.COM d. “More individuals with bipolar disorder come from high socioeconomic and educational backgrounds.” ANS: B Evidence of genetic transmission is supported by lifetime prevalence statistics. The incorrect options do not support the theory of genetic transmission and other factors involved in the etiology of bipolar disorder. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 13-8 TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 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 behavior without entering into a power struggle. Which initial approach should the nurse select? 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 behavior is annoying others.” ANS: A

VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

The distractibility characteristic of manic episodes can assist the nurse to direct the patient toward more appropriate, constructive activities without entering into power struggles. Humor usually backfires by either encouraging the patient or inciting anger. Limit setting and honest feedback may seem heavy-handed and may incite anger. PTS: REF: Plan) MSC:

1 DIF: Cognitive Level: Apply (Application) Pages 13-18, 19, 25, 46 (Table 13-3) | Page 13-19 (Case Study and Nursing Care TOP: Nursing Process: Implementation Client Needs: Psychosocial Integrity

12. The nurse receives a laboratory report indicating a patient’s serum level is 1 mEq/L. The patient’s last dose of lithium was 8 hours ago. This result is a. within therapeutic limits. b. below therapeutic limits. c. above therapeutic limits. d. invalid because of the time lapse since the last dose. ANS: A Normal range for a blood sample taken 8 to 12 hours after the last dose of lithium is 0.6 to 1.2 mEq/L. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 13-26, 27, 28, 49 (Table 13-4) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity 13. Consider these three anticonvulsant medications: divalproex, carbamazepine, and NURSINGTB.COM gabapentin. Which medication also belongs to this classification? a. clonazepam b. risperidone c. lamotrigine d. aripiprazole ANS: C The three drugs in the stem of the question are all anticonvulsants. Lamotrigine is also an anticonvulsant. Clonazepam is an anxiolytic; aripiprazole and risperidone are antipsychotic drugs. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 13-28, 51(Table 13-5) TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity 14. When a hyperactive patient diagnosed with acute mania is hospitalized, what is the initial nursing intervention? a. Allow the patient to act out feelings. b. Set limits on patient behavior as necessary. c. Provide verbal instructions to the patient to remain calm. d. Restrain the patient to reduce hyperactivity and aggression. ANS: B

VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

This intervention provides support through the nurse’s presence and provides structure as necessary while the patient’s control is tenuous. Acting out may lead to loss of behavioral control. The patient will probably be unable to focus on instructions and comply. Restraint is used only after other interventions have proved ineffective. PTS: REF: TOP: MSC:

1 DIF: Cognitive Level: Apply (Application) Pages 13-18, 19, 46 (Table 13-3) | Page 13-19 (Case Study and Nursing Care Plan) Nursing Process: Planning Client Needs: Safe, Effective Care Environment

15. At a unit meeting, the staff discusses decor for a special room for patients with acute mania. Which suggestion is appropriate? a. An extra-large window with a view of the street b. Neutral walls with pale, simple accessories c. Brightly colored walls and print drapes d. Deep colors for walls and upholstery ANS: B The environment for a manic patient should be as simple and nonstimulating as possible. Manic patients are highly sensitive to environmental distractions and stimulation. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 13-18, 19, 46 (Table 13-3) | Page 13-19 (Case Study and Nursing Care Plan) TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity 16. A patient demonstrating behaviors associated with acute mania has exhausted the staff by noon. Staff members are feelingNURSINGTB.COM defensive and fatigued. Which action will the staff take initially? 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 behavior. d. Explain to the patient that the behavior is unacceptable. ANS: B When staff members are exhausted, the patient has succeeded in keeping the environment unsettled and avoided outside controls on behavior. Staff meetings can help minimize staff splitting and feelings of anger, helplessness, confusion, and frustration. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Pages 13-30, 31 TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment 17. A patient experiencing acute mania undresses in the group room and dances. The nurse intervenes initially by 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.

VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

ANS: C Patients must be protected from the embarrassing consequences of their poor judgment whenever possible. Protecting the patient from public exposure by matter-of-factly covering the patient and removing him or her from the area with a sufficient number of staff to avoid argument and provide control is an effective approach. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 13-18, 19, 46 (Table 13-3) TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity 18. 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 four pairs of shoes.” Select the nurse’s appropriate intervention. The nurse a. suggests the patient have a friend do the shopping and bring purchases to the unit. b. invites the patient to sit together and look at new fashion magazines. c. tells the patient computer use is not allowed until self-control improves. d. asks whether the patient has enough money to pay for the purchases. ANS: B Situations such as this offer an opportunity to use the patient’s distractibility to staff’s advantage. Patients become frustrated when staff deny requests that the patient sees as entirely reasonable. Distracting the patient can avoid power struggles. Suggesting that a friend do the shopping would not satisfy the patient’s need for immediacy and would ultimately result in the extravagant expenditure. Asking whether the patient has enough money would likely precipitate an angry response. NURSINGTB.COM PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 13-18, 19, 46 (Table 13-3) | Page 13-19 (Case Study and Nursing Care Plan) TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

19. 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 a. meals. b. an antacid. c. an antiemetic. d. a large glass of juice. ANS: A Some patients find that taking lithium with meals diminishes nausea. The incorrect options are less helpful. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 13-53 (Box 13-1) TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity 20. A health teaching plan for a patient taking lithium should include instructions to 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.

VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

d. avoid eating aged cheese, processed meats, and red wine. ANS: A Sodium depletion and dehydration increase the chance for development of lithium toxicity. The other options offer inappropriate information. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 13-53 (Box 13-1) TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity 21. Which nursing diagnosis would most likely apply to a patient diagnosed with major depressive disorder as well as one experiencing acute mania? a. Deficient diversional activity b. Disturbed sleep pattern c. Fluid volume excess d. Defensive coping ANS: B Patients with mood disorders, both depression and mania, experience sleep pattern disturbances. Assessment data should be routinely gathered about this possible problem. Deficient diversional activity is more relevant for patients with depression. Defensive coping is more relevant for patients with mania. Fluid volume excess is less relevant for patients with mood disorders than is deficient fluid volume. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Pages 13-12, 19, 44 (Table 13-2) | Page 13-14; also incorporates content from Chapter 14 TOP: Nursing Process: Diagnosis/Analysis NURSINGTB.COM MSC: Client Needs: Psychosocial Integrity 22. Which dinner menu is best suited for a patient with acute mania? 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 flavored gelatin with whipped cream ANS: C These foods provide adequate nutrition, but more importantly, they are finger foods that the hyperactive patient could eat while in motion. The foods in the incorrect options cannot be eaten without utensils. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 13-18, 19, 46 (Table 13-3) | Page 13-19 (Case Study and Nursing Care Plan) TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity 23. Outcome identification for the treatment plan of a patient experiencing grandiose thinking associated with acute mania will focus on a. developing an optimistic outlook. b. distorted thought self-control. c. interest in the environment. d. sleep pattern stabilization.

VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

ANS: B The desired outcome is that the patient will be able to control the grandiose thinking...