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A patient develops mania after discontinuing lithium. New prescriptions are written to resume lithium twice daily and begin olanzapine. This is the expected reaction to the addition of olanzapine to the medication regimen?
- A. Minimize the side effects of lithium.
- B. Bring hyperactivity under rapid control.
- C. Enhance the antimanic actions of lithium.
- D. Provide long-term control of hyperactivity.
Correct Answer: B
Rationale: Olanzapine has a rapid onset to control hyperactivity initially, as lithium requires time to reach therapeutic levels. It does not enhance lithium's effects or minimize side effects.
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A patient diagnosed with bipolar disorder is dressed in a red leotard and brightly colored scarves. The patient cusses while twirling and shadowboxing. Then the patient says gaily, 'Do you like my scarves? Here... they are my gift to you.' How should the nurse document the patient's mood?
- A. Labile and euphoric
- B. Irritable and belligerent
- C. Highly suspicious and arrogant
- D. Excessively happy and confident
Correct Answer: A
Rationale: The patient has demonstrated angry behavior and pleasant, happy behavior within seconds of each other. Excessive happiness indicates euphoria. Mood swings are often rapid and seemingly without understandable reason in patients who are manic. These swings are documented as labile.
When a hyperactive patient experiencing acute mania is hospitalized, what initial nursing intervention is a priority?
- A. Allowing the patient to act out his or her feelings
- B. Setting limits on the patient's behavior as necessary
- C. Providing verbal instructions to the patient to remain calm
- D. Restraining the patient to reduce hyperactivity and aggression
Correct Answer: B
Rationale: Setting limits provides structure and support while the patient's control is tenuous, prioritizing safety. Other options may escalate behavior or are inappropriate initially.
At a unit meeting, staff members discuss the decor for a special room for patients experiencing mania. What select is the best option?
- A. Extra-large window with a view of the street
- B. Neutral walls with pale, simple accessories
- C. Brightly colored walls and print drapes
- D. Deep colors for walls and upholstery
Correct Answer: B
Rationale: A nonstimulating environment with neutral decor reduces sensory overload for manic patients. Other options may overstimulate or pose safety risks.
A patient diagnosed with bipolar disorder is hyperactive and manic after discontinuing lithium. The patient threatens to hit another patient. Which comment by the nurse is appropriate?
- A. Stop that! No one did anything to provoke an attack by you.'
- B. If you do that one more time, you will be secluded immediately.'
- C. Do not hit anyone. If you are unable to control yourself, we will help you.'
- D. You know we will not let you hit anyone. Why do you continue this behavior?'
Correct Answer: C
Rationale: Setting limits in simple, concrete terms helps de-escalate the situation while offering assistance. The other options either threaten punishment or fail to provide environmental safety.
A patient experiencing acute mania waves a newspaper and says, 'I must have my credit card and use the computer right now. A store is having a big sale and I need to order 10 dresses and four pairs of shoes.' What is the nurse's most appropriate intervention?
- A. Suggesting to the patient to ask a friend to do the shopping and bring purchases to the unit
- B. Inviting the patient to sit with the nurse and look at new fashion magazines
- C. Telling the patient that computer use is not allowed until self-control improves
- D. Asking whether the patient has enough money to pay for the purchases
Correct Answer: B
Rationale: Distraction with fashion magazines leverages the patient's distractibility to avoid power struggles and reduce impulsive behavior. Other options may escalate frustration.