Flashcards 26. Keltner’s Psychiatric Nursing, 9th Edition Chapter 26 – Bipolar Disorders

A patient in acute mania is inappropriately humorous. Patients and staff are laughing at the patient's expense and embarrassment. What intervention should the nurse implement immediately?

A. Distract the patient to engage in another activity apart from the group.

B. Confront the group to stop the disrespectful behavior.

C. Join the group, and further assess the situation.

D. Consult the multidisciplinary team to determine the behavioral consequences for the staff.

A. Distract the patient to engage in another activity apart from the group.

Utilizing the distractibility of the patient therapeutically and advocating in removing the patient from the embarrassing situation should take priority. The nurse should advocate for the patient first and foremost, then address the issue with the group. Staff behavior should be addressed but does not have priority.

It is most important for the nurse to include the client's significant others when teaching which aspect of bipolar self-care?

A. The need to notify the health care provider when the client is facing a crisis situation

B. The importance of eating a heart-healthy diet and exercising regularly

C. Watching for and reporting impending signs of relapse such as sleeping difficulties and irritability

D. Receiving credit counseling in the case the client's behavior has resulted in a large debt

C. Watching for and reporting impending signs of relapse such as sleeping difficulties and irritability

It is most important to be proactive and to act so as to avoid a crisis situation. The significant others can assist the patient with self-monitoring and can aid in timely intervention by the health care professional. Eating well, counseling, and notifying a health care provider are important but do not take priority in this situation.

Which nursing intervention is likely to be most helpful in providing adequate nutrition while the patient is experiencing acute mania?

A. Provide nutrient-rich finger foods so the patient can eat while walking and talking.

B. Offer only liquids that are rich in calories to avoid choking.

C. Make food readily available knowing the client will eat when hungry.

D. Insist that the patient join the other patients on the unit during mealtimes.

a. Provide nutrient-rich finger foods so the patient can eat while walking and talking.

Providing portable, nutrient-rich foods will best support the patient nutritionally during an acute manic episode, which represents an enormous calorie expenditure. Offering only liquids prevents intake of whole foods. The patient is often too distracted and busy to eat. Requiring the patient to join the group at mealtimes is not realistic for a patient in acute mania.

A nurse who understands the psychopathology of bipolar disorder will include which intervention into the client's care plan?

A. Assist the patient in making frequent calls to friends and neighbors while on the inpatient unit.

B. Distract the patient to avoid negative outcomes resulting from manic behavior.

C. Provide frequent large meals to the patient who is experiencing flight of ideas.

D. Promote the therapeutic relationship with humor and joking behaviors.

B. Distract the patient to avoid negative outcomes resulting from manic behavior.

Therapeutic use of distraction is most helpful when a patient experiences acute mania and demonstrates the best understanding of the disease process. Encouragement in any nontherapeutic activities does not reflect understanding of the patient's disease process by facilitating rest. Small, frequent meals that are portable are best for the patient; simple verbal directions and interruption of flight of ideas are therapeutic. Behaviors such as humor on the part of the nurse may serve to further escalate or fuel the patient's mania and inappropriate behavior (looseness, grandiosity, intrusiveness

When comparing the needs of patients experiencing depression and those experiencing bipolar disorder, both groups will require which intervention?

A. Careful monitoring of environmental stimuli

B. Suicide and escape precautions

C. Fall and seizure precautions

D. Assessment of eating and sleeping patterns

d. Assessment of eating and sleeping patterns

Both groups experience variances in eating and sleeping and will need careful assessments and monitoring. The depressed patient is not generally in need of escape precautions. Only the manic patient requires a low-stimuli environment. It is not a given that both type of patients are at risk for falls or seizures.

Which assessment data would be inconsistent with a diagnosis of mania?

A. The patient is demonstrating severe irritability.

B. Family report that the mood change occurred gradually over a 5-day period.

C. The behaviors have increased in severity since onset 2 weeks ago.

D. The patient has been abusing alcohol consistently since onset of symptoms.

b. Family report that the mood change occurred gradually over a 5-day period.

Manic episodes usually begin suddenly, escalate rapidly, and last from a few days to several months. To meet diagnostic criteria, the symptoms must persist for at least 1 week (or less if hospitalization is required). Manic episodes are characterized by an elevated, expansive, or irritable mood. Judgment is impaired, social blunders occur, and involvement with alcohol and drugs is common.

A patient being assessed for a possible bipolar II disorder diagnosis. A positive response by a to which assessment data would support the diagnosis?

A. "Has anyone told you that you are hyper than usual?"

B. "Over the last 6-day period would you say you've more irritable than usual?"

C. "Do you feel that people are out to get you?"

D. "Have you been sleepier than usual the last month?"

A. "Has anyone told you that you are hyper than usual"

Bipolar II disorder diagnoses require evidence of a hypomanic (normally revved-up state of mind that affects your mood, thoughts, and behavior) episode. For a hypomanic episode to be diagnosed, the length of the episode must be at least 4 days in duration. Paranoid delusions are not a diagnostic criterion, nor would sleepiness be symptomatic.

Which assessment question is appropriate to identify a unique characteristic of a patient experiencing bipolar depression?

A. "Do you experience insomnia on a regular basis?"

B. "Have you experienced a weight loss recently?"

C. "Have you ever been diagnosed with anorexia?"

D. "Do you experience paranoid thoughts?"

D. "Do you experience paranoid thoughts"

Manic individuals often attempt to control others and to achieve their goals through which mechanism?

A. Displaying tantrum-like behavior when frustrated

B. Physically aggressive behavior directed toward others

C. Manipulatively praising others to gain favor

D. Threatening to physically harm themselves

c. Manipulatively praising others to gain favor

A common technique directed toward controlling others, especially to achieve personal goals, is to manipulate the self-esteem of others through praise and compliments. Manic individuals can become verbally abusive when they are not having their needs met, but rarely do they resort to physical aggression or self-harm.

What initial intervention should be implemented by the nurse when managing a manic patient whose behavior is disrupting a group therapy session?

A. Setting behavioral limits for the patient that are appropriate and well defined

B. Remaining involved with the patient while demonstrating a calm demeanor

C. Communicating with the patient using brief, simple statements

D. Removing the patient from the group to de-escalate the situation

B. Remaining involved with the patient while demonstrating a calm demeanor

When the nurse is able to remain calm instead of becoming angry, it helps both the manic patient as well as the other patients in the group. The remaining options may become appropriate, but they would not be the initial intervention.