Austin Community College RNSG2213/ RNSG 2213 Exam #2 Complete Test bank_ Fall 2021 ALL ANSWERS 100% GUARANTEED GRADE A+

1. having mania. The nurse anticipates the physician will most likely prescribe: A pt has been dx as a. Lithium 2. SJ Syndrome is a severe and potentially fatal syndrome that is indicated by a rash and flu- like symptoms. It sometimes is caused by which medication? a. Lamotrigine (Lamictal) 3. A pt develops mania after dc-ing Lithium. New meds are written to resume 2x daily Lithium and begin Zyprena (olanzapine). The addition of Zyprexa will: a. Bring hyperactivity under rapid control 4. A pt is admitted to the hospital w/ a dx of Bipolar Disorder. He has been taking Lithium for several yrs, but no longer effective in managing his acute manic episodes. Which type of med is likely to be prescribed now? a. Anticonvulsant 5. A pt who has been on Depakote (valproate) for bipolar disorder for 2 weeks continues to be manic. The serum valproate level is 25 . Which of the following applies? a. This is below the therapeutic range, so the dose needs to be increased 6. A pt dx w/ Bipolar disorder is hyperactive and manic after dc-ing Lithium. The pt threatens to hit another pt. Which comment by the nurse is appropriate? a. “Do not hit anyone. If you’re unable to control yourself, we’ll help you.” 7. A person is directing traffic on a busy street and making obscene gestures at passing cars. The individual has not eaten or slept for 3 days. What features of mania are evident? a. Poor judgement and hyperactivity 8. A pt dx w/ bipolar disorder has rapid cycles. The HCP prescribes an anticonvulsant. To prepare teaching materials, which drugs should the nurse anticipate will be prescribed? a. Tegretol (carbamazepine) 9. A nurse is planning activities for a pt who has bipolar disorder w/ aggressive social behavior. Which activity would be most appropriate for this pt? a. Shooting baskets 10. A manic pt announces to everyone in the dayroom that a stripper is coming to perform this evening. When the nurse firmly states that this will not happen, the manic pt becomes verbally abusive and threatens the nurse w/ physical violence. The most appropriate action by the nurse would be: a. With assistance, escort the manic pt to his/her room and offer Haldol 11. A female pt is under evaluation for imminent suicide risk. Which information given by her would be most significant? a. Reference to suicide as the best solution 12. A pt experiencing acute mania has disrobed in the hall 3 times in 2 hrs. The nurse should: a. Arrange for one-on-one supervision 13. A pt experiencing acute mania is dancing atop the pool table in the rec room. The pt waves a cue in one hand and says, “I’ll throw the pool balls if anyone comes near me!” The nurse’s first intervention is to: a. Clear the room of all other pts 14. Mood congruent psychotic features in depressed pts may include all but: a. Delusion of grandeur i. Does include: nihilistic (life is meaningless belief) delusions, delusions of guilt, delusions of poverty 15. Which is the most severe form of Bipolar Disorder? a. Bipolar Disorder Type I 16. Which nursing response demonstrates accurate information that should be discussed w/ a female pt diagnosed with bipolar disorder w/ her support system. a. “Remember that alcohol and caffeine can trigger a relapse of your symptoms” b. “It’s critical to let your HCP know immediately if you aren’t sleeping well” c. “Is your family prepared to be actively involved in helping manage this disorder?” d. “Bc symptoms tend to come and go, you need to be able to recognize the early signs” 17. Which statement by a pt demonstrates an understanding of the effective use of Lithium to manage bipolar mania? a. “I have to keep reminding myself to consistently drink six 12-oz glasses of fluid every day” b. “I discussed w/ my psychiatric care provider the diuretic my cardiologist prescribed” c. “I’ve already made arrangements for my monthly lab work” 18. Substance abuse is often present in ppl dx w/ bipolar disorder. A 28-yr-old female w/ a dx of bipolar disorder drinks alcohol instead of taking her prescribed medications. A nurse caring for this pt would recognize that: a. Alcohol ingestion is a form of self-medication 19. A 33-yr-old female dx w/ bipolar type I has been functioning well on Lithium for 11 months. At her last checkup the psychiatric NP states, “You’re ready now to enter maintenance therapy stage, so at this time i’m going to adjust your dosage by prescribing”: a. A lower dose 20. A female pt has been admitted following an acute manic episode. The admitting nurse suspects Lithium toxicity. What assessment findings would confirm the nurse’s suspicion? a. Ataxia, severe hypotension, large volume of dilute urine PowerPoint Questions 1. Lower level mania alternating w/ serious depression? a. Bipolar II 2. Full blown mania w/ severe depression? a. Bipolar I 3. Hypomania w/ mild to moderate depression? i. Cyclothymic Disorder 4. Psychosis present: a. Bipolar I 5. Pressured Speech → rapid and frantic speech 6. Flight Of ideas → speech pattern w/ rapid transition frOm tOpic tO tOpic 7. Tangential thinking → giving all manner Of extraneous detail when answering a simple question 8. Delusion → false ideas not based On reality 9. Grandiosity →exaggerated sense of One’s impOrtance/pOwer 10. The py may use humor, manipulation, power struggles, or demanding behavior to prevent you setting limits or controlling dangerous behavior. Importance of: a. Consistent setting of limits: all staff on board b. Be aware of client efforts to split staff to loosen staff limits c. Calm, firm, neutral approach. Don’t become defensive & exasperated d. State unit policy, don’t argue, debate or defend rules. Be prepared to diffuse conflict 11. Which nursing chart entry is documentation of a behavioral symptom of mania? a. Pacing halls throughout the day. Exhibits poor impulse control. 12. A client seen in the emergency department is experiencing irritability, pressured speech, and increased levels of anxiety. Which would be the nurse’s priority intervention: a. Assess VS and complete a physical assessment 13. 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 finding will priority concern for this pt’s plan of care: a. Hyperactivity; not eating and sleeping 14. When a hyperactive pt dx w/ acute manis is hospitalized, what is the initial nursing intervention? a. Set limits of pt behavior as necessary 15. A pt w. Bipolar disorder was hospitalized 7 days ago and has been taking lithium 600mg tid. Staff observes increased agitation, pressured speech, poor personal hygiene, and hyperactivity. Which action demonstrates that the nurse understands the likely cause of the pts behavior? a. Consider the need to check the lithium levels, pt may not be swallowing the meds i. Takes 7-10 days for therapeutic effect , should see improvement os S/S 16. An outpatient w/ bipolar disorder is prescribed lithium. The pt telephones the nurse to say, “I’ve had severe diarrhea for 4 days. I feel very weak and unsteady when I walk. My usual hand tremor has gotten worse. What should I do?” The nurse will advise the pt to: a. Have someone bring the pt to the clinic immediately i. Pt may have lithium toxicity 17. Which suggestions are appropriate for the family of a pt dx w/ bipolar disorder who is being treated as an outpatient during a hypomanic episode? a. Limit credit card access b. Provide a structured environment c. Monitor the pt’s sleep patterns 18. The primary HCP prescribes a serum lithium level tomorrow for a client receiving 300mg PO 3x daily for the past 5 days. At which of the following times should the nurse plan to have the blood specimen obtained? a. Before breakfast i. 8-12 hrs after last dose is best 19. After the nurse administers Haldol 5mg PO to a client w/ acute mania, the client refuses to lie down on her bed, runs out on the unit, pushes other clients out of the way, throws the phone close to a peer’s head and screams threatening remarks to the staff. Which of the following should the nurse do next? a. Seclude the client and use restraints if necessary 20. Low sodium intake leads to: a. High lithium levels 21. Dehydrations can lead to: a. High lithium levels 22. Lithium level affected by: a. VOmiting, diarrhea → Increased levels b. Sunny day, sweating, not drinking → Increased levels c. Eating lOts Of salt fOOds → Decreased levels d. Exercising → Increased levels 23. A pt w. Acute mania has disrobed in the hall 3 times in 2 hrs. The nurse should: a. Arrange for one-on-one supervision 24. Which doctor's order might you question after admission? a. Low sodium diet 25. A nurse prepares to lead a psycho-educational group for pts who take anticonvulsants to manage bipolar disorder. The nurse should invite pt’s who take which drugs? a. Lamotrigine (Lamictal) i. RepOrt rash tO HCP → SJ syndrOme b. Carbamazepine (Tegretol) 26. A nurse was giving health teaching to a client with newly prescribed lithium. Which of the following statements of the client indicates a good understanding about the med? a. “I can still eat my favorite salty foods” 27. A pt w/ bipolar disorder taking lithium is experiencing diarrhea and vomiting. What should the nurse do first? a. Hold the next dose and obtain a stat order for serum lithium level, and contact HCP 28. Expected side effects or signs of moderate toxicity with lithium? a. DrOwsiness → expected b. Dizziness → expected c. GI upset → expected d. Mild thirst → expected e. Increase urine vOlume → expected f. Fine hand tremOr → expected 29. The nurse who presents a psycho-education program to clients w/ bipolar disorder mentions that the hallmarks of impending relapse include: a. Reduced need for sleep and racing thoughts Quizlets/Test Bank 1. The nurse receives a lab report indicating a pt’s serum level is 1 meq/l. The pt’s last dose of lithium was 8 hrs ago. This result is: a. Within therapeutic limits i. Maintenance: 0.6-1 ii. Acute mania: 0.5-1.2 iii. To avoid serious toxicity: do not exceed 1.5, Sever level over 2.0 2. You are talking to the client who is speaking rapidly and with flight of ideas. Your most therapeutic response is: a. You are talking a bit too fast. Can you slow down a little and tell me again? 3. Lamictal is lamotrigine, is used for: a. Bipolar depression 4. Seclusion protocol usually includes documentation of attempts to use least restrictive interventions and usually requires an order from the doctor and an evaluation within one hours by an independent practitioner: a. TRUE 5. Which meds are the 1st line of treatment for a person w/ acute depressive disorder episodes? a. Lithium and lamictal 6. Why are antidepressants for bipolar depression not a major class for bipolar disorder? a. Not recommended due to the lack of switching to mania Anxiety Disorders/Somatic Symptom Disorders BB quiz 1. Which benzo has the U.S. FDA approve