👤 By the CinnaRN Clinical Content Team🕐 Updated 2026-08-23🏷️ Psychosocial Integrity🔖 Free to read, print, and share
Also known as: manic depression · bipolar · manic depressive · mania · bipolar 1
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Use this quick-reference guide to spot, treat, and prevent Bipolar Disorder on the NCLEX. Keep it handy during review and on exam day!
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📒 The 1-minute cheat sheet
🩺 Signs
Mania: ↑ energy, grandiosity, no sleep
Pressured speech, flight of ideas
Risky behavior, poor judgment
🧪 Meds
Lithium: level 0.6–1.2 mEq/L
Toxic > 1.5; steady Na+ & fluids
✅ Do
Calm, low-stim environment
Finger foods, high-cal, hydrate
🚩 Report
Tremor, diarrhea, confusion = toxicity
Exhaustion, dehydration
📚 Bipolar Disorder — full study notes
The cheat sheet above is your quick recall card. These notes go deeper — what it is, what to do first, what must be reported, and what to teach.
Bipolar disorder is a mood disorder that cycles between episodes of mania (or hypomania) and depression. A manic episode features abnormally elevated, expansive, or irritable mood with increased energy lasting at least one week. Lithium and certain anticonvulsants/antipsychotics are mainstays; mania is a psychiatric emergency due to exhaustion, dehydration, and impaired judgment. Memory aid DIG FAST: Distractibility, Indiscretion/impulsivity, Grandiosity, Flight of ideas, Activity increase, decreased Sleep need, Talkativeness.
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Key points
Understand these first
Mania presents with grandiosity, decreased need for sleep, pressured speech, flight of ideas, and distractibility.
Manic clients show poor judgment, impulsivity, and high-risk behaviors such as spending sprees and hypersexuality.
Clients in mania often neglect food, fluids, rest, and hygiene, risking physical exhaustion.
Depressive phases mirror major depressive disorder including suicide risk.
Lithium has a narrow therapeutic range and requires routine serum monitoring.
Antidepressants alone can trigger a switch into mania in bipolar clients.
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Nursing priorities
What to do, in order
Maintain physical safety and reduce environmental stimulation in a calm, structured setting.
Provide high-calorie finger foods and fluids the client can eat on the move to prevent exhaustion and dehydration.
Set firm, consistent limits on manipulative or intrusive behavior without arguing.
Redirect excessive energy into nonstimulating, noncompetitive activities.
Monitor lithium levels and assess for signs of toxicity.
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Red flags — report now
Escalate immediately
Lithium level above 1.5 mEq/L (toxicity): coarse tremor, ataxia, severe vomiting/diarrhea, confusion, seizures - hold dose and notify provider.
Continuous hyperactivity without rest or intake can progress to fatal exhaustion and requires urgent intervention.
Escalating aggression or threats to self/others requires immediate safety measures.
Creatinine 0.6-1.2 mg/dL to monitor renal clearance of lithium
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Patient teaching
What patients must know
Maintain consistent salt and fluid intake; major changes alter lithium levels.
Have lithium levels checked regularly and report tremor, vomiting, diarrhea, or confusion.
Take medication even when feeling well; stopping causes relapse.
❓ Bipolar Disorder: NCLEX FAQs
What are the priority nursing interventions for Bipolar Disorder?
Maintain physical safety and reduce environmental stimulation in a calm, structured setting. Provide high-calorie finger foods and fluids the client can eat on the move to prevent exhaustion and dehydration. Set firm, consistent limits on manipulative or intrusive behavior without arguing. Redirect excessive energy into nonstimulating, noncompetitive activities.
What are the warning signs of Bipolar Disorder a nurse must report?
Lithium level above 1.5 mEq/L (toxicity): coarse tremor, ataxia, severe vomiting/diarrhea, confusion, seizures - hold dose and notify provider. Continuous hyperactivity without rest or intake can progress to fatal exhaustion and requires urgent intervention. Escalating aggression or threats to self/others requires immediate safety measures.
What do I need to know about Bipolar Disorder for the NCLEX?
Mania presents with grandiosity, decreased need for sleep, pressured speech, flight of ideas, and distractibility. Manic clients show poor judgment, impulsivity, and high-risk behaviors such as spending sprees and hypersexuality. Clients in mania often neglect food, fluids, rest, and hygiene, risking physical exhaustion. Depressive phases mirror major depressive disorder including suicide risk.
What patient teaching is important for Bipolar Disorder?
Maintain consistent salt and fluid intake; major changes alter lithium levels. Have lithium levels checked regularly and report tremor, vomiting, diarrhea, or confusion. Take medication even when feeling well; stopping causes relapse.
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Quick Tip
Mania presents with grandiosity, decreased need for sleep, pressured speech, flight of ideas, and distractibility.