Bipolar Disorder
Mrs. A is admitted to the medical/surgical unit with a diagnosis of dehydration and pneumonia. She has a history of bipolar disorder and is controlled on lithium. As her nurse, you know you must:
A. Treat her carefully because she may become catatonic.
B. Observe for signs of lithium toxicity from dehydration.
C. Alert the other staff of the “psych” patient on the unit.
D. Treat the medical illness only.
B. Observe for signs of lithium toxicity from dehydration.
When setting limits with patients with personality disorders, the consequences of violating those limits should be set:
A. When the behavior is done.
B. Just before the nurse anticipates the behavior.
C. When the staff or family complains about the behavior.
D. When the limit is set.
D. When the limit is set.
Brian, an 18-year-old with schizophrenia, has a negative attitude, is delusional, hears voices, and is withdrawing from others. A nursing intervention that is appropriate for promoting activity for Brian is:
A. Tell him “the voices” told you he should participate in the weekly party.
B. Remind him that he does not want to get worse by sitting alone.
C. Tell him he must join the party; it is part of his care plan.
D. Invite him to join in the party.
D. Invite him to join in the party.
You are working the night shift in your surgical unit. Ms. Y, who is 1 day postoperative for a total hip replacement, is taking several medications for pain, along with an antibiotic. She is 70 years old and presented as alert and oriented before surgery. She lives independently. Ms. Y suddenly begins screaming and thrashing in bed, begging you to “Get the spiders out of my bed!” What is the best explanation for Ms. Y’s behavior?
A. Delusions
B. Delirium
C. Dementia
D. Sepsis
B. Delirium
You have just completed teaching with a patient who is beginning lithium. Which of the following statements made by the patient demonstrates understanding of this drug?
a. “I will need to increase my salt intake while taking this drug.”
b. “I will need regular blood testing while taking this drug.”
c. “I may develop mild memory loss while taking this drug.”
d. “Lithium cannot be taken with tyrosine-containing foods.”
b. “I will need regular blood testing while taking this drug.”
Marge is a 68-year-old woman with a long history of bipolar disorder I. She is brought to the emergency department by her sister, who reports that Marge has been increasingly agitated, is unable to sleep, and told her daughter that the mayor was calling her for advice on running the city. The behavior is an example of:
A. Delusions of grandeur
B. Delusions of persecution
C. Auditory hallucinations
D. Schizophrenia
A. Delusions of grandeur
David, 30 years old, comes to your unit for treatment of multiple broken bones after a car accident. He is friendly and flirtatious, but very demanding. As you gather data from him, you learn that the police have been looking for him for petty theft. He laughs and says, “Like they don’t have better things to do!” He states he has changed jobs three times in the past year and has just broken off his second engagement. His former fiancée is visiting and privately tells you that you need to be careful because “he doesn’t always tell the truth.” You suspect which of the following personality disorders?
A. Paranoid
B. Dependent
C. Antisocial
D. Schizoid
C. Antisocial
Mr. G is calling out, “Nurse!” When you arrive in his room, he tells you to be careful of the snake in the corner. You do not see anything in the corner. Mr. G is experiencing a (an):
A. Hallucination
B. Attention-seeking behavior
C. Illusion
D. Delusion
A. Hallucination
Which of the following would you expect to see in a patient who is diagnosed with a neurocognitive disorder?
A. Intact memory
B. Appropriate behavior
C. Disorganization of thought
D. Orientation to person, place, and time
C. Disorganization of thought
You are about to begin teaching a patient with a psychosis about taking typical antipsychotic drugs. Which of the following statements would you include in your teaching plan?
a. “Do not abruptly stop taking this drug.”
b. “Take these drugs with a glass of grapefruit juice.”
c. “Take these drugs at night with your sleep drug.”
d. “You will experience the effects of these drugs within 30 minutes of taking them.”
a. “Do not abruptly stop taking this drug.”
The health-care provider orders lithium carbonate 600 mg three times daily for a newly diagnosed bipolar patient. The therapeutic blood level for acute mania is:
A. 1.0–1.5 mEq/L
B. 10–15 mEq/L
C. 0.5–1.0 mEq/L
D. 5–10 mEq/L
A. 1.0–1.5 mEq/L
Patients who display very bizarre behavior most likely have which of the following types of personality disorder?
A. Narcissistic
B. Schizotypal
C Antisocial
D. Borderline
B. Schizotypal
Of the following responses, which would be your best response to Mr. G regarding the snake that he sees?
A. “Don’t worry; I’ll get rid of it.” (You pretend to remove the snake.)
B. “I don’t see a snake; what else do you see that isn’t there?”
C. “I don’t see a snake. It is time for your group meeting. I’ll walk with you to the meeting room.”
D. “Where is it? I hate snakes. Let’s get out of here.”
C. “I don’t see a snake. It is time for your group meeting. I’ll walk with you to the meeting room.”
The use of reality-orienting techniques would be helpful with which patient?
A. One in the advanced stage of Alzheimer’s disease
B. One with advanced vascular dementia
C. An elderly patient who is confused and screaming out for her mother
D. One who is recovering from delirium and seems more relaxed when reminded of where she is
D. One who is recovering from delirium and seems more relaxed when reminded of where she is
Which symptoms would you expect a patient who is experiencing mania? (Select all that apply.)
a. Catatonia
b. CNS depression
c. Increased energy
d. Grandiose notions
e. Poor judgement
f. Excessive sleepiness
c. Increased energy
d. Grandiose notions
e. Poor judgement
What is cyclothymic disorder?
A. A chronic mood disorder of at least 2 years
B. A one-time event of hypomania
C. A continuous state of hypomania for 2 years
D. A chronic depression for 2 years
A. A chronic mood disorder of at least 2 years
Your patient has been admitted with a diagnosis of bilateral pneumonia. You have trouble communicating with this patient, who is pouty and demanding of your constant attention. She talks for long periods about the smallest details of her life. Besides the pneumonia, you ask the physician if the patient has a history of which of the following personality disorders?
A. Schizoid
B. Antisocial
C. Narcissistic
D. Borderline
C. Narcissistic
Which of the following pairs of symptoms are closely associated with EPS?
A. Muscle rigidity and protruding tongue
B. Overly emotional, depressed
C. Shuffling gait and depression
D. Fatigue and painful joints
A. Muscle rigidity and protruding tongue
Mr. H has been admitted to your nursing home in late-stage Alzheimer’s disease. His wife is crying and says to you, “Nurse, when will he get better? I don’t know what I will do without him at home. Why can’t the doctor fix him?” Your best response to Mrs. H is:
A. “Hopefully with time he will improve.”
B. “Maybe you should stop visiting for a few days, and then you’ll feel better.”
C. “You sound really worried. Tell me what the doctor has told you about his condition.”
D. “Mrs. H, your doctor has explained that Mr. H will not get better. You need to make a plan for the future.”
C. “You sound really worried. Tell me what the doctor has told you about his condition.”
Your manic patient has lost 5 pounds and is underweight. Which meal is most appropriate?
A. Grilled chicken and baked potato
B. Spaghetti and meatballs
C. Chili and crackers
D. Chicken fingers and French fries
D. Chicken fingers and French fries
Your manic patient says, “Everything I do is great.” How should you respond?
A. “Yes, I am happy for you.”
B. “Tell me about a time in your life when things didn’t go as planned.”
C. “No one can be great at everything.”
D. “Keep it up.”
B. “Tell me about a time in your life when things didn’t go as planned.”
Nursing care for people with personality disorders includes all of the following EXCEPT:
A. Unconditional positive regard.
B. Trust.
C. Limit setting.
D. Vague communication (to decrease feelings of inferiority).
D. Vague communication (to decrease feelings of inferiority).
A patient who repeats a word or part of a word over and over might be said to have which of the following symptoms?
A. Echolalia
2. Echopraxia
C. Illusion
D. Word salad
A. Echolalia
Donepezil (Aricept) is a medication approved for the treatment of symptoms of Alzheimer’s-type dementia. Nurses must be alert to which of the following side effects?
A. Tachycardia
B. Insomnia
C. Mania
D. Weight gain
B. Insomnia
A nursing intervention for a person with schizophrenia is to:
A. Reinforce the hallucinations.
B. Keep the person oriented to reality and to the present.
C. Encourage the patient to begin psychoanalysis.
D. Encourage competitive activities.
B. Keep the person oriented to reality and to the present.