NURS 218 Psychotic Bipolar TPN HA Seizures
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Free NURS 218 Psychotic Bipolar TPN HA Seizures Questions
A patient with epilepsy reports experiencing an aura. What is the nurse's priority action?
- A. Monitor vital signs
- B. Administer lorazepam IV
- C. Ensure safety by padding bed rails and lowering the bed
- D. 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
The nurse cares for a client receiving total parenteral nutrition (TPN) who now has a blood glucose of 172 mg/dL. What interventions should the nurse provide?
- A. Monitor for headache and shakiness
- B. Administer sliding scale insulin per protocol.
- C. Decrease the infusion rate and notify the provider.
- D. Assess for hyperosmolar diuresis.
Explanation
B. Administer sliding scale insulin per protocol.
A blood glucose of 172 mg/dL is a common and expected finding in clients receiving TPN due to its high dextrose concentration. The correct intervention is to administer insulin according to the facility’s sliding scale protocol. This safely lowers blood glucose and prevents complications without altering the TPN infusion, which should never be adjusted without a provider’s prescription.
Correct Answer Is:
B. Administer sliding scale insulin per protocol.
A patient is withdrawn in the hospital room, does not speak to anyone, and does not perform any self-care activities.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?
- A. Depression
- B. Waxy flexibility
- C. Avolition
- D. 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 Clients may appear withdrawn, show little to no initiative, and fail to engage in self-care tasks such as bathing, dressing, or interacting with others.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
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 teaching a newly licensed nurse about the use of electroconvulsive therapy (ECT) for the treatment of bipolar disorder. Which statement by the newly licensed nurse indicates understanding?
- A. “ECT is prescribed to prevent relapse of bipolar disorder.”
- B. “ECT is effective for clients who are experiencing severe mania.”
- C. “ECT is the recommended initial treatment for bipolar disorder.”
- D. “ECT is contraindicated for clients who have suicidal ideation.”
Explanation
B. “ECT is effective for clients who are experiencing severe mania.”
ECT can be used for treatment-resistant or severe mania, especially when rapid symptom control is needed or when medications have not been effective. It is effective at reducing extreme agitation, risk-taking behaviors, and psychosis associated with severe manic episodes. This makes ECT an appropriate and evidence-supported option in selected bipolar disorder cases.
Correct Answer Is:
B. “ECT is effective for clients who are experiencing severe mania.”
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
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 client diagnosed with chronic seizures is admitted to the emergency department. Select the nursing priorities in the emergency treatment of status epilepticus. Select all that apply.
- A. Administer IV lorazepam
- B. Monitor for respiratory depression
- C. Establish IV access
- D. Prep for immediate surgery
- E. Maintain airway
- F. Administer oral antiseizure medications
Explanation
A. Administer IV lorazepam
IV lorazepam is the first-line medication for stopping status epilepticus because it rapidly terminates seizure activity by enhancing GABA inhibition in the brain. Early benzodiazepine administration is critical to prevent prolonged seizures, neurological injury, and hypoxia.
B. Monitor for respiratory depression
Benzodiazepines used to treat status epilepticus can depress respiration. Additionally, prolonged seizures impair breathing and put the client at high risk for hypoxia. Continuous monitoring is essential so that airway support or ventilation can be provided immediately if needed.
C. Establish IV access
IV access is essential for administering emergency antiseizure medications such as lorazepam and IV antiepileptics that follow (e.g., phenytoin, levetiracetam). Without IV access, treatment is delayed, increasing risk of brain injury or death.
E. Maintain airway
Maintaining airway patency is a top priority because tonic-clonic seizure activity interferes with normal breathing patterns. The client may experience hypoxia, apnea, or airway obstruction. Positioning, suctioning as needed, and preparing for advanced airway support are essential.
Correct Answer Is:
A. Administer IV lorazepam
B. Monitor for respiratory depression
C. Establish IV access
E. Maintain airway
The nurse witnesses a patient with a seizure disorder suddenly begin jerking the arms and legs, fall to the floor, and regain consciousness immediately. What is the priority nursing intervention?
- A. Assess for possible head injury
- B. Give divalproex as ordered
- C. Document the timing and description of the jerking
- D. Notify the patient's health care provider
Explanation
A. Assess for possible head injury
Because the patient fell during the seizure, the immediate nursing priority is to assess for injury—especially head trauma. Even with a brief seizure followed by immediate recovery, the fall may have caused impact injuries, bleeding, or neurological compromise. Safety and physical assessment always come first after a witnessed seizure involving a fall.
Correct Answer Is:
A. Assess for possible head injury
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?
- A. “You are lucky, why do you say that?”
- B. “You should not feel that way.”
- C. “Did you get your medication today?”
- D. “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?”
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.
- A. 0.45 mL
- B. 0.93 mL
- C. 1.20 mL
- D. 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
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