Nokea
A person is directing traffic on a busy street while shouting and making obscene gestures at passing cars. The person has not slept or eaten for 3 days. What features of mania are evident?
- A. Increased muscle tension and anxiety
- B. Vegetative signs and poor grooming
- C. Poor judgment and hyperactivity
- D. Cognitive deficit and sad mood
Correct Answer: C
Rationale: Hyperactivity (directing traffic) and poor judgment (putting self in a dangerous position) are characteristic of manic episodes. The distractors do not specifically apply to mania.
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A patient diagnosed with bipolar disorder is in the maintenance phase of treatment. The patient asks, 'Do I have to keep taking this lithium even though my mood is stable now?' Select the nurse's most appropriate response.
- A. You will be able to stop the medication in approximately 1 month.'
- B. Taking the medication every day helps prevent relapses and recurrences.'
- C. Usually patients take this medication for approximately 6 months after discharge.'
- D. It's unusual that the health care provider has not already stopped your medication.'
Correct Answer: B
Rationale: Lithium maintenance prevents recurrences, and this response promotes compliance. Other options provide incorrect information.
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.
A patient experiencing acute mania is dancing atop the pool table in the recreation room. The patient waves a pool cue in one hand and says, 'I'll protect myself if anyone comes near me.' What is the nurse's first intervention?
- A. Telling the patient, 'You need to be secluded.'
- B. Demanding the patient, 'get down from the table.'
- C. Clearing the room of all other patients.
- D. Assembling staff for a show of force.
Correct Answer: C
Rationale: Clearing the room ensures safety, allowing time to plan further interventions. Other options may escalate the situation.
A patient diagnosed with bipolar disorder has been hospitalized for 7 days and has taken lithium 600 mg three times daily. Staff members observe increased agitation, pressured speech, poor personal hygiene, hyperactivity, and bizarre clothing. What is the nurse's best intervention?
- A. Educate the patient about the proper ways to perform personal hygiene and coordinate clothing.
- B. Continue to monitor and document the patient's speech patterns and motor activity.
- C. Ask the health care provider to prescribe an increased dose and frequency of lithium.
- D. Consider the need to check the lithium level. The patient may not be swallowing medications.
Correct Answer: D
Rationale: Persistent manic symptoms suggest possible nonadherence, warranting a lithium level check. Increasing the dose or other options are less appropriate.
What is the focus of outcome identification for the treatment plan of a patient presenting with grandiose thinking associated with acute mania?
- A. Maintaining an interest in the environment
- B. Developing an optimistic outlook
- C. Self-control of distorted thinking
- D. Stabilizing the sleep pattern
Correct Answer: C
Rationale: Controlling grandiose thinking is the primary outcome, as it addresses the core symptom of mania. Other options are less directly related.