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 cares for a client receiving total parenteral nutrition (TPN). Which items should be included in the plan of care? Select all that apply.
- Use line for all IV medications
- Use an infusion pump.
- Monitor daily weights.
- Monitor lab values.
- 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 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?
- Consumed some foods high in tyramine
- Developed early signs of lithium toxicity
- Tolerance to the lithium has been developed
- 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
To provide effective care for the patient diagnosed with schizophrenia, the nurse should frequently assess for which associated condition(s)? Select all that apply.
- Major depressive disorder
- Metabolic syndrome
- Stomach cancer
- Polydipsia
- Alcohol use disorder
Explanation
A. Major depressive disorder
Depression commonly co-occurs with schizophrenia and is a major risk factor for suicide. Many patients experience depressive symptoms during both acute and residual phases of the illness. Ongoing assessment is essential to detect hopelessness, social withdrawal, and suicidal ideation early.
B. Metabolic syndrome
Antipsychotic medications—especially second-generation agents—significantly increase the risk of metabolic syndrome, including weight gain, hyperlipidemia, and insulin resistance. Regular monitoring of BMI, blood glucose, lipids, and waist circumference is crucial to prevent cardiovascular complications.
D. Polydipsia
Psychogenic polydipsia occurs in some patients with schizophrenia and can lead to water intoxication, hyponatremia, confusion, and seizures. Monitoring fluid intake, electrolytes, and mental status is essential to ensure safety and prevent life-threatening electrolyte disturbances.
E. Alcohol use disorder
Substance use disorders, especially alcohol use, are highly prevalent among individuals with schizophrenia. Alcohol complicates symptom control, interferes with medications, increases relapse rates, and worsens overall functioning. Regular screening supports early intervention and improved outcomes.
Correct Answer Is:
A. Major depressive disorder
B. Metabolic syndrome
D. Polydipsia
E. Alcohol use disorder
A nurse is completing an admission assessment for a patient who has schizophrenia. Which finding should the nurse document as a positive symptom?
- Flat affect
- Poverty of speech
- Lack of motivation
- Delusion of persecution
Explanation
D. Delusion of persecution
Delusions are positive symptoms of schizophrenia. Positive symptoms reflect an excess or distortion of normal functioning. A delusion of persecution is a fixed false belief that others intend to harm, follow, or conspire against the patient. These symptoms represent added experiences not present in healthy individuals and are key indicators of psychosis.
Correct Answer Is:
D. Delusion of persecution
A hospitalized patient has excessive talking, reports having an increased libido and a euphoric mood. The patient has not slept in days and is prescribed Lithium and Clozapine. What laboratory result would require immediate nursing intervention?
- Na – 136 mEq/L
- WBC – 2500/mm³
- Lithium level – 1.1 mEq/L
- K – 4.9 mEq/L
Explanation
B. WBC – 2500/mm³
A white blood cell count of 2500/mm³ indicates severe leukopenia, a dangerous adverse effect of clozapine. Clozapine can cause agranulocytosis, leaving the patient highly vulnerable to life-threatening infection. Any WBC below 3000 requires immediate discontinuation of clozapine and urgent medical intervention. This is the most critical and life-threatening finding.
Correct Answer Is:
B. WBC – 2500/mm³
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?
- 1 avoid foods with tyramine; 2 liver enzyme levels; 3 mild hand tremor
- 1 ensure adequate hydration and sodium intake; 2 lithium blood levels; 3 coarse tremor
- 1 eat a high-protein diet; 2 potassium levels; 3 drowsiness
- 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
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?
- Propranolol
- Fluvastatin
- Lamotrigine
- 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
A patient with epilepsy reports experiencing an aura. What is the nurse's priority action?
- Monitor vital signs
- Administer lorazepam IV
- Ensure safety by padding bed rails and lowering the bed
- Place oxygen by nasal cannula
Explanation
C. Ensure safety by padding bed rails and lowering the bed
An aura often signals that a seizure is about to occur. The nurse’s immediate priority is safety. This includes lowering the bed, padding side rails, removing nearby hazards, and preparing the environment to prevent injury. These actions protect the patient during the imminent seizure and reduce the risk of falls, head trauma, or bodily injury.
Correct Answer Is:
C. Ensure safety by padding bed rails and lowering the bed
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?
- Patient experiences a seizure
- White blood cell count falls below 3000 mm³
- Complains of a dry mouth
- 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 patient is withdrawn in the hospital room, does not speak to anyone, and does not perform any self-care activities. The nurse should document this as which negative symptom of schizophrenia?
- Depression
- Waxy flexibility
- Avolition
- Auditory hallucinations
Explanation
C. Avolition
Avolition is a negative symptom of schizophrenia characterized by a lack of motivation to begin or continue goal-directed activities. Clients may appear withdrawn, show little to no initiative, and fail to engage in self-care tasks such as bathing, dressing, or interacting with others. This symptom reflects diminished drive, not sadness or psychosis, and is commonly seen in individuals with chronic schizophrenia.
Correct Answer Is:
C. Avolition
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