Chapter 26: Bipolar Disorders: Nursing Care of Person with Mood Lability

Format: Multiple Choice

Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

Cognitive Level: Apply

Integrated Process: Teaching/Learning

Objective: 6

Page and Header: 446, Lithium Carbonate

1. A client asks the nurse whether the client needs to alter any of the client’s activities because the client is taking lithium carbonate. Which response would be most appropriate?

A) “Increase your salt intake if an activity causes you to perspire heavily.”

B) “Wear sunscreen when you are going to be outdoors in the summer.”

C) “Drink less fluid than usual now that you are taking this drug.”

D) “No changes are necessary for strenuous activities you do outdoors.”

Page and Header: 436, Bipolar I Disorder

2. A nurse is assessing a client with bipolar disorder who is experiencing mania. The client states, “I’m just so beautiful. Everyone just stops and stares at how gorgeous I am. People constantly want to have sex with me.” The nurse interprets these statements as indicative of which type of mood?

A) Irritable

B) Elevated

C) Expansive

D) Euphoric

Page and Header: 438, Comorbidity

3. A nurse is reviewing the medical record of a client diagnosed with bipolar disorder. The nurse would most likely expect to find a history of which condition?

A) Panic disorder

B) Schizophrenia

C) Delusional disorder

D) Posttraumatic stress disorder

Page and Header: 440, Safety Issues

4. A nurse is developing a presentation for families who have members diagnosed with bipolar disorders. When describing this condition to the group, which would the nurse most likely include?

A) As the person ages, the episodes tend to decrease.

B) Environmental stressors are a key cause of these disorders.

C) The risk for suicide is high with either depression or mania.

D) Risk-taking behaviors are more common during a depressive episode.

Page and Header: 450, Divalproex Sodium

5. A client diagnosed with bipolar disorder is prescribed divalproex sodium as part of the treatment plan. When monitoring the client’s blood concentration of this drug, which level would alert the nurse to the need to change the dosage?

A) 30 ng/mL

B) 55 ng/mL

C) 75 ng/mL

D) 115 ng/mL

Page and Header: 452, Lamotrigine

6. A client diagnosed with bipolar disorder, having experienced a depressive episode, is prescribed lamotrigine. After educating the client on this medication, the nurse determines that the education was successful when the client makes which statement?

A) “I need to notify my primary care provider if I develop a skin rash.”

B) “I need to have my blood tested about once a month.”

C) “I have to watch how much salt I use every day.”

D) “This drug can affect my liver function.”

Page and Header: 452, Administering and Monitoring Medications

7. A nurse is preparing to administer medications to a client diagnosed with bipolar disorder who is experiencing acute mania. Which action would be most appropriate for the nurse to take?

A) Tell the client firmly that medication compliance is vital.

B) Allow the client to participate in the treatment decision.

C) Restrain the client before administering the medication.

D) Notify the primary care provider about the client’s refusal of the medication.

Page and Header: 450, Table 26.3

8. A client who is prescribed lithium comes to the clinic for an evaluation. During the visit, the client reports a fine hand tremor. Which action by the nurse would be most appropriate?

A) Immediately obtain a specimen to determine the client’s blood drug concentration.

B) Suggest that the client take the medication with meals or snacks.

C) Assist the client in minimizing exposure to stressors.

D) Encourage the client to elevate the affected hand on a pillow.

Page and Header: 451, Table 26.4

9. A client’s blood concentration of carbamazepine is increased. When reviewing the client’s medication history, use of which medication would alert the nurse to a possible interaction?

A) Phenobarbital

B) Primidone

C) Phenytoin

D) Diltiazem

Page and Header: 446, Physical Care

10. A client diagnosed with bipolar disorder has a history of multiple episodes and states, “I’m so frustrated with what’s happened because of these episodes.” Which would the nurse encourage to help support this client’s recovery?

A) Codependence

B) Hope

C) Self-control

D) Independent decision-making

Page and Header: 448, Table 26.1

11. A client prescribed lithium therapy has a plasma blood concentration of 2.2 mEq/L. Which would the nurse expect to assess with moderate toxicity?

A) Confusion

B) Fine resting hand tremor

C) Loose stools

D) Muscular weakness

Page and Header: 438, Key Characteristics 26.1

12. When caring for a client who is demonstrating mania, which assessment would the nurse make?

A) Unusual self-confidence

B) Slow, repetitive speech

C) Logical thinking

D) Narrowed focus

Page and Header: 436, Bipolar I Disorder

13. A client is exhibiting signs of a manic episode manifested by an elevated mood. Which expression would the nurse expect to assess?

A) Feelings of being on top of the world

B) Lack of restraint with feelings

C) Overvalued sense of self-importance

D) Indiscriminate enthusiasm for interactions

Page and Header: 439, Chronic Stress, Inflammation, and Kindling

14. After educating a class on the etiology of bipolar disorders, a nursing instructor determines that the education was successful when the class uses which description for the kindling theory?

A) A dysregulation in the circadian rhythm, leading to sleep disturbance

B) A single gene or sequence of genes causing pathologic changes

C) Exposure to repetitive sub-threshold stressors at vulnerable times

D) “Wear and tear” on the body from mood episodes leading to increased problems

Page and Header: 450, Carbamazepine

16. A client is brought to the emergency department by a sibling. The client has a history of bipolar disorder and is prescribed valproate. The sibling reports the client took the medication about 2 hours ago and recently became very disoriented and agitated. The nurse suspects toxicity based on which assessment? Select all that apply.

A) Tachypnea

B) Bradycardia

C) Hypotension

D) Dizziness

E) Respiratory depression

Page and Header: 448, Table 26.1

17. A client diagnosed with bipolar disorder has a lithium drug concentration of 1.2 mEq/L. Which finding would the nurse expect to assess? Select all that apply.

A) Metallic taste

B) Ataxia

C) Diarrhea

D) Slurred speech

E) Fasciculations

F) Muscle weakness

Page and Header: 454, Box 26.1

18. A nurse is preparing an education plan for the family members of a client who has been diagnosed with bipolar disorder. After teaching them about potential indicators for relapse, the nurse determines that the education was effective when the family members identify which indicator as suggesting mania? Select all that apply.

A) Avoiding people

B) Sleeping more than usual

C) Talking faster than usual

D) Being hungry all the time

E) Reading several books at once

Page and Header: 438, Comorbidity

19. A client is diagnosed with bipolar I disorder. When assessing the client, the nurse would be alert for other signs of which comorbidities? Select all that apply.

A) Panic disorder

B) Social phobia

C) Antisocial personality disorder

D) Delirium

E) Somatoform disorder

Page and Header: 449, Table 26.2

20. A client diagnosed with bipolar disorder is prescribed lithium. The nurse is reviewing the client’s medication history for drugs that could interact with lithium. The nurse would monitor the client’s serum lithium concentrations closely for toxicity if the client’s history included use of which medication? Select all that apply.

A) Captopril

B) Fluoxetine

C) Hydrochlorothiazide

D) Mannitol

E) Isosorbide