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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.
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A patient tells the nurse, 'I am so ashamed of being bipolar. When I'm manic, my behavior embarrasses my family. Even if I take my medication, there's no guarantee I won't have a relapse. I am such a burden to my family.' These statements support which nursing diagnoses?
- A. Powerlessness
- B. Defensive coping
- C. Chronic low self-esteem
- D. Impaired social interaction
- E. Risk-prone health behavior
Correct Answer: A,C
Rationale: The patient's shame and perceived burden reflect chronic low self-esteem and powerlessness. Other diagnoses are not supported by the statements.
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.
A patient diagnosed with bipolar disorder is being treated as an outpatient during a hypomanic episode. Which suggestions should the nurse provide to the family to assist in managing these behaviors?
- A. Provide structure.
- B. Limit credit card access.
- C. Encourage group social interaction.
- D. Limit work to half days.
- E. Monitor the patient's sleep patterns.
Correct Answer: A,B,E
Rationale: Structure, limited financial access, and sleep monitoring help manage hypomania by reducing stimulation and impulsivity. Group interaction and partial work may exacerbate symptoms.
A patient experiencing acute mania undresses in the group room and dances. What should be the nurse's first intervention?
- A. Quietly ask the patient, 'Why don't you put on your clothes?'
- B. Firmly tell the patient, 'Stop dancing, and put on your clothing.'
- C. Put a blanket around the patient and walk with the patient to a quiet room.
- D. Allow the patient stay in the group room while moving the other patients to a different area.
Correct Answer: C
Rationale: Covering the patient and removing them from the area protects them from embarrassment and maintains safety. Other options are less effective or inappropriate.
This nursing diagnosis applies to a patient experiencing mania: imbalanced nutrition: less than body requirements, related to insufficient caloric intake and hyperactivity as evidenced by 5-pound weight loss in 4 days. What is the most appropriate outcome related to patient behavior?
- A. Asking staff for assistance with feeding within 4 days
- B. Drinking six servings of a high-calorie, high-protein drink each day
- C. Consistently sitting with others for at least 30 minutes at mealtime within 1 week
- D. Wearing appropriate attire for age and gender within 1 week while in the psychiatric unit
Correct Answer: B
Rationale: High-calorie, high-protein supplements address the nutritional deficit caused by hyperactivity. Other options do not directly ensure adequate caloric intake.