1. The nurse observes that a client with bipolar disorder is pacing in the hall, talking loudly and

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1. The nurse observes that a client with bipolar disorder is pacing in the hall, talking loudly and rapidly, and using elaborate hand gestures. The nurse concludes that the client is demonstrating which?




d.Psychomotor agitation


2.A client with bipolar disorder begins taking lithium carbonate (lithium) 300 mg four times a day. After 3 days of therapy, the client says, “My hands are shaking.” Which is the best response by the nurse?

a.”Fine motor tremors are an early effect of lithium therapy that usually subsides in a few weeks.”

b.”It is nothing to worry about unless it continues for the next month.”

c.”Tremors can be an early sign of toxicity, but we’ll keep monitoring your lithium level to make sure you’re OK.”

d.”You can expect tremors with lithium. You seem very concerned about such a small tremor.”


3.What are the most common types of side effects from SSRIs?

a.Dizziness, drowsiness, and dry mouth

b.Convulsions and respiratory difficulties

c.Diarrhea and weight gain

d.Jaundice and agranulocytosis


4.The nurse observes that a client with depression sat at a table with two other clients during lunch. Which is the best feedback the nurse could give the client?

a.”Do you feel better after talking with others during lunch?”

b.”I’m so happy to see you interacting with other clients.”

c.”I see you were sitting with others at lunch today.”

d.”You must feel much better than you were a few days ago.”

5.Which term typifies the speech of a person in the acute phase of mania?

a.Flight of ideas

b.Psychomotor retardation




6.What is the rationale for a person taking lithium to have enough water and salt in his or her diet?

a.Salt and water are necessary to dilute lithium to avoid toxicity.

b.Water and salt convert lithium into a usable solute.

c.Lithium is metabolized in the liver, necessitating increased water and salt.

d.Lithium is a salt that has greater affinity for receptor sites than sodium chloride.



7.Identify the serum lithium level for maintenance and safety.

a.0.1 to 1 mEq/L

b.0.5 to 1.5 mEq/L

c.10 to 50 mEq/L

d.50 to 100 mEq/L


8.A client says to the nurse, “You are the best nurse I’ve ever met. I want you to remember me.” What is an appropriate response by the nurse?

a.”Thank you. I think you are special too.”

b.”I suspect you want something from me. What is it?”

c.”You probably say that to all your nurses.”

d.”Are you thinking of suicide?”


9.A client with mania begins dancing around the day room. When she twirled her skirt in front of the male clients, it was obvious she had no underwear on. The nurse distracts her and takes her to her room to put on underwear. The nurse acted as she did to


a.minimize the client’s embarrassment about her present behavior.

b.keep her from dancing with other clients.

c.avoid embarrassing the male clients who are watching.

d.teach her about proper attire and hygiene.




Select all that apply.

1.Which actions would indicate an increased suicidal risk?

a.An abrupt improvement in mood

b.Calling family members to make amends

c.Crying when discussing sadness

d.Feeling overwhelmed by simple daily tasks

e.Statements such as “I’m such a burden for everyone”

f.Statements such as “Everything will be better soon”


2.Which activities would be appropriate for a client with mania?

a.Drawing a picture

b.Modeling clay

c.Playing bingo

d.Playing table tennis

e.Stretching exercises

f.Stringing beads




June, 46 years old, is divorced with three children, 10, 13, and 16 years of age. She works in the county clerk’s office and has called in sick four times in the past 2 weeks. June has lost 17 pounds in the past 2 months, is spending a lot of time in bed, but still feels exhausted “all the time.” During the admission interview, June looks overwhelmingly sad, is tearful, has her head down, and makes little eye contact. She answers the nurse’s questions with one or two words. The nurse considers postponing the remainder of the interview because June seems unable to provide much information.


1.What assessment data are crucial for the nurse to obtain before ending the interview?


2.Identify three nursing diagnoses on the basis of the available data.


3.Identify a short-term outcome for each of the nursing diagnoses.


4.Discuss nursing interventions that would be helpful for June.


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