Ch 15 part 3

harojiva's version from 2015-10-07 01:50


29. A new client with mania is admitted to the unit. This client is loud and disruptive of the ward milieu. The nursing staff remain calm and patient. During arts and crafts activities, when this clientÕs attempts to run the group are ignored, the client begins to curse at the leader. The BEST nursing intervention is to:


a. encourage the group to accept peer leadership
b. ignore the bad language and remain calm
c. escort this client to a quiet private room
d. give this client a more important task


When a client becomes disruptive during a group meeting, the best nursing intervention is to escort the client to a quiet private room. The client may need to be in an environment with less stimulation. The nurse would stay with the client to discuss the clientÕs feelings at the time. This would help facilitate the nurse-client relationship and indicate nursing presence.


PTS: 1 DIF: Analysis REF: The Ward Milieu and the Manic Client


30. Which therapy would MOST likely lead to better outcomes for a client who has bipolar disorder?


a. psychotherapy alone
b. psychoanalysis combined with antimanic medication
c. antimanic medication and group therapy
d. medication alone


Better outcomes for clients with bipolar disorder result from the administration of antimanic medications along with group therapy. The medications will address symptoms related to the disorder, including: irritability, delusions, hallucinations, and so on. Group therapy will provide the client with an opportunity to develop socialization skills and improve interpersonal relationships.


PTS: 1 DIF: Application REF: Planning/Interventions


31. Although rarely used, which of the following treatments has been found effective in the treatment of mania?


a. cognitive therapy
b. electroconvulsive shock therapy
c. seclusion and restraint
d. monoamine oxidase (MAO) inhibitors


Although rarely used, electroconvulsive therapy is effective in treating mania. It may have a role in situations where lithium is contraindicated, particularly during early pregnancy. Some evidence supports the usefulness of calcium channel blockers in mania unresponsive to either lithium or anticonvulsants.


PTS: 1 DIF: Comprehension
REF: Treatment and Clinical Management| Other Treatments


32. A new client asks about the use of low-field magnetic stimulation of the brain. The advanced practice nurse would correctly answer that preliminary data suggests some evidence that this newer nonpharmacological treatment may:


a. worsen manic symptoms
b. reduce the frequency of cycling
c. not be an effective treatment
d. improve depressive symptoms


There has been recent interest in the use of low-field magnetic stimulation of the brain in the management of affective condition, including bipolar disorder. Preliminary data suggest some evidence of improvement in depressive symptoms.


PTS: 1 DIF: Application
REF: Treatment and Clinical Management| Other Treatments


33. A 26-year-old female client diagnosed with bipolar disorder delivers her first child. The nurseÕs assessment is guided by the knowledge that epidemiological data suggests:


a. a strong link between bipolar disorder and postpartum psychosis
b. postpartum hormonal changes help improve the symptoms of bipolar disorder
c. bipolar disorder symptoms resume after delivery at the same level as prepregnancy
d. no discernible pattern relating postpartum depression with preexisting bipolar disorder


Epidemiological data suggests that there is a strong link between bipolar disorder and postpartum psychosis. Women with depression occurring either before pregnancy or during gestation must be followed closely during and after pregnancy to anticipate the potential for postpartum depression or psychosis. Research suggests that the decrease in estrogen levels combined with sleep disturbances place the woman at risk for postpartum psychosis.


PTS: 1 DIF: Application REF: Nursing Care| Women and Bipolar Disorder


34. Which of the following nursing approaches to the client with mania is consistent with Rosemarie ParseÕs theory of human becoming?


a. being present for the client, offering unconditional support
b. directing the clientÕs increased energy to productive outlets
c. creating a structured environment to reduce stress
d. establishing regular rest periods for the client


According to ParseÕs theory of human becoming, being present for the client and offering unconditional support would be the best approach to the client with mania. The nurse seeks to understand the clientÕs interpretation of his or her lived experiences. Nursing interventions begin with being fully present for the person and making no demands. Next, in the context of caring and support, the nurse would tease out multiple complex realities of the clientÕs experiences so that the nurseÕs understanding of the clientÕs world can guide nursing interventions.


PTS: 1 DIF: Application REF: Nursing Theory| Theory of Human Becoming


35. You are the nurse working with a newly admitted client who is experiencing mania. This client has had several days of increased energy and constant activity. Because patient agency is limited for this client, which of the following nursing interventions would be suggested by Dorothea OremÕs self-care deficit theory of nursing?


a. Encourage the clientÕs idea of setting up a volleyball game.
b. Schedule brief, quiet one-on-one time and quiet time alone.
c. Do nothing, as the clientÕs energy will decrease.
d. Include this client in group therapy.


Using OremÕs self-care deficit theory of nursing, the nurse would recognize that a client experiencing mania would have limited patient agency. Limited patient agency would be a direct consequence of the amount of energy the client had exerted over the past several days. When experiencing mania the client most likely does not address nutritional needs or needs related to safety. The most appropriate nursing intervention would be to schedule brief one-to-one sessions and quiet time alone. If the client continued the current pace, exhaustion would occur. It is the nurseÕs role to assist the client with meeting basic needs as identified by Maslow.


PTS: 1 DIF: Application REF: Nursing Theory| Self-Care Deficit Theory


36. The advanced practice nurse is working with a young adult who is having her first manic episode and is newly diagnosed with bipolar I disorder. The advanced practice nurse meets with the clientÕs family to discuss the diagnosis and to provide support. The nurse understands that the MOST important information that families need to know early is about:


a. the disease and what to expect
b. the threat of genetically passing on the disease
c. what caused the manic episode
d. their own risk of getting the disease


The most important information for the advanced practice nurse to supply the family is information about the disease and what to expect. Because individuals with mania may rapidly cycle into depression, the risk of self-injury and suicide must be discussed with the family. In this situation the nurseÕs role is one of both support and listening as well as one of educating.


PTS: 1 DIF: Application REF: Support for the client's family


37. A client is admitted with a diagnosis of bipolar disorder. This client is dressed in a flowing purple robe. The nurse who conducts the admission interview asks this client if he believes that he has extraordinary abilities or powers. The nurse is assessing for which of the following symptoms?


a. delusions of persecution
b. ideas of reference
c. grandiosity and inflated self-esteem
d. flight of ideas


The nurse would assess for symptoms of grandiosity and inflated self-esteem. The clientÕs appearance in a flowing purple robe is an example of the bizarre dress of clients who are in a manic state. Also, by asking the client if he believes he has extraordinary powers and abilities would be a method to determine the clientÕs level of self-esteem. The nurse would recognize that delusions of grandeur are often identified in clients with psychotic disorders such as bipolar disorder.


PTS: 1 DIF: Application REF: The Ward Milieu and the Manic Client


38. The nurse is assessing a newly admitted client with a diagnosis of bipolar disorder I. Which of the following questions is appropriately worded?


a. ÒHow much sex have you had recently?Ó
b. ÒDo you have delusions?Ó
c. ÒDo you feel exhausted?Ó
d. ÒHave you spent more money than usual recently?Ó


The most appropriate question for the nurse to ask would focus on whether the client feels exhausted. Assessment for a newly hospitalized client should include the current status of the client. Determining if the client is exhausted provides the nurse with information on whether the clientÕs basic needs have been met. Clients with a diagnosis of bipolar disorder I may experience symptoms of depression such as little appetite or difficulties with getting adequate, restful sleep. A client with mania would be exhausted because of his or her constant activity, which would interfere with taking the time to eat or sleep.


PTS: 1 DIF: Application REF: The Ward Milieu and the Manic Client


39. You are working with a client who recently underwent a hysterectomy. She has a history of bipolar disorder. When she arrives at the postsurgical checkup, she is speaking more slowly, is crying, and reports that she feels depressed. Which of the following risks should be assessed at this time?


a. risk for hallucinations
b. risk for suicide
c. risk for exhaustion
d. risk for violence


The nurse would assess for risk of suicide. The nurseÕs assessment of the clientÕs slow speech, crying, and statement of feeling depressed indicates to the nurse that the client might in fact be depressed. Given the history of bipolar disorder, compounded by a recent major surgery, the nurse would recognize that the client is at risk for suicide.


PTS: 1 DIF: Analysis REF: Assessment


40. Which of the following is the MOST important outcome for the client in the extremely manic phase of the illness? The client will:


a. remain safe and physically supported
b. establish socially acceptable boundaries with others
c. recognize behaviors that place her at risk for mania
d. identify the need to remain on prescribed medications


The most important outcome for a client in the extremely manic phase would be that the client remain safe and physically supported. This outcome is most important because a client in a manic state may participate in activities that could be harmful to him- or herself or others. Also, the excitation of a manic state would interfere with the client taking time to address other basic needs such as the need for food and water. Ultimately, nursing interventions would be directed at addressing these problems.


PTS: 1 DIF: Analysis REF: Outcome Identification


41. A 33-year-old computer salesman was admitted to the hospital for hypomanic behavior. His wife states that he has always been aggressive and Òcan sell ice to people in Alaska.Ó He has many interests and has had two promotions in the last year. For the past 2 weeks, he has worked night and day on a plan he believes will enable him to buy out most of the computer software companies. He is restless and talks constantly. Which of the following nursing interventions would have the highest priority in this clientÕs immediate care?


a. Discuss the reality of his business plans with him.
b. Encourage problem solving and responsible behavior.
c. Help him gain insight into feelings of low self-esteem.
d. Provide a structured, nonstimulating environment.


The priority nursing intervention for this client would be to provide a structured, nonstimulating environment. The environment should be free of objects that could be used to harm him- or herself or others and free of extraneous noise or stimulation. All verbal communication from the nurse should be short, concise, and clear. The client must be assisted with developing a slower pace than the one he has been experiencing over the past 2 weeks.


PTS: 1 DIF: Analysis REF: Planning/Interventions


42. Which of the following strategies would the nurse plan for a client who has been in the manic state for days and is unable to sit still long enough to eat meals?


a. Ask about favorite foods and order them.
b. Order finger foods that can be eaten while walking.
c. Ask relatives to bring in some favorite foods.
d. Have the health care provider order intravenous supplements.


The nursing strategy for a client in a manic state who is unable to sit still long enough to eat meals would be to provide finger foods that can be eaten while walking. Finger foods such as fruits and finger sandwiches can be eaten while the client is walking. They will provide the nourishment needed by this client and reduce the possibility of poor nutrition. Intravenous supplements would only be used in extreme cases of malnutrition.


PTS: 1 DIF: Application REF: Planning/Interventions


43. You are working with a client who is in the manic phase and having difficulty sleeping, with only 0 to 2 hours of sleep recorded by the night shift nurse. Which of the following would you write as a nursing diagnosis using North American Nursing Diagnosis Association (NANDA) classifications?


a. difficulty sleeping, manic related, evidenced by complaint of problems sleeping
b. loss of sleep, sensory related, evidenced by staying up most of the night according to staff
c. sleep pattern disturbance, related to sensory alterations, evidenced by sleep record (0 to 2 hours per night)
d. sensory overload, biochemically related, evidenced by lack of sleep


The most appropriate NANDA classification would be, ÒSleep pattern disturbance, related to sensory alterations, evidenced by sleep record (0 to 2 hours per night).Ó This particular diagnosis contains all three parts needed for a NANDA diagnosis. The parts include the problem, what the problem is related to, and how the problem is demonstrated. The other three options would not be correct for this client, according to NANDA.


PTS: 1 DIF: Application REF: Nursing Diagnosis