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
Prescribed: Heparin 50 units/kg subcutaneous daily Available: Heparin 5,000 units per mL Patient weight: 93 kg How many mL will the nurse administer per dose? Record your answer to the hundredth.
- 0.45 mL
- 0.93 mL
- 1.20 mL
- 1.50 mL
Explanation
To calculate the dose, multiply 50 units/kg × 93 kg = 4,650 units needed per dose. The concentration available is 5,000 units/mL. Divide 4,650 ÷ 5,000 = 0.93 mL. Recording to the hundredth is required, and 0.93 mL accurately delivers the prescribed dose. This ensures safe administration and avoids under- or overdosing the anticoagulant.
Correct Answer Is:
B. 0.93 mL
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.
- 6.2 mL
- 9.8 mL
- 12.5 mL
- 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
During a manic episode, a client says to the nurse, “I hate you, I hate my life, I am going to beat something. I have so much anger right now.” Which statement by the nurse would be most effective at this time?
- “You are lucky, why do you say that?”
- “You should not feel that way.”
- “Did you get your medication today?”
- “You sound frustrated; can I help?”
Explanation
D. “You sound frustrated; can I help?”
This response acknowledges the client's feelings without judgment and uses therapeutic communication. It helps de-escalate anger, shows presence, and opens the door for the client to express emotions safely. It is calm, supportive, and non-confrontational, which is critical during a manic episode when agitation may escalate to aggression.
Correct Answer Is:
D. “You sound frustrated; can I help?”
Which nursing response demonstrates accurate information that should be discussed with the patient diagnosed with bipolar disorder? Select all that apply.
- “Remember that alcohol and caffeine can trigger a relapse of your symptoms.”
- “The symptoms tend to come and go and so you need to be able to recognize the early signs.”
- “Due to the risk of a manic episode, antidepressant therapy is never used with bipolar disorder.”
- “Keep all follow-up appointments with your care provider(s).”
- “It’s critical to let your health care provider know immediately if you aren’t sleeping well.”
Explanation
A. “Remember that alcohol and caffeine can trigger a relapse of your symptoms.”
Alcohol and caffeine can destabilize mood and trigger mania or depression. Alcohol interferes with medications and disrupts sleep, while caffeine stimulates the CNS and can intensify manic symptoms. Teaching avoidance of these substances is appropriate and essential for maintaining stability.
B. “The symptoms tend to come and go and so you need to be able to recognize the early signs.”
Bipolar disorder is cyclical. Clients benefit from learning early warning signs of mania or depression, such as decreased sleep, increased energy, irritability, or social withdrawal. Early recognition allows for rapid treatment and reduces relapse severity.
D. “Keep all follow-up appointments with your care provider(s).”
Ongoing monitoring is critical because medication levels, symptom patterns, and side effects must be regularly assessed. Missing follow-up appointments increases relapse risk and reduces the effectiveness of treatment planning.
E. “It’s critical to let your health care provider know immediately if you aren’t sleeping well.”
Sleep disturbance is one of the earliest and most reliable predictors of a manic episode. Reporting sleep changes promptly enables early intervention and can prevent full-blown mania.
Correct Answer Is:
A. “Remember that alcohol and caffeine can trigger a relapse of your symptoms.”
B. “The symptoms tend to come and go and so you need to be able to recognize the early signs.”
D. “Keep all follow-up appointments with your care provider(s).”
E. “It’s critical to let your health care provider know immediately if you aren’t sleeping well.”
The nurse is caring for a patient on a maintenance dose of lithium carbonate. What electrolyte is most important to maintain at therapeutic levels when taking lithium carbonate?
- Potassium
- Sodium
- Magnesium
- Chloride
Explanation
B. Sodium
Sodium balance is critical when taking lithium carbonate because lithium and sodium compete for reabsorption in the kidneys. Low sodium levels cause the kidneys to retain more lithium, leading to lithium toxicity, which can be life-threatening. Clients must maintain normal sodium intake and hydration. Conditions that lower sodium—such as diuretics, sweating, vomiting, or low-salt diets—significantly increase the risk of lithium accumulation.
Correct Answer Is:
B. Sodium
The patient diagnosed with schizophrenia is refusing medication and is displaying paranoid behavior. The nurse recognizes that schizophrenia can result in which patient belief?
- The medications will make them sick.
- They are not actually ill.
- Nurses are trying to control their minds.
- Medications provided are ineffective.
Explanation
C. Nurses are trying to control their minds.
Paranoia is a common positive symptom of schizophrenia. Patients may believe that staff are controlling, watching, or manipulating their thoughts. This delusional belief explains medication refusal and mistrust. Such paranoid delusions can severely impair insight and cooperation with treatment, making therapeutic communication essential.
Correct Answer Is:
C. Nurses are trying to control their minds.
A patient is having a status epilepticus seizure. The nurse will anticipate which medication will be prescribed?
- Gabapentin
- Pregabalin
- Lorazepam
- Carbamazepine
Explanation
C. Lorazepam
Lorazepam is the first-line medication for status epilepticus because it rapidly stops ongoing seizure activity by enhancing GABA activity in the brain. It has a fast onset, can be given IV, and provides immediate seizure control while additional long-acting antiepileptic medications are prepared. Early administration is critical to prevent hypoxia, brain injury, or prolonged neurologic complications.
Correct Answer Is:
C. Lorazepam
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?
- Initiate one-to-one observation of the client.
- Encourage the client to participate in group therapy on the unit.
- Notify the provider of the client’s statement.
- 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.
Which medication would the nurse expect the patient to take prophylactically to prevent recurrence of migraine headaches?
- Butalbital
- Ergotamine
- Zolmitriptan
- Propranolol
Explanation
D. Propranolol
Propranolol is a beta blocker commonly prescribed prophylactically to prevent recurrent migraine headaches. It reduces the frequency and severity of migraines when taken daily. It is not used to stop an active migraine but is effective as long-term preventive therapy.
Correct Answer Is:
D. Propranolol
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
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