Varcarolis-Ch.-16:-Bipolar-Spectrum-Disorders
1. A-health-teaching-plan-for-a-patient-taking-lithium-should-include-instructions-
to:-
a. maintain-normal-salt-and-fluids-in-the-diet.
b. drink-twice-the-usual-daily-amount-of-fluids.
c. double-the-lithium-dose-if-diarrhea-or-vomiting-occurs.
d. avoid-eating-aged-cheese,-processed-meats,-and-red-wine.-
CORRECT-ANSWER-a.-maintain-normal-salt-and-fluids-in-the-diet.
Sodium-depletion-and-dehydration-increase-the-chance-for-developing-lithium-
toxicity.-The-incorrect-options-offer-inappropriate-information.
2. A-nurse-prepares-the-plan-of-care-for-a-patient-having-a-manic-episode.-Which-
nursing-diagnoses-are-most-likely?-Select-all-that-apply.
a. Imbalanced-nutrition:-more-than-body-requirements
b. Disturbed-thought-processes
c. Sleep-deprivation-
d. Chronic-confusion-
e. Social-isolation-
--CORRECT-ANSWER-b.-Disturbed-thought-processes,-c.-Sleep-
deprivation-
People-with-mania-are-hyperactive-and-often-do-not-take-the-time-to-eat-and-
drink-properly.-Their-high-levels-of-activity-consume-calories;-therefore-
deficits-in-nutrition-may-occur.-Sleep-is-reduced.-Their-socialization-is-
impaired-but-not-isolated.-Confusion-may-be-acute-but-not-chronic.
3. A-nurse-receives-this-laboratory-result-for-a-patient-diagnosed-with-bipolar-
disorder:-lithium-level-1-mEq/L.-This-result-is:
a. within-therapeutic-limits
b. below-therapeutic-limits
c. above-therapeutic-limits
d. incorrect-because-of-inaccurate-testing-
--CORRECT-ANSWER--a.-within-therapeutic-limits
The-normal-range-for-a-blood-sample-taken-8-to-12-hours-after-the-last-dose-of-
lithium-is-0.4-to-1-mEq/L.
4. 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.
--CORRECT-ANSWER-b.-brings-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.
5. A-patient-diagnosed-with-bipolar-disorder-and-who-takes-lithium-telephones-
the-nurse-at-the-clinic-to-say,-Ive-had-severe-diarrhea-4-days.-I-feel-very-weak-
and-unsteady-when-I-walk.-My-usual-hand-tremor-has-gotten-worse.-What-
should-I-do?-The-nurse-should-advise-the-patient:
a. Restrict-oral-fluids-for-24-hours-and-stay-in-bed.
b. Have-someone-bring-you-to-the-clinic-immediately.
c. Drink-a-large-glass-of-water-with-1-teaspoon-of-salt-added.
d. Take-an-over-the-counter-antidiarrheal-medication-hourly-until-the-
diarrhea-subsides.-
--CORRECT-ANSWER-b.-Have-someone-bring-you-to-the-clinic-
immediately.
The-symptoms-described-suggest-lithium-toxicity.-The-patient-should-have-a-
lithium-level-drawn-and-may-require-further-treatment.-Because-neurologic-
symptoms-are-present,-the-patient-should-not-drive-and-should-be-
accompanied-by-another-person.-The-incorrect-options-will-not-address-the-
patients-symptoms.-Restricting-oral-fluids-will-make-the-situation-worse.
6. A-patient-diagnosed-with-bipolar-disorder-commands-other-patients,-Get-me-a-
book.-Take-this-stuff-out-of-here,-and-other-similar-demands.-The-nurse-wants-
to-interrupt-this-behavior-without-entering-into-a-power-struggle.-Select-the-
best-initial-approach-by-the-nurse.
a. Distraction:-Lets-go-to-the-dining-room-for-a-snack.
b. Humor:-How-much-are-you-paying-servants-these-days?
c. Limit-setting:-You-must-stop-ordering-other-patients-around.
d. Honest-feedback:-Your-controlling-behavior-is-annoying-others.-
--CORRECT-ANSWER-a.-Distraction:-Lets-go-to-the-dining-room-for-a-
snack.
1. A-health-teaching-plan-for-a-patient-taking-lithium-should-include-instructions-
to:-
a. maintain-normal-salt-and-fluids-in-the-diet.
b. drink-twice-the-usual-daily-amount-of-fluids.
c. double-the-lithium-dose-if-diarrhea-or-vomiting-occurs.
d. avoid-eating-aged-cheese,-processed-meats,-and-red-wine.-
CORRECT-ANSWER-a.-maintain-normal-salt-and-fluids-in-the-diet.
Sodium-depletion-and-dehydration-increase-the-chance-for-developing-lithium-
toxicity.-The-incorrect-options-offer-inappropriate-information.
2. A-nurse-prepares-the-plan-of-care-for-a-patient-having-a-manic-episode.-Which-
nursing-diagnoses-are-most-likely?-Select-all-that-apply.
a. Imbalanced-nutrition:-more-than-body-requirements
b. Disturbed-thought-processes
c. Sleep-deprivation-
d. Chronic-confusion-
e. Social-isolation-
--CORRECT-ANSWER-b.-Disturbed-thought-processes,-c.-Sleep-
deprivation-
People-with-mania-are-hyperactive-and-often-do-not-take-the-time-to-eat-and-
drink-properly.-Their-high-levels-of-activity-consume-calories;-therefore-
deficits-in-nutrition-may-occur.-Sleep-is-reduced.-Their-socialization-is-
impaired-but-not-isolated.-Confusion-may-be-acute-but-not-chronic.
3. A-nurse-receives-this-laboratory-result-for-a-patient-diagnosed-with-bipolar-
disorder:-lithium-level-1-mEq/L.-This-result-is:
a. within-therapeutic-limits
b. below-therapeutic-limits
c. above-therapeutic-limits
d. incorrect-because-of-inaccurate-testing-
--CORRECT-ANSWER--a.-within-therapeutic-limits
The-normal-range-for-a-blood-sample-taken-8-to-12-hours-after-the-last-dose-of-
lithium-is-0.4-to-1-mEq/L.
4. 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.
--CORRECT-ANSWER-b.-brings-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.
5. A-patient-diagnosed-with-bipolar-disorder-and-who-takes-lithium-telephones-
the-nurse-at-the-clinic-to-say,-Ive-had-severe-diarrhea-4-days.-I-feel-very-weak-
and-unsteady-when-I-walk.-My-usual-hand-tremor-has-gotten-worse.-What-
should-I-do?-The-nurse-should-advise-the-patient:
a. Restrict-oral-fluids-for-24-hours-and-stay-in-bed.
b. Have-someone-bring-you-to-the-clinic-immediately.
c. Drink-a-large-glass-of-water-with-1-teaspoon-of-salt-added.
d. Take-an-over-the-counter-antidiarrheal-medication-hourly-until-the-
diarrhea-subsides.-
--CORRECT-ANSWER-b.-Have-someone-bring-you-to-the-clinic-
immediately.
The-symptoms-described-suggest-lithium-toxicity.-The-patient-should-have-a-
lithium-level-drawn-and-may-require-further-treatment.-Because-neurologic-
symptoms-are-present,-the-patient-should-not-drive-and-should-be-
accompanied-by-another-person.-The-incorrect-options-will-not-address-the-
patients-symptoms.-Restricting-oral-fluids-will-make-the-situation-worse.
6. A-patient-diagnosed-with-bipolar-disorder-commands-other-patients,-Get-me-a-
book.-Take-this-stuff-out-of-here,-and-other-similar-demands.-The-nurse-wants-
to-interrupt-this-behavior-without-entering-into-a-power-struggle.-Select-the-
best-initial-approach-by-the-nurse.
a. Distraction:-Lets-go-to-the-dining-room-for-a-snack.
b. Humor:-How-much-are-you-paying-servants-these-days?
c. Limit-setting:-You-must-stop-ordering-other-patients-around.
d. Honest-feedback:-Your-controlling-behavior-is-annoying-others.-
--CORRECT-ANSWER-a.-Distraction:-Lets-go-to-the-dining-room-for-a-
snack.
