NURS 241- EXAM 1 PSYCHOSIS, ELECTROLYTES, FLUID
BALANCE, & HF || ACKNOWLEDGED ANSWERS 100%.
Match the following with either a) hypotonic, b) isotonic, or c) hypertonic
1) D5W in body
2) D5 .25%NS
3) D5 .45NS
4) 0.45%NS
5) D10W
6) Normosol
7) 0.33%NS
8) 3%NS
9) D5W in bag
10) D5NS
11) 0.225%NS
12) 0.9%NS
13) LR
14) D5LR correct answers Hypotonic:
1) D5W in body
4) 0.45%NS
7) 0.33%NS
11) 0.225%NS
Isotonic:
2) D5 .25%NS
6) Normosol
9) D5W in bag
,12) 0.9%NS
13) LR
Hypertonic:
3) D5 .45NS
5) D10W
8) 3%NS
10) D5NS
14) D5LR
Which of the following nursing interventions would the nurse perform for the client with
psychosis/schizophrenia? (Select all that apply)
a) Assess home medications and current doses, and verify proper administration/dosing with
patient
b) Look for signs and symptoms of suicidal ideation, thoughts, or plans.
c) Assess any available MRI or CT scans to rule out injury
d) Assess labs including electrolytes and any substance abuse toxicology reports correct answers
a) Assess home medications and current doses, and verify proper administration/dosing with
patient
b) Look for signs and symptoms of suicidal ideation, thoughts, or plans.
c) Assess any available MRI or CT scans to rule out injury
d) Assess labs including electrolytes and any substance abuse toxicology reports
-This is an accurate statement. the nurse should assess not only the medications, but should
recognize usual doses and if the patient is following the treatment plan. in addition, many
psychiatric medications can have significant side effects that impacts patient use and compliance.
-Suicide risk is real for clients living with psychosis/schizophrenia. The nurse should assess for
risk of suicide. Suicide can be considered a true 'extreme version' critical scenario with
psychosis/schizophrenia.
,The nurse is taking care of the client with schizophrenia who has current visual hallucinations of
seeing bats in the activity room. Which of the following statements indicate that nurse
understands therapeutic communication techniques for the client? (Select all that apply.)
a) "I'm sure it will get better when your meds kick in"
b) "I will just sit here quietly with you. If you want to talk about it, that's ok"
c) "So what you are saying is that you are seeing small flying animals"
d) " Let's see what's on TV"
e) "I am not seeing bats in the activity room" correct answers b) "I will just sit here quietly with
you. If you want to talk about it, that's ok"
c) "So what you are saying is that you are seeing small flying animals"
e) "I am not seeing bats in the activity room"
*This is a correct answer and demonstrates therapeutic listening and/or silence.
This shows clarification and reinforcing reality.
The nurse is taking care of the patient with acute paranoid schizophrenia. Which of the following
medication orders is the most correct?
a) Haldol decanoate (haloperidol) 15 mg IV x 1 for acute psychosis
b) Haldol decanoate (haloperidol) 150 mg orally every 12 hours
c) Haldol decanoate (haloperidol) 1.5 mg orally every 12 hours
d) Haldol decanoate (haloperidol) 0.15 mg IM x 1 for acute psychosis correct answers c) Haldol
decanoate (haloperidol) 1.5 mg orally every 12 hours
*This is 3 mg daily which falls within the correct range for this medication.
Which of the following predisposing factors are most prevalent in the development of psychosis?
(Select all that apply)
a) Age 65+
b) Encephalitis and/or other infections
, c) Substance abuse
d) High income
e) White / caucasian ethnicity correct answers b) Encephalitis and/or other infections
c) Substance abuse
e) White / caucasian ethnicity
*You're a winner! Infections can cause symptoms of psychosis and should be ruled out as a part
of the diagnosis process.
Yes! There are higher rates of psychosis/schizophrenia with substance abuse, particularly
methamphetamine (and others)
Yes! Psychosis/schizophrenia is more prevalent in white/Caucasian ethnicity than
Hispanic/Latinx, Asian, or Native American ethnicity.
The nurse is taking care of a new admission patient with known schizophrenia who has been
having diarrhea for 3 days from a new medication regimen. The patient is restless and agitated,
and has twitching in their face and hands. The patient states they "can't go on like this." Put the
following nursing interventions in order of prioritization.
____ Assess patient vital signs, intake and output and basic neurological orientation
____ Start IV fluids of 0.9 NS with 20 meq potassium
____ Notify provider of findings
____ Assess lab values including magnesium and sodium
____ Assess that the patient is safe and free from imminent danger including suicidal ideation
correct answers __2__ Assess patient vital signs, intake and output and basic neurological
orientation
__5__ Start IV fluids of 0.9 NS with 20 meq potassium
__4__ Notify provider of findings
__3__ Assess lab values including magnesium and sodium
__1__ Assess that the patient is safe and free from imminent danger including suicidal ideation
*This is the second most accurate assessment. These are baseline informational pieces needed to
BALANCE, & HF || ACKNOWLEDGED ANSWERS 100%.
Match the following with either a) hypotonic, b) isotonic, or c) hypertonic
1) D5W in body
2) D5 .25%NS
3) D5 .45NS
4) 0.45%NS
5) D10W
6) Normosol
7) 0.33%NS
8) 3%NS
9) D5W in bag
10) D5NS
11) 0.225%NS
12) 0.9%NS
13) LR
14) D5LR correct answers Hypotonic:
1) D5W in body
4) 0.45%NS
7) 0.33%NS
11) 0.225%NS
Isotonic:
2) D5 .25%NS
6) Normosol
9) D5W in bag
,12) 0.9%NS
13) LR
Hypertonic:
3) D5 .45NS
5) D10W
8) 3%NS
10) D5NS
14) D5LR
Which of the following nursing interventions would the nurse perform for the client with
psychosis/schizophrenia? (Select all that apply)
a) Assess home medications and current doses, and verify proper administration/dosing with
patient
b) Look for signs and symptoms of suicidal ideation, thoughts, or plans.
c) Assess any available MRI or CT scans to rule out injury
d) Assess labs including electrolytes and any substance abuse toxicology reports correct answers
a) Assess home medications and current doses, and verify proper administration/dosing with
patient
b) Look for signs and symptoms of suicidal ideation, thoughts, or plans.
c) Assess any available MRI or CT scans to rule out injury
d) Assess labs including electrolytes and any substance abuse toxicology reports
-This is an accurate statement. the nurse should assess not only the medications, but should
recognize usual doses and if the patient is following the treatment plan. in addition, many
psychiatric medications can have significant side effects that impacts patient use and compliance.
-Suicide risk is real for clients living with psychosis/schizophrenia. The nurse should assess for
risk of suicide. Suicide can be considered a true 'extreme version' critical scenario with
psychosis/schizophrenia.
,The nurse is taking care of the client with schizophrenia who has current visual hallucinations of
seeing bats in the activity room. Which of the following statements indicate that nurse
understands therapeutic communication techniques for the client? (Select all that apply.)
a) "I'm sure it will get better when your meds kick in"
b) "I will just sit here quietly with you. If you want to talk about it, that's ok"
c) "So what you are saying is that you are seeing small flying animals"
d) " Let's see what's on TV"
e) "I am not seeing bats in the activity room" correct answers b) "I will just sit here quietly with
you. If you want to talk about it, that's ok"
c) "So what you are saying is that you are seeing small flying animals"
e) "I am not seeing bats in the activity room"
*This is a correct answer and demonstrates therapeutic listening and/or silence.
This shows clarification and reinforcing reality.
The nurse is taking care of the patient with acute paranoid schizophrenia. Which of the following
medication orders is the most correct?
a) Haldol decanoate (haloperidol) 15 mg IV x 1 for acute psychosis
b) Haldol decanoate (haloperidol) 150 mg orally every 12 hours
c) Haldol decanoate (haloperidol) 1.5 mg orally every 12 hours
d) Haldol decanoate (haloperidol) 0.15 mg IM x 1 for acute psychosis correct answers c) Haldol
decanoate (haloperidol) 1.5 mg orally every 12 hours
*This is 3 mg daily which falls within the correct range for this medication.
Which of the following predisposing factors are most prevalent in the development of psychosis?
(Select all that apply)
a) Age 65+
b) Encephalitis and/or other infections
, c) Substance abuse
d) High income
e) White / caucasian ethnicity correct answers b) Encephalitis and/or other infections
c) Substance abuse
e) White / caucasian ethnicity
*You're a winner! Infections can cause symptoms of psychosis and should be ruled out as a part
of the diagnosis process.
Yes! There are higher rates of psychosis/schizophrenia with substance abuse, particularly
methamphetamine (and others)
Yes! Psychosis/schizophrenia is more prevalent in white/Caucasian ethnicity than
Hispanic/Latinx, Asian, or Native American ethnicity.
The nurse is taking care of a new admission patient with known schizophrenia who has been
having diarrhea for 3 days from a new medication regimen. The patient is restless and agitated,
and has twitching in their face and hands. The patient states they "can't go on like this." Put the
following nursing interventions in order of prioritization.
____ Assess patient vital signs, intake and output and basic neurological orientation
____ Start IV fluids of 0.9 NS with 20 meq potassium
____ Notify provider of findings
____ Assess lab values including magnesium and sodium
____ Assess that the patient is safe and free from imminent danger including suicidal ideation
correct answers __2__ Assess patient vital signs, intake and output and basic neurological
orientation
__5__ Start IV fluids of 0.9 NS with 20 meq potassium
__4__ Notify provider of findings
__3__ Assess lab values including magnesium and sodium
__1__ Assess that the patient is safe and free from imminent danger including suicidal ideation
*This is the second most accurate assessment. These are baseline informational pieces needed to
