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15 part 2

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harojiva's version from 2015-10-07 01:48

Section

15. Tobacco abuse among persons with bipolar disorder is:

 

a. relatively rare compared to other psychiatric disorders
b. contraindicated when taking antimanic medications
c. extremely common but not frequently addressed by psychiatric caregivers
d. of minor concern to the psychiatric caregiver

 

ANS: C
Tobacco abuse is extremely common among persons with bipolar disorder and is among the most dangerous associations, leading to loss of life and increased morbidity. There are only limited data on the frequency with which persons with bipolar disorder are offered smoking cessation counseling and treatment. In a study of psychiatric practice using the National Ambulatory Medical Care Survey, Himelhoch and Daumit (2003) report that clients with bipolar disorder were more likely to receive smoking-related counseling than were those with some other disorders.

 

PTS: 1 DIF: Comprehension
REF: Associated Disorders/Dual Diagnoses| Substance Abuse

 

16. You are working with elderly clients. One of your clients begins to have an elevated mood and some symptoms associated with mania. This client has no history of manic episodes or bipolar disorder. You know that which of the following is a common cause of mania in the elderly who have NO history of mood disorders?

 

a. missed medication
b. polypharmacy
c. failure to eat
d. eating certain foods

 

ANS: B
The elderly are particularly sensitive to drug effects and may develop either mania or delirium in response to single drugs or to polypharmacy (the administration of multiple drugs, often for multiple medical indications). The nurse would know to determine other medications that the client has received.

 

PTS: 1 DIF: Application REF: Etiology| Other Causes| Drugs

 

17. Which of the following life stressors has been associated with episodes of manic symptoms?

 

a. loss
b. winter season
c. allergies
d. sleep deprivation

 

ANS: D
Sleep deprivation may sometimes trigger mania. In some persons, symptoms seem to respond to restorative sleep.

 

PTS: 1 DIF: Comprehension REF: Clinical Course| Life Stress

 

18. If a client has a dual diagnosis of schizoaffective disorder, bipolar type, he would likely display which of the following symptoms?

 

a. prolonged delusions or hallucinations when his mood disorder is in the actively manic phase
b. delusions or hallucinations during the depressed phase of bipolar disorder
c. prolonged delusions or hallucinations when his mood disorder is in remission
d. illusions and social phobias during his manic or depressed phase

 

ANS: C
An individual with a dual diagnosis of schizoaffective disorder bipolar type would display prolonged delusions, hallucinations, or both. These delusions or hallucinations typically occur at times when their mood disorders (either mania, depression, or both) are in remission.

 

PTS: 1 DIF: Comprehension
REF: Associated Disorders/Dual Diagnoses| Schizoaffective Disorder

 

19. In assessing a client with a diagnosis of borderline personality disorder, who is admitted for Òfeeling down and suicidal,Ó the nurse finds a history of bipolar symptoms. The nurse knows it is important to report these findings to the health care provider, because if this client has undiagnosed bipolar II disorder and the provider prescribes an antidepressant medication, the client may experience which of the following?

 

a. prolonged depression
b. a manic episode
c. increased suicidal ideation
d. increase in borderline symptoms

 

ANS: B
Recognizing subtle bipolar features is important in assessment of borderline personality. If bipolar II is present and not diagnosed, a manic attack may occasionally result from administering antidepressant medication to one who is bipolar but thought to be borderline, though the risk in bipolar II disorder is likely lower than in bipolar I.

 

PTS: 1 DIF: Analysis
REF: Associated Disorders/Dual Diagnoses| Borderline Personality

 

20. Because there have been many well-known artists, poets, and writers who suffered from manic-depressive illness, the manic state has been associated with creativity. Which of the following manic symptoms will MOST likely lead to increased productivity?

 

a. increased risk-taking
b. hallucinations
c. increased libido
d. delusions

 

ANS: A
Perhaps the willingness to take risks seen in mania has a counterpart in productive creative work. For the artist, poet, and writer, risk taking may lead to unanticipated accomplishment.

 

PTS: 1 DIF: Comprehension
REF: Bipolar Disorder and Creativity| Madness

 

21. The effectiveness of atypical neuroleptics such as olanzapine in the management of acute mania:

 

a. has never been conclusively demonstrated in controlled trials
b. is based primarily on anecdotal evidence
c. is disputed by most creditable psychopharmacology researchers
d. has been clearly shown through a series of randomized controlled trials

 

ANS: D
Randomized control trials have demonstrated the effectiveness of neuroleptic medication in the management of acute mania. One such drug is olanzapine.

 

PTS: 1 DIF: Comprehension
REF: Treatment and Clinical Management| Pharmacological Treatment

 

22. Which of the following medications has a direct mood-stabilizing effect for the acute phase of mania within 24 to 72 hours after the first dose?

 

a. lithium carbonate (Eskalith)
b. haloperidol (Haldol)
c. valproic acid (Depakene)
d. clonazepam (Klonopin)

 

ANS: C
Valproic acid (divalproex) has a direct mood-stabilizing effect, and it may begin to work within 24 to 72 hours. Consequently, it is sometimes administered as part of the initial pharmacological treatment of acute mania or may sometimes be used alone.

 

PTS: 1 DIF: Comprehension
REF: Treatment and Clinical Management| Pharmacological Treatment

 

23. You are working with a client who has a diagnosis of bipolar disorder and is taking lithium. Your client is in a manic phase and is not eating or drinking much water. You are concerned when the client develops a fever of 101 degrees, seems confused, and has a blood pressure of 100/64 (baseline 132/84). It is time for the client to receive her next dose of lithium. The client has a prn order for Tylenol gr 650 for fever above 100 degrees Fahrenheit. You would do which of the following?

 

a. Give the lithium and Tylenol, and force fluids.
b. Hold the lithium, and give the Tylenol.
c. Hold the lithium, and call the provider immediately.
d. Report findings to the provider when he or she makes rounds.

 

ANS: C
Even though the client has an order for Tylenol, if temperature is above 100 degrees, the nurse should hold this clientÕs lithium and call the provider immediately. Other data, such as the drop in B/P and confusion, suggests that the client may be experiencing lithium toxicity.

 

PTS: 1 DIF: Analysis
REF: Treatment and Clinical Management| Pharmacological Treatment| Lithium

 

24. Which of the following groups of organs is MOST important to evaluate for potential adverse effects when a client is taking lithium?

 

a. heart, liver, and thyroid
b. stomach, lungs, and kidneys
c. skin, nervous system, and pancreas
d. kidneys, thyroid, and nervous system

 

ANS: D
The three organs to evaluate for potential adverse effects are the thyroid gland, kidneys, and nervous system. The thyroid gland should be evaluated for possible hypothyroidism, which occurs in 5% to 35% of cases. The kidneys should be evaluated since lithium decreases renal concentrating ability. In addition the nervous system should be evaluated because tremor and decreased motor coordination occur in some individuals.

 

PTS: 1 DIF: Comprehension
REF: Treatment and Clinical Management| Pharmacological Treatment| Lithium

 

25. Which of the following is important for the nurse to know when administering carbamazepine (Tegretol)?

 

a. cannot safely be combined with lithium
b. is contraindicated for anyone who is sensitive to tricyclic antidepressants
c. has indications for acute and maintenance use that differ from those of lithium
d. is not given until after a lithium trial

 

ANS: B
The nurse should be aware that carbamazepine (Tegretol) is related to tricyclic antidepressants, so persons sensitive to these drugs should not use carbamazepine. Periodic blood testing and serum levels are required for safe and effective use.

 

PTS: 1 DIF: Application
REF: Treatment and Clinical Management| Pharmacological Treatment| Lithium

 

26. In comparison with lithium, carbamazepine, and divalproex, atypical antipsychotics:

 

a. may have some safety advantages
b. are not appropriate for use in the treatment of bipolar disorder
c. seem to be less effective in the treatment of bipolar disorder
d. do not appear to work when used by themselves (ÒmonotherapyÓ)

 

ANS: A
Newer neuroleptics, the second-generation antipsychotics such as olanzapine, clozapine, quetiapine, risperidone, and ziprasidone do appear to have usefulness in chronic management of bipolar disorder and may have some safety advantages over lithium, carbamazepine, and divalproex. These drugs may be used by themselves (ÒmonotherapyÓ) or may be combined with other agents to increase effectiveness. These medications are associated with significant weight gain and may increase risk for cardiovascular disease unless careful attention is paid to both weight and the consequences of metabolic syndrome (blood pressure, cholesterol and other lipids, blood sugar).

 

PTS: 1 DIF: Comprehension
REF: Treatment and Clinical Management| Pharmacological Treatment| Antipsychotics

 

27. In the treatment of depression associated with bipolar disorder, newer antidepressants such as selective serotonin reuptake inhibitors (SSRIs):

 

a. tend to cause a paradoxical deepening of depression
b. improve the effectiveness of treatment
c. are recommended only to supplement lithium to control depression
d. prevent the development of mania or rapid cycling

 

ANS: C
Antidepressants such as SSRIs are only advised as one of several options that can be used when depressive symptoms make it necessary to supplement lithium. Mood stabilizers are the primary approach to treatment of bipolar disorder.

 

PTS: 1 DIF: Comprehension
REF: Treatment and Clinical Management| Pharmacological Treatment| Antidepressants and Bipolar Disorder

 

28. Divalproex (valproic acid) is associated with significant weight gain and:

 

a. lowered seizure threshold
b. polycystic ovarian syndrome in women
c. development of anorexia nervosa
d. priapism in men

 

ANS: B
Divalproex (valproic acid) is associated with significant weight gain. It may also be associated with polycystic ovarian syndrome in women. This is a relatively common condition nearly always associated with obesity.