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NURS 663: PREGNANT WOMAN WITH BIPOLAR DISORDER (NEI) EXAM QUESTIONS AND ANSWERS
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NURS 663: PREGNANT WOMAN WITH BIPOLAR DISORDER (NEI) EXAM QUESTIONS AND ANSWERS
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NURS 663: PREGNANT WOMAN WITHBIPOLAR DISORDER (NEI) EXAM
QUESTIONS AND ANSWERS
A 24-year-old female presents with psychotic symptoms and moderate agitation not
relieved through de-escalation measures. Which of the following atypical antipsychotics
is available in a short-acting intramuscular formulation?
A. Lurasidone
B. Risperidone
C. Ziprasidone - Answer-C. Ziprasidone
A 27-year-old patient who has been taking an atypical antipsychotic for bipolar disorder
for the last 2 years has just found out that she is 12 weeks pregnant. Cumulative data
for atypical antipsychotic use in pregnancy show an increased risk of:
A. Major malformations during the first trimester
B. Abnormal muscle movements in infants
C. Withdrawal symptoms in infants
D. B and C
E. A, B, and C - Answer-D. B and C
Patient Intake
The patient is a 34-year-old white woman with a long history of bipolar disorder and
multiple hospitalizations
She is college educated but has endured periods of homelessness related to her illness
She had been stable on lithium for 3 years and was attending school when she
unexpectedly discovered that she was pregnant with a baby fathered by her ex-
boyfriend
This was 2 months ago; at that time, she was approximately 4 months pregnant
Having heard that lithium can cause birth defects, she immediately stopped taking it
without seeking medical advice or substituting any other medications
This is the patient's second pregnancy; she delivered a healthy infant at age 28; the
baby was adopted out in an open adoption
The patient is brought in now by the police for screaming at people at a nearby
shopping mall
She is labile, alternately screaming and crying or laughing and flirting with men, and she
is often i - Answer-N/A
Which of the following would you consider an appropriate management strategy for this
pregnant patient with acute agitation and assaultive behavior?
A. Use seclusion or restraints to prevent her from hurting herself or others; avoid any
medications for fear of their effects on the fetus
, B. Use seclusion or restraints to prevent her from hurting herself or others; wait to use
medication until after she cooperates with labs in case her agitation is related to the
ingestion of any drugs
C. Use intramuscular (IM) benzodiazepines to rapidly calm her; use restraints only until
she is calmer
D. Use IM antipsychotic medication to calm her; use restraints only until she is calmer
E. Use lithium because it worked well for her before; it is not available intramuscularly
so would need to be offered orally - Answer-D. Use IM antipsychotic medication to calm
her; use restraints only until she is calmer
Attendees Notes
The ideal first-line approach to manage agitation and aggression would be de-
escalation and environmental manipulation. Assure the patient is physically comfortable.
Offer food and/or beverages. Decrease external stimuli. Minimize waiting time. Remove
potentially dangerous objects. Respect personal space. Do not be provocative.
Establish verbal contact. Be concise. Identify wants and feelings. Listen closely to what
the patient is saying. Agree or agree to disagree. Set clear limits. Offer choices and
optimism. Debrief the patient and staff
In this case, the patient is refusing to cooperate with basic care (e.g., vital signs) and
has hit a male nurse; her symptoms and the potential danger to herself and others are
serious enough that additional steps are necessary - Answer-N/A
Attendees Notes
Seclusion or restraints in the absence of medication would not be the best choice for
this patient. Restraints are themselves associated with a risk of injury that may exceed
any risk associated with medication. In the absence of medication, patients are likely to
stay in restraints longer. The use of restraints poses the additional complication of
requiring the patient to lie in a position not recommended during pregnancy. In a patient
this agitated, it would be terrifying for her (and everyone around her) t.o continue in her
psychotic state, untreated, while in restraints. For these reasons, the best decision may
be to utilize medication in order to minimize the need for restraints
The ideal medication for agitation would be easy to administer, non-traumatic, provide
rapid tranquilization without excessive sedation, and have a fast onset of action with low
risk for side effects
Benzodiazepines may - Answer-N/A
Case Outcomes
The patient receives IM haloperidol, which is considered relatively safe in pregnant
women
She sleeps for 6 hours, with normal vital signs, and when she wakes, she is still labile
but no longer threatening
She refuses to have labs drawn but cooperates with a urine drug screen, which is
positive for tetrahydrocannabinol (THC)
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