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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 to receive lithium therapy as part of the treatment plan for bipolar disorder. When reviewing the client?s medication history, which agents would alert the nurse to the possibility that a decrease in lithium dosage may be needed? Select all that apply.
- A. Lisinopril
- B. Hydrochlorothiazide
- C. Indomethacin
- D. Caffeine
- E. Aspirin
Correct Answer: B,C
Rationale: Hydrochlorothiazide (B) and indomethacin (C) reduce lithium excretion, increasing lithium levels and requiring potential dose reduction to avoid toxicity. Lisinopril (A), caffeine (D), and aspirin (E) have minimal impact on lithium pharmacokinetics.
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.
A client with bipolar disorder has had a history of multiple episodes and states, I?m so frustrated with what?s happened because of these episodes. Which of the following would the nurse encourage to help support this client?s recovery?
- A. Codependence
- B. Hope
- C. Self-control
- D. Independent decision making
Correct Answer: B
Rationale: Encouraging hope (B) fosters resilience and motivation for recovery in bipolar disorder, countering frustration. Codependence (A) is unhealthy, self-control (C) is important but less primary, and independent decision-making (D) may be impaired during episodes.
A client with bipolar disorder has a lithium drug level of 1.2 mEq/L. Which of the following would the nurse expect to assess? Select all that apply.
- A. Metallic taste
- B. Ataxia
- C. Diarrhea
- D. Slurred speech
- E. Fasciculations
- F. Muscle weakness
Correct Answer: A,C,F
Rationale: A lithium level of 1.2 mEq/L is within the therapeutic range (0.6?1.2 mEq/L) but at the upper limit, where mild side effects like metallic taste (A), diarrhea (C), and muscle weakness (F) may occur. Ataxia (B), slurred speech (D), and fasciculations (E) are more typical of toxicity (>1.5 mEq/L).