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
The nurse is observing a patient diagnosed with schizophrenia. Which characteristic presents the greatest risk for injury to others?
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Negative symptoms
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Depersonalization
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Paranoia
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Pressured speech
Explanation
C. Paranoia
Paranoia involves intense distrust and suspicion of others. A paranoid patient may misinterpret neutral actions as threatening, leading to defensive or aggressive behavior. This creates the highest risk of harm to others, especially if the patient believes someone intends to hurt or control them. Paranoia is strongly associated with unpredictable violence in psychotic disorders.
Correct Answer Is:
C. Paranoia
The nurse is planning the care for the client in the image who is experiencing a hallucination. What is the first nursing intervention for this client? A Use a group of several staff to provide comfort to the client. B Provide support to the client with touch and reassurance. C Consider the need for medications that may console the client. D Have one or two staff reinforce that the client is safe.
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A Use a group of several staff to provide comfort to the client.
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B Provide support to the client with touch and reassurance.
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C Consider the need for medications that may console the client.
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D Have one or two staff reinforce that the client is safe.
Explanation
D. Have one or two staff reinforce that the client is safe.
The first priority with a hallucinating client is to reduce stimuli and provide calm, simple reassurance. Approaching the client with one or two staff prevents overwhelming them and promotes a sense of safety. Using clear, supportive statements helps ground the client and decreases fear associated with hallucinations.
Correct Answer Is:
D. Have one or two staff reinforce that the client is safe.
A physician prescribes an additional medication for a patient taking an antipsychotic agent. The medication is to be administered “prn for extrapyramidal symptoms (EPS).” Which assessment data would prompt the nurse to administer this medication?
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Patient experiences a seizure
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White blood cell count falls below 3000 mm³
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Complains of a dry mouth
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Tremors and a shuffling gait
Explanation
D. Tremors and a shuffling gait
These findings are classic extrapyramidal symptoms (EPS), specifically pseudoparkinsonism. EPS can occur with first-generation antipsychotics and include tremors, rigidity, masked facial expression, drooling, and shuffling gait. A PRN antiparkinsonian medication such as benztropine or diphenhydramine is indicated to treat these symptoms.
Correct Answer Is:
D. Tremors and a shuffling gait
A nurse is speaking with a patient who has schizophrenia when the patient suddenly stops focusing on the nurse's questions and begins looking at the ceiling and talking to themselves. Which action should the nurse take?
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Tell the patient, "You seem to be looking at something on the ceiling. I see something there, too."
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Continue the interview without comment on the patient's behavior.
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Stop the interview at this point and resume later when the patient is better able to concentrate.
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Ask the patient, "Are you seeing something on the ceiling?"
Explanation
Asking the patient directly whether they are seeing something on the ceiling is the safest and most therapeutic action. It assesses for hallucinations without validating or denying the experience. This approach is grounded in therapeutic communication: acknowledge the behavior, gather accurate information, and maintain patient trust. It also helps the nurse determine whether the patient is responding to internal stimuli and whether safety concerns or further interventions are needed.
Correct Answer Is:
D. Ask the patient, "Are you seeing something on the ceiling?"
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)
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4 tablets
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6 tablets
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8 tablets
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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
What patient education points should the nurse emphasize for a client newly diagnosed with epilepsy?
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Avoid alcohol and sleep deprivation
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Record seizure activity in a journal
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Wear a medical alert bracelet
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Take medication at the same time every day
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Stop taking medication if no seizures occur for a week
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You may drive once seizures are controlled following the first week of therapy
Explanation
A. Avoid alcohol and sleep deprivation
Clients with epilepsy must avoid alcohol and sleep deprivation because both significantly lower the seizure threshold and increase the likelihood of breakthrough seizures. Alcohol interferes with antiseizure medications and sleep deprivation disrupts brain electrical stability. Educating the client to maintain consistent sleep patterns and avoid substances that trigger seizures is essential in preventing seizure recurrence and maintaining safety.
B. Record seizure activity in a journal
Tracking seizure activity helps evaluate treatment effectiveness and identify patterns or triggers. Journaling details such as time, duration, aura, movements, and postictal symptoms helps the provider adjust medications more accurately. This record also helps the client recognize early warning signs and take safety precautions if needed.
C. Wear a medical alert bracelet
A medical alert bracelet ensures that others, including emergency personnel, know the client has epilepsy if a seizure occurs in public. This improves safety and ensures rapid, appropriate treatment. It also prevents misinterpretation of symptoms and alerts responders to avoid harmful actions such as restraining the client or inserting objects in the mouth.
D. Take medication at the same time every day
Antiseizure medications require consistent blood levels to prevent breakthrough seizures. Taking the medication at the same time daily maintains therapeutic levels and maximizes effectiveness. Irregular dosing leads to fluctuations that can trigger seizures. Clients should be taught strict adherence and not to skip or double doses.
Correct Answer Is:
A. Avoid alcohol and sleep deprivation
B. Record seizure activity in a journal
C. Wear a medical alert bracelet
D. Take medication at the same time every day
The nurse cares for a client receiving total parenteral nutrition (TPN). Which items should be included in the plan of care? Select all that apply.
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Use line for all IV medications
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Use an infusion pump.
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Monitor daily weights.
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Monitor lab values.
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Provide oral care if NPO.
Explanation
B. Use an infusion pump.
TPN must always be delivered through an infusion pump to ensure a consistent, accurate flow rate. The high concentration of dextrose and electrolytes makes manual regulation unsafe. Even slight changes in the infusion rate can create metabolic instability, including hypoglycemia or fluid overload. Pumps provide precise control, reducing risk and maintaining steady nutrient delivery essential for patients receiving TPN.
C. Monitor daily weights.
Daily weights are essential because they help evaluate fluid balance, nutritional status, and the effectiveness of TPN therapy. Rapid weight gain can indicate fluid overload, while weight loss may signal inadequate caloric intake. Weight trends provide critical information about metabolic and hydration status, making daily monitoring a fundamental part of TPN assessment.
D. Monitor lab values.
Clients on TPN require frequent monitoring of electrolytes, glucose, liver function, and triglycerides. TPN can cause shifts in electrolytes, hepatic stress, or metabolic complications, so labs guide adjustments to the formula. Close monitoring helps detect issues early and ensures safe and effective TPN therapy, preventing complications such as hyperglycemia or electrolyte imbalances.
E. Provide oral care if NPO.
Even when a client is NPO, oral mucosa must be kept moist and clean to prevent dryness, cracking, and infection. TPN patients often have no oral intake, increasing the risk of poor oral hygiene and discomfort. Regular oral care supports comfort, prevents bacterial buildup, and promotes overall health while the client receives nutrition intravenously.
Correct Answer Is:
B. Use an infusion pump.
C. Monitor daily weights.
D. Monitor lab values.
E. Provide oral care if NPO.
A nurse is caring for a patient on an acute mental health unit. The patient reports hearing voices that are stating, “kill your doctor.” Which action should the nurse take first?
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Initiate one-to-one observation of the client.
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Encourage the client to participate in group therapy on the unit.
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Notify the provider of the client’s statement.
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Focus the client on reality.
Explanation
A. Initiate one-to-one observation of the client
Command hallucinations that direct a patient to harm someone represent an immediate safety emergency. The nurse’s first action must be to protect the client, staff, and others by placing the patient on one-to-one observation. This ensures constant supervision, prevents potential violence, and allows the nurse to monitor changes in behavior while further interventions are arranged.
Correct Answer Is:
A. Initiate one-to-one observation of the client.
Use the drop-down lists to complete the sentences: The nurse provides medication education for a client prescribed lithium. The nurse instructs the client to 1 __________ and informs them of the need to monitor 2 __________. The nurse also recognizes that a 3 __________ would be a critical finding and should be reported to the health care provider. Which of the following options correctly completes the statements?
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1 avoid foods with tyramine; 2 liver enzyme levels; 3 mild hand tremor
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1 ensure adequate hydration and sodium intake; 2 lithium blood levels; 3 coarse tremor
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1 eat a high-protein diet; 2 potassium levels; 3 drowsiness
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1 avoid carbohydrates; 2 urine ketone levels; 3 weight loss
Explanation
Lithium requires consistent hydration and adequate sodium to prevent toxicity. Lithium blood levels must be monitored due to its narrow therapeutic index. A coarse tremor is an early sign of lithium toxicity and must be reported immediately.
Correct Answer Is:
B. 1 ensure adequate hydration and sodium intake; 2 lithium blood levels; 3 coarse tremor
Which nursing diagnosis is a priority for a patient with depression and a patient with acute mania?
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Deficient diversional activity
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Impaired social interaction
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Defensive coping
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Disturbed sleep pattern
Explanation
D. Disturbed sleep pattern
Both patients with depression and those experiencing acute mania commonly have severe disturbances in sleep. In depression, clients may have insomnia or hypersomnia, both of which worsen mood and functioning. In acute mania, decreased need for sleep can escalate mania, increase impulsivity, impair judgment, and lead to exhaustion. Sleep disruption affects safety, cognition, and emotional stability, making it the priority diagnosis for both disorders.
Correct Answer Is:
D. Disturbed sleep pattern
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