BIPOLAR DISORDERS UPDATED Exam
Questions and CORRECT Answers
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 - CORRECT ANSWER -
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.
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 -
CORRECT ANSWER - 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
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 - CORRECT ANSWER - 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.
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. -
CORRECT ANSWER - 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.
Feedback 3: Even little amounts of stimulation can increase symptoms and agitation in an
acutely manic patient. Conveying a calm attitude and voice contributes to a lower level of
stimulation when communicating with this client
Feedback 5: Offering activities that provide safe outlets for the excessive energy and
hyperactivity that occur in manic episodes can be an effective distraction and a tool to reduce
agitation
, A client demonstrating manic behavior has become demanding and hyperactive. Which is the
most appropriate nursing intervention to address these client behaviors?
A. Help lessen the client's feelings of guilt and rejection
B. Warn the client that restraints may be necessary if behavior does not improve
C. Maintain a supportive, structured environment, setting firm limits in a nonthreatening manner.
D. Introduce the client to peers in order to increase interpersonal contacts - CORRECT
ANSWER - C. Maintain a supportive, structured environment, setting firm limits in a
nonthreatening manner.
The client is having difficulty controlling behavior and maintaining impulse control. the nurse
must help the client to do so in an objective, nonjudgmental way, focusing on the behavior and
not the client
A client who is prescribed lithium carbonate is being discharged from inpatient care. Which
medication information should he nurse teach this client?
A. "Do not alter your dietary sodium intake."
B. "Have serum lithium levels checked every 6 months."
C. "Limit fluid intake to 1,000 mL per day."
D. "Adjust the dose if you feel out of control." - CORRECT ANSWER - A. "Do not alter
your dietary sodium intake."
Clients taking lithium should consume a diet adequate in sodium and drink 2,000-3,000 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, resulting in toxicity. Conversely, if sodium levels are significantly increased,
it will reduce the level of lithium, resulting in decreased efficacy. Maintaining normal sodium
and fluid levels is critical to maintaining therapeutic levels of lithium.
A client diagnosed with bipolar disorder is experiencing hyperactive behavior and weight loss.
Which nutritional intervention would be most therapeutic for this client?
A. Allow the client full kitchen privileges to eat anything as needed (PRN)
B. Initiate tube feedings with nutritional supplements
C. provides small, frequent feedings of finger foods.
Questions and CORRECT Answers
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 - CORRECT ANSWER -
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.
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 -
CORRECT ANSWER - 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
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 - CORRECT ANSWER - 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.
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. -
CORRECT ANSWER - 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.
Feedback 3: Even little amounts of stimulation can increase symptoms and agitation in an
acutely manic patient. Conveying a calm attitude and voice contributes to a lower level of
stimulation when communicating with this client
Feedback 5: Offering activities that provide safe outlets for the excessive energy and
hyperactivity that occur in manic episodes can be an effective distraction and a tool to reduce
agitation
, A client demonstrating manic behavior has become demanding and hyperactive. Which is the
most appropriate nursing intervention to address these client behaviors?
A. Help lessen the client's feelings of guilt and rejection
B. Warn the client that restraints may be necessary if behavior does not improve
C. Maintain a supportive, structured environment, setting firm limits in a nonthreatening manner.
D. Introduce the client to peers in order to increase interpersonal contacts - CORRECT
ANSWER - C. Maintain a supportive, structured environment, setting firm limits in a
nonthreatening manner.
The client is having difficulty controlling behavior and maintaining impulse control. the nurse
must help the client to do so in an objective, nonjudgmental way, focusing on the behavior and
not the client
A client who is prescribed lithium carbonate is being discharged from inpatient care. Which
medication information should he nurse teach this client?
A. "Do not alter your dietary sodium intake."
B. "Have serum lithium levels checked every 6 months."
C. "Limit fluid intake to 1,000 mL per day."
D. "Adjust the dose if you feel out of control." - CORRECT ANSWER - A. "Do not alter
your dietary sodium intake."
Clients taking lithium should consume a diet adequate in sodium and drink 2,000-3,000 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, resulting in toxicity. Conversely, if sodium levels are significantly increased,
it will reduce the level of lithium, resulting in decreased efficacy. Maintaining normal sodium
and fluid levels is critical to maintaining therapeutic levels of lithium.
A client diagnosed with bipolar disorder is experiencing hyperactive behavior and weight loss.
Which nutritional intervention would be most therapeutic for this client?
A. Allow the client full kitchen privileges to eat anything as needed (PRN)
B. Initiate tube feedings with nutritional supplements
C. provides small, frequent feedings of finger foods.
