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The nurse is preparing a teaching plan for the family of a client who has been diagnosed with bipolar disorder. After teaching them about potential indicators for relapse, the nurse determines that the teaching was effective when they identify which of the following as suggesting mania? Select all that apply.
- A. Avoiding people
- B. Sleeping more than usual
- C. Talking faster than usual
- D. Being hungry all the time
- E. Reading several books at once
Correct Answer: C,E
Rationale: Mania is characterized by rapid speech (C) and multitasking behaviors like reading multiple books simultaneously (E), reflecting increased energy and distractibility. Avoiding people (A) and sleeping more (B) suggest depression, and constant hunger (D) is not specific to mania.
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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 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 is receiving divalproex sodium as part of the treatment plan. When monitoring the client?s blood level for this drug, which level would alert the nurse to the need to change the dosage?
- A. 30 ng/mL
- B. 55 ng/mL
- C. 75 ng/mL
- D. 115 ng/mL
Correct Answer: D
Rationale: The therapeutic range for divalproex sodium (valproic acid) is 50?100 µg/mL (often reported as ng/mL in some contexts). A level of 115 ng/mL (D) is above this range, indicating potential toxicity and the need for dosage reduction. Levels of 30, 55, and 75 ng/mL (A, B, C) are below or within the therapeutic range.
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 asks the nurse if he needs to alter any of his activities because he is taking lithium carbonate. Which of the following responses would be most appropriate?
- A. Increase your salt intake if an activity causes you to perspire heavily.
- B. Wear sunscreen when you are going to be outdoors in the summer time.
- C. Drink less fluid than usual now because you are taking this drug.
- D. No changes are necessary for strenuous activities you do outdoors.
Correct Answer: A
Rationale: Lithium levels can increase to toxic levels with dehydration from heavy perspiration, as sodium loss affects lithium excretion. Increasing salt intake (A) during such activities helps maintain safe lithium levels. Sunscreen (B) is unrelated, reducing fluid (C) risks toxicity, and no changes (D) ignores the risk of dehydration.