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A client is to receive lithium therapy as part of the treatment plan for bipolar disorder. When reviewing the client?s medication history, which agents would alert the nurse to the possibility that a decrease in lithium dosage may be needed? Select all that apply.
- A. Lisinopril
- B. Hydrochlorothiazide
- C. Indomethacin
- D. Caffeine
- E. Aspirin
Correct Answer: B,C
Rationale: Hydrochlorothiazide (B) and indomethacin (C) reduce lithium excretion, increasing lithium levels and requiring potential dose reduction to avoid toxicity. Lisinopril (A), caffeine (D), and aspirin (E) have minimal impact on lithium pharmacokinetics.
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The nurse is assessing a client with bipolar disorder who is experiencing mania. The client states, I?m just so beautiful. Everyone just stops and stares at how gorgeous I am. Men constantly want to have sex with me. The nurse interprets these statements as indicative of which type of mood?
- A. Irritable
- B. Elevated
- C. Expansive
- D. Euphoric
Correct Answer: C
Rationale: Expansive mood (C) in mania is characterized by grandiose, exaggerated self-perception, as seen in the client?s statements about beauty and desirability. Irritable mood (A) involves agitation, elevated mood (B) is less specific, and euphoric mood (D) reflects intense happiness without the grandiose quality.
A client who is receiving lithium comes to the clinic for an evaluation. During the visit, the client reports a fine hand tremor. Which action by the nurse would be most appropriate?
- A. Immediately obtain a specimen to determine the client?s blood drug level.
- B. Suggest that the client take the medication with meals or snacks.
- C. Assist the client in minimizing exposure to stressors.
- D. Encourage the client to elevate the affected hand on a pillow.
Correct Answer: B
Rationale: A fine hand tremor is a common, benign side effect of lithium. Taking the medication with meals or snacks (B) can reduce gastrointestinal irritation and tremor severity. Immediate blood testing (A) is unnecessary unless toxicity is suspected, stress reduction (C) is less relevant, and elevation (D) is ineffective.
A client asks the nurse if he needs to alter any of his activities because he is taking lithium carbonate. Which of the following responses would be most appropriate?
- A. Increase your salt intake if an activity causes you to perspire heavily.
- B. Wear sunscreen when you are going to be outdoors in the summer time.
- C. Drink less fluid than usual now because you are taking this drug.
- D. No changes are necessary for strenuous activities you do outdoors.
Correct Answer: A
Rationale: Lithium levels can increase to toxic levels with dehydration from heavy perspiration, as sodium loss affects lithium excretion. Increasing salt intake (A) during such activities helps maintain safe lithium levels. Sunscreen (B) is unrelated, reducing fluid (C) risks toxicity, and no changes (D) ignores the risk of dehydration.
A client is brought to the emergency department by his brother. The client has a history of bipolar disorder for which he is taking divalproex. The brother reports that he watched his brother take the medication about 2 hours ago. He stated, A little while ago, he got very disoriented and agitated. The nurse suspects toxicity based on assessment of which of the following? Select all that apply.
- A. Tachypnea
- B. Bradycardia
- C. Hypotension
- D. Nystagmus
- E. Vomiting
Correct Answer: D,E
Rationale: Divalproex toxicity may present with nystagmus (D) and vomiting (E), alongside disorientation and agitation, due to neurological and gastrointestinal effects. Tachypnea (A), bradycardia (B), and hypotension (C) are less specific to valproate toxicity.
A client with bipolar disorder has a lithium drug level of 1.2 mEq/L. Which of the following would the nurse expect to assess? Select all that apply.
- A. Metallic taste
- B. Ataxia
- C. Diarrhea
- D. Slurred speech
- E. Fasciculations
- F. Muscle weakness
Correct Answer: A,C,F
Rationale: A lithium level of 1.2 mEq/L is within the therapeutic range (0.6?1.2 mEq/L) but at the upper limit, where mild side effects like metallic taste (A), diarrhea (C), and muscle weakness (F) may occur. Ataxia (B), slurred speech (D), and fasciculations (E) are more typical of toxicity (>1.5 mEq/L).