NURS 218 Psychotic Bipolar TPN HA Seizures at Baton Rouge General School of Nursing
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Free NURS 218 Psychotic Bipolar TPN HA Seizures at Baton Rouge General School of Nursing Questions
A client with schizophrenia becomes violent on the unit. What is the first nursing action?
- A. Discuss with the client the need to change their behavior according to policy.
- B. Engage the assistance of other clients to help subdue the violent client.
- C. Administer the pm medication to calm the client's violent tendencies.
- D. Call for staff assistance to ensure safety of staff and the other clients.
Explanation
When a client becomes violent, the nurse’s immediate priority is safety. Calling for staff assistance ensures enough trained personnel are present to protect the client, other patients, and staff members. This action allows the team to implement de-escalation techniques or physical intervention safely if needed. Addressing safety first prevents injury and creates a controlled environment in which further interventions can occur appropriately.
Correct Answer Is:
D. Call for staff assistance to ensure safety of staff and the other clients.
A patient with schizophrenia began to take the first-generation antipsychotic haloperidol (Haldol) last week. The nurse now discovers the patient diaphoretic, non-verbal, sitting very stiffly and not moving. Vital signs are: BP 170/100, P 110, T 104.2°F. What is the priority nursing intervention?
- A. Hold his medication for now and consult his prescriber when he comes to the unit later today.
- B. Reassure him that although there is no treatment for his tardive dyskinesia, it will pass.
- C. Administer a medication such as benztropine IM to correct this dystonic reaction.
- D. Hold his medication and contact his prescriber.
Explanation
D. Hold his medication and contact his prescriber.
This patient is showing signs of neuroleptic malignant syndrome (NMS): extreme muscle rigidity, high fever, autonomic instability, diaphoresis, altered responsiveness, and elevated vital signs. NMS is a life-threatening emergency associated with antipsychotics like haloperidol. The nurse must immediately stop the medication and contact the prescriber for rapid medical intervention, which typically includes ICU-level care, cooling measures, hydration, and medications such as dantrolene or bromocriptine.
Correct Answer Is:
D. Hold his medication and contact his prescriber.
A nurse assesses a patient who takes a maintenance dose of lithium carbonate for bipolar disorder. The patient complains of a hand tremor, nausea, vomiting, and diarrhea. The patient’s gait is unsteady. How does the nurse interpret these assessment findings?
- A. Consumed some foods high in tyramine
- B. Developed early signs of lithium toxicity
- C. Tolerance to the lithium has been developed
- D. Has not taken the lithium as directed
Explanation
B. Developed early signs of lithium toxicity
Hand tremors, nausea, vomiting, diarrhea, and an unsteady gait are classic early manifestations of lithium toxicity. Lithium has a narrow therapeutic range, and even slight increases in levels can cause neurologic and gastrointestinal symptoms. These findings indicate that the lithium level may be above the therapeutic threshold, requiring immediate evaluation, lab monitoring, and potential dose adjustment to prevent progression to severe toxicity.
Correct Answer Is:
B. Developed early signs of lithium toxicity
A nurse approaches the client with a known diagnosis of Bipolar Disorder. Which intervention is indicated?
- A. Offer another activity, such as exercise, music or reading, to the client.
- B. Provide client control using the least restrictive restraints needed.
- C. Try to shout in order to acquire and maintain the client's attention.
- D. During a calm moment, indicate you are interested in helping the client.
Explanation
Offering another activity helps redirect excess energy and agitation that commonly occur during manic episodes. Structured, calming, or physically engaging activities help reduce anxiety, promote self-regulation, and allow the client to channel hyperactivity in a safe way. This intervention also supports therapeutic rapport by giving the client choices and maintaining a calm, supportive environment without escalating confrontation or overstimulation.
Correct Answer Is:
A. Offer another activity, such as exercise, music or reading, to the client.
The patient tells the RN that she “takes a lot of Tylenol” for a bad headache. The RN should caution the patient to take no more than ___ tablets per 24 hours. (Refer to the image: Tylenol Extra Strength, 500 mg per tablet)
- A. 4 tablets
- B. 6 tablets
- C. 8 tablets
- D. 10 tablets
Explanation
Tylenol Extra Strength contains 500 mg of acetaminophen per tablet. The maximum safe adult dose of acetaminophen is 4,000 mg (4 g) in 24 hours. To calculate the safe tablet limit: 4,000 mg ÷ 500 mg = 8 tablets Taking more than 8 tablets in 24 hours increases the risk of liver toxicity and acute liver injury. Staying within the recommended limit helps ensure safe pain management.
Correct Answer Is:
C. 8 tablets
A nurse is reviewing medications for a newly admitted patient who has bipolar disorder and is experiencing mania. Which of the following prescriptions should the nurse realize is expected to reduce the patient's mania?
- A. Propranolol
- B. Fluvastatin
- C. Lamotrigine
- D. Lorazepam
Explanation
D. Lorazepam
Lorazepam is a benzodiazepine used to rapidly reduce agitation, hyperactivity, and insomnia during acute manic episodes. While not a long-term mood stabilizer, it is commonly prescribed in the hospital setting to help control severe mania until a mood stabilizer reaches therapeutic levels. Its calming effect and fast onset make it an expected and appropriate medication during acute mania.
Correct Answer Is:
D. Lorazepam
Prescribed: Acyclovir 12 mg/kg PO daily Available: Acyclovir 100 mg / 2 mL Patient weight: 115 lb How many mL will the nurse administer per dose? Record your answer to the tenth.
- A. 6.2 mL
- B. 9.8 mL
- C. 12.5 mL
- D. 15.4 mL
Explanation
First convert the patient’s weight from pounds to kilograms: 115 lb ÷ 2.2 = 52.3 kg Next calculate the prescribed dose: 12 mg × 52.3 kg = 627.6 mg Determine concentration of available medication: 100 mg in 2 mL → 50 mg per mL Now calculate required volume: 627.6 mg ÷ 50 mg/mL = 12.55 mL Rounded to the nearest tenth = 12.5 mL Therefore, the nurse should administer 12.5 mL per dose.
Correct Answer Is:
C. 12.5 mL
After teaching a patient about management of migraine headaches, the nurse determines that the teaching has been effective when the patient makes which statement?
- A. “The sumatriptan will help to increase the blood flow to my brain.”
- B. “I will take the topiramate as soon as any headache starts.”
- C. “I will try to lie down someplace dark and quiet when the headaches begin.”
- D. “A glass of wine might help me relax and prevent headaches from developing.”
Explanation
C. “I will try to lie down someplace dark and quiet when the headaches begin.”
Resting in a dark, quiet environment is an effective non-pharmacologic intervention for migraine management. Light, sound, and sensory stimulation often worsen migraine pain, so reducing stimuli can lessen severity and support recovery. This response shows correct understanding of lifestyle and environmental strategies that help alleviate symptoms.
Correct Answer Is:
C. “I will try to lie down someplace dark and quiet when the headaches begin.”
A nurse is caring for a client who has bipolar disorder. The client states, "I am very rich, and I feel I must give my money to you." Which response should the nurse make?
- A. "I can request that your case manager discuss appropriate charity options with you."
- B. "You should know that giving away your money is inappropriate."
- C. "I am here to provide care and cannot accept this from you."
- D. "Why do you think you feel the need to give money away?"
Explanation
C. "I am here to provide care and cannot accept this from you."
This response sets a clear, professional boundary while avoiding confrontation. Manic clients often demonstrate impulsivity and grandiosity, including giving away money. The nurse must provide a firm but nonjudgmental statement that protects the client’s finances and maintains ethical standards. This response addresses the behavior directly without discouraging further communication or escalating the client’s emotions.
Correct Answer Is:
C. "I am here to provide care and cannot accept this from you."
A client with irritable bowel syndrome is prescribed nocturnal total parenteral nutrition via a central venous access device. Which elements are critical in the plan of care? Select all that apply.
- A. Provide round-the-clock infusion of total parenteral nutrition.
- B. Titrate client up to prescribed rate for one hour before the infusion.
- C. Include a filter in the total parenteral nutrition intravenous tubing.
- D. Validate the prescription and contents of the total parenteral nutrition.
- E. Check blood glucose prior to the total parenteral nutrition infusion.
- F. Taper off the infusion for one to two hours each morning.
Explanation
C. Include a filter in the total parenteral nutrition intravenous tubing.
A filter must always be used with TPN to prevent particulate matter, undissolved components, or microbial contamination from entering the bloodstream. TPN solutions are highly concentrated, and a filter provides an important safety measure by reducing the risk of emboli and infection. This is a critical element in all forms of TPN administration.
D. Validate the prescription and contents of the total parenteral nutrition.
TPN formulations are customized daily based on the patient’s laboratory values and nutritional needs. Therefore, the nurse must verify the prescription, ingredients, and solution label before administration. This ensures accuracy in electrolyte concentration, dextrose levels, amino acids, and additives to prevent metabolic complications or errors.
E. Check blood glucose prior to the total parenteral nutrition infusion.
Because TPN contains high concentrations of dextrose, clients are at risk for hyperglycemia. A baseline glucose reading is essential before starting each infusion, especially with nocturnal TPN, to prevent metabolic instability. Monitoring helps guide insulin therapy and detect early complications related to glucose fluctuations.
F. Taper off the infusion for one to two hours each morning.
Abrupt discontinuation of TPN can cause rebound hypoglycemia because the pancreas has adjusted to high dextrose levels. Tapering reduces the infusion gradually, allowing the body to adapt and preventing sudden drops in blood glucose. This is especially critical with nocturnal TPN schedules.
Correct Answer Is:
C. Include a filter in the total parenteral nutrition intravenous tubing.
D. Validate the prescription and contents of the total parenteral nutrition.
E. Check blood glucose prior to the total parenteral nutrition infusion.
F. Taper off the infusion for one to two hours each morning.
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