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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).
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A nurse is preparing to administer medications to a female client with bipolar disorder who is experiencing acute mania. Which of the following would be most appropriate for the nurse to do?
- A. Tell the client firmly that she must take her medication.
- B. Allow the client to participate in the treatment decision.
- C. Restrain the client before administering the medication.
- D. Notify the physician about the client?s refusal of the medication.
Correct Answer: B
Rationale: Allowing the client to participate in treatment decisions (B) fosters autonomy and therapeutic alliance, appropriate unless the client is too impaired to decide. Firm insistence (A) may escalate agitation, restraint (C) is a last resort, and notifying the physician (D) assumes refusal prematurely.
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 diagnosed with bipolar disorder and experiencing mania is admitted to the inpatient psychiatric setting. During the acute phase of mania, which medication would the nurse expect to most likely administer?
- A. Lithium carbonate (Lithium)
- B. Haloperidol lactate (Haldol)
- C. Fluoxetine (Prozac)
- D. Paroxetine (Paxil)
Correct Answer: B
Rationale: Haloperidol (B), a typical antipsychotic, is commonly used in acute mania to rapidly control severe agitation, impulsivity, and psychotic symptoms due to its fast-acting nature. Lithium (A) is effective for long-term mood stabilization but slower in acute mania. Fluoxetine (C) and paroxetine (D), SSRIs, are used for depression, not mania, and may worsen manic symptoms.
A client with bipolar disorder is receiving divalproex sodium as part of the treatment plan. When monitoring the client?s blood level for this drug, which level would alert the nurse to the need to change the dosage?
- A. 30 ng/mL
- B. 55 ng/mL
- C. 75 ng/mL
- D. 115 ng/mL
Correct Answer: D
Rationale: The therapeutic range for divalproex sodium (valproic acid) is 50?100 µg/mL (often reported as ng/mL in some contexts). A level of 115 ng/mL (D) is above this range, indicating potential toxicity and the need for dosage reduction. Levels of 30, 55, and 75 ng/mL (A, B, C) are below or within the therapeutic range.