A patient diagnosed with bipolar disorder becomes hyperactive after discontinuing lithium. The patient threatens to hit another patient. Which comment by the nurse is appropriate?

"You know we will not let you hit anyone. Why do you continue this behavior?"

"Do not hit anyone. If you are unable to control yourself, we will help you."

"Stop that! No one did anything to provoke an attack by you."

"If you do that one more time, you will be secluded immediately."

Answer and Explanation

The Correct Answer is B

Rationale:
A. This approach is confrontational and accusatory, which may escalate agitation in a hyperactive or manic patient.
B. This response sets clear limits in a calm, supportive, and non-threatening manner, while also offering assistance with impulse control.
C. This statement is shaming and could escalate aggression rather than de-escalate the situation.
D. This is a threat rather than a therapeutic intervention, and it may increase the patient's agitation or resistance.

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Correct Answer is A

Explanation

Rationale:
A. Painting is a solitary, creative activity that requires minimal cognitive processing and social interaction, making it suitable for clients experiencing disturbed thoughts.
B. Playing cards requires attention to rules and interaction, which might be difficult during disturbed thoughts.
C. Playing board games often requires sustained concentration and social engagement, which may be overwhelming initially.
D. Playing checkers also requires strategy and focus, which may not be appropriate during acute thought disturbances.

A. within therapeutic limits B. above therapeutic limits C. invalid because of the time lapse since the last dose D. below therapeutic limits

Correct Answer is A

Explanation

Rationale:
A. A lithium serum level between 0.6 and 1.2 mEq/L is generally considered within the therapeutic range for maintenance treatment.
B. Above therapeutic limits would typically be >1.5 mEq/L, which increases toxicity risk.
C. While timing of blood draw is important, an 8-hour interval is acceptable for monitoring lithium levels (usually drawn 12 hours post-dose but 8 hours is still interpretable).
D. A level of 1 mEq/L is not below therapeutic limits.

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A patient diagnosed with bipolar disorder becomes hyperactive after discontinuing lithium. The patient threatens to hit another patient. Which comment by the nurse is appropriate?

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