Varcarolis Ch. 16: Bipolar Spectrum
Disorders
A person is directing traffic on a busy street while shouting and making obscene gestures at
passing cars. The person has not slept or eaten for 3 days. What features of mania are evident?
a. Increased muscle tension and anxiety
b. Vegetative signs and poor grooming
c. Poor judgment and hyperactivity
d. Cognitive deficit and sad mood - Answer- c. Poor judgment and hyperactivity
Hyperactivity (directing traffic) and poor judgment (putting self in a dangerous position) are
characteristic of manic episodes. The distractors do not specifically apply to mania.
A patient diagnosed with bipolar disorder is dressed in a red leotard and brightly colored scarves.
The patient says, Ill punch you, munch you, crunch you, while twirling and shadowboxing. Then
the patient says gaily, Do you like my scarves? Herethey are my gift to you. How should the nurse
document the patients mood?
a. Labile and euphoric
b. Irritable and belligerent
c. Highly suspicious and arrogant
d. Excessively happy and confident - Answer- a. Labile and euphoric
The patient has demonstrated angry behavior and pleasant, happy behavior within seconds of
each other. Excessive happiness indicates euphoria. Mood swings are often rapid and seemingly
without understandable reason in patients who are manic. These swings are documented as
labile. Irritability, belligerence, excessive happiness, and confidence are not entirely correct terms
for the patients mood. A high level of suspicion is not evident.
A patient experiencing mania has not eaten or slept for 3 days. Which nursing diagnosis has
priority?
a. Risk for injury
b. Ineffective coping
c. Impaired social interaction
d. Ineffective therapeutic regimen management - Answer- a. Risk for injury
Although each of the nursing diagnoses listed is appropriate for a patient having a manic episode,
the priority lies with the patients physiologic safety. Hyperactivity and poor judgment place the
patient at risk for injury.
A patient diagnosed with bipolar disorder is hyperactive and manic after discontinuing lithium. The
patient threatens to hit another patient. Which comment by the nurse is appropriate?
a. Stop that! No one did anything to provoke an attack by you.
b. If you do that one more time, you will be secluded immediately.
c. Do not hit anyone. If you are unable to control yourself, we will help you.
d. You know we will not let you hit anyone. Why do you continue this behavior? - Answer- c. Do
not hit anyone. If you are unable to control yourself, we will help you.
, When the patient is unable to control his or her behavior and violates or threatens to violate the
rights of others, limits must be set in an effort to de-escalate the situation. Limits should be set in
simple, concrete terms. The incorrect responses do not offer appropriate assistance to the patient
and threaten the patient with seclusion as punishment. Asking why does not provide for
environmental safety.
This nursing diagnosis applies to a patient experiencing mania: Imbalanced nutrition: less than
body requirements, related to insufficient caloric intake and hyperactivity as evidenced by 5-pound
weight loss in 4 days. Select the most appropriate outcome. The patient will:
a. ask staff for assistance with feeding within 4 days.
b. drink six servings of a high-calorie, high-protein drink each day.
c. consistently sit with others for at least 30 minutes at mealtime within 1 week.
d. consistently wear appropriate attire for age and sex within 1 week while in the psychiatric unit. -
Answer- b. drink six servings of a high-calorie, high-protein drink each day.
High-calorie, high-protein food supplements will provide the additional calories needed to offset
the patients extreme hyperactivity. Sitting with others or asking for assistance does not mean the
patient will eat or drink. Appropriate attire is unrelated to the nursing diagnosis.
A patient develops mania after discontinuing lithium. New prescriptions are written to resume
lithium twice daily and begin olanzapine (Zyprexa). The addition of olanzapine to the medication
regimen will:
a. minimize the side effects of lithium.
b. bring hyperactivity under rapid control.
c. enhance the antimanic actions of lithium.
d. provide long-term control of hyperactivity. - Answer- b. bring hyperactivity under rapid control.
Manic symptoms are controlled by lithium only after a therapeutic serum level is attained. Because
this takes several days to accomplish, a drug with rapid onset is necessary to reduce the
hyperactivity initially. Antipsychotic drugs neither enhance lithiums antimanic activity nor minimize
the side effects. Lithium is used for long-term control.
A patient diagnosed with bipolar disorder has rapid cycles. The health care provider prescribes an
anticonvulsant medication. To prepare teaching materials, which drug should the nurse anticipate
will be prescribed?
a. phenytoin (Dilantin)
b. clonidine (Catapres)
c. carbamazepine (Tegretol)
d. chlorpromazine (Thorazine) - Answer- c. carbamazepine (Tegretol)
Some patients with bipolar disorder, especially those who have only short periods between
episodes, have a favorable response to the anticonvulsants carbamazepine and valproate.
Phenytoin is also an anticonvulsant but is not used for mood stabilization. Carbamazepine seems
to work better in patients with rapid cycling and in severely paranoid, angry patients with manic
episodes.
The cause of bipolar disorder has not been determined, but:
a. several factors, including genetics, are implicated.
b. brain structures were altered by stresses early in life. c. excess norepinephrine is probably a
major factor.
Disorders
A person is directing traffic on a busy street while shouting and making obscene gestures at
passing cars. The person has not slept or eaten for 3 days. What features of mania are evident?
a. Increased muscle tension and anxiety
b. Vegetative signs and poor grooming
c. Poor judgment and hyperactivity
d. Cognitive deficit and sad mood - Answer- c. Poor judgment and hyperactivity
Hyperactivity (directing traffic) and poor judgment (putting self in a dangerous position) are
characteristic of manic episodes. The distractors do not specifically apply to mania.
A patient diagnosed with bipolar disorder is dressed in a red leotard and brightly colored scarves.
The patient says, Ill punch you, munch you, crunch you, while twirling and shadowboxing. Then
the patient says gaily, Do you like my scarves? Herethey are my gift to you. How should the nurse
document the patients mood?
a. Labile and euphoric
b. Irritable and belligerent
c. Highly suspicious and arrogant
d. Excessively happy and confident - Answer- a. Labile and euphoric
The patient has demonstrated angry behavior and pleasant, happy behavior within seconds of
each other. Excessive happiness indicates euphoria. Mood swings are often rapid and seemingly
without understandable reason in patients who are manic. These swings are documented as
labile. Irritability, belligerence, excessive happiness, and confidence are not entirely correct terms
for the patients mood. A high level of suspicion is not evident.
A patient experiencing mania has not eaten or slept for 3 days. Which nursing diagnosis has
priority?
a. Risk for injury
b. Ineffective coping
c. Impaired social interaction
d. Ineffective therapeutic regimen management - Answer- a. Risk for injury
Although each of the nursing diagnoses listed is appropriate for a patient having a manic episode,
the priority lies with the patients physiologic safety. Hyperactivity and poor judgment place the
patient at risk for injury.
A patient diagnosed with bipolar disorder is hyperactive and manic after discontinuing lithium. The
patient threatens to hit another patient. Which comment by the nurse is appropriate?
a. Stop that! No one did anything to provoke an attack by you.
b. If you do that one more time, you will be secluded immediately.
c. Do not hit anyone. If you are unable to control yourself, we will help you.
d. You know we will not let you hit anyone. Why do you continue this behavior? - Answer- c. Do
not hit anyone. If you are unable to control yourself, we will help you.
, When the patient is unable to control his or her behavior and violates or threatens to violate the
rights of others, limits must be set in an effort to de-escalate the situation. Limits should be set in
simple, concrete terms. The incorrect responses do not offer appropriate assistance to the patient
and threaten the patient with seclusion as punishment. Asking why does not provide for
environmental safety.
This nursing diagnosis applies to a patient experiencing mania: Imbalanced nutrition: less than
body requirements, related to insufficient caloric intake and hyperactivity as evidenced by 5-pound
weight loss in 4 days. Select the most appropriate outcome. The patient will:
a. ask staff for assistance with feeding within 4 days.
b. drink six servings of a high-calorie, high-protein drink each day.
c. consistently sit with others for at least 30 minutes at mealtime within 1 week.
d. consistently wear appropriate attire for age and sex within 1 week while in the psychiatric unit. -
Answer- b. drink six servings of a high-calorie, high-protein drink each day.
High-calorie, high-protein food supplements will provide the additional calories needed to offset
the patients extreme hyperactivity. Sitting with others or asking for assistance does not mean the
patient will eat or drink. Appropriate attire is unrelated to the nursing diagnosis.
A patient develops mania after discontinuing lithium. New prescriptions are written to resume
lithium twice daily and begin olanzapine (Zyprexa). The addition of olanzapine to the medication
regimen will:
a. minimize the side effects of lithium.
b. bring hyperactivity under rapid control.
c. enhance the antimanic actions of lithium.
d. provide long-term control of hyperactivity. - Answer- b. bring hyperactivity under rapid control.
Manic symptoms are controlled by lithium only after a therapeutic serum level is attained. Because
this takes several days to accomplish, a drug with rapid onset is necessary to reduce the
hyperactivity initially. Antipsychotic drugs neither enhance lithiums antimanic activity nor minimize
the side effects. Lithium is used for long-term control.
A patient diagnosed with bipolar disorder has rapid cycles. The health care provider prescribes an
anticonvulsant medication. To prepare teaching materials, which drug should the nurse anticipate
will be prescribed?
a. phenytoin (Dilantin)
b. clonidine (Catapres)
c. carbamazepine (Tegretol)
d. chlorpromazine (Thorazine) - Answer- c. carbamazepine (Tegretol)
Some patients with bipolar disorder, especially those who have only short periods between
episodes, have a favorable response to the anticonvulsants carbamazepine and valproate.
Phenytoin is also an anticonvulsant but is not used for mood stabilization. Carbamazepine seems
to work better in patients with rapid cycling and in severely paranoid, angry patients with manic
episodes.
The cause of bipolar disorder has not been determined, but:
a. several factors, including genetics, are implicated.
b. brain structures were altered by stresses early in life. c. excess norepinephrine is probably a
major factor.
