Nurs 663: Pregnant Woman with
Bipolar Disorder (NEI) exam
questions and answers
A 24-year-old female presents with psychotic symptoms and
moderate agitation not relieved through de-escalation measures.
Which of the following atypical antipsychotics is available in a short-
acting intramuscular formulation?
A. Lurasidone
B. Risperidone
C. Ziprasidone
C. Ziprasidone
A 27-year-old patient who has been taking an atypical antipsychotic
for bipolar disorder for the last 2 years has just found out that she
is 12 weeks pregnant. Cumulative data for atypical antipsychotic
use in pregnancy show an increased risk of:
A. Major malformations during the first trimester
B. Abnormal muscle movements in infants
C. Withdrawal symptoms in infants
D. B and C
E. A, B, and C
D. B and C
Patient Intake
The patient is a 34-year-old white woman with a long history of
bipolar disorder and multiple hospitalizations
She is college educated but has endured periods of homelessness
related to her illness
She had been stable on lithium for 3 years and was attending school
when she unexpectedly discovered that she was pregnant with a
baby fathered by her ex-boyfriend
This was 2 months ago; at that time, she was approximately 4
months pregnant
, Having heard that lithium can cause birth defects, she immediately
stopped taking it without seeking medical advice or substituting any
other medications
This is the patient’s second pregnancy; she delivered a healthy
infant at age 28; the baby was adopted out in an open adoption
The patient is brought in now by the police for screaming at people
at a nearby shopping mall
She is labile, alternately screaming and crying or laughing and
flirting with men, and she is often incoherent
She denies homicidal ideation but hits a male nurse who is caring
for another patient in the emergency room (ER)
She denies suicidal ideation, then bursts into tears
She has leaves in her hair and is malodorous enough that other
patients in the ER complain, but she refuses to change into clean
clothing
The patient also refuses to cooperate with labs or even vital signs
N/A
Which of the following would you consider an appropriate
management strategy for this pregnant patient with acute agitation
and assaultive behavior?
A. Use seclusion or restraints to prevent her from hurting herself or
others; avoid any medications for fear of their effects on the fetus
B. Use seclusion or restraints to prevent her from hurting herself or
others; wait to use medication until after she cooperates with labs
in case her agitation is related to the ingestion of any drugs
C. Use intramuscular (IM) benzodiazepines to rapidly calm her; use
restraints only until she is calmer
D. Use IM antipsychotic medication to calm her; use restraints only
until she is calmer
E. Use lithium because it worked well for her before; it is not
available intramuscularly so would need to be offered orally
D. Use IM antipsychotic medication to calm her; use restraints only
until she is calmer
Attendees Notes
The ideal first-line approach to manage agitation and aggression
would be de-escalation and environmental manipulation. Assure the
Bipolar Disorder (NEI) exam
questions and answers
A 24-year-old female presents with psychotic symptoms and
moderate agitation not relieved through de-escalation measures.
Which of the following atypical antipsychotics is available in a short-
acting intramuscular formulation?
A. Lurasidone
B. Risperidone
C. Ziprasidone
C. Ziprasidone
A 27-year-old patient who has been taking an atypical antipsychotic
for bipolar disorder for the last 2 years has just found out that she
is 12 weeks pregnant. Cumulative data for atypical antipsychotic
use in pregnancy show an increased risk of:
A. Major malformations during the first trimester
B. Abnormal muscle movements in infants
C. Withdrawal symptoms in infants
D. B and C
E. A, B, and C
D. B and C
Patient Intake
The patient is a 34-year-old white woman with a long history of
bipolar disorder and multiple hospitalizations
She is college educated but has endured periods of homelessness
related to her illness
She had been stable on lithium for 3 years and was attending school
when she unexpectedly discovered that she was pregnant with a
baby fathered by her ex-boyfriend
This was 2 months ago; at that time, she was approximately 4
months pregnant
, Having heard that lithium can cause birth defects, she immediately
stopped taking it without seeking medical advice or substituting any
other medications
This is the patient’s second pregnancy; she delivered a healthy
infant at age 28; the baby was adopted out in an open adoption
The patient is brought in now by the police for screaming at people
at a nearby shopping mall
She is labile, alternately screaming and crying or laughing and
flirting with men, and she is often incoherent
She denies homicidal ideation but hits a male nurse who is caring
for another patient in the emergency room (ER)
She denies suicidal ideation, then bursts into tears
She has leaves in her hair and is malodorous enough that other
patients in the ER complain, but she refuses to change into clean
clothing
The patient also refuses to cooperate with labs or even vital signs
N/A
Which of the following would you consider an appropriate
management strategy for this pregnant patient with acute agitation
and assaultive behavior?
A. Use seclusion or restraints to prevent her from hurting herself or
others; avoid any medications for fear of their effects on the fetus
B. Use seclusion or restraints to prevent her from hurting herself or
others; wait to use medication until after she cooperates with labs
in case her agitation is related to the ingestion of any drugs
C. Use intramuscular (IM) benzodiazepines to rapidly calm her; use
restraints only until she is calmer
D. Use IM antipsychotic medication to calm her; use restraints only
until she is calmer
E. Use lithium because it worked well for her before; it is not
available intramuscularly so would need to be offered orally
D. Use IM antipsychotic medication to calm her; use restraints only
until she is calmer
Attendees Notes
The ideal first-line approach to manage agitation and aggression
would be de-escalation and environmental manipulation. Assure the
