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A nurse is caring for a client who has bipolar disorder.

Exhibits

Which of the following assessment findings require immediate follow- up? (Select all that apply.)

A.

Blood pressure

B.

Lithium level

C.

Sodium level

D.

WBC count

E.

Thyroid-stimulating (TSH) level

F.

BUN level

G.

Levothyroxine dosage

H.

Acetaminophen

I.

Lithium dosage

Answer and Explanation

Correct Answer : B,C,F,I

A. Blood pressure – Within normal range (115/76 mm Hg). No immediate concern.
B. Lithium level – 1.7 mEq/L is above the therapeutic range (0.8–1.2). Toxicity is likely, especially with the client’s symptoms (tremor, confusion, GI upset). Requires urgent follow-up.
C. Sodium level – 128 mEq/L indicates hyponatremia. Low sodium increases the risk for lithium toxicity because lithium and sodium compete for renal reabsorption.
D. WBC count – Within normal range (7,000/mm³).
E. TSH level – Mildly elevated (6). Suggests hypothyroidism (a side effect of lithium) but not immediately life-threatening. Requires follow-up, but not urgent.
F. BUN level –Elevated at 30 mg/dL (normal 10–20). Indicates impaired renal function, which reduces lithium clearance and increases toxicity risk.
G. Levothyroxine dosage – No immediate safety issue noted; managed long term.
H. Acetaminophen – Daily 325 mg is safe; not a concern.
I. Lithium dosage – Current dose (600 mg BID) is likely contributing to toxicity and must be reassessed immediately.


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Related Questions

Correct Answer is B

Explanation

A. Distinguishing between reality and fantasy shows intact cognition, not mental illness.
B. A persistent sad, hopeless mood suggests depression, a hallmark of mental illness when symptoms are severe and ongoing.
C. Occasional anxiety and insomnia can be normal stress responses, not necessarily mental illness.
D. Difficulty making a decision about work is a common life stressor, not a clear sign of mental illness.

Correct Answer is C

Explanation

A. Haloperidol is not commonly associated with bleeding; this is more relevant to anticoagulants or antiplatelet therapy.

B. Pancreatitis is more commonly associated with certain antipsychotics like clozapine or valproate, not haloperidol.

C. Haloperidol, a typical antipsychotic, can prolong the QT interval and cause cardiac dysrhythmias, especially in higher doses or IV administration. Monitoring ECG and cardiac status is important.

D. Cataract formation is a potential adverse effect of long-term use of atypical antipsychotics such as quetiapine or olanzapine, not haloperidol.

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