NUR215 EXAM QUESTIONS AND ANSWERS A+ GRADED
Mania
Alteration inn mood that is expressed by feelings of inflated self-esteem, grandiosity,
hyperactivity, agitation, racing thoughts, and accelerated thinking and speaking
May participate in risky or pleasure seeking activities
How long does mania typically last?
1 week but could be longer
Hypomania
A somewhat milder form of mania, which is not severe enough to cause marked
impairment in social or occupational functioning or to require hospitalization
How long does hypomania typically last?
4 days
bipolar 1 disorder
Full syndrome of manic or mixed symptoms for at least one week, and may also
experience episodes of depression
Experiences psychotic symptoms
Bipolar 2 disorder
Bouts of major depression with episodic occurrence of hypomania, but have never met
criteria for full manic episode
High risk for suicide due to depression
Cyclothymic disorder
Chronic mood disturbance with at least 2 year duration
Numerous episodes of hypomania and depressed mood of insufficient severity to meet
criteria for either bipolar 1 or 2
Substance and medication induced bipolar disorder
A disturbance of mood (depression or mania) that is considered to be the direct result of
the physiological effects of a substance (for example, ingestion of or withdrawal from a
drug of abuse or a medication or other treatment)
Bipolar disorder due to another medical condition
Characterized by an abnormally and persistently elevated, expansive, or irritable mood
and excessive activity or energy that is judged to be the result of direct physiological
effects of another medical condition
Stage one: hypomania
- symptoms may not be severe enough to cause marked impairment in social or
occupational functioning or to require hospitalization
- cheerful mood, rapid flow of ideas, heightened perception, increased motor activity
Stage two: acute mania
- marked impairment in functioning, usually requiring hospitalization
- elation and euphoria, continuous high
- flight of ideas, accelerated or pressured speech
- hallucinations and delusions
- excessive motor activity and little need for sleep
- sexual interest is increased
Stage three: delirious mania
, - Intensification of symptoms associated with acute mania that is rare because of the
availability of antipsychotic meds
- labile mood, panic anxiety, irritable, clouding of consciousness, disorientation
- exhaustion and possible death without intervention
electroconvulsive therapy (ECT) used when . . .
1. Client does not tolerate medication
2. Client fails to respond to medication
3. Client's life is threatened by dangerous behavior or exhaustion
Medications for mania
Lithium carbonate, anticonvulsants, antipsychotics
Medications for depressive phase of bipolar disorder
Antidepressants
Why should you caution use of antidepressants to treat bipolar disorder?
SSRIs and other antidepressants carry risk of inducing mania
Lithium MOA
Works by stabilizing electric activity of neurons and thought to modify effects of
neurotransmitters
Interact with sodium and potassium at the cell membrane to stabilize electrical activity
Therapeutic range for lithium
0.6-1.2 mEq/L
How long does it take for lithium to start working?
1-3 weeks
Common adverse reactions of lithium (<1.2 mEq/L)
N/V/D, thirst, polyuria, lethargy, slurred speech, muscle weakness, fine hand tremors
What to do if patient starts showing signs of lithium toxicity?
Hold dose and contact doctor
Early signs of lithium toxicity (1.3-2.0 mEq/L)
Coarse hand tremor, incoordination, persistent GI upset (N/V/D), muscle weakness,
mental confusion, sedation
Advanced signs of lithium toxicity (2.0-2.5 mEq/L)
Extreme polyuria of dilute urine, tinnitus, seizures, blurred vision, involuntary extremity
movement, ataxia
What can you give a patient to help excrete lithium faster during toxicity?
Mannitol
Signs & treatment of lithium toxicity >2.5 mEq/L
- Seizures, oliguria, lithium-induced diabetes insipidus, death
- Medication discontinued and give patient dialysis to help excrete lithium
Client/family education for lithium
- Do not skimp on dietary sodium
- Take medication regularly
- Blood levels must be monitored 2x/week initially and then once every 2 months
- Monitor I&O
- Take with meals
Anti-epileptic / anticonvulsant drugs for bipolar
Depakote, Tegretol, Lamictal, Neurontin, Topamax, Trileptal
Patient education for anti-epileptic / anticonvulsants
Mania
Alteration inn mood that is expressed by feelings of inflated self-esteem, grandiosity,
hyperactivity, agitation, racing thoughts, and accelerated thinking and speaking
May participate in risky or pleasure seeking activities
How long does mania typically last?
1 week but could be longer
Hypomania
A somewhat milder form of mania, which is not severe enough to cause marked
impairment in social or occupational functioning or to require hospitalization
How long does hypomania typically last?
4 days
bipolar 1 disorder
Full syndrome of manic or mixed symptoms for at least one week, and may also
experience episodes of depression
Experiences psychotic symptoms
Bipolar 2 disorder
Bouts of major depression with episodic occurrence of hypomania, but have never met
criteria for full manic episode
High risk for suicide due to depression
Cyclothymic disorder
Chronic mood disturbance with at least 2 year duration
Numerous episodes of hypomania and depressed mood of insufficient severity to meet
criteria for either bipolar 1 or 2
Substance and medication induced bipolar disorder
A disturbance of mood (depression or mania) that is considered to be the direct result of
the physiological effects of a substance (for example, ingestion of or withdrawal from a
drug of abuse or a medication or other treatment)
Bipolar disorder due to another medical condition
Characterized by an abnormally and persistently elevated, expansive, or irritable mood
and excessive activity or energy that is judged to be the result of direct physiological
effects of another medical condition
Stage one: hypomania
- symptoms may not be severe enough to cause marked impairment in social or
occupational functioning or to require hospitalization
- cheerful mood, rapid flow of ideas, heightened perception, increased motor activity
Stage two: acute mania
- marked impairment in functioning, usually requiring hospitalization
- elation and euphoria, continuous high
- flight of ideas, accelerated or pressured speech
- hallucinations and delusions
- excessive motor activity and little need for sleep
- sexual interest is increased
Stage three: delirious mania
, - Intensification of symptoms associated with acute mania that is rare because of the
availability of antipsychotic meds
- labile mood, panic anxiety, irritable, clouding of consciousness, disorientation
- exhaustion and possible death without intervention
electroconvulsive therapy (ECT) used when . . .
1. Client does not tolerate medication
2. Client fails to respond to medication
3. Client's life is threatened by dangerous behavior or exhaustion
Medications for mania
Lithium carbonate, anticonvulsants, antipsychotics
Medications for depressive phase of bipolar disorder
Antidepressants
Why should you caution use of antidepressants to treat bipolar disorder?
SSRIs and other antidepressants carry risk of inducing mania
Lithium MOA
Works by stabilizing electric activity of neurons and thought to modify effects of
neurotransmitters
Interact with sodium and potassium at the cell membrane to stabilize electrical activity
Therapeutic range for lithium
0.6-1.2 mEq/L
How long does it take for lithium to start working?
1-3 weeks
Common adverse reactions of lithium (<1.2 mEq/L)
N/V/D, thirst, polyuria, lethargy, slurred speech, muscle weakness, fine hand tremors
What to do if patient starts showing signs of lithium toxicity?
Hold dose and contact doctor
Early signs of lithium toxicity (1.3-2.0 mEq/L)
Coarse hand tremor, incoordination, persistent GI upset (N/V/D), muscle weakness,
mental confusion, sedation
Advanced signs of lithium toxicity (2.0-2.5 mEq/L)
Extreme polyuria of dilute urine, tinnitus, seizures, blurred vision, involuntary extremity
movement, ataxia
What can you give a patient to help excrete lithium faster during toxicity?
Mannitol
Signs & treatment of lithium toxicity >2.5 mEq/L
- Seizures, oliguria, lithium-induced diabetes insipidus, death
- Medication discontinued and give patient dialysis to help excrete lithium
Client/family education for lithium
- Do not skimp on dietary sodium
- Take medication regularly
- Blood levels must be monitored 2x/week initially and then once every 2 months
- Monitor I&O
- Take with meals
Anti-epileptic / anticonvulsant drugs for bipolar
Depakote, Tegretol, Lamictal, Neurontin, Topamax, Trileptal
Patient education for anti-epileptic / anticonvulsants
