A Client is admitted to the psychiatric unit accompanied by her husband. She brings six suitcases and three shopping bags. She orders the nurse to carry her bags. Her husband states she has been purchasing items that hey can not afford and has not slept for 4 nights
1. Which additional information would be priority for the nurse to seek from the client's husband?;
a. The client's fluid and food intake.
b. Their current financial status.
c. The client's usual sleeping pattern.
d. Whether the client becomes agitated easily.
(The correct answer is a, Assessing nutritional status is a priority in this situation. A client with bipolar disorder,maniac phase commonly does not have time to eat or drink because of their state of constant activity and easy destructibility. Altered nutritional status and constant physical activity can lead to malnutrition,weight loss and physical exhaustion.These state can lead to death appropriate attention is not instituted. Financial status is neither important nor something that the nurse can modify. Client with bipolar disorder,maniac phase typically go on spending sprees, have disturbed sleep patterns and exhibit hostility when their personal desires are limited)
2. The husband apologizes to the nurse for his wife's demanding behavior. Which of the following possible replies by the nurse would the best?;
a. "I'am sure she's doing the best she can".
b. "It's all right.We have been treated worse".
c. "It must be hard for you to see her like this".
d. "I understand.What happened to set her off like this?".
(The correct answer is c, when the client's husband apologizes for her behavior, it's best to focus on the husband's feelings and to be supportive of him. To say that the client doing best she can and that the nurse is used to being treated worse by clients ignores the husband's feelings. To ask what caused the client's behavior suggests criticism of the client and asks the husband for a judgement that he may not be able to make
accurately).
3. The client put out her hand and says to the nurse,"watch out! Here I come", She then put her hands down and sits in the chair. After determining that the client is not about to harm any one. The nurse should intervene by
a. giving the client a book of her choice to read.
b. placing the client in isolation to work out her aggression in private.
c. taking the client to a punching bag for exercise to release excess energy.
d. having the client continue to sit while holding her hands to help her gain control herself.
(The correct answer is c, If a client overactive behavior acts aggressively, the nurse should first take measures to protect herself and others from harm. However,when the aggression subsides,effort should be made to provide activity that is most likely to decrease tension and energy such as using a punching bag. Reading a book, holding the client's hands or placing her in isolation to walkout aggression in private will not meet her needs to reduce energy and tension. However when selecting an activity for a hyperactive client,care should be taken so that the activity does not overstimulate an already overactive client).
4. The client is scheduled to go to the radiology department. Before taking the client for X-Ray examination, which of the following actions should the nurse take?;
a. Explain the x ray procedure in simple term.
b. Provide a detailed explanation of the x ray procedure.
c. Say nothing before taking her to x ray department.
d. Bring another staff member along in case she resists going to x ray department.
(The correct answer is a, It is best to explain the x ray procedure to the client in simple term. Saying nothing or giving overly detailed explanation is inappropriate;the client need some explanation but details are unnecessary. There is no indication that additional help is needed fro this client).
5. The nurse notes that the client is too busy investigating the unit and over seeing the activities of other client to eat dinner. To help the client obtain sufficient nourishment, which of the following plans would be best?;
a. Serve food that she can carry with her.
b. Allow her to send out for her favorite foods.
c. Serve food in small,attractively arrange portion.
d. Allow her to enter the unit kitchen for extra food as necessary.
(The correct answer is a, Because the client is very active,it would be best to give her food she can carry with her and eat as she moves. Allowing the client in the unit kitchen is impractical and she most likely would be too busy to eat anyway. Allowing the client to send out for her favorite foods and serving food in small,attractively,arranged portions it will not meet the
problem of ensuring that the active client has proper nourishment).
6. Later the same evening,the client appears at the nurse's station with brightly rouged cheeks,ornament in the hair and three pairs of false eyelashes,wearing a sheer nightgown,high heel and bracelets up to her elbows. Which of the following actions should the nurse take in relation to the client's at-tire?;
a. Redirect the client to her room and help her put on proper apparel.
b. Allow the client to wear what she likes and get her involved in a unit activity.
c. Remind the client that she agreed to wear slacks and shirt when out her room.
d. Ask the client to put on hospital pajamas until she can dress appropriately on her room.
(The correct answer is a, Explanations are unlikely to be of value for this client. It will best to assist the client into proper attire in matter-of-fact way. At this point,the nurse needs to assist the client in setting limits on her behavior).
7. As the nurse approaches the lounge area,the client states."The sun is shining,where is my son? I lover lucy.Let play ball". The client is displaying
a. concreteness.
b. flight of ideas.
c. depersonalization.
d. use of neologisms.
(The correct answer is b, The patient is demonstrating flight of ideas. Concreteness involves interpreting another person's word literally. Depersonalization refers to feelings of strangeness concerning the environment or the self. A neologism is a word coined by a client).
8. The client's speech pattern is related primarily to
a. underlying hostilities.
b. loose ego boundaries
c. feelings to anxiety.
d. distortion in self-concept.
(The correct answer is c, The anxiety the client feels gives rise to the distorted thinking displayed in such speech patterns as flight of ideas. Loose ego boundaries ,underlying hostilities and distortion in self-concept have little,if any,relation to the thought disorder described here).
9. Which of of the following responses by the nurse will be good therapeutic for the client?;
a. "Let's talk about what you did to day instead".
b. "Hos does the sun shining relate to your son?".
c. "You are talking nonsense.Try to stay on one subject?".
d. "I can not follow you.It will help me if you'd speak a little slower".
(The correct answer is d, The nurse take responsibility for not being able to understand the client by asking the client to speak more slowly so that the nurse can follow the client's train of taught. This is least likely to arouse anxiety in the client. Although helping the client make adequate connection between events is desirable,the manner in which it is done (when the nurse asks how the sun shining relates to her son) offer a threat by requiring that the client analyze thoughts and describe why they occur. Changing the subject by suggesting that the client talk about what she did yesterday is not helpful and does not focus to the client's needs. Reprimanding the client by indicating that she is talking nonsensically also is not helpful for the client in this situation).
10. The client is intrusive and disruptive to others clients. He constantly walks about the unit interrupting others. Which plan should the nurse institute the first in this situation?;
a. Escort the client to his room and explain that he cannot came out until he gets permission.
b. Set limits on the client behavior. Explain what is expected and what the consequences will be if limits are violated.
c. Ask another staff member to take the client to watch television for the next hour.
d. Bargain with the client. Explain which privileges he can attain if he can control his behavior.
(The correct answer is b,Setting limits of behavior and explaining consequences if the limits are violated informer the client about which behaviors are unacceptable and sets limit on manipulative behavior. The client becomes aware of what is expected and what will happen if he not responsible to his own behavior. Taking the client to his room and telling him that he can came out when permitted does not teach him what behavior is acceptable,give him the opportunity to accept responsibility for himself or clearly define the consequence of the inability to control himself. Asking a staff member to take him to watch television is not appropriate because in addition to the above,the client most likely cannot sit for an hour and television may be too stimulating. The nurse should never bargain,argue or reason with this type of client. Rather the nurse states what the limits are,what is expected and what will occur if limits are not observed).
11. Which activity will be most therapeutic for channeling the client's hyperactive behavior?,allowing the client to
a. lead some group activities.
b. clean his room and day room.
c. read to patients who are depressed.
d. exercise and move about as much as possible.
(The correct answer is b, Channeling activities through constructive task,such as cleaning,allow the client to express aggressive behavior. During periods of client of hyperactivity,it is generally advisable not to involve the client in activities with other clients because the technique tends to be non therapeutic. Allowing the hyperactive client exercise and move about as much as possible is likely to lead to exhaustion).
12. Which of the following feeling states is reflected by the client's behavior during a manic episode?
a. Guilt.
b. Anger.
c. Mistrust.
d. Hostility.
(The correct answer is d, during a manic phase the client is un likely to show evidence of feelings of guilt,anger or mistrust. Hostility is a more characteristic feeling).
13. The client sometimes make inappropriate request,for example,he call an office supply store to order many items and charges them to his account,which of the following nursing interventions would be best in this situation?
a. Tell the client that the request will be filled.
b. Explain to the client that his request is denied.
c. Suggest to the client that part of his request can be met.
d. Call the store cancel the request with out telling the client.
(The correct answer is b, Here, the nurse has a responsibility to deny the client's request because it is inappropriate and financially irresponsible. Limit setting is also an important part of working with client,especially those in a hyperactive phase of their illness).
14. The nurse evaluate the client's condition daily. During the client period of euphoria the nurse should especially alert for which condition?;
a. Gastritis and vertigo.
b. Exhaustion and infection.
c. Convulsions and dermatitis.
d. Bradycardia and palpitations.
(The correct answer is b, The client should be observed for physical exhaustion,which predisposes to infection when a hyperactive client experiences euphoria and becomes overacting. The client has been taking lithium carbonate (Lithane) for hyperactivity as prescribed by his physician. While the client is taking the drug,the nurse should ensure that he has an adequate intake of
a. sodium.
b. iron.
c. iodine.
d. calcium.
(The correct answer is a, Sodium is necessary for renal excretion of lithium carbonate (Lithane). A low sodium intake results in retention of lithium and eventual lithium toxicity).
16. Which of the following clinical manifestations would alert the nurse to lithium toxicity?;
a. Increasingly agitated behavior.
b. Markedly increased food intake.
c. Sudden increase in blood pressure.
d. Anorexia with nausea and vomiting.
(The correct answer is d, Clinical manifestations of lithium toxicity include anorexia,nausea and vomiting,diarrhea,coarse hand tremors,twitching,lethargy,decreased urine output,decreased blood pressure and impaired consciousness).
17. After 10 days of Lithium therapy,the client's lithium level is 1 mEq/L. The nurse knows that this value indicates which of the following?
a. A laboratory error.
b. An anticipated therapeutic blood level of the drug.
c. An atypical client response to the drug.
d. A toxic level.
(The correct answer is b, The therapeutic blood level rang for lithium is between 0.6-1.4 mEq/L for adult. A level of 1.0 mEq/L can be anticipated after 10 days of treatment).
18. The client expresses the belief that he was born out of wedlock to a famous woman. When dealing with this delusion of grandeur,the nurse should first try to.
a. get the client discuss another topic.
b. involve the client in a simple group project.
c. convince the client that he is wrong in his belief.
d. satisfy the client's implied need to feel important.
(The correct answer is d, When the client has delusions of grandeur, its not helpful to change the topic of discussion, involve him in a group project or try to convince him that his thoughts are erroneous. It is far better to try to satisfy him implied need to feel important because this recognizes the cause of the behavior and helps make him feel important).
A Client is irritable and hostile. He becomes agitated and verbally lashes out when his personal needs are not immediately met by the staff.
19. When the client's request for a pass is refused by the physician,he utters a stream of profanities. Which of the following statements best describes the client's behavior? The client's anger is usually
a. not intended personally.
b. a reliable sign of serious pathology.
c. an intended attack on the physician's skill.
d. a sign that his condition is improving.
(The correct answer is a, Staff members sometimes are the recipients of a client's angry behavior because they are safe targets and a re available for attack. The display of anger is rarely intended to be personal. Nor is such behavior necessarily a sign of serious pathology, and attack on a physician's skill or a sign that the client's condition is improving).
20. A Goal of the client's treatment plan is to reduce his activity and aggression. Which of the following comments by the nurse when the client's anger escalates would best help him move to ward his treatment goal?;
a. "You must go to your room or into seclusion now"
b. "You are disturbing others client,if you don't stop you will need to go into seclusion"
c. "You have a choice to go to your room voluntary or being escorted to your room".
d. "Your behavior is disturbing the unit. Let's find a quiet place and talk about what is happening"
(The correct answer is c, Whenever possible,the client should first be given choose when action must be taken because of behavior. In this situation,this is best accomplished by telling the client that he has choose of going to his room voluntarily or being escorted to his room. The client's room should be used first;if this does not help the seclusion may be indicated. Because the client's anger is increasing,the situation is beyond discussion)
21. After two weeks of hospitalization,the client has improved with medication and therapy. Which statement made by the client indicates therapeutic gain and readiness for discharge?;
a. "I am cured now and wont't need my medicine when I go home".
b. "I know that I am getting sick when I get very angry".
c. "My medicine really help me. I will be ready to go back in a few weeks".
d. "I'like feeling high from my illness. It help me feel greats and gives me a lot of energy".
(The correct answer is c, The client's statements reflecting cure and not needing medication are unrealistic and inaugurate. The presence of anger does not indicate of illness. The feeling of anger is normal.Enjoyment of the state that mania produces implies that the client may not take his medication.It also implies that he does not understand the personal,family,medical and social problems that the ,manic phase entails).
22. The client's wife ask the nurse what she can do to help her husband at home. Which of the following actions by family members on behalf of the client would probably be least helpful?;
a. Try to keep the client free from worry and anxiety.
b. Relieve the client of some home responsibilities he had.
c. Develop effective communication techniques with the client at home.
d. Learn to recognize when the client is showing signs of drug toxicity.
(The correct answer is a, For the client going home,it is best to suggest that he be relieved of some home responsibilities,that better communication be developed and that family members learn to recognize sign of toxicity while the client is on drug therapy. It is unrealistic and impractical to attempt to eliminate worry and anxiety from a client's environment).
23.The client's illness is most likely related to which of the following factors?;
a. Having been molested as a preschool-age child.
b. A family history of mood disorders.
c. High level of potassium in the brain.
d. Excessive alcohol intake.
(The correct answer is b, A family history of mood disorders is commonly present. Histories of child molestation, high potassium levels in the brain and drinking alcohol have not been found to be of etiologic significance fir this illness).
The Client with bipolar disorder meets with the nurse at the community mental health center for follow up care.
24. The client has been taking valproic (Depakene),500 mg tid for one month. The serum blood level is 60 uq/ml. The client states that her stomach feels upset after she takes the medication. Which of the following statements by the nurse would be most helpful?;
a. "We will adjust the dose of your medication"
b. "Chew the tablet before swallowing it".
c. "Take the valproic acid with meals or food".
d. "We will have you take your medication all at one time".
(The correct answer is c, Valproic Acid can be taken with food or at meal time to minimize gastrointestinal upset. The client's dosage of medication is appropriate and the serum level is therapeutic between 50 and 100 uq/ml. The tablet should not be chewed because of the possibility of mouth and throat irritation. Valproic acid is given in two to four doses daily because of its short half-life (6-16 hours,peaking in less than 4 hours)
25. The client states her husband told her she must be a weak person because she cannot control her behavior and has to rely on pills to control her. Which of the following statements by the nurse would be most appropriate?;
a. "Bipolar disorder is biochemical disorder that necessitates medication like Depakene to help control the symptoms and keep your mood stable".
b. "Bipolar disorder is more prevalent in certain personality types".
c. "Relying on pills temporarily is necessary to help your control your illness".
d. "Your husband may be correct because stronger people are better able to control their symptoms"
(The correct answer is a, Bipolar disorder is biochemical in nature and can be treated effectively with lithium,tegretol or valproic acid. The client cannot voluntarily control her symptoms o the illness and the disorder does not affect one type of personality over another. The client is not to be blamed or her responsible for her illness. Telling the client to rely on pills temporarily is inaccurate and not helpful because the nurse cannot predict the length of time the client will need medication).
26. The nurse would judge client education regarding valproic acid (Depakene) as effective if the client states
a. "I can stop the Depakene because the serum level is normal".
b. "I can take the depakene only when I feel I need It".
c. "Depakene is safe to use when I get Pregnant"
d. "I might need to take the Depakene for a long time"
(The correct answer is d, Becasue bipolar disorder is a biochemical disorder, the client needs to know that she may need medication for length of time. Stopping the depakene may cause a return of symptoms and taking the depakene on an as needed basis may be harmfull because of toxicity or may be inadequate to manage symptoms and to balance brain neurotransmitters. It is not safe to taker when pregnant because of risk to the fetus. The client should inform the nurse and physician if she thinks she might be pregnant)
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