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A patient diagnosed with bipolar disorder commands other patients, 'Get me a book. Take this stuff out of here,' and other similar demands. What is the best initial approach by the nurse to interrupt this behavior without entering into a power struggle?
- A. Distraction: 'Let's go to the dining room for a snack.'
- B. Humor: 'How much are you paying servants these days?'
- C. Limit setting: 'You must stop ordering other patients around.'
- D. Honest feedback: 'Your controlling behavior is annoying others.'
Correct Answer: A
Rationale: Distraction leverages the patient's distractibility to redirect behavior constructively, avoiding power struggles. Other options may incite anger or seem confrontational.
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Which dinner menu is best suited for the patient diagnosed with bipolar disorder experiencing acute mania?
- A. Spaghetti and meatballs, salad, a banana
- B. Beef and vegetable stew, a roll, chocolate pudding
- C. Broiled chicken breast on a roll, an ear of corn, apple
- D. Chicken casserole, green beans, flavored gelatin with whipped cream
Correct Answer: C
Rationale: Finger foods like chicken on a roll and corn allow the hyperactive patient to eat on the go. Other options require utensils, which may be impractical.
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 receiving lithium should be assessed for which evidence of early toxicity?
- A. Pharyngitis, mydriasis, and dystonia
- B. Alopecia, purpura, and drowsiness
- C. Diarrhea, thirst, and vomiting
- D. Ascites, dyspnea, and edema
Correct Answer: C
Rationale: Diarrhea, thirst, and vomiting are early signs of lithium toxicity. Other options are unrelated to lithium therapy.
This is the primary reason that the cause of bipolar disorder has not been determined?
- A. Several factors, including genetics, are implicated.
- B. Brain structures were altered by trauma early in life.
- C. Excess norepinephrine is probably a major factor.
- D. Excess sensitivity in dopamine receptors may exist.
Correct Answer: A
Rationale: The interplay of multiple factors, including genetics and neurotransmitter imbalances, is the most likely explanation for bipolar disorder. Other options are too specific or narrow.
A patient experiencing acute mania has exhausted the staff members by noon. The patient has joked, manipulated, insulted, and been aggressive all morning. Staff members are feeling defensive and fatigued. Which is the best action?
- A. Confer with the health care provider regarding use of seclusion for this patient.
- B. Hold a staff meeting to discuss consistency and limit setting approaches.
- C. Conduct a meeting with all patients to discuss the behavior.
- D. Explain to the patient that the behavior is unacceptable.
Correct Answer: B
Rationale: A staff meeting promotes consistency and limit setting, reducing staff splitting and frustration. Seclusion is not warranted, and other options are less effective.