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
A nurse is completing an admission assessment for a patient who has schizophrenia. Which finding should the nurse document as a positive symptom?
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Flat affect
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Poverty of speech
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Lack of motivation
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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
Which nursing response demonstrates accurate information that should be discussed with the patient diagnosed with bipolar disorder? Select all that apply.
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“Remember that alcohol and caffeine can trigger a relapse of your symptoms.”
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“The symptoms tend to come and go and so you need to be able to recognize the early signs.”
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“Due to the risk of a manic episode, antidepressant therapy is never used with bipolar disorder.”
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“Keep all follow-up appointments with your care provider(s).”
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“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.”
During a generalized tonic–clonic seizure, what is the nurse's immediate priority?
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Insert an oral airway
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Open the patient's airway
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Restrain the patient's arms and legs
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Protect the patient from injury
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
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
A patient is experiencing a manic episode. Which symptoms would the nurse expect to find upon assessment?
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Flat affect and suicidal ideations
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Increased appetite and hypersomnia
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Psychomotor retardation and fatigue
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Flight of ideas and pressured speech
Explanation
D. Flight of ideas and pressured speech
During a manic episode, patients display elevated energy, rapid thought processes, and an accelerated speech pattern known as pressured speech. Flight of ideas—quickly shifting from one topic to another—is also common due to racing thoughts. These are hallmark findings of mania and help distinguish it from depressive episodes or psychomotor slowing.
Correct Answer Is:
D. Flight of ideas and pressured speech
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 cares for a client receiving total parenteral nutrition (TPN). Which client response indicates the development of possible complications to TPN? Select all that apply.
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IV site without redness or edema
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Weight gain of 1.3 kg/day
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Blood glucose 65 mg/dL
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Reflux of gastric feedings
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Potassium level 4.3 mEq/dL
Explanation
B. Weight gain of 1.3 kg/day
A rapid weight gain of over 1 kg per day indicates fluid overload, a serious complication of TPN. Excessive fluid retention can occur due to the high osmolarity and volume of TPN solutions. This finding suggests the need for reassessment of infusion rate, fluid balance, and possible signs of edema or heart strain.
C. Blood glucose 65 mg/dL
A blood glucose of 65 mg/dL shows hypoglycemia, which may occur if the TPN infusion is interrupted, tapered too quickly, or not adequately managed. Because TPN contains high dextrose levels, the pancreas adjusts by secreting insulin—making abrupt changes dangerous. Hypoglycemia is a significant TPN complication requiring immediate action.
Correct Answer Is:
B. Weight gain of 1.3 kg/day
C. Blood glucose 65 mg/dL
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?
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"I can request that your case manager discuss appropriate charity options with you."
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"You should know that giving away your money is inappropriate."
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"I am here to provide care and cannot accept this from you."
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"Why do you think you feel the need to give money away?"
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."
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?
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Propranolol
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Fluvastatin
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Lamotrigine
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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
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?
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Monitor for headache and shakiness
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Administer sliding scale insulin per protocol.
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Decrease the infusion rate and notify the provider.
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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.
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