Question

A nurse is caring for a client who has bipolar disorder and a new prescription for valproate. Which of the following instructions should the nurse give the client about the use of this medication?

Answer 1

Correct Answers:

Liver function tests must be monitored.

Rationale :

💎 Valproate is a mood stabilizer commonly used to manage bipolar disorder, especially during manic episodes.

💎 One of its critical adverse effects is hepatotoxicity, which can develop insidiously and lead to liver failure.

💎 Liver function tests (LFTs) must be checked before initiation and periodically during therapy.

💎 Clients should be monitored for signs such as abdominal pain, jaundice, and nausea, which may indicate liver issues.

💎 Nurses must educate clients on the importance of routine lab monitoring and reporting symptoms of liver dysfunction promptly.

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Answer 2

Correct Answers:

Have consistent unit routines.

Rationale :

🔄 During the manic phase of bipolar disorder, clients may display hyperactivity, distractibility, and poor impulse control.

🔄 Having consistent routines helps reduce overstimulation and provides a sense of structure and predictability, which can stabilize mood.

🔄 A structured environment also minimizes disorganization and potential agitation.

🔄 This approach enhances therapeutic boundaries, promotes cooperation, and lowers anxiety for the client.

🔄 It is a key nursing strategy in milieu management for individuals in manic states.

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Answer 3

Correct Answers:

Setting and maintaining consistent unit policies that are enforced by all staff.

Rationale :

📋 Consistency among staff is vital for managing clients with bipolar disorder, especially those in a manic phase who may test boundaries.

📋 When unit policies are clearly explained and uniformly enforced, it reduces confusion and manipulation.

📋 This approach promotes safety, fairness, and emotional containment, which supports the therapeutic milieu.

📋 Consistency also prevents staff splitting behaviors and fosters a predictable healing environment.

📋 It is a core principle in managing challenging behaviors on mental health units.

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Answer 4

Correct Answers:

Withhold the medication.

Rationale :

♦️ Blurred vision and ataxia are early signs of lithium toxicity, which can progress to serious neurologic and renal complications.

♦️ Therapeutic serum lithium levels range from 0.6 to 1.2 mEq/L, and toxicity may occur at levels above this.

♦️The nurse’s first priority is to withhold the medication and notify the provider for serum level evaluation.

♦️ Continuing the medication without assessment can exacerbate toxicity, leading to seizures, coma, or death.

♦️ Immediate action is essential for client safety and prevention of irreversible damage.

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Answer 5

Correct Answers:

Sodium.

Rationale :

⏺️ Sodium levels directly affect lithium excretion by the kidneys; low sodium can lead to lithium retention and toxicity.

⏺️ Clients taking lithium should maintain a consistent sodium intake to avoid dangerous fluctuations in lithium levels.

⏺️ Dehydration, vomiting, or low-sodium diets can all increase lithium levels dangerously.

⏺️ Nurses must educate clients to avoid drastic dietary changes and to maintain hydration.

⏺️ Monitoring sodium intake is critical to ensure stable pharmacokinetics of lithium.

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Answer 6

Correct Answers:

Lithium.
Valproate.
Carbamazepine.
Paroxetine.

Rationale :

Lithium

Lithium is the gold standard mood stabilizer for treating both acute mania and long-term maintenance in bipolar disorder.
It works by modulating neurotransmitter activity, especially serotonin and norepinephrine, to stabilize mood fluctuations.
Regular serum lithium monitoring is essential due to its narrow therapeutic index and risk of toxicity, especially with dehydration or sodium imbalance.

Valproate

Valproate (valproic acid) is an anticonvulsant also used as a mood stabilizer, particularly effective in managing acute manic episodes.
It is especially useful in clients who are non-responsive to lithium or have mixed or rapid cycling features.
Liver function and platelet counts must be monitored, as the drug carries a risk for hepatotoxicity and thrombocytopenia.

Carbamazepine

Carbamazepine is another anticonvulsant with mood-stabilizing effects, effective in treating mania and preventing recurrence in bipolar disorder.
It is particularly beneficial in rapid cycling bipolar and those with treatment-resistant mania.
The drug can cause leukopenia, hyponatremia, and liver enzyme elevations, so CBC and liver function monitoring are critical.

Paroxetine

Paroxetine is a selective serotonin reuptake inhibitor (SSRI) occasionally used to treat the depressive phase of bipolar disorder.
It should be used with caution and always alongside a mood stabilizer, as SSRIs alone may trigger manic episodes.
Its use may be beneficial for clients with bipolar depression, especially when depressive symptoms are severe and impairing.

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Answer 7

Correct Answers:

Tell the client that the hallucination is not a part of reality.

Rationale :

🟣 The nurse should use reality orientation to help the client distinguish between hallucinations and the actual environment.

🟣 Saying the hallucination is not real gently challenges the false perception without confronting or arguing.

🟣 This method respects the client's experience while promoting grounding and orientation.

🟣 It maintains the nurse-client relationship and supports therapeutic communication.

🟣 Reinforcing reality helps the client regain cognitive control and reduces fear or agitation.

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Answer 8

Correct Answers:

Command hallucination.

Rationale :

🔴 Command hallucinations pose the highest risk because they may direct the client to harm themselves or others.

🔴 These hallucinations are auditory and often involve imperative language such as “jump” or “kill.”

🔴 Immediate assessment of content, intent, and plan is necessary for safety.

🔴 This requires urgent intervention, including close monitoring and potential medication adjustment.

🔴 Safety is always the nurse’s highest priority in psychiatric care.

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Answer 9

Correct Answers:

Provide reassurance and comfort ensuring the client is safe.

Rationale :

🎯 When a client with schizophrenia is confused and displaying distorted thinking, the top priority is to ensure safety and emotional stability.

🎯 Reassurance and presence help reduce anxiety and prevent agitation or impulsive actions.

🎯 Redirecting or distracting too soon may increase disorientation or paranoia.

🎯 The nurse’s calm, grounding approach supports reality orientation while protecting the client’s well-being.

🎯 Safety always comes before participation in activities or use of medications unless risk is imminent.

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Answer 10

Correct Answers:

Walking with the nurse in the courtyard.

Rationale :

🟢 Clients in the manic phase of bipolar disorder have excessive energy, poor concentration, and may be easily overstimulated.

🟢 Activities should be non-competitive, calming, and supervised to promote emotional regulation and safety.

🟢 Walking provides a safe outlet for physical energy without overstimulation from groups or competition.

🟢 One-on-one engagement with the nurse also fosters therapeutic communication while minimizing distractions.

🟢 This intervention supports both emotional stability and physical exertion in a controlled manner.

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RN ATI Custom Nurs120 Psychiatric Nursing Fall-2023 Exam 2

No.

1 :
A nurse is caring for a client who has bipolar disorder and a new prescription for valproate. Which of the following instructions should the nurse give the client about the use of this medication?

2 :
A nurse is planning care for a client who is in the manic phase of bipolar disorder. Which of the following interventions should the nurse include in the client's plan of care?.

3 :
Which nursing intervention will have the greatest impact on both the management of care and on milieu environment when considering the clients diagnosed with bipolar disorder?

4 :
A nurse is caring for a client who has bipolar disorder and is taking lithium. The client reports blurred vision and ataxia. Which of the following actions should the nurse take?

5 :
A nurse is teaching a client who has a new prescription for lithium to treat bipolar disorder. The nurse should instruct the client to ensure an adequate intake of which of the following dietary elements?

6 :
A nurse is reviewing medication records for several clients who have bipolar disorder. The nurse should recognize that which of the following medications are used to treat clients who have bipolar disorder. (Select all that apply.).

7 :
A nurse is caring for a client who has schizophrenia and is experiencing a hallucination. Which of the following actions should the nurse take?

8 :
A nurse is caring for a client who has schizophrenia and is experiencing a variety of hallucinations. Which of the following hallucinations is the priority for the nurse to address?

9 :
A nurse is caring for a client who has been diagnosed with schizophrenia and appears confused and has distortions in their thinking and speech patterns. Which of the following is the priority nursing intervention for this client?

10 :
A nurse is caring for a client who has bipolar disorder and is in the manic phase. The client says he is bored. Which of the following activities is appropriate for the nurse to suggest to this client?

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RN ATI Custom Nurs120 Psychiatric Nursing Fall-2023 Exam 2

No.

1 : A nurse is caring for a client who has bipolar disorder and a new prescription for valproate. Which of the following instructions should the nurse give the client about the use of this medication?

2 : A nurse is planning care for a client who is in the manic phase of bipolar disorder. Which of the following interventions should the nurse include in the client's plan of care?.

3 : Which nursing intervention will have the greatest impact on both the management of care and on milieu environment when considering the clients diagnosed with bipolar disorder?

4 : A nurse is caring for a client who has bipolar disorder and is taking lithium. The client reports blurred vision and ataxia. Which of the following actions should the nurse take?

5 : A nurse is teaching a client who has a new prescription for lithium to treat bipolar disorder. The nurse should instruct the client to ensure an adequate intake of which of the following dietary elements?

6 : A nurse is reviewing medication records for several clients who have bipolar disorder. The nurse should recognize that which of the following medications are used to treat clients who have bipolar disorder. (Select all that apply.).

7 : A nurse is caring for a client who has schizophrenia and is experiencing a hallucination. Which of the following actions should the nurse take?

8 : A nurse is caring for a client who has schizophrenia and is experiencing a variety of hallucinations. Which of the following hallucinations is the priority for the nurse to address?

9 : A nurse is caring for a client who has been diagnosed with schizophrenia and appears confused and has distortions in their thinking and speech patterns. Which of the following is the priority nursing intervention for this client?

10 : A nurse is caring for a client who has bipolar disorder and is in the manic phase. The client says he is bored. Which of the following activities is appropriate for the nurse to suggest to this client?

1 :
A nurse is caring for a client who has bipolar disorder and a new prescription for valproate. Which of the following instructions should the nurse give the client about the use of this medication?

2 :
A nurse is planning care for a client who is in the manic phase of bipolar disorder. Which of the following interventions should the nurse include in the client's plan of care?.

3 :
Which nursing intervention will have the greatest impact on both the management of care and on milieu environment when considering the clients diagnosed with bipolar disorder?

4 :
A nurse is caring for a client who has bipolar disorder and is taking lithium. The client reports blurred vision and ataxia. Which of the following actions should the nurse take?

5 :
A nurse is teaching a client who has a new prescription for lithium to treat bipolar disorder. The nurse should instruct the client to ensure an adequate intake of which of the following dietary elements?

6 :
A nurse is reviewing medication records for several clients who have bipolar disorder. The nurse should recognize that which of the following medications are used to treat clients who have bipolar disorder. (Select all that apply.).

7 :
A nurse is caring for a client who has schizophrenia and is experiencing a hallucination. Which of the following actions should the nurse take?

8 :
A nurse is caring for a client who has schizophrenia and is experiencing a variety of hallucinations. Which of the following hallucinations is the priority for the nurse to address?

9 :
A nurse is caring for a client who has been diagnosed with schizophrenia and appears confused and has distortions in their thinking and speech patterns. Which of the following is the priority nursing intervention for this client?

10 :
A nurse is caring for a client who has bipolar disorder and is in the manic phase. The client says he is bored. Which of the following activities is appropriate for the nurse to suggest to this client?