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
1.
Which nursing diagnosis is a priority for a patient with depression and a patient with acute mania?
- A. Deficient diversional activity
- B. Impaired social interaction
- C. Defensive coping
- D. Disturbed sleep pattern
Explanation
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
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
2.
During a generalized tonic–clonic seizure, what is the nurse's immediate priority?
- A. Insert an oral airway
- B. Open the patient's airway
- C. Restrain the patient's arms and legs
- D. Protect the patient from injury
Explanation
Explanation
D. Protect the patient from injury
During a tonic–clonic seizure, the nurse must immediately ensure the patient is safe by protecting the head, removing nearby hazards, and easing the patient to the floor if possible. This prevents trauma, fractures, or head injury. The nurse should maintain a safe environment until the seizure ends naturally. Preventing harm is the priority before assessing airway, breathing, or post-seizure status.
Correct Answer Is:
D. Protect the patient from injury
D. Protect the patient from injury
During a tonic–clonic seizure, the nurse must immediately ensure the patient is safe by protecting the head, removing nearby hazards, and easing the patient to the floor if possible. This prevents trauma, fractures, or head injury. The nurse should maintain a safe environment until the seizure ends naturally. Preventing harm is the priority before assessing airway, breathing, or post-seizure status.
Correct Answer Is:
D. Protect the patient from injury
3.
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
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.
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.
4.
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?
- A. Initiate one-to-one observation of the client.
- B. Encourage the client to participate in group therapy on the unit.
- C. Notify the provider of the client’s statement.
- D. Focus the client on reality.
Explanation
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.
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.
5.
A nurse is caring for a newly admitted patient experiencing mania. The nurse should recognize that which patient statement would provide the best supportive evidence of this diagnosis?
- A. “I can’t stop my sexual urges. They have led me to numerous affairs.”
- B. “I am the Messiah. I rule the world.”
- C. “The FBI has tapped my room and are out to get me.”
- D. “My wife is distraught about my overspending.”
Explanation
Explanation
A. “I can’t stop my sexual urges. They have led me to numerous affairs.”
Hypersexuality, increased risky behaviors, and poor impulse control are classic symptoms of mania. Individuals in a manic episode often display heightened libido, impaired judgment, and impulsive behaviors such as sexual indiscretions. This statement best reflects a hallmark behavioral pattern of mania and provides strong supportive evidence for the diagnosis.
Correct Answer Is:
A. “I can’t stop my sexual urges. They have led me to numerous affairs.”
A. “I can’t stop my sexual urges. They have led me to numerous affairs.”
Hypersexuality, increased risky behaviors, and poor impulse control are classic symptoms of mania. Individuals in a manic episode often display heightened libido, impaired judgment, and impulsive behaviors such as sexual indiscretions. This statement best reflects a hallmark behavioral pattern of mania and provides strong supportive evidence for the diagnosis.
Correct Answer Is:
A. “I can’t stop my sexual urges. They have led me to numerous affairs.”
6.
What patient education points should the nurse emphasize for a client newly diagnosed with epilepsy?
- 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
- E. Stop taking medication if no seizures occur for a week
- F. You may drive once seizures are controlled following the first week of therapy
Explanation
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
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
7.
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
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."
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."
8.
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
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.
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.
9.
Which nursing response demonstrates accurate information that should be discussed with the patient diagnosed with bipolar disorder? Select all that apply.
- 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.”
- C. “Due to the risk of a manic episode, antidepressant therapy is never used with bipolar disorder.”
- 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.”
Explanation
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.”
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.”
10.
When caring for a patient with a seizure disorder who is hospitalized, which precaution would the nurse institute for someone with seizure precautions?
- A. Keep a tongue blade at the bedside
- B. Place oxygen and suction equipment at the bedside
- C. Monitor vital signs every 15 minutes
- D. Place patient in bilateral wrist restraints
Explanation
Explanation
B. Place oxygen and suction equipment at the bedside
Seizure precautions require keeping oxygen and suction readily available. After a seizure, the patient may have airway obstruction from secretions or decreased level of consciousness. Suction helps clear the airway, and oxygen supports adequate ventilation. These actions prevent complications such as hypoxia, aspiration, and respiratory distress, making them essential parts of seizure precautions.
Correct Answer Is:
B. Place oxygen and suction equipment at the bedside
B. Place oxygen and suction equipment at the bedside
Seizure precautions require keeping oxygen and suction readily available. After a seizure, the patient may have airway obstruction from secretions or decreased level of consciousness. Suction helps clear the airway, and oxygen supports adequate ventilation. These actions prevent complications such as hypoxia, aspiration, and respiratory distress, making them essential parts of seizure precautions.
Correct Answer Is:
B. Place oxygen and suction equipment at the bedside
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