Choice A rationale:
High serum sodium levels do not directly cause toxic levels of valproate.
Choice B rationale:
While regular health monitoring is important, specifically performing thyroid function tests every 6 months is not a standard requirement for valproate use.
Choice C rationale:
A pretreatment electroencephalogram (EEG) is not typically required before starting valproate.
Choice D rationale:
Liver function tests must be monitored as valproate can cause liver failure that may be fatal.

Choice A rationale:
Having consistent unit routines can provide a sense of stability and predictability, which can be beneficial for a client in the manic phase of bipolar disorder.
Choice B rationale:
Providing a stimulating environment can potentially exacerbate symptoms of mania, making it an inappropriate intervention.
Choice C rationale:
Scheduling daily seclusion times is not typically recommended as it can lead to feelings of isolation.
Choice D rationale:
Discouraging daytime napping can potentially lead to fatigue and worsen symptoms, so it’s not typically recommended.

Choice A rationale:
While educating the client about policies upon admission to the unit is important, it may not have the greatest impact on both the management of care and on milieu environment.
Choice B rationale:
Instructing the client that intrusive behaviors are not appropriate is important, but it may not have the greatest impact on both the management of care and on milieu environment.
Choice C rationale:
Ensuring that the client’s medication therapy is administered in a timely manner is crucial, but it may not have the greatest impact on both the management of care and on milieu environment.
Choice D rationale:
Setting and maintaining consistent unit policies that are enforced by all staff can create a stable and predictable environment, which can have a significant impact on both the management of care and on milieu environment.

Choice A rationale:
The client is displaying manifestations of lithium toxicity, which includes ataxia and blurred vision. Therefore, the nurse should withhold the medication.
Choice B rationale:
Administering the next dose as prescribed could potentially exacerbate the client’s symptoms and increase the risk of further toxicity.
Choice C rationale:
Propranolol is not typically used in the management of lithium toxicity.
Choice D rationale:
Levothyroxine is used to treat hypothyroidism and is not relevant in this context.

Choice A rationale:
Vitamin K is not specifically related to the management of bipolar disorder or the use of lithium.
Choice B rationale:
Clients under lithium therapy don’t need to limit their sodium intake. It is recommended to keep salt intake the same as before prescription of the lithium medication.
Choice C rationale:
While potassium is an important dietary element, it is not specifically related to the management of bipolar disorder or the use of lithium.
Choice D rationale:
Vitamin C is not specifically related to the management of bipolar disorder or the use of lithium.

Choice A rationale:
Lithium is a mood stabilizer commonly used in the treatment of bipolar disorder.
Choice B rationale:
Valproate is an antiepileptic and mood-stabilizing medication commonly used to treat bipolar disorder.
Choice C rationale:
Carbamazepine is an anticonvulsant medication that has been found effective in managing mood swings in bipolar disorder.
Choice D rationale:
Donepezil is primarily used to treat Alzheimer’s disease and is not typically used in the treatment of bipolar disorder.
Choice E rationale:
Paroxetine is a type of antidepressant known as an SSRI, and it can be used in the treatment of bipolar disorder.

Choice A rationale:
Asking direct questions about the hallucination may validate the hallucination as real in the client’s mind.
Choice B rationale:
Instructing the client to argue with the voices could potentially increase the client’s distress.
Choice C rationale:
Acting as if the hallucination is real may reinforce the client’s belief in the hallucination.
Choice D rationale:
Telling the client that the hallucination is not a part of reality can help ground the client in reality.

Ventricular fibrillation: The correct electricity is Defibrillation. Ventricular fibrillation is a life-threatening condition that requires immediate medical attention. Defibrillation is the process of delivering an electric shock to the heart to stop the fibrillation and allow the heart’s normal rhythm to resume4.

PVC-run ventricular tachycardia with a pulse: The correct electricity is Synchronized Cardioversion. This is used when the patient is hemodynamically stable. It involves the delivery of a therapeutic dose of electrical current to the heart at a specific moment in the cardiac cycle5.

Atrial Flutter: The correct electricity is Synchronized Cardioversion. Atrial flutter is a type of abnormal heart rhythm, or arrhythmia. It can be treated with synchronized cardioversion, in which a controlled electric shock is delivered to the heart to restore normal rhythm5.

Bradycardia: The correct electricity is Transcutaneous Pacing. This is a temporary means of pacing a patient’s heart during a medical emergency. It should be undertaken by healthcare providers who are trained in the procedure5.

So, the correct answer is Defibrillation for Ventricular fibrillation, Synchronized Cardioversion for PVC-run ventricular tachycardia with a pulse and Atrial Flutter, and Transcutaneous Pacing for Bradycardia, after analyzing all choices.

Choice A rationale:
Command hallucinations can direct the patient to harm themselves or others, making it the priority to address.
Choice B rationale:
Tactile hallucinations, while distressing, are not typically as immediately dangerous as command hallucinations.
Choice C rationale:
Gustatory hallucinations, while potentially disturbing, do not usually pose an immediate threat.
Choice D rationale:
Visual hallucinations, while potentially distressing, are not typically as immediately dangerous as command hallucinations.

Choice A rationale:
Ensuring the client goes to group activities as planned is important, but not the priority when the client is confused and has distorted thinking.
Choice B rationale:
Using distraction such as television or music can be helpful, but it is not the priority intervention.
Choice C rationale:
Providing reassurance and comfort ensuring the client is safe is the priority as it directly addresses the client’s immediate needs.
Choice D rationale:
Giving PRN medications to treat increased hallucinations may be necessary, but it is not the first action to take.