Chapter 16 practice exam questions PDF

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Chapter 16 practice exam questions...

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1. A person is directing traffic on a busy street while shouting and making obscene gestures at passing cars. 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 deficit and sad mood ANS: C

Hyperactivity (directing traffic) and poor judgment (putting self in a dangerous position) are characteristic of manic episodes. The distractors do not specifically apply to mania. DIF: Cognitive Level: Comprehension (Understanding) REF: Pages: 282-287 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity 2. A patient diagnosed with bipolar disorder is dressed in a red leotard and brightly colored scarves. The patient says, “I’ll punch you, munch you, crunch you,” while twirling and shadowboxing. Then 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? a. Labile and euphoric b. Irritable and belligerent c. Highly suspicious and arrogant d. Excessively happy and confident ANS: A

The patient has demonstrated angry behavior and pleasant, happy behavior within seconds of each other. Excessive happiness indicates euphoria. Mood swings are often rapid and seemingly without understandable reason in patients who are manic. These swings are documented as labile. Irritability, belligerence, excessive happiness, and confidence are not entirely correct terms for the patient’s mood. A high level of suspicion is not evident. DIF: Cognitive Level: Application (Applying) REF: Pages: 282-284 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity 3. A patient experiencing mania has not eaten or slept for 3 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 physiologic safety. Hyperactivity and poor judgment place the patient at risk for injury.

DIF: Cognitive Level: Application (Applying) TOP: Nursing Process: Diagnosis| Nursing Process: Analysis MSC: NCLEX: Safe, Effective Care Environment

REF: Pages: 288-289

4. A patient diagnosed with bipolar disorder is hyperactive and manic 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 and threaten the patient with seclusion as punishment. Asking “why” does not provide for environmental safety. DIF: Cognitive Level: Application (Applying) REF: Pages: 290-293 TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment 5. This nursing diagnosis applies to a patient experiencing 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 the most appropriate outcome. The patient will: a. ask staff for assistance with feeding within 4 days. b. drink six servings of a high-calorie, highprotein drink each day. c. consistently sit with others for at least 30 minutes at mealtime within 1 week. d. consistently wear appropriate attire for age and sex within 1 week while in 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 will eat or drink. Appropriate attire is unrelated to the nursing diagnosis. DIF: Cognitive Level: Application (Applying)

REF: Page: 291

TOP: Nursing Process: Outcomes Identification MSC: NCLEX: Physiological Integrity

A patient develops mania after discontinuing lithium. New prescriptions are written to resume lithium twice daily and begin olanzapine (Zyprexa). The addition of olanzapine to the medication regimen will: a. minimize the side effects of lithium. b. bring hyperactivity under rapid control. c. enhance the antimanic actions of lithium. d. provide long-term control of hyperactivity. 6.

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 nor minimize the side effects. Lithium is used for long-term control. DIF: Cognitive Level: Application (Applying) REF: Page: 294 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

A patient diagnosed with bipolar disorder has rapid cycles. The health care provider prescribes an anticonvulsant medication. To prepare teaching materials, which drug should the nurse anticipate will be prescribed? a. phenytoin (Dilantin) b. clonidine (Catapres) c. carbamazepine (Tegretol) d. chlorpromazine (Thorazine) 7.

ANS: C

Some patients with bipolar disorder, especially those who have only short periods between episodes, have a favorable response to the anticonvulsants carbamazepine and valproate. Phenytoin is also an anticonvulsant but is not used for mood stabilization. Carbamazepine seems to work better in patients with rapid cycling and in severely paranoid, angry patients with manic episodes. DIF: Cognitive Level: Application (Applying) REF: Pages: 295-297 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 8. a. b. c.

The cause of bipolar disorder has not been determined, but: several factors, including genetics, are implicated. brain structures were altered by stresses early in life. excess norepinephrine is probably a major factor.

d.

excess sensitivity in dopamine receptors may exist.

ANS: A

At this time, the interplay of complex independent variables is most likely the best explanation of the cause for bipolar disorder. Various theories implicate genetics, endocrine imbalance, early stress, and neurotransmitter imbalances. DIF: Cognitive Level: Comprehension (Understanding) REF: Pages: 281-282 TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

The spouse of a patient diagnosed with bipolar disorder asks what evidence supports the possibility of genetic transmission of bipolar disorders. Select the nurse’s best response. a. “A high proportion of patients diagnosed with bipolar disorders are found among creative writers.” b. “A higher rate of relatives diagnosed with bipolar disorder is found among patients with bipolar disorder.” c. “Patients diagnosed with bipolar disorder have higher rates of relatives who respond in an exaggerated way to daily stresses.” d. “More individuals diagnosed with bipolar disorder come from high socioeconomic and educational backgrounds.” 9.

ANS: B

Evidence of genetic transmission is supported when twins or relatives of patients with a particular disorder also show an incidence of the disorder that is higher than the incidence in the general public. The incorrect options do not support the theory of genetic transmission of bipolar disorder. DIF: Cognitive Level: Application (Applying) REF: Pages: 281-282 TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

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. Select the best initial approach by the nurse. 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.” 10.

d.

Honest feedback: “Your controlling behavior is annoying others.”

ANS: A

The distractibility characteristic of manic episodes can assist the nurse to direct the patient toward more appropriate, constructive activities without entering into a power struggle. Humor usually backfires by either encouraging the patient or inciting anger. Limit setting and honest feedback may seem heavy-handed to a labile patient and may incite anger. DIF: Cognitive Level: Application (Applying) REF: Page: 290 | Pages: 292-293 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity 11. A nurse receives this laboratory result for a patient diagnosed with bipolar disorder: lithium level 1 mEq/L. This result is: a. within therapeutic limits b. below therapeutic limits c. above therapeutic limits d. incorrect because of inaccurate testing ANS: A

The normal range for a blood sample taken 8 to 12 hours after the last dose of lithium is 0.4 to 1 mEq/L. DIF: Cognitive Level: Comprehension (Understanding) REF: Pages: 294-295 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

Consider these three drugs: divalproex (Depakote), carbamazepine (Tegretol), and gabapentin (Neurontin). Which drug also belongs to this group? a. clonazepam (Klonopin) b. risperidone (Risperdal) c. lamotrigine (Lamictal) d. aripiprazole (Abilify) 12.

ANS: C

The three drugs in the stem of this question are all anticonvulsants. Lamotrigine is also an anticonvulsant. Clonazepam is an anxiolytic; aripiprazole and risperidone are antipsychotic drugs. DIF: Cognitive Level: Comprehension (Understanding) REF: Page: 297 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 13. When a hyperactive patient experiencing acute mania is hospitalized, what initial nursing intervention is a priority? a. Allow the patient to act out his or her feelings.

b. c. d.

Set limits on the patient’s behavior as necessary. Provide verbal instructions to the patient to remain calm. Restrain the patient to reduce hyperactivity and aggression.

ANS: B

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 the 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. DIF: Cognitive Level: Application (Applying) REF: Pages: 290-291 TOP: Nursing Process: Planning MSC: NCLEX: Safe, Effective Care Environment 14. At a unit meeting, staff members discuss the decor for a special room for patients experiencing mania. Select the best option. a. 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 patient experiencing mania should be as simple and as nonstimulating as possible. Patients experiencing mania are highly sensitive to environmental distractions and stimulation. Draperies present a risk for injury. DIF: Cognitive Level: Application (Applying) REF: Pages: 289-291 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity 15. A patient experiencing acute mania has exhausted the staff members by noon. The patient has joked, manipulated, insulted, and fought all morning. Staff members are feeling defensive and fatigued. Which is the best action? a. Confer with the health care provider regarding use of seclusion for this patient. b. Hold a staff meeting to discuss consistency and limit-setting approaches. c. Conduct a meeting with all patients to discuss the behavior. d. Explain to the patient that the behavior is unacceptable. ANS: B

When staff members are overwhelmed, 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. Criteria for seclusion have not been met. DIF: Cognitive Level: Application (Applying) REF: Pages: 289-290 TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment 16. A patient experiencing acute mania undresses in the group room and dances. The nurse’s first intervention would be to: a. quietly ask the patient, “Why don’t you put on your clothes?” b. firmly tell the patient, “Stop dancing, and put on your clothing.” c. put a blanket around the patient, and walk with the patient to a quiet room. d. allow the patient stay in the group room. Move the other patients to a different area. 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 members to avoid argument and provide control is an effective approach. DIF: Cognitive Level: Application (Applying) REF: Page: 285 | Pages: 290-291 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 17. A patient experiencing acute mania 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 most appropriate intervention. a. Suggest to the patient to ask a friend do the shopping and bring purchases to the unit. b. Invite the patient to sit with the nurse and look at new fashion magazines. c. Tell the patient that computer use is not allowed until self-control improves. d. Ask 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 the staff’s advantage. Patients become frustrated when staff members 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. DIF: Cognitive Level: Analysis (Analyzing) REF: Page: 284 | Page: 289 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

A patient diagnosed with bipolar disorder is being treated on an outpatient basis with lithium carbonate 300 mg three times daily. The patient complains of nausea. To reduce the nausea, the nurse can suggest that the lithium be taken with: a. meals. b. an antacid. c. a large glass of juice. d. an antiemetic medication. 18.

ANS: A

Some patients find that taking lithium with meals diminishes nausea. The incorrect options are less helpful. DIF: Cognitive Level: Application (Applying) REF: Page: 296 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 19. 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 fluids. c. double the lithium dose if diarrhea or vomiting occurs. d. avoid eating aged cheese, processed meats, and red wine. ANS: A

Sodium depletion and dehydration increase the chance for developing lithium toxicity. The incorrect options offer inappropriate information. DIF: Cognitive Level: Application (Applying) REF: Page: 296 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 20. Which nursing diagnosis would most likely apply to both a patient diagnosed with major depressive disorder (MDD) 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 diagnosed 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 diagnosed with MDD. Defensive coping is more relevant for patients experiencing mania. Fluid volume excess is less relevant for patients diagnosed with mood disorders than is deficient fluid volume. DIF: Cognitive Level: Analysis (Analyzing) TOP: Nursing Process: Diagnosis| Nursing Process: Analysis MSC: NCLEX: Psychosocial Integrity

REF: Page: 288

Which dinner menu is best suited for the patient diagnosed with bipolar disorder experiencing acute mania? a. Spaghetti and meatballs, salad, a banana b. Beef and vegetable stew, a roll, chocolate pudding c. Broiled chicken breast on a roll, an ear of corn, apple d. Chicken casserole, green beans, flavored gelatin with whipped cream 21.

ANS: C

The correct foods provide adequate nutrition but, more importantly, are finger foods that the hyperactive patient could “eat on the run.” The foods in the incorrect options cannot be eaten without utensils. DIF: Cognitive Level: Application (Applying) REF: Page: 291 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 22. Outcome identification for the treatment plan of a patient with grandiose thinking associated with acute mania focuses on: a. maintaining an interest in the environment. b. developing an optimistic outlook. c. self-control of distorted thinking. d. stabilizing the sleep pattern. ANS: C

The desired outcome is that the patient will be able to control the grandiose thinking associated with acute mania as evidenced by making realistic comments about self, abilities, and plans. Patients with acute mania are already unduly optimistic as a result of their use of denial, and they are overly interested in their environment. Sleep stability is a desired outcome but is not related to distorted thought processes. DIF: Cognitive Level: Application (Applying) REF: Pages: 288-289 TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity 23. Which documentation indicates that the treatment plan for a patient experiencing acute mania has been effective?

a. b. c. d.

“Converses without interrupting; clothing matches; participates in activities.” “Irritable, suggestible, distractible; napped for 10 minutes in afternoon.” “Attention span short; writing copious notes; intrudes in conversations.” “Heavy makeup; seductive toward staff; pressured speech.”

ANS: A

The descriptors given indicate the patient is functioning at an optimal level, using appropriate behavior, and thinking without becoming overstimulated by unit activities. The incorrect options reflect manic behavior. DIF: Cognitive Level: Application (Applying) REF: Pages: 299-300 TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial Integrity 24. A patient experiencing mania dances around the unit, seldom sits, monopolizes conversations, interrupts, and intrudes. Which nursing intervention will best assist the patient with energy conservation? a. Monitor physiologic functioning b. Provide a subdued environment c. Supervise personal hygiene d. Observe for mood changes ANS: B

All the options are reasonable interventions with a patient with acute mania, but providing a subdued environment directly relates to the outcome of energy conservation by decreasing stimulation and helping balance activity and rest. DIF: Cognitive Level: Application (Applying) REF: Pages: 290-293 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integri...