NURS 222: Bipolar Disorder & Mood Stabilizers Comprehensive Exam
2026 |WCU
1. A client is admitted with Bipolar I Disorder, manic episode. Which clinical
manifestation most distinguishes Bipolar I from Bipolar II?
A. Absence of any depressive episodes in the clinical history.
B. Frequent cycling between hypomania and mild depression.
C. Chronicity of symptoms lasting at least two years.
D. Presence of at least one episode of full-blown mania causing marked impairment.
Answer: D
Rationale: Bipolar I requires at least one manic episode (severe enough to cause marked
impairment or hospitalization). Bipolar II involves hypomania and major depression, but
never full mania.
2. A nurse is assessing a client in an acute manic phase. The client states, ‘I am
the CEO of the universe and I have a secret plan to end world hunger by
tomorrow.’ This is an example of:
A. Flight of ideas
B. Clang associations
C. Tangentiality
D. Grandiosity
Answer: D
Rationale: Grandiosity is an inflated sense of self-importance, power, or knowledge,
common in manic episodes.
,3. The therapeutic range for Lithium carbonate in the maintenance phase is
generally:
A. 0.2 - 0.5 mEq/L
B. 2.5 - 3.0 mEq/L
C. 1.5 - 2.0 mEq/L
D. 0.6 - 1.2 mEq/L
Answer: D
Rationale: The standard therapeutic range for lithium maintenance is 0.6 to 1.2 mEq/L.
Levels above 1.5 mEq/L indicate toxicity.
4. Which of the following electrolyte imbalances is most likely to precipitate
lithium toxicity?
A. Hyperkalemia
B. Hypermagnesemia
C. Hypocalcemia
D. Hyponatremia
Answer: D
Rationale: Lithium is a salt; if sodium levels are low (hyponatremia), the kidneys conserve
lithium, leading to toxic levels.
5. A client taking Lithium for three weeks reports fine hand tremors. Which
action by the nurse is most appropriate?
A. Immediately stop the medication and notify the provider.
B. Reassure the client that this is a common, expected side effect.
C. Prepare the client for an emergency hemodialysis session.
D. Administer a STAT dose of Epinephrine.
Answer: B
Rationale: Fine hand tremors are a common, expected side effect of lithium. Coarse
tremors, however, indicate toxicity.
, 6. Which anticonvulsant medication used as a mood stabilizer requires frequent
monitoring of liver function tests (LFTs) and platelets?
A. Lamotrigine
B. Valproic acid (Depakote)
C. Gabapentin
D. Lorazepam
Answer: B
Rationale: Valproic acid can cause hepatotoxicity and thrombocytopenia, requiring regular
LFT and CBC monitoring.
7. A client taking Lamotrigine (Lamictal) for bipolar maintenance develops a
faint red rash on their chest. What is the priority nursing action?
A. Apply a topical corticosteroid and monitor.
B. Instruct the client to stop the medication and seek immediate medical evaluation.
C. Advise the client to take an antihistamine.
D. Document the finding as an expected side effect of the titration.
Answer: B
Rationale: A rash while taking Lamotrigine could indicate Stevens-Johnson Syndrome
(SJS), a life-threatening skin reaction. The drug must be stopped immediately.
8. A manic client is pacing the unit and has not eaten for 24 hours. Which
nutritional intervention is most effective?
A. Sitting with the client for a full 30-minute meal.
B. Offering high-calorie, high-protein finger foods.
C. Placing the client in seclusion for mealtime.
D. Administering total parenteral nutrition (TPN).
Answer: B
Rationale: Manic clients are often too hyperactive to sit for meals; finger foods allow them
to eat while moving.
2026 |WCU
1. A client is admitted with Bipolar I Disorder, manic episode. Which clinical
manifestation most distinguishes Bipolar I from Bipolar II?
A. Absence of any depressive episodes in the clinical history.
B. Frequent cycling between hypomania and mild depression.
C. Chronicity of symptoms lasting at least two years.
D. Presence of at least one episode of full-blown mania causing marked impairment.
Answer: D
Rationale: Bipolar I requires at least one manic episode (severe enough to cause marked
impairment or hospitalization). Bipolar II involves hypomania and major depression, but
never full mania.
2. A nurse is assessing a client in an acute manic phase. The client states, ‘I am
the CEO of the universe and I have a secret plan to end world hunger by
tomorrow.’ This is an example of:
A. Flight of ideas
B. Clang associations
C. Tangentiality
D. Grandiosity
Answer: D
Rationale: Grandiosity is an inflated sense of self-importance, power, or knowledge,
common in manic episodes.
,3. The therapeutic range for Lithium carbonate in the maintenance phase is
generally:
A. 0.2 - 0.5 mEq/L
B. 2.5 - 3.0 mEq/L
C. 1.5 - 2.0 mEq/L
D. 0.6 - 1.2 mEq/L
Answer: D
Rationale: The standard therapeutic range for lithium maintenance is 0.6 to 1.2 mEq/L.
Levels above 1.5 mEq/L indicate toxicity.
4. Which of the following electrolyte imbalances is most likely to precipitate
lithium toxicity?
A. Hyperkalemia
B. Hypermagnesemia
C. Hypocalcemia
D. Hyponatremia
Answer: D
Rationale: Lithium is a salt; if sodium levels are low (hyponatremia), the kidneys conserve
lithium, leading to toxic levels.
5. A client taking Lithium for three weeks reports fine hand tremors. Which
action by the nurse is most appropriate?
A. Immediately stop the medication and notify the provider.
B. Reassure the client that this is a common, expected side effect.
C. Prepare the client for an emergency hemodialysis session.
D. Administer a STAT dose of Epinephrine.
Answer: B
Rationale: Fine hand tremors are a common, expected side effect of lithium. Coarse
tremors, however, indicate toxicity.
, 6. Which anticonvulsant medication used as a mood stabilizer requires frequent
monitoring of liver function tests (LFTs) and platelets?
A. Lamotrigine
B. Valproic acid (Depakote)
C. Gabapentin
D. Lorazepam
Answer: B
Rationale: Valproic acid can cause hepatotoxicity and thrombocytopenia, requiring regular
LFT and CBC monitoring.
7. A client taking Lamotrigine (Lamictal) for bipolar maintenance develops a
faint red rash on their chest. What is the priority nursing action?
A. Apply a topical corticosteroid and monitor.
B. Instruct the client to stop the medication and seek immediate medical evaluation.
C. Advise the client to take an antihistamine.
D. Document the finding as an expected side effect of the titration.
Answer: B
Rationale: A rash while taking Lamotrigine could indicate Stevens-Johnson Syndrome
(SJS), a life-threatening skin reaction. The drug must be stopped immediately.
8. A manic client is pacing the unit and has not eaten for 24 hours. Which
nutritional intervention is most effective?
A. Sitting with the client for a full 30-minute meal.
B. Offering high-calorie, high-protein finger foods.
C. Placing the client in seclusion for mealtime.
D. Administering total parenteral nutrition (TPN).
Answer: B
Rationale: Manic clients are often too hyperactive to sit for meals; finger foods allow them
to eat while moving.
