Aug 31 ACE NCLEX with Practice Question

August 31, 2024

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The registered nurse supervises a student nurse who is caring for a client newly prescribed lithium for the treatment of bipolar disorder. Which action by the student indicates a need for further teaching?

Advises the client to drink 2-3 liters of water each day

Instructs the client to limit intake of cola, tea, coffee, and alcohol

Shows the client how to carefully check food labels to follow a low-sodium diet

Teaches the client that it may take up to several weeks for the drug to be effective

Lithium Toxicity 

Features

Acute: gastrointestinal findings - nausea, vomiting, diarrhea; neurologic findings occur later Features

Chronic: neurologic - ataxia, sluggishness, confusion, agitation, neuromuscular excitability (coarse tremor)

Prevention

• Avoid sodium depletion; low sodium intake precipitates lithium toxicity Prevention
• Eat regular diet & drink adequate fluids (2-3 L/day)
• Therapeutic level is 0.6-1.2 mEq/L (0.6-1.2 mmol/L)
• Level >1.5 mEq/L (1.5 mmol/L) is considered toxic

Lithium carbonate is a mood stabilizer used for the treatment of bipolar disorder. Lithium levels take some time to reach therapeutic levels, often up to a few weeks (Option 4). Clients will need to have their lithium levels carefully monitored when starting therapy, as the therapeutic range is narrow (0.6-1.2 mEq/L [0.6-1.2mmol/L]). Blood sodium levels affect the renal excretion of lithium, as lithium and sodium are excreted in a parallel mechanism by the kidney. If sodium intake is limited or the body is depleted of its normal sodium (eg, excessive perspiration, vomiting, diarrhea), lithium is reabsorbed by the kidneys, increasing the possibility of toxicity (Option 3). Therefore, clients on lithium must consume adequate sodium in the diet. Care should be taken to avoid dehydration, so diuretic medications and substances with a diuretic effect (eg, coffee, cola, tea, alcoholic beverages) must be limited or avoided, and clients are advised to drink 2-3 liters of water each day (Options 1 and 2).

Lithium Toxicity 

Features

Acute: gastrointestinal findings - nausea, vomiting, diarrhea; neurologic findings occur later Features

Chronic: neurologic - ataxia, sluggishness, confusion, agitation, neuromuscular excitability (coarse tremor)

Prevention

• Avoid sodium depletion; low sodium intake precipitates lithium toxicity Prevention
• Eat regular diet & drink adequate fluids (2-3 L/day)
• Therapeutic level is 0.6-1.2 mEq/L (0.6-1.2 mmol/L)
• Level >1.5 mEq/L (1.5 mmol/L) is considered toxic

Lithium carbonate is a mood stabilizer used for the treatment of bipolar disorder. Lithium levels take some time to reach therapeutic levels, often up to a few weeks (Option 4). Clients will need to have their lithium levels carefully monitored when starting therapy, as the therapeutic range is narrow (0.6-1.2 mEq/L [0.6-1.2mmol/L]). Blood sodium levels affect the renal excretion of lithium, as lithium and sodium are excreted in a parallel mechanism by the kidney. If sodium intake is limited or the body is depleted of its normal sodium (eg, excessive perspiration, vomiting, diarrhea), lithium is reabsorbed by the kidneys, increasing the possibility of toxicity (Option 3). Therefore, clients on lithium must consume adequate sodium in the diet. Care should be taken to avoid dehydration, so diuretic medications and substances with a diuretic effect (eg, coffee, cola, tea, alcoholic beverages) must be limited or avoided, and clients are advised to drink 2-3 liters of water each day (Options 1 and 2).

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Aug 31 ACE NCLEX with Practice Question

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Aug 30 ACE NCLEX with Practice Question