Bipolar Disorder (22 Questions)

1. Mme Gagnon, 28 years old, is admitted for an acute manic episode of Bipolar I Disorder. She is hyperactive, pacing the hallway continuously, talking rapidly (pressured speech), and has lost 3 kg in the last 4 days because she "doesn't have time to sit."
Medical Order: Diet as tolerated. Valproic Acid (Depakote) 250 mg PO TID.

Question: Which nursing intervention is best suited to meet her nutritional needs during this acute phase? *
2. M. Tremblay, 45 years old, has been taking Lithium Carbonate 300 mg PO TID for 2 years. He comes to the clinic complaining of severe diarrhea, vomiting, and you notice his hands have a coarse, jerky tremor. He appears unsteady on his feet (ataxia).
Recent History: He had the flu last week and was dehydrated.

Question:
What is your interpretation of these symptoms and the priority action? *
3. M. Roy, admitted for mania, is dressed in flamboyant clothing and is interrupting a group therapy session. He is making sexually inappropriate comments to a shy, depressed female patient, causing her visible distress.

Question:
What is the appropriate nursing intervention? *
4. Mme Lefebvre is in a manic phase. She has not slept for three nights. She spends the night organizing the books in the common room and doing push-ups. She appears energetic but her eyes are bloodshot.
Medical Order: Quetiapine (Seroquel) 50 mg PO HS.

Question:
Why is addressing the sleep deficit a medical priority in this patient? *
5. M. Dubé, 30 years old, was recently diagnosed with Bipolar II Disorder. The physician prescribes Lamotrigine (Lamictal) 25 mg PO daily. You are providing discharge teaching.

Question:
Which specific symptom must M. Dubé report to the emergency department immediately? *
6. Mme Cloutier has Bipolar I Disorder. She was hospitalized 2 weeks ago for severe mania. Now, her energy has crashed, she refuses to get out of bed, and she states, "I ruined my family's finances when I was high. I am better off dead."

Question:
Why is this specific transition period (from mania to depression) considered high risk for suicide? *
7. M. Fortin approaches the nursing station demanding to use the phone. He states, "I need to call the Prime Minister. I have the solution to the national debt, and he is waiting for my call. I am his chief advisor."

Question:
What is the most therapeutic response? *
9. M. Lambert is being discharged on Lithium Carbonate. He asks about his diet. He mentions he usually eats a low-sodium diet because his father had high blood pressure.

Question:
What is the correct health teaching regarding sodium (salt) intake while on Lithium? *
10. A nursing student asks you about the difference between the diagnosis of Mme Caron (Bipolar I) and M. Boucher (Bipolar II).
History: Mme Caron required hospitalization for psychosis and safety. M. Boucher has periods of high energy and productivity but has never been hospitalized for mania, though he suffers deep depressions.

Question:
What is the primary clinical difference distinguishing Bipolar I from Bipolar II? *
11. Mme Beaulieu, 35 years old, has a history of Bipolar I Disorder. Her husband brings her to the emergency department. He reports that over the past week, she has been sleeping only 2-3 hours per night, talking rapidly and jumping from topic to topic during conversations, and has spent $15,000 on online shopping (purchasing designer handbags, jewelry, and a motorcycle she cannot ride). When you assess her, she is wearing bright, mismatched clothing with excessive makeup, speaks in a loud, animated voice, and interrupts your questions to tell you about her "brilliant new business idea." She states, "I feel amazing! I have never been more creative and productive in my life!"

Medical Order: Mood stabilizer to be determined after assessment.

Question:
Which specific behavior from the history most clearly indicates that Mme Beaulieu is experiencing a manic episode? *
12. M. Grenier, 42 years old, admitted for acute mania, has been making repeated sexual advances toward female staff members. He follows a young nurse down the hallway making explicit comments about her body. The nurse feels threatened and uncomfortable.

Question:
What is the most appropriate immediate nursing intervention? *
13. M. Bouchard, 28 years old, is being started on Divalproex Sodium (Epival/Depakote) for acute mania. Before administering the first dose, you review his laboratory results.

Question:
Which baseline laboratory value is most critical to check due to a rare but fatal adverse reaction associated with this medication? *
14. You are attempting to interview Mme Lavoie. When you ask, "How are you feeling today?", she replies: "Feeling? Peeling! Like a banana. I slipped on the ice. Ice is cold, like my ex-husband's heart. Heart attack! Call 911. I need to go to space."

Question:
What is the clinical term for this thought process? *
15. Mme St-Jean, 50 years old, is taking Carbamazepine (Tegretol) 200 mg PO BID as a mood stabilizer. She comes to the clinic for a follow-up.

Medical Order: CBC and Liver Function Tests (LFTs) every 3 months.

Question:
Why is regular blood monitoring essential for this specific medication? *
16. M. Perrin, 40 years old, visits his GP complaining of low energy and sadness. He is diagnosed with Major Depression and prescribed Sertraline (Zoloft). Two weeks later, his wife brings him to the ER. He has not slept in 4 days, is talking a mile a minute, and claims he has written a symphony.

History: This is his first episode of high energy.

Question:
What is the most likely explanation for this clinical presentation? *
17. M. Lavoie, 28 years old, is brought to the ER by police. His family reports he has been agitated, irritable, pacing, and sleeping only 1 hour per night. However, unlike previous manic episodes where he was euphoric, he is now crying uncontrollably, expressing hopelessness, and stating, "Everything is pointless, I want to die, but I can't sit still."

Question:
How do you classify this presentation? *
18. Mme Beaulieu, admitted for mania, is wearing a very revealing top and is approaching male patients in the common room, touching their arms and whispering suggestive comments. The male patients look uncomfortable.

Question:
What is the most appropriate nursing intervention? *
19. M. Fortin, admitted for mania, announces at 02:00, "I'm leaving right now to drive to Montreal to meet with my business partners for a million-dollar deal!" He is walking toward the exit door.

Medical Order: Voluntary Admission.

Question:
What is your priority action? *
20. M. Cloutier is being assessed for Bipolar II. His wife says, "Sometimes he gets super energetic for 4 or 5 days. He cleans the whole house, sleeps only 4 hours but feels rested, and is very productive at work. He isn't mean or crazy, just 'up'."

Question:
How does this description fit the criteria for Hypomania? *
21. Mme Fortin is in the acute phase of mania. She is restless and agitated. You are planning the activity schedule for the day.

Question:
Which activity is most therapeutic for her current state? *
22. M. Lapierre, a 28-year-old athlete with Bipolar I Disorder, has been stable on Lithium Carbonate 300 mg PO TID for one year. During his clinic visit, he excitedly tells you, "I have signed up for a full marathon (42 km) next month. I plan to train hard and sweat it out!"

Question:
What is the priority nursing advice regarding his medication and this activity? *