NURS 218 Psychotic Bipolar TPN HA Seizures at Baton Rouge General School of Nursing

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

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

Explanation
C. “I will try to lie down someplace dark and quiet when the headaches begin.”​
Resting in a dark, quiet environment is an effective non-pharmacologic intervention for migraine management. Light, sound, and sensory stimulation often worsen migraine pain, so reducing stimuli can lessen severity and support recovery. This response shows correct understanding of lifestyle and environmental strategies that help alleviate symptoms.
Correct Answer Is:
C. “I will try to lie down someplace dark and quiet when the headaches begin.”

Explanation
C. “If I feel good, I can stop the medication.”​
This statement indicates a need for further teaching because antiseizure medications must be taken consistently and long-term, even when the patient feels well. Stopping antiseizure drugs abruptly can trigger rebound seizures, status epilepticus, or loss of seizure control. Patients should never discontinue medication without direct medical supervision.
Correct Answer Is:
C. “If I feel good, I can stop the medication.”

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.”

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

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

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

Explanation
C. Remove dangerous objects from the client's surroundings​
Clients experiencing mania may act impulsively or aggressively due to poor judgment, high energy, and decreased impulse control. Removing dangerous objects reduces the risk of self-harm or harm to others and creates a safer environment. This is a primary safety intervention and must be done early to prevent escalation and injury.
D. Offer physical activity during periods of agitation​
Manic clients often have excess energy and restlessness. Providing structured physical activity—such as pacing with the nurse or using an exercise room—helps channel this energy safely. Redirection through activity is a therapeutic strategy that decreases agitation and helps the client regain a sense of control.
E. Stay calm during periods of agitation​
A calm approach reduces stimulation and helps the client de-escalate. Manic clients react strongly to staff tone and energy; a calm demeanor prevents escalation and maintains a therapeutic environment. The nurse’s emotional control models grounding and stability, which supports patient safety.
F. Ensure adequate staff to ensure control of client agitation​
Manic episodes can escalate quickly, and additional staff may be needed to maintain safety, offer redirection, or assist with interventions. Adequate staffing ensures safer de-escalation, prevents injury, and supports both the client and the nurse during episodes of agitation.
Correct Answer Is:
C. Remove dangerous objects from the client’s surroundings​
D. Offer physical activity during periods of agitation​
E. Stay calm during periods of agitation​
F. Ensure adequate staff to ensure control of client agitation