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The nurse is reviewing the medical record of a client with bipolar disorder. The nurse would most likely expect to find a history of which of the following?
- A. Panic disorder
- B. Schizophrenia
- C. Delusional disorder
- D. Posttraumatic stress disorder
Correct Answer: A
Rationale: Panic disorder (A) commonly co-occurs with bipolar disorder due to shared neurobiological pathways and anxiety?s prevalence in mood disorders. Schizophrenia (B) and delusional disorder (C) are psychotic disorders with distinct features, and PTSD (D) is less commonly associated with bipolar disorder.
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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 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.
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.
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.
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.