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A concerned family member tells the nurse, 'I am concerned about my brother. He has been acting very different lately.' Knowing the family has a history of bipolar disorder, the nurse inquiries further about this. Which behavior during the past week might indicate that the brother has bipolar disorder?
- A. Taking unnecessary risks
- B. Sleeping more
- C. Intense focus
- D. Showing low self-esteem
Correct Answer: A
Rationale: Taking unnecessary risks is a symptom of mania, characteristic of bipolar disorder, unlike the other options.
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Which meal would the nurse provide to best meet the nutritional needs of a client who is manic?
- A. Peanut butter sandwich, chips, cola
- B. Fried chicken, mashed potatoes, milk
- C. Ham sandwich, cheese slices, milk
- D. Spaghetti, garlic bread, salad, tea
Correct Answer: C
Rationale: Finger foods like a ham sandwich and cheese slices are high in calories and protein, suitable for a manic client's mobility.
Which statements about the etiology of bipolar disorder do most psychoanalytical theories subscribe to? Select all that apply.
- A. Norepinephrine levels may be increased in mania.
- B. Manic episodes are a defense against underlying depression.
- C. Acetylcholine seems to be implicated in mania.
- D. The id takes over the ego and acts as an undisciplined hedonistic being (child).
Correct Answer: B,D
Rationale: Psychoanalytical theories view mania as a defense against depression, with the id overriding the ego, acting impulsively.
The wife of a client with bipolar disorder calls the nurse expressing distress about recent spending. The nurse's action would be considered
- A. inappropriate; the nurse should not give advice to the wife.
- B. inappropriate; the husband has the legal right to spend personal money.
- C. appropriate; the wife is responsible for the husband's actions since he has a mental illness.
- D. appropriate; the wife needs support in setting boundaries.
Correct Answer: D
Rationale: Supporting the wife in setting boundaries is appropriate, as it empowers her to manage the client's manic behavior.
Which time periods during antidepressant therapy are persons most likely to commit suicide? Select all that apply.
- A. After starting antidepressant therapy but not having reached the therapeutic level
- B. After having reached the therapeutic level of antidepressants and maintained it for several years
- C. If the client has made a choice to discontinue antidepressant therapy without medical supervision and is becoming gradually more depressed
- D. If the client does not adhere to the medication regimen and takes antidepressant medications irregularly
- E. Prior to initiating antidepressant therapy but before the depression results in lack of energy
Correct Answer: A,C,D,E
Rationale: Suicide risk is highest when energy increases before mood stabilizes, or during untreated or poorly managed depression.
A client who is manic states, 'What time is it? I have to see the doctor. Is breakfast here yet? I've got to see the doctor first. Can I get my cereal out of the kitchen?' Which would be the most appropriate response by the nurse?
- A. Please slow down. I'm not sure what you need first.
- B. You will have to be quiet and have breakfast after the doctor comes.
- C. Are you hungry?
- D. Your thoughts seem to be racing this morning.
Correct Answer: A
Rationale: Asking the client to slow down facilitates communication without blaming, addressing their pressured speech.