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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 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 with bipolar disorder having experienced a depressive episode is prescribed lamotrigine. After teaching the client about this medication, the nurse determines that the teaching was successful when the client states which of the following?
- A. I need to notify my physician if I develop a skin rash.
- B. I need to have my blood tested about once a month.
- C. I need to watch how much salt I use every day.
- D. This drug can affect my liver function.
Correct Answer: A
Rationale: Lamotrigine (A) carries a risk of serious skin rashes, such as Stevens-Johnson syndrome, requiring immediate reporting. Blood testing (B) is not routine for lamotrigine, salt intake (C) is irrelevant, and liver function (D) is less commonly affected compared to other mood stabilizers.
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 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.
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.