Bipolar 1 or 2
A nurse is assessing a client with a diagnosis of Bipolar II disorder. Which of the following clinical findings are most consistent with this diagnosis?
a. Persistent elevated mood lasting at least one week with psychotic features
b. History of at least one major depressive episode and one hypomanic episode
c. Severe mania requiring hospitalization
d. Alternating periods of dysthymia and cyclothymia
b. History of at least one major depressive episode and one hypomanic episode
True or False?
A pt with Bipolar d/o has been maintained on lithium with no problem for 3 years but develops a sudden onset of N/V/D and generalized myopathy. The pts lithium level is 1.8. This patient is experiencing Lithium Toxicity?
A patient with Bipolar I disorder is admitted to the psychiatric unit during a manic episode. Which symptoms should the nurse expect to observe?
A. Pressured speech, decreased need for sleep, grandiosity, and impulsive behavior
B. Low mood, anhedonia, hypersomnia, and psychomotor retardation
C. Flat affect, social withdrawal, and disorganized thought processes
D. Mildly elevated mood, increased productivity, and improved social functioning
A. Pressured speech, decreased need for sleep, grandiosity, and impulsive behavior
What 3 classes of meds are used in the treatment of acute mania?
1. Mood Stabilizer (Lithium)
2. Anticonvulsants
3. Antipsychotics
A pt with bipolar d/o is exhibiting an elevated mood and a feeling of increased productivity. The pt is able to function reasonably well, but others have noted changes in the pts mood and behavior. This type of behavior would be classified as a?
A. Hypomanic episode
B. Depressive episode
C. Cyclothymic episode
D. Manic episode
A. Hypomanic episode (functional mania)
FYI: Cyclothymic episode (rapid cycling for at least 2 yrs, fluctuating mood disturbance involving periods of hypomanic/depressive episodes that don’t meet criteria for bipolar d/o)
Which of the following classes of medications is most likely to trigger a psychotic or manic response?
A. Antipsychotics
B. Anticonvulsants
C. Anxiolytics
D. Antidepressants
D. Antidepressants
-can cause Activation Syndrome especially in bipolar 2 depressed pts.
- Caused when an antidepressant is used as monotherapy or itself.
-DRs use combo of antidepressants and antipsychotics together example is Fluoxetine/Prozac and Olanzapine/Zyprexa to tx bipolar is sold under the branded name Symbyax).
The nurse is reviewing medications commonly used to "stabilize mood" in patients with bipolar disorder. Which of the following medications are used to help stabilize mood? Select all that apply.
A. Lithium
B. Lurasidone
C. Clonazepam
D. Carbamazepine
E. Lamotrigine
F. Gabapentin
G. Valproate
A. Lithium
B. Lurasidone
D. Carbamazepine
E. Lamotrigine
F. Gabapentin
G. Valproate
Which Bipolar meds are leveable? Select all that apply.
A. Lithium
B. Valproate
C. Carbamazepine
D. Gabapentin
E. LamotrigineA. Lithium
B. Valproate
C. Carbamazepine
A patient diagnosed with Bipolar II disorder is being assessed in the outpatient clinic. Which symptoms would the nurse most likely expect during a depressive episode?
A. Hypersomnia, low energy, feelings of worthlessness, and slowed speech
B. Elevated mood, grandiosity, and decreased need for sleep
C. Hallucinations, disorganized speech, and catatonia
D. Euphoric mood, pressured speech, and flight of ideas
A. Hypersomnia, low energy, feelings of worthlessness, and slowed speech
Bipolar II disorder is characterized by hypomania and major depressive episodes. During the depressive phase, patients commonly experience:
hypersomnia or insomnia
psychomotor slowing
low energy
poor concentration
feelings of guilt or worthlessness
depressed mood
The psychiatric condition that is most commonly associated with hypothyroidism is?
A. Psychosis
B. Schizophrenia
C. Bipolar
D. Anxiety
Most common thyroid abnormality seen in bipolar patients is Hypothyroidism → think bipolar depression
Hyperthyroidism → think mania‑like symptoms, can mimic or exacerbate mania.
A pt with Bipolar D/O is extremely manipulative and often behaves in an sexually provocative and inappropriate manner with staff members and other patients. The most appropriate method of dealing with this inappropriate behavior is to?
A. Utilize positive reinforcement and negative consequences
B. Use chemical restraints to control inappropriate behavior
C. Refer the matter to the pts psychiatrist for guidance
D. Isolate the pt from others until behavior improves
A. Utilize positive reinforcement and negative consequences
Manic patients often have difficulty recognizing boundaries and may act impulsively. Interventions include:
-Set clear, simple, and consistent limits
-Use calm redirection rather than confrontation
-Reduce environmental stimulation
-Provide structured, noncompetitive activities
-Protect the patient from embarrassment
-Ensure adequate nutrition, hydration, and rest
When a patient is prescribed Lamotrigine, what serious side effect are we educating patients to look out for?
Steven Johnsons syndrome (severe rash).
A patient newly admitted with Bipolar I disorder is observed pacing rapidly in the hallway with an elevated mood, pressured speech, irritability, and grandiose delusions. Which nursing diagnosis should the nurse identify as the priority?
A. Risk for injury
B. Ineffective coping
C. Risk for imbalanced nutrition: less than body requirements
D. Disturbed thought processes
A. Risk for injury — Priority During an acute manic episode, the patient’s pacing, increased psychomotor activity, irritability, and grandiose delusions significantly elevate the risk of accidental harm, impulsive behavior, or poor judgment. Mania impairs the ability to recognize danger, and the combination of high energy and impaired impulse control makes safety the immediate priority.
A patient newly diagnosed with Bipolar I disorder, most recent episode manic with psychotic features, has been assigned the nursing diagnosis Imbalanced nutrition: less than body requirements. Which dinner tray would be most appropriate for this patient?
A. Chicken fingers with fries, a banana, and a soda
B. Chicken Parm with pasta, an apple, and an ensure
C. Beef and barley stew with bread and milk
D. Chicken Caesar salad with chocolate pudding and juice
A. Chicken fingers with fries, a banana, and a soda — Most appropriate
Patients in acute mania often have poor concentration, limited ability to sit still, and decreased attention span, making it difficult to eat meals that require utensils or extended time.
Finger foods are quick, portable, high‑calorie, and easy to consume while the patient continues to pace or move around. This supports the goal of increasing caloric intake in a patient with imbalanced nutrition: less than body requirements.
A newly diagnosed pt with bipolar d/o has been prescribed Lithium. When teaching the pt about the medication, the initial symptoms that the nurse should advise the pt to expect include?
A. Fine tremors, Polydipsia, Polyuria & GI upset
B. Dysuria and constipation
C. Coarse tremors, nausea and vomiting (These are s/s of toxicity)
D. Headache, dizziness, and tinnitus
A. Fine tremors, Polydipsia, Polyuria & GI upset
If Lithium Toxicity is suspected what is the nurse’s priority for this patient?
A. Repeat bloodwork, call Dr., give med, EKG & Fluids
B. Hold med, call Dr., repeat bloodwork, EKG, IV fluids and possible dialysis
C. Start Dialysis, repeat bloodwork, call Dr., EKG & Fluids
D. Give med, call Dr., repeat bloodwork, EKG, Fluids, and possible dialysis
B. Hold med, call Dr., repeat bloodwork, EKG, IV fluids and possible dialysis
A patient diagnosed with Bipolar II disorder has been assigned the nursing diagnosis Impaired social interaction related to asociality. Which outcome is most appropriate for this patient?
A. The patient will demonstrate an appropriate interaction with the treatment team by the third day of inpatient admission.
B. The patient will feel comfortable enough to share personal information with peers in the dining room.
C. The patient will spend fewer than 8 hours per 24‑hour period isolated in their room.
D. The patient will verbalize plans for outpatient follow‑up with their therapist by day five of admission.
A. The patient will demonstrate an appropriate interaction with the treatment team by the third day of inpatient admission.
For the nursing diagnosis Impaired social interaction related to asociality, the most appropriate outcome is one that is realistic, measurable, and directly connected to improving social engagement.
A patient newly diagnosed with Bipolar I disorder has recently started lithium therapy. The nurse is providing discharge teaching about laboratory monitoring. Which patient statement indicates that the teaching has been effective?
A. “Once my lithium dose is stable, I’ll only need my blood levels checked about once a month or every few months.”
B. “I will need to have my lithium level checked every week for as long as I’m taking it.”
C. “I only need my lithium level checked if I start to feel sick or dehydrated.”
D. “After the first level is drawn, I won’t need any more blood tests unless my dose changes.”
A. “Once my lithium dose is stable, I’ll only need my blood levels checked about once a month or every few months.”
Lithium requires frequent monitoring when first initiated—typically weekly until the patient reaches a therapeutic and stable dose.
Once the dose is stable and the patient is clinically steady, monitoring becomes less frequent, usually monthly, then every few months depending on provider judgment and patient stability.
The nurse is reviewing discharge teaching with a patient newly prescribed lithium for Bipolar I disorder. Which patient statement indicates that further teaching is required?
A. “If I get a stomach bug with vomiting or diarrhea, I should keep taking my lithium and just try to stay hydrated.”
B. “I need to keep my salt intake consistent each day so my lithium level doesn’t change suddenly.”
C. “I should drink plenty of water throughout the day to prevent dehydration.”
D. “I’ll need regular blood tests to check my lithium level, especially when I’m first starting the medication.”
Correct answer is A.
A patient should contact their provider if they develop vomiting, diarrhea, fever, or dehydration. GI illnesses can cause rapid fluid loss, which leads to dangerously high lithium levels and toxicity.
B. “I need to keep my salt intake consistent…” is Correct sudden changes in sodium intake alter lithium reabsorption in the kidneys, risking toxicity or subtherapeutic levels.
C. “I should drink plenty of water…” is Correct adequate hydration prevents lithium accumulation and toxicity.
D. “I’ll need regular blood tests…” is Correct lithium levels are checked weekly when starting, then monthly or every few months once stable.
A nurse is assessing a client admitted to the psychiatric unit with a diagnosis of Bipolar I disorder, currently in a manic episode. Which of the following findings should the nurse expect? Select all that apply.
a. Pressured speech and flight of ideas
b. Decreased need for sleep
c. Feelings of worthlessness and hopelessness
d. Excessive spending and hypersexual behavior
e. Elevated or irritable mood
f. Impaired ability to complete daily tasks and maintain relationships
a,b,d,e,f
c. is incorrect: Feelings of worthlessness and hopelessness (depressive episode not mania)