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
REMEMBER: Antipsychotics are used for "psychosis" its in the name ANTI-Psychotics, used to knock down psychosis during mania while "mood stabilizer like lithium, anticonvulsants or Latuda kicks in."
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 refers to a low-level and less dramatic mania. (think functional mania)
*Unlike mania, psychosis is never present with hypomania.
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).
`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)
Which Bipolar meds are leveable? Select all that apply.
A. Lithium
B. Valproate
C. Carbamazepine
D. Gabapentin
E. Lamotrigine
A. 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 client in an acute manic episode is exhibiting constant movement, rapid and loud speech, irritability, minimal sleep, and impulsive behaviors. The nurse is identifying priority nursing diagnoses for this patient. Which diagnosis must take precedence at this time?
A. Risk for injury
B. Ineffective coping
C. Disturbed thought processes
D. Risk for imbalanced nutrition: less than body requirements
A. Risk for injury
Risk for injury is the priority because acute mania is characterized by hyperactivity, poor judgment, impulsivity, decreased need for sleep, and psychomotor agitation, all of which significantly increase the likelihood of accidental harm, exhaustion, or unsafe behaviors. Protecting the patient from injury is always the first priority before addressing coping, thought processes, or nutritional concerns.
True or False?
Meals requiring utensils are preferred for patients in acute mania because they encourage the patient to slow down and focus.
False
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 nurse is working with a patient in the maintenance phase following an acute manic episode. Which outcome is the most appropriate goal for this phase of treatment?
A. Maintain adequate hydration and stable cardiac status.
B. Sleep at least 6 hours per night with staff redirection.
C. Identify personal triggers that increase the risk of future manic episodes.
D. Accept staff direction to reduce pacing and hyperactivity.
Correct Answer: C. Identify personal triggers that increase the risk of future manic episodes.
The maintenance phase begins once acute symptoms have resolved. The focus shifts from physiological stabilization to relapse prevention, education, support, and problem‑solving skills
A. Maintain adequate hydration and stable cardiac status. These are acute‑phase priorities aimed at physiological safety during severe mania.
B. Sleep at least 6 hours per night with staff redirection. Sleep stabilization is important, but needing staff redirection indicates the patient is still in the acute or continuation phase, not maintenance.
D. Accept staff direction to reduce pacing and hyperactivity. This reflects acute‑phase behavioral control, not long‑term relapse‑prevention work.
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 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 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. Ziprasidone
C. Clonazepam
D. Carbamazepine
E. Lamotrigine
F. Gabapentin
G. Valproate
F. Lurasidone
A. Lithium-only true mood stabilizer
D. Carbamazepine-anticonvulsant used to stabilize mood
E. Lamotrigine-anticonvulsant used to stabilize mood
F. Gabapentin-anticonvulsant used to stabilize mood
G. Valproate-anticonvulsant used to stabilize mood
F. Lurasidone (Latuda) its an antipsychotic but remember "take with fooda, improves your MOOD and attituda."
Incorrect:
B. Ziprasidone-is an antipsychotic used for acute mania/psychosis symptoms
C. Clonazepam- Benzo used for anxiety