RNSG 2213 (M.H.) - Exam 2, Modlule 4: Bipolar dx|Bipolar
Disorder Assessment, Nursing Care, Pharmacotherapy, Lithium,
Anticonvulsants, Antipsychotics, Benzodiazepines, Mania,
Hypomania, Depression, Mixed Episodes, Rapid Cycling, Psychosis,
Suicide Risk, Mood Stabilizers, Therapeutic Drug Monitoring,
Serum Levels, Toxicity, Side Effects, EPS, Metabolic Syndrome,
Patient Safety, Seclusion, Milieu Management, Psychoeducation,
CBT, IPSRT, Family-Focused Therapy, ECT, Medication Adherence,
Crisis Planning, Early Relapse Recognition, Support Networks Exam
Questions Verified and Provided with Complete A+ Graded
Rationales Latest Updated 2026
1a. Differentiate between bipolar 1, bipolar 2 and cyclothymic disorder.
Bipolar I: Manic episodes (with possible depressive episodes). you get psychosis (not present in type II)
Bipolar II: Hypomanic and major depressive episodes (no full manic episodes).
Cyclothymic: Chronic mood fluctuations without severe episodes. have dysthymia not major depression.
Bipolar I Disorder
Definition: Characterized by at least one manic episode, which may be preceded or followed by
hypomanic or major depressive episodes.
Manic Episode: Symptoms include elevated mood, increased energy, decreased need for sleep,
grandiosity, talkativeness, distractibility, and risky behavior. These symptoms significantly impair
functioning or require hospitalization to prevent harm.
Depressive Episodes: While not required for diagnosis, individuals often experience major depressive
episodes.
,Bipolar II Disorder
Definition: Involves at least one major depressive episode and at least one hypomanic episode, but no
full manic episodes.
Hypomanic Episode: Similar to manic symptoms but less severe and does not cause significant
impairment in functioning or require hospitalization.
Depressive Episodes: Typically more frequent and often more severe compared to those in Bipolar I.
Cyclothymic Disorder
Definition: A milder form of bipolar disorder characterized by numerous periods of hypomanic
symptoms and periods of depressive symptoms lasting for at least two years (one year in children and
adolescents). However, the symptoms do not meet the criteria for a hypomanic or major depressive
episode.
Symptoms: Fluctuations in mood are less severe and do not lead to significant impairment in
functioning.
10 things to know before class module 4
1b. Do you know what rapid cycling and mixed episodes are?
Rapid Cycling: Four or more episodes in a year.
Mixed Episodes: Symptoms of both mania and depression at the same time.
Rapid Cycling
,Definition: Refers to the occurrence of four or more mood episodes (manic, hypomanic, or depressive)
within a single year. Episodes can be of varying lengths and can shift quickly from one mood state to
another.
Implications: Rapid cycling can complicate treatment and is often associated with a poorer prognosis.
Mixed Episodes
Definition: Involves the presence of symptoms of both mania (or hypomania) and depression
simultaneously. For example, a person may feel extremely energetic while also experiencing conflicting
emotions and behaviors.
10 things to know before class module 4
2. When assessing a patient, how might the symptoms of mania and depression present?
Mania s/s
extreme energy, euphoria, rapid speech, racing thoughts, decreased need for sleep, impulsive behavior,
and grandiosity
depression s/s
persistent sadness, low energy, loss of interest in activities, feelings of worthlessness, difficulty
concentrating, changes in appetite, and suicidal thoughts; both can also manifest with irritability and
agitation depending on the individual case.
10 things to know before class module 4
3a. Discuss how the nurse will use communication, milieu considerations and seclusion for acute mania
(Page 244)
, communiation:
The goal is to first engage the agitated individual, establish a collaborative relationship, and then
verbally deescalate or help the person return to a less agitated state (Spencer & Johnson, 2016).
Safety is a priority during the acute phase. Setting limits in a firm, nonthreatening, and neutral manner
prevents further escalation of mania and provides safe boundaries for the patient and others. Early
intervention in escalating behavior helps the patient stay in better control and leads to better outcomes.
Attempts should be made to avoid a power struggle with the patient by setting limits on behavior only
when it is necessary for safety reasons
10 things to know before class module 4
3b. Discuss how the nurse will use communication, milieu considerations and seclusion for acute mania
(Page 244)
an atmosphere with decreased stimulation. There should be space for solitary or noncompetitive
activities, such as writing, drawing, or pacing/walking. The staff members need to maintain close
observation and intervene to protect the patient from potentially embarrassing behaviors on the unit.
Interactions with others on the unit must also be observed. The intrusive behaviors of the person in a
manic state may lead to confrontation by other patients in the therapeutic community. A patient should
be assigned a private room when possible and encouraged to return to the room when showing
beginning signs of agitation. When a patient's activity begins to escalate, the staff members need to
employ additional interventions. Spencer and Johnson (2016) summarized verbal deescalation
techniques as strategies for dealing with agitated or aggressive behaviors. Refer to Chapter 24 for
effective verbal deescalation techniques. Immediate administration of a sedating medication, like
antipsychotics or benzodiazepines to decrease anxiety, is also a useful option. When verbal deescalation
techniques do not work, seclusion may be necessary to prevent harm to self or others.
10 things to know before class module 4
3c. Discuss how the nurse will use communication, milieu considerations and seclusion for acute mania
(Page 244)
Disorder Assessment, Nursing Care, Pharmacotherapy, Lithium,
Anticonvulsants, Antipsychotics, Benzodiazepines, Mania,
Hypomania, Depression, Mixed Episodes, Rapid Cycling, Psychosis,
Suicide Risk, Mood Stabilizers, Therapeutic Drug Monitoring,
Serum Levels, Toxicity, Side Effects, EPS, Metabolic Syndrome,
Patient Safety, Seclusion, Milieu Management, Psychoeducation,
CBT, IPSRT, Family-Focused Therapy, ECT, Medication Adherence,
Crisis Planning, Early Relapse Recognition, Support Networks Exam
Questions Verified and Provided with Complete A+ Graded
Rationales Latest Updated 2026
1a. Differentiate between bipolar 1, bipolar 2 and cyclothymic disorder.
Bipolar I: Manic episodes (with possible depressive episodes). you get psychosis (not present in type II)
Bipolar II: Hypomanic and major depressive episodes (no full manic episodes).
Cyclothymic: Chronic mood fluctuations without severe episodes. have dysthymia not major depression.
Bipolar I Disorder
Definition: Characterized by at least one manic episode, which may be preceded or followed by
hypomanic or major depressive episodes.
Manic Episode: Symptoms include elevated mood, increased energy, decreased need for sleep,
grandiosity, talkativeness, distractibility, and risky behavior. These symptoms significantly impair
functioning or require hospitalization to prevent harm.
Depressive Episodes: While not required for diagnosis, individuals often experience major depressive
episodes.
,Bipolar II Disorder
Definition: Involves at least one major depressive episode and at least one hypomanic episode, but no
full manic episodes.
Hypomanic Episode: Similar to manic symptoms but less severe and does not cause significant
impairment in functioning or require hospitalization.
Depressive Episodes: Typically more frequent and often more severe compared to those in Bipolar I.
Cyclothymic Disorder
Definition: A milder form of bipolar disorder characterized by numerous periods of hypomanic
symptoms and periods of depressive symptoms lasting for at least two years (one year in children and
adolescents). However, the symptoms do not meet the criteria for a hypomanic or major depressive
episode.
Symptoms: Fluctuations in mood are less severe and do not lead to significant impairment in
functioning.
10 things to know before class module 4
1b. Do you know what rapid cycling and mixed episodes are?
Rapid Cycling: Four or more episodes in a year.
Mixed Episodes: Symptoms of both mania and depression at the same time.
Rapid Cycling
,Definition: Refers to the occurrence of four or more mood episodes (manic, hypomanic, or depressive)
within a single year. Episodes can be of varying lengths and can shift quickly from one mood state to
another.
Implications: Rapid cycling can complicate treatment and is often associated with a poorer prognosis.
Mixed Episodes
Definition: Involves the presence of symptoms of both mania (or hypomania) and depression
simultaneously. For example, a person may feel extremely energetic while also experiencing conflicting
emotions and behaviors.
10 things to know before class module 4
2. When assessing a patient, how might the symptoms of mania and depression present?
Mania s/s
extreme energy, euphoria, rapid speech, racing thoughts, decreased need for sleep, impulsive behavior,
and grandiosity
depression s/s
persistent sadness, low energy, loss of interest in activities, feelings of worthlessness, difficulty
concentrating, changes in appetite, and suicidal thoughts; both can also manifest with irritability and
agitation depending on the individual case.
10 things to know before class module 4
3a. Discuss how the nurse will use communication, milieu considerations and seclusion for acute mania
(Page 244)
, communiation:
The goal is to first engage the agitated individual, establish a collaborative relationship, and then
verbally deescalate or help the person return to a less agitated state (Spencer & Johnson, 2016).
Safety is a priority during the acute phase. Setting limits in a firm, nonthreatening, and neutral manner
prevents further escalation of mania and provides safe boundaries for the patient and others. Early
intervention in escalating behavior helps the patient stay in better control and leads to better outcomes.
Attempts should be made to avoid a power struggle with the patient by setting limits on behavior only
when it is necessary for safety reasons
10 things to know before class module 4
3b. Discuss how the nurse will use communication, milieu considerations and seclusion for acute mania
(Page 244)
an atmosphere with decreased stimulation. There should be space for solitary or noncompetitive
activities, such as writing, drawing, or pacing/walking. The staff members need to maintain close
observation and intervene to protect the patient from potentially embarrassing behaviors on the unit.
Interactions with others on the unit must also be observed. The intrusive behaviors of the person in a
manic state may lead to confrontation by other patients in the therapeutic community. A patient should
be assigned a private room when possible and encouraged to return to the room when showing
beginning signs of agitation. When a patient's activity begins to escalate, the staff members need to
employ additional interventions. Spencer and Johnson (2016) summarized verbal deescalation
techniques as strategies for dealing with agitated or aggressive behaviors. Refer to Chapter 24 for
effective verbal deescalation techniques. Immediate administration of a sedating medication, like
antipsychotics or benzodiazepines to decrease anxiety, is also a useful option. When verbal deescalation
techniques do not work, seclusion may be necessary to prevent harm to self or others.
10 things to know before class module 4
3c. Discuss how the nurse will use communication, milieu considerations and seclusion for acute mania
(Page 244)
