Chapter 22. Bipolar and Related
Disorders
A client diagnosed with bipolar disorder and experiencing mania is admitted to the inpatient psychiatric
setting. During the acute phase of mania, which medication would the nurse expect to most likely
administer?
A) Lithium carbonate (Lithium)
B) Haloperidol lactate (Haldol)
C) Fluoxetine (Prozac)
D) Paroxetine (Paxil) - ANS B
A client asks the nurse if he needs to alter any of his activities because he is taking lithium carbonate.
Which of the following responses 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 time.
C) Drink less fluid than usual now because you are taking this drug.
D) No changes are necessary for strenuous activities you do outdoors. - ANS A
The 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. Men 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 - ANS The client's statements reflect an expansive mood, which is characterized by lack of
restraint in expressing feelings; an overvalued sense of self-importance; and a constant and
indiscriminate enthusiasm for interpersonal, sexual, or occupational interactions. An irritable mood is
characterized by easy annoyance and provocation to anger, particularly when wishes are challenged or
thwarted. An elevated mood can be expressed as euphoria (exaggerated feelings of well-being) or
elation
,The nurse is reviewing the medical record of a client with bipolar disorder. The nurse would most likely
expect to find a history of which of the following?
A) panic disorder
B) schizophrenia
C) delusional disorder
D) post traumatic stress disorder - ANS a
A nurse is developing a presentation for families who have members that have been diagnosed with
bipolar disorders. When describing this condition to the group, which of the following would the nurse
most likely include?
A) As the person ages, the episodes tend to decrease over time.
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 with a depressive episode. - ANS C
A client is to receive lithium therapy as part of the treatment plan for bipolar disorder. When reviewing
the client's medication history, which agents would alert the nurse to the possibility that a decrease in
lithium dosage may be needed? Select all that apply.
A) Lisinopril
B) Hydrochlorothiazide
C) Indomethacin
D) Caffeine
E) Aspirin - ANS a, b, c
A client with bipolar disorder is receiving divalproex sodium as part of the treatment plan. When
monitoring the client's blood level for 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 - ANS a
A client with bipolar disorder having experienced a depressive episode is prescribed lamotrigine. After
teaching the client about this medication, the nurse determines that the teaching was successful when
the client states which of the following?
A) I need to notify my physician 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. - ANS A
Black box label for rash. Skin rashes can be severe and could possibly indicate Steven Johnson's
Syndrome (SJS).
A nurse is preparing to administer medications to a female client with bipolar disorder who is
experiencing acute mania. Which of the following would be most appropriate for the nurse to do?
A) Tell the client firmly that she must take her medication.
B) Allow the client to participate in the treatment decision.
C) Restrain the client before administering the medication.
D) Notify the physician about the client's refusal of the medication. - ANS B
A client who is receiving 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 level.
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. - ANS Fine hand tremor is a side effect
of lithium therapy that can worsen with anxiety and intentional movement. The nurse would provide
support and reassurance , and encourage the patient the client to minimize their exposure to stressors.
If the client is experiencing difficult at work the provider should be notified. There is no need to obtain a
drug level.
A client's blood level of carbamazepine is increased. When reviewing the client's medication history,
which of the following would alert the nurse to a possible interaction?
A) Phenobarbital
B) Primidone
C) Phenytoin
D) Diltiazem - ANS d
A client is brought to the emergency department by his brother. The client has a history of bipolar
disorder for which he is taking divalproex. The brother reports that he watched his brother take the
medication about 2 hours ago. He stated, A little while ago, he got very disoriented and agitated. The
nurse suspects toxicity based on assessment of which of the following? Select all that apply.
A) Tachypnea
B) Bradycardia
C) Hypotension
D) Nystagmus
E) V omiting - ANS c, d, e
A client with bipolar disorder has a lithium drug level of 1.2 mEq/L. Which of the following would the
nurse expect to assess? Select all that apply.
a) metallic taste
B) ataxia
C) diarrhea
D) slurred speech
Disorders
A client diagnosed with bipolar disorder and experiencing mania is admitted to the inpatient psychiatric
setting. During the acute phase of mania, which medication would the nurse expect to most likely
administer?
A) Lithium carbonate (Lithium)
B) Haloperidol lactate (Haldol)
C) Fluoxetine (Prozac)
D) Paroxetine (Paxil) - ANS B
A client asks the nurse if he needs to alter any of his activities because he is taking lithium carbonate.
Which of the following responses 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 time.
C) Drink less fluid than usual now because you are taking this drug.
D) No changes are necessary for strenuous activities you do outdoors. - ANS A
The 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. Men 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 - ANS The client's statements reflect an expansive mood, which is characterized by lack of
restraint in expressing feelings; an overvalued sense of self-importance; and a constant and
indiscriminate enthusiasm for interpersonal, sexual, or occupational interactions. An irritable mood is
characterized by easy annoyance and provocation to anger, particularly when wishes are challenged or
thwarted. An elevated mood can be expressed as euphoria (exaggerated feelings of well-being) or
elation
,The nurse is reviewing the medical record of a client with bipolar disorder. The nurse would most likely
expect to find a history of which of the following?
A) panic disorder
B) schizophrenia
C) delusional disorder
D) post traumatic stress disorder - ANS a
A nurse is developing a presentation for families who have members that have been diagnosed with
bipolar disorders. When describing this condition to the group, which of the following would the nurse
most likely include?
A) As the person ages, the episodes tend to decrease over time.
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 with a depressive episode. - ANS C
A client is to receive lithium therapy as part of the treatment plan for bipolar disorder. When reviewing
the client's medication history, which agents would alert the nurse to the possibility that a decrease in
lithium dosage may be needed? Select all that apply.
A) Lisinopril
B) Hydrochlorothiazide
C) Indomethacin
D) Caffeine
E) Aspirin - ANS a, b, c
A client with bipolar disorder is receiving divalproex sodium as part of the treatment plan. When
monitoring the client's blood level for 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 - ANS a
A client with bipolar disorder having experienced a depressive episode is prescribed lamotrigine. After
teaching the client about this medication, the nurse determines that the teaching was successful when
the client states which of the following?
A) I need to notify my physician 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. - ANS A
Black box label for rash. Skin rashes can be severe and could possibly indicate Steven Johnson's
Syndrome (SJS).
A nurse is preparing to administer medications to a female client with bipolar disorder who is
experiencing acute mania. Which of the following would be most appropriate for the nurse to do?
A) Tell the client firmly that she must take her medication.
B) Allow the client to participate in the treatment decision.
C) Restrain the client before administering the medication.
D) Notify the physician about the client's refusal of the medication. - ANS B
A client who is receiving 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 level.
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. - ANS Fine hand tremor is a side effect
of lithium therapy that can worsen with anxiety and intentional movement. The nurse would provide
support and reassurance , and encourage the patient the client to minimize their exposure to stressors.
If the client is experiencing difficult at work the provider should be notified. There is no need to obtain a
drug level.
A client's blood level of carbamazepine is increased. When reviewing the client's medication history,
which of the following would alert the nurse to a possible interaction?
A) Phenobarbital
B) Primidone
C) Phenytoin
D) Diltiazem - ANS d
A client is brought to the emergency department by his brother. The client has a history of bipolar
disorder for which he is taking divalproex. The brother reports that he watched his brother take the
medication about 2 hours ago. He stated, A little while ago, he got very disoriented and agitated. The
nurse suspects toxicity based on assessment of which of the following? Select all that apply.
A) Tachypnea
B) Bradycardia
C) Hypotension
D) Nystagmus
E) V omiting - ANS c, d, e
A client with bipolar disorder has a lithium drug level of 1.2 mEq/L. Which of the following would the
nurse expect to assess? Select all that apply.
a) metallic taste
B) ataxia
C) diarrhea
D) slurred speech
