RNSG 2213 Exam #2 Final Test
Questions with Solved Solutions 2025-
2026 Updated.
What are bipolar spectrum disorders? - Answer Brain disorders that cause unusual shifts in
mood, energy, judgement and the ability to carry out daily tasks. It is a flaw in chemistry, not
character. Characterized by periods of mania or hypomania
What is the epidemiology of bipolar disorders and what are the common misdiagnosis? -
Answer •Onset in age: 18 in BP 1, 20 in BP 2
•Gender: B1 equal in Ms & Fs, B2 twice as common in Fs
•Commonly misdiagnosed as: depression, BPD
What are the three types of bipolar disorders and their characteristics? - Answer •BP 1:
characterized by at least one episode of mania, commonly includes major depressive episodes
and psychosis. Marked impairment of social and occupational functioning.
•BP 2: characterized by at least one period of hypomania (never full mania) alternating with one
or more periods of depression.
•Cyclothymic disorder: characterized by alternating hypomania and dysthymia (not major
depression) for at least 2 years duration.
What is mania and it's characteristics? - Answer An exaggerated, elevated, expansive or
irritable mood, accompanied by a persistent increase in activity and/or energy
-feelings of euphoria or irritability and anger
-impulsive, high-risk behavior: shopping sprees, drug and alcohol misuse, sexual promiscuity
-increased activity, energy, rapid speech
-fleeting, often grandiose ideas. Disorganized thoughts
-decreased sleep, decreased appetite, decreased concentration
-delusions and hallucinations (severe)
What is hypomania and it's characteristics? - Answer Less severe and less intense form of
mania that must last at least four days. Psychotic symptoms are not present.
What is the etiology of bipolar disorders and the three main causes? - Answer No single
cause but there are multiple variables:
•genetics: first generation children are 7-10 times more likely to develop. Children with two
parents has a 50% chance to develop.
,•neurobiological: disruption in dopamine, serotonin, norepinephrine, glutamate and GABA
•neuroendocrine: abnormalities in the HTP axis and stress response. Triggering an increase in
ADH and cortisol
•stress does not cause bipolar disorder, but can trigger an acute episode
What does neuro-imaging reveal in a person with bipolar disorder? - Answer •reduced
hippocampal volume
•reduced bilateral cerebral gray matter
•dysfunction in the prefrontal cortex
•dysfunction in the límbic system
What can trigger a bipolar episode? - Answer •lack of sleep or an irregular schedule
•relationship conflicts
•abusing drugs (cocaine/anohetamines) and alcohol
•antidepressants
•seasonal changes
•childbirth
•grief
•job loss
What are symptoms if a depressive episode in bipolar disorder? - Answer Features or typical
major depression:
•psychomotor retardation
•insomnia or hypersomnia
•loss of concentration
•feelings of worthlessness, guilt, obsessive rumination, recurrent d thoughts of death/suicide
*psychotic features more common than in unipolar depression
What are mixed features/mixed episodes and rapid cycling? - Answer Mixed features: when
mania and depression occur at the same time. Extreme anxiety, agitation and irritability
Rapid cycling: 4 or more episodes in a year. Severe form of the disorder
What are some mental status assessment findings in patients with bipolar disorder? - Answer
•appearance: inappropriate dress, bizarre garb, disheveled
•speech: rapid, pressured, loud, disorganized, flight of ideas, clang, incoherent
•mood: irritable, angry, elevated mood, euphoria, depression
,•hallucinations/delusions: altered sensory perceptions, paranoia, grandiosity
•disruptive behavior: sarcastic, guarded, demanding, threatening behavior, assaultive
•insight/judgement, impaired: hypersexual, intrusive, in depression: unrealistically negative
Assess physiological safety: dehydration, cardiac status, not eating, not sleeping, wether patient
is a danger to self or others: poor impulse control, inappropriate sexual activity, anger
Assess for coexisting conditions: substance abuse, cardiac problems, financial crisis, family crisis
What is therapeutic milieu/milieu therapy for patients with bipolar disorder? - Answer An
atmosphere with decreased stimuli
•staff maintains a closed observation to intervene to protect patient from inappropriate
behavior
•verbal deescalation
•immediate administration of sedating medications (antipsychotics or benzodiazepines)
•seclusion may be necessary. Patient should be assigned a private room and encouraged to
return to room when aggressive
What are some nursing interventions and considerations in patients with bipolar disorder? -
Answer Safety is the number one priority
•rest, hydrate/nutrition, reestablish physical well being
•assess for suicide, guilt, hopelessness
•develop rapport, help patient feel understood and accepted
•consistently set limits, all staff on board with communication
•be are of clients efforts to split off staff
•be calm, firm and neutral. Resist becoming defensive
•state unit policy, do not argue, debate or defend rules
•reinforce reality for disturbances in perception. Watch for poor judgement and intrusiveness
•manage medications: administer BEFORE patients behavior becomes destructive. educate
patient and family
•decrease environmental stimuli
•encourage verbalization of feelings
•encourage supervised physically activity to decrease tension and hyperactivity
What are some therapies for patients with bipolar disorder? - Answer •cognitive behavior
therapy: helps people learn to change harmful or negative thought patterns
, •family-focused therapy: enhances families coping mechanisms and recognizing new episodes
early and how to help
•interpersonal and social rhythm therapy: helps improve a persons relationship with others and
manage their faulty routines. Can aid in regular sleep schedule which can protect against manic
episodes
•support groups
What are the four major classes of medications for bipolar disorder? - Answer 1. Lithium
2. Anticonvulsants
3. Antipsychotics
4. Benzodiazepines
*Antidepressants are not recommended because of risk for inducing mania. If used, used with a
mood stabilizer and risks/benefits must be weighed
What are the treatment goals for bipolar disorder? - Answer 1. Primary goal: Mood
stabilization (get acute mania under control)
2. Continue goal: Reduce the risk of and incidence of relapse
3. Return to prior level of functioning
*individuals often require multiple meds and no single drug/combination is always effective
What is lithium? - Answer First in line treatment for bipolar disorder. Treats mania, bipolar
depression and prevents manic and depressive episodes. Significant anti-suicidal effects.
What is the dosage of lithium and it's therapeutic ranges? - Answer •Dosage: 300-600mgs 2-
3x day. Can take 3-6 weeks to show a full therapeutic response and levels must be monitored
(take with meals to reduce nausea)
•Therapeutic ranges:
-mania: 0.5-1.2mEq/L
-maintenance: 0.6-1.0mEq/L
What are the side effects/adverse effects of lithium? - Answer Expected: fine tremors,
nausea, weight gain, mild thirst, polyuria, sedation
Early toxicity (1.5mEq/L): fine tremors, nausea, weight gain, mild thirst, polyuria, sedation,
vomiting, diarrhea, slurred speech, muscle weakness
Questions with Solved Solutions 2025-
2026 Updated.
What are bipolar spectrum disorders? - Answer Brain disorders that cause unusual shifts in
mood, energy, judgement and the ability to carry out daily tasks. It is a flaw in chemistry, not
character. Characterized by periods of mania or hypomania
What is the epidemiology of bipolar disorders and what are the common misdiagnosis? -
Answer •Onset in age: 18 in BP 1, 20 in BP 2
•Gender: B1 equal in Ms & Fs, B2 twice as common in Fs
•Commonly misdiagnosed as: depression, BPD
What are the three types of bipolar disorders and their characteristics? - Answer •BP 1:
characterized by at least one episode of mania, commonly includes major depressive episodes
and psychosis. Marked impairment of social and occupational functioning.
•BP 2: characterized by at least one period of hypomania (never full mania) alternating with one
or more periods of depression.
•Cyclothymic disorder: characterized by alternating hypomania and dysthymia (not major
depression) for at least 2 years duration.
What is mania and it's characteristics? - Answer An exaggerated, elevated, expansive or
irritable mood, accompanied by a persistent increase in activity and/or energy
-feelings of euphoria or irritability and anger
-impulsive, high-risk behavior: shopping sprees, drug and alcohol misuse, sexual promiscuity
-increased activity, energy, rapid speech
-fleeting, often grandiose ideas. Disorganized thoughts
-decreased sleep, decreased appetite, decreased concentration
-delusions and hallucinations (severe)
What is hypomania and it's characteristics? - Answer Less severe and less intense form of
mania that must last at least four days. Psychotic symptoms are not present.
What is the etiology of bipolar disorders and the three main causes? - Answer No single
cause but there are multiple variables:
•genetics: first generation children are 7-10 times more likely to develop. Children with two
parents has a 50% chance to develop.
,•neurobiological: disruption in dopamine, serotonin, norepinephrine, glutamate and GABA
•neuroendocrine: abnormalities in the HTP axis and stress response. Triggering an increase in
ADH and cortisol
•stress does not cause bipolar disorder, but can trigger an acute episode
What does neuro-imaging reveal in a person with bipolar disorder? - Answer •reduced
hippocampal volume
•reduced bilateral cerebral gray matter
•dysfunction in the prefrontal cortex
•dysfunction in the límbic system
What can trigger a bipolar episode? - Answer •lack of sleep or an irregular schedule
•relationship conflicts
•abusing drugs (cocaine/anohetamines) and alcohol
•antidepressants
•seasonal changes
•childbirth
•grief
•job loss
What are symptoms if a depressive episode in bipolar disorder? - Answer Features or typical
major depression:
•psychomotor retardation
•insomnia or hypersomnia
•loss of concentration
•feelings of worthlessness, guilt, obsessive rumination, recurrent d thoughts of death/suicide
*psychotic features more common than in unipolar depression
What are mixed features/mixed episodes and rapid cycling? - Answer Mixed features: when
mania and depression occur at the same time. Extreme anxiety, agitation and irritability
Rapid cycling: 4 or more episodes in a year. Severe form of the disorder
What are some mental status assessment findings in patients with bipolar disorder? - Answer
•appearance: inappropriate dress, bizarre garb, disheveled
•speech: rapid, pressured, loud, disorganized, flight of ideas, clang, incoherent
•mood: irritable, angry, elevated mood, euphoria, depression
,•hallucinations/delusions: altered sensory perceptions, paranoia, grandiosity
•disruptive behavior: sarcastic, guarded, demanding, threatening behavior, assaultive
•insight/judgement, impaired: hypersexual, intrusive, in depression: unrealistically negative
Assess physiological safety: dehydration, cardiac status, not eating, not sleeping, wether patient
is a danger to self or others: poor impulse control, inappropriate sexual activity, anger
Assess for coexisting conditions: substance abuse, cardiac problems, financial crisis, family crisis
What is therapeutic milieu/milieu therapy for patients with bipolar disorder? - Answer An
atmosphere with decreased stimuli
•staff maintains a closed observation to intervene to protect patient from inappropriate
behavior
•verbal deescalation
•immediate administration of sedating medications (antipsychotics or benzodiazepines)
•seclusion may be necessary. Patient should be assigned a private room and encouraged to
return to room when aggressive
What are some nursing interventions and considerations in patients with bipolar disorder? -
Answer Safety is the number one priority
•rest, hydrate/nutrition, reestablish physical well being
•assess for suicide, guilt, hopelessness
•develop rapport, help patient feel understood and accepted
•consistently set limits, all staff on board with communication
•be are of clients efforts to split off staff
•be calm, firm and neutral. Resist becoming defensive
•state unit policy, do not argue, debate or defend rules
•reinforce reality for disturbances in perception. Watch for poor judgement and intrusiveness
•manage medications: administer BEFORE patients behavior becomes destructive. educate
patient and family
•decrease environmental stimuli
•encourage verbalization of feelings
•encourage supervised physically activity to decrease tension and hyperactivity
What are some therapies for patients with bipolar disorder? - Answer •cognitive behavior
therapy: helps people learn to change harmful or negative thought patterns
, •family-focused therapy: enhances families coping mechanisms and recognizing new episodes
early and how to help
•interpersonal and social rhythm therapy: helps improve a persons relationship with others and
manage their faulty routines. Can aid in regular sleep schedule which can protect against manic
episodes
•support groups
What are the four major classes of medications for bipolar disorder? - Answer 1. Lithium
2. Anticonvulsants
3. Antipsychotics
4. Benzodiazepines
*Antidepressants are not recommended because of risk for inducing mania. If used, used with a
mood stabilizer and risks/benefits must be weighed
What are the treatment goals for bipolar disorder? - Answer 1. Primary goal: Mood
stabilization (get acute mania under control)
2. Continue goal: Reduce the risk of and incidence of relapse
3. Return to prior level of functioning
*individuals often require multiple meds and no single drug/combination is always effective
What is lithium? - Answer First in line treatment for bipolar disorder. Treats mania, bipolar
depression and prevents manic and depressive episodes. Significant anti-suicidal effects.
What is the dosage of lithium and it's therapeutic ranges? - Answer •Dosage: 300-600mgs 2-
3x day. Can take 3-6 weeks to show a full therapeutic response and levels must be monitored
(take with meals to reduce nausea)
•Therapeutic ranges:
-mania: 0.5-1.2mEq/L
-maintenance: 0.6-1.0mEq/L
What are the side effects/adverse effects of lithium? - Answer Expected: fine tremors,
nausea, weight gain, mild thirst, polyuria, sedation
Early toxicity (1.5mEq/L): fine tremors, nausea, weight gain, mild thirst, polyuria, sedation,
vomiting, diarrhea, slurred speech, muscle weakness
