A suicidal client, with a history of manic behavior, is admitted to the ED. The
client's diagnosis is documented as Bipolar I disorder: current episode depressed.
What is the rationale for this diagnosis instead of a diagnosis of major depressive
disorder?
A. The physician does not believe the client is suffering from major depression
B. the client has experienced a manic episode in the past.
C. the client does not exhibit psychotic symptoms.
D. There is no history of major depression in the client's family
Ans: B. the client has experienced a manic episode in the past.
The client's past history of mania and current suicide attempt support the
diagnosis of Bipolar I disorder: current episode depressed. According to the DSM-
5 criteria, a manic episode rules out the diagnosis of major depressive disorder.
Quiz In the initial stages of caring for a client experiencing an acute manic
episode, what should the nurse consider to be the priority nursing diagnosis?
A. Risk for injury related to excessive hyperactivity
,B. Disturbed sleep pattern related to manic hyperactivity
C. Imbalanced nutrition, less than body requirements related to inadequate
intake
D. Situational low self-esteem related to embarrassment secondary to high-risk
behaviors
Ans: A. Risk for injury related to excessive hyperactivity
According to Maslow's hierarchy of needs, maintaining client safety is always a
priority. The impulsiveness and hyperactivity seen in clients diagnosed with acute
mania puts them at risk for injury
Quiz A client, who is prescribed lithium carbonate, is being discharged from
inpatient care. Which medication information should the nurse teach this client?
A. do not skimp on dietary sodium intake
B. have serum lithium levels checked every 6 months
C. limit fluid intake to 1000 mL of fluid per day
D. adjust the dose if you feel out of control
Ans: A. do not skimp on dietary sodium intake
Clients taking lithium should consume a diet adequate in sodium and drink 2500-
3000 mL of fluid per day. Lithium is a salt and competes in the body with sodium.
If sodium is lost, the body will retain lithium with resulting toxicity. Maintaining
, normal sodium and fluid levels is critical to maintaining therapeutic levels of
lithium and preventing toxicity.
Quiz Harold is admitted to the psychiatric unit with bipolar I disorder: manic
episode in a highly-agitated state. His speech is rapid and incoherent, he is pacing
and in constant motion, and he is loudly proclaiming that his "lawyers are on the
way and every one of you is going to be sued for malpractice." Which of the
following nursing interventions are appropriate in this situation? (Select all that
apply)
A. Provide an environment with low levels of stimulation
B. Set limits on Harold's threats by instructing him that he is not permitted to sue
the staff
C. Convey a calm attitude and voice when communicating with Harold.
D. Put Harold in seclusion with restraints for the protection of himself and others.
E. Offer activities that will provide safe outlets for Harold's agitation and excessive
energy.
Ans: A. Provide an environment with low levels of stimulation
C. Convey a calm attitude and voice when communicating with Harold.
E. Offer activities that will provide safe outlets for Harold's agitation and excessive
energy.
Feedback 1: Even little amounts of stimulation can increase symptoms and
agitation in an acutely manic patient. Providing an environment with the low
levels of stimulation is a priority to reduce the risk of further escalation.
client's diagnosis is documented as Bipolar I disorder: current episode depressed.
What is the rationale for this diagnosis instead of a diagnosis of major depressive
disorder?
A. The physician does not believe the client is suffering from major depression
B. the client has experienced a manic episode in the past.
C. the client does not exhibit psychotic symptoms.
D. There is no history of major depression in the client's family
Ans: B. the client has experienced a manic episode in the past.
The client's past history of mania and current suicide attempt support the
diagnosis of Bipolar I disorder: current episode depressed. According to the DSM-
5 criteria, a manic episode rules out the diagnosis of major depressive disorder.
Quiz In the initial stages of caring for a client experiencing an acute manic
episode, what should the nurse consider to be the priority nursing diagnosis?
A. Risk for injury related to excessive hyperactivity
,B. Disturbed sleep pattern related to manic hyperactivity
C. Imbalanced nutrition, less than body requirements related to inadequate
intake
D. Situational low self-esteem related to embarrassment secondary to high-risk
behaviors
Ans: A. Risk for injury related to excessive hyperactivity
According to Maslow's hierarchy of needs, maintaining client safety is always a
priority. The impulsiveness and hyperactivity seen in clients diagnosed with acute
mania puts them at risk for injury
Quiz A client, who is prescribed lithium carbonate, is being discharged from
inpatient care. Which medication information should the nurse teach this client?
A. do not skimp on dietary sodium intake
B. have serum lithium levels checked every 6 months
C. limit fluid intake to 1000 mL of fluid per day
D. adjust the dose if you feel out of control
Ans: A. do not skimp on dietary sodium intake
Clients taking lithium should consume a diet adequate in sodium and drink 2500-
3000 mL of fluid per day. Lithium is a salt and competes in the body with sodium.
If sodium is lost, the body will retain lithium with resulting toxicity. Maintaining
, normal sodium and fluid levels is critical to maintaining therapeutic levels of
lithium and preventing toxicity.
Quiz Harold is admitted to the psychiatric unit with bipolar I disorder: manic
episode in a highly-agitated state. His speech is rapid and incoherent, he is pacing
and in constant motion, and he is loudly proclaiming that his "lawyers are on the
way and every one of you is going to be sued for malpractice." Which of the
following nursing interventions are appropriate in this situation? (Select all that
apply)
A. Provide an environment with low levels of stimulation
B. Set limits on Harold's threats by instructing him that he is not permitted to sue
the staff
C. Convey a calm attitude and voice when communicating with Harold.
D. Put Harold in seclusion with restraints for the protection of himself and others.
E. Offer activities that will provide safe outlets for Harold's agitation and excessive
energy.
Ans: A. Provide an environment with low levels of stimulation
C. Convey a calm attitude and voice when communicating with Harold.
E. Offer activities that will provide safe outlets for Harold's agitation and excessive
energy.
Feedback 1: Even little amounts of stimulation can increase symptoms and
agitation in an acutely manic patient. Providing an environment with the low
levels of stimulation is a priority to reduce the risk of further escalation.
