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The nurse is assessing a client with bipolar disorder who is experiencing mania. The client states, I?m just so beautiful. Everyone just stops and stares at how gorgeous I am. Men constantly want to have sex with me. The nurse interprets these statements as indicative of which type of mood?
- A. Irritable
- B. Elevated
- C. Expansive
- D. Euphoric
Correct Answer: C
Rationale: Expansive mood (C) in mania is characterized by grandiose, exaggerated self-perception, as seen in the client?s statements about beauty and desirability. Irritable mood (A) involves agitation, elevated mood (B) is less specific, and euphoric mood (D) reflects intense happiness without the grandiose quality.
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A nurse is preparing to administer medications to a female client with bipolar disorder who is experiencing acute mania. Which of the following would be most appropriate for the nurse to do?
- A. Tell the client firmly that she must take her medication.
- B. Allow the client to participate in the treatment decision.
- C. Restrain the client before administering the medication.
- D. Notify the physician about the client?s refusal of the medication.
Correct Answer: B
Rationale: Allowing the client to participate in treatment decisions (B) fosters autonomy and therapeutic alliance, appropriate unless the client is too impaired to decide. Firm insistence (A) may escalate agitation, restraint (C) is a last resort, and notifying the physician (D) assumes refusal prematurely.
A client is brought to the emergency department by his brother. The client has a history of bipolar disorder for which he is taking divalproex. The brother reports that he watched his brother take the medication about 2 hours ago. He stated, A little while ago, he got very disoriented and agitated. The nurse suspects toxicity based on assessment of which of the following? Select all that apply.
- A. Tachypnea
- B. Bradycardia
- C. Hypotension
- D. Nystagmus
- E. Vomiting
Correct Answer: D,E
Rationale: Divalproex toxicity may present with nystagmus (D) and vomiting (E), alongside disorientation and agitation, due to neurological and gastrointestinal effects. Tachypnea (A), bradycardia (B), and hypotension (C) are less specific to valproate toxicity.
A client?s blood level of carbamazepine is increased. When reviewing the client?s medication history, which of the following would alert the nurse to a possible interaction?
- A. Phenobarbital
- B. Primidone
- C. Phenytoin
- D. Diltiazem
Correct Answer: D
Rationale: Diltiazem (D), a calcium channel blocker, inhibits the metabolism of carbamazepine, increasing its blood levels and risking toxicity. Phenobarbital (A), primidone (B), and phenytoin (C) are enzyme inducers that typically decrease carbamazepine levels.
A client diagnosed with bipolar disorder and experiencing mania is admitted to the inpatient psychiatric setting. During the acute phase of mania, which medication would the nurse expect to most likely administer?
- A. Lithium carbonate (Lithium)
- B. Haloperidol lactate (Haldol)
- C. Fluoxetine (Prozac)
- D. Paroxetine (Paxil)
Correct Answer: B
Rationale: Haloperidol (B), a typical antipsychotic, is commonly used in acute mania to rapidly control severe agitation, impulsivity, and psychotic symptoms due to its fast-acting nature. Lithium (A) is effective for long-term mood stabilization but slower in acute mania. Fluoxetine (C) and paroxetine (D), SSRIs, are used for depression, not mania, and may worsen manic symptoms.
A client who is receiving lithium comes to the clinic for an evaluation. During the visit, the client reports a fine hand tremor. Which action by the nurse would be most appropriate?
- A. Immediately obtain a specimen to determine the client?s blood drug level.
- B. Suggest that the client take the medication with meals or snacks.
- C. Assist the client in minimizing exposure to stressors.
- D. Encourage the client to elevate the affected hand on a pillow.
Correct Answer: B
Rationale: A fine hand tremor is a common, benign side effect of lithium. Taking the medication with meals or snacks (B) can reduce gastrointestinal irritation and tremor severity. Immediate blood testing (A) is unnecessary unless toxicity is suspected, stress reduction (C) is less relevant, and elevation (D) is ineffective.