A client has begun a long-term maintenance therapy with lithium, which has a narrow therapeutic index. Which adverse effect is most important for the nurse to include in the teaching plan?

Choice A reason: Denying muscle spasms is normal and not a complication. Muscle twitching indicates hypocalcemia, a thyroidectomy risk due to parathyroid damage. Absence of spasms is reassuring, per postoperative complication monitoring and endocrine surgical care standards in nursing.

Choice B reason: Back and joint pain are nonspecific and not typical thyroidectomy complications. Muscle twitching suggests hypocalcemia, a critical issue post-thyroidectomy. Pain requires assessment but is less urgent, per postoperative monitoring and complication management protocols in surgical nursing.

Choice C reason: Muscle twitching in hands and feet indicates hypocalcemia, a serious complication from parathyroid gland damage during thyroidectomy. This requires immediate calcium replacement to prevent tetany, per postoperative complication monitoring and endocrine surgical care protocols in nursing practice.

Choice D reason: Diaphoresis without headache is nonspecific and not a primary thyroidectomy complication. Muscle twitching signals hypocalcemia, needing urgent intervention. Diaphoresis requires monitoring but is less critical, per postoperative assessment and complication management standards in surgical nursing.

Choice A reason: Dependence is not a primary concern with lithium, a mood stabilizer. Toxicity is critical due to lithium’s narrow therapeutic range, risking severe complications. Dependence is more relevant to other drugs, per psychopharmacology and lithium therapy education standards in nursing.

Choice B reason: Interactions are important but less urgent than toxicity, which can be life-threatening with lithium’s narrow therapeutic index. Toxicity education emphasizes monitoring blood levels to prevent harm, per psychopharmacology and patient safety protocols in lithium therapy teaching.

Choice C reason: Toxicity is the most critical adverse effect to teach, as lithium’s narrow therapeutic index risks severe complications like seizures or renal failure. Monitoring symptoms and blood levels ensures safety, per evidence-based psychopharmacology and patient education protocols for lithium therapy in nursing.

Choice D reason: Tolerance is not a significant issue with lithium, unlike toxicity, which is life-threatening due to its narrow therapeutic range. Teaching toxicity symptoms prioritizes patient safety, per lithium therapy management and psychopharmacological education standards in nursing practice.