CH 15

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


1. The client who is experiencing an elevated, expansive, or irritable mood is said to be experiencing ____________________.


ANS: mania


PTS: 1


2. The combination of symptoms of mania and depression in the same client is referred to as ____________________.


ANS: bipolar disorder


PTS: 1


3. Most manic episodes present before the age of ____________________.




PTS: 1


4. Among findings from different studies, the percentage of persons with manic-depressive disorder who are said to abuse alcohol is ____________________%.




PTS: 1


5. An inflated appraisal of oneÕs worth, knowledge, power, or importance, often including delusional thinking, is termed ____________________.


ANS: grandiosity


PTS: 1




1. A client with manic behavior was admitted to the unit this morning. The client is pacing the floor and has pressured speech showing flight of ideas. This client has a delusion that she has been canonized as a saint and is openly angry at all the ÒsinnersÓ on the ward. The nurse assesses this client as high risk for assaulting behavior. Which of the following stages of mania represents this clientÕs current state?


a. stage I
b. stage II
c. stage III
d. stage IV


The client is in stage II of mania. Cognitive aspects of this stage consist of flight of ideas and delusions that the client is exhibiting. Her speech is pressured and she is a risk for assaulting behavior, which are also characteristics of this stage.


PTS: 1 DIF: Analysis REF: Table 15-1 Stages of Mania


2. As mania progresses and persists over time, it becomes more:


a. ego-dystonic
b. pleasurable
c. ego-syntonic
d. creative


As mania persists and progresses, it takes on more frightening, or ego-dystonic, aspects. Individuals who demonstrate ego-dystonic behavior have thoughts, compulsions, and dreams that are in conflict with their own ego or own self-perspective.


PTS: 1 DIF: Comprehension REF: Competencies| Mania


3. The diagnosis of hypomania in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), has the same seven criteria as mania, except only three of the symptoms must be present and the hypomania must last at least:


a. 1 day
b. 4 days
c. 1 week
d. 1 month


The defining characteristics of hypomania include the same seven criteria for mania, but to diagnose hypomania, only three symptoms need to be present. These three symptoms need only to have lasted 4 days. In contrast to mania, hypomanic symptoms need not cause any disturbances in functioning but must be observable by others.


PTS: 1 DIF: Comprehension
REF: Manic Behaviors| Hypomania


4. When the Òswitch processÓ occurs more than four times per year, the client is said to have a:


a. concurrent dissociative disorder
b. rapid cycling bipolar disorder
c. cyclothymic pattern
d. continuous cycling manic depression


Rapid cyclers are defined as individuals who switch from episodes of euphoria to episodes of depression. Rapid cyclers are defined as individuals who have four or more episodes in a year. Although the overall incidence of bipolar disorder does not differ much between men and women, nearly all rapid cyclers are women.


PTS: 1 DIF: Comprehension
REF: Manic Behaviors| Bipolar Disorder


5. There is some evidence that selective serotonin reuptake inhibitors (SSRIs):


a. are the type of antidepressant most likely to provoke switching
b. should be contraindicated for use with bipolar disorder
c. have a decreased risk of provoking switching
d. do not appreciably alleviate depression in bipolar disorder


There is some evidence that selective serotonin reuptake inhibitors (SSRIs) have a decreased risk of provoking switching. Switching from depression to mania may often be provoked by antidepressant medication, especially tricyclics. St. JohnÕs wort (an over-the-counter medication), which is unregulated by the Food and Drug Administration (FDA), has been reported to provoke switching in some individuals who use it to treat depressive episodes.


PTS: 1 DIF: Comprehension REF: Etiology| Molecular Basis


6. Amelia is diagnosed with bipolar disorder. During the course of treatment, she is discontinued from an antidepressant medication. The advanced practice nurse working with Amelia knows that in some individuals diagnosed with bipolar disorder, discontinuation of antidepressants may lead to:


a. complete remission of symptoms
b. suppression of cortisol
c. hypothyroidism
d. mania


Discontinuation of antidepressants may lead to mania in some individuals. Some neurophysiologists have evoked the concept of ÒkindlingÓ to explain aspects of the course of bipolar disorder, especially the switch process from depression to mania.


PTS: 1 DIF: Analysis REF: Etiology| Molecular Basis


7. The work of Joffe et al. emphasizes that studies of efficacy of treatment may need to focus on:


a. the clientÕs perception of benefit
b. the DSM-based diagnostic criteria
c. hormonal responses to medication
d. length of symptom-free periods


The work of Joffe and colleagues emphasizes that studies of the efficacy of treatment may need to focus on the clientÕs perception of benefit, not on DSM-based diagnostic criteria. Except when due to organic causes, mania almost never occurs without depression. Nearly all persons with mania have a form of bipolar disorder.


PTS: 1 DIF: Comprehension
REF: Manic Behaviors| Bipolar Disorder


8. Jerry is a very creative artist. He is known by his friends for giving wonderful parties with eccentric themes. Jerry experiences hypomanic and melancholic states from time to time. He feels no need for treatment. If Jerry did seek treatment, which of the following terms in the DSM-IV would describe JerryÕs moods?


a. bipolar I
b. major depressive disorder
c. cyclothymic pattern
d. borderline personality


If Jerry needed treatment, the DSM-IV term cyclothymic pattern would be used. DSM-IV-TR describes cyclothymic patterns in which individuals cycle between hypomanic and melancholic states but do not qualify for a diagnosis of major depressive disorder.


PTS: 1 DIF: Application REF: Manic Behaviors| Bipolar Disorder


9. The tendency for bipolar disorder to be inherited is supported, at the present time, by studies that:


a. link bipolar disorder with chromosome 13
b. show that 70% of relatives of clients with bipolar disease will have a bipolar disorder
c. examine the comorbidity of bipolar disorder among identical twins and fraternal twins
d. determine retrospectively by genogram the relatives of the client who had bipolar disorder


A very striking finding about bipolar depressive disorder is its tendency to be inherited. Some of the best data on the inheritance of manic-depressive illness come from studies of twins. If one of two identical twins is manic-depressive, the other is almost certain to develop the disease. For fraternal twins (who share much less of their genetic makeup), the risk is much lower, about 20%.


PTS: 1 DIF: Comprehension REF: Etiology| Molecular Basis


10. Support for the theory that bipolar disease is due to a biochemical abnormality of the brain is supported by brain research using which of the following techniques?


a. positron emission tomography (PET) scanning that shows metabolic activity in the brain
b. computed tomography (CT) scanning that shows brain structure and metabolic activity
c. urinalysis that shows the presence of serotonin and dopamine
d. cerebral spinal fluid analysis that shows brain serotonin transporting protein


Support for this view comes from the technique of positron emission tomography (PET) scanning. The PET scan is somewhat similar to the computed tomography (CT) scan, but instead of viewing brain structure, it detects areas of metabolic activity. While the significance of findings remains unknown, there do appear to be recognizable differences between metabolism in normal persons and in persons suffering from mania.


PTS: 1 DIF: Comprehension REF: Etiology| Molecular Basis


11. Which of the following possible causes of mania should be ruled out before a diagnosis of manic episode can be made?


a. hypochondria
b. thyroid disorders
c. depression
d. heart disease


Thyroid and other endocrine abnormalities (particularly CushingÕs disease or syndrome) can cause manic symptoms. Many neurological conditions, including brain tumors and the aftermath of brain injury from trauma or stroke, can also precipitate mania.


PTS: 1 DIF: Analysis REF: Etiology| Other Causes| Physical Disease


12. Common classes of drugs that induce mania are:


a. diuretics
b. corticosteroids
c. tranquilizers
d. analgesics


Corticosteroids is a common class of drugs that induce mania in clients of any age. Levodopa may also induce mania. Clients taking anabolic steroids may be at particular risk for mania and may not admit to steroid use even if asked. Other medications that may occasionally cause mania include baclofen, bromocriptine, captopril, chloroquine, and thyroxine.


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


13. The nurse is working with a young adult who has been diagnosed with bipolar I for the last 3 years. This client was admitted with mania after going on an alcohol and drug binge, was treated for 4 days, and is to be discharged from the unit with medication with follow-up appointment for outpatient treatment of drug abuse. The nurse is MOST concerned about predischarge assessment of the clientÕs:


a. intent to keep follow-up clinic appointment
b. intent to attend Alcoholics Anonymous group
c. risk for suicide
d. access to drugs


The risk of successful suicide in persons with mania increases in the presence of substance abuse or prior suicide attempts. Because the young man was admitted with mania and a history of alcohol and drug abuse, the nurse would be concerned about conducting a predischarge assessment to determine if the client is a suicidal risk.


PTS: 1 DIF: Analysis REF: Clinical Course| Risk for Suicide in Mania


14. When compared to the use of divalproex, treatment of bipolar disorder with lithium has been associated with:


a. decreased risk of suicide
b. worsening of rapid cycling
c. provocation of switching
d. better and quicker control of acute mania


Treatment of bipolar disorder with lithium has been associated with a decreased risk of suicide compared to the use of divalproax, another common medication. The atypical psychotic medication clozapine may also reduce suicide risk.


PTS: 1 DIF: Comprehension
REF: Clinical Course| Risk for Suicide in Mania