A nurse is providing discharge teaching to a client who has bipolar disorder and will be discharged with a prescription for lithium. The nurse could teach the client which of the following factors puts her at risk for lithium toxicity?

A client runs 4 miles outdoors every afternoon.

The client eats 2 to 3 gm of sodium-containing foods daily.

The client drinks 2 liters of liquids daily.

The client eats foods high in tyramine.

Answer and Explanation

The Correct Answer is A

Correct answer: A

A. A client runs 4 miles outdoors every afternoon:

Explanation: Exercise, especially vigorous exercise like running, can increase sweating, which leads to dehydration. Dehydration can decrease lithium excretion, potentially resulting in higher lithium levels in the bloodstream and an increased risk of toxicity. Therefore, this factor puts the client at risk for lithium toxicity.

B. The client eats 2 to 3 gm of sodium-containing foods daily:

Explanation: Sodium levels can affect lithium levels in the body. High sodium levels in the blood can decrease lithium reabsorption by the kidneys, leading to increased lithium excretion and lower lithium levels in the bloodstream. This does not put the client at direct risk for lithium toxicity. In fact, consuming sodium-containing foods may help mitigate the risk of lithium toxicity.

C. The client drinks 2 liters of liquids daily:

Explanation: Adequate fluid intake is generally important, but it is not a direct risk factor for lithium toxicity. In fact, staying hydrated can be beneficial for overall health and proper kidney function, which plays a role in lithium excretion.

D. The client eats foods high in tyramine:

Explanation: Foods high in tyramine are a concern when taking certain classes of antidepressants called monoamine oxidase inhibitors (MAOIs). Lithium does not interact with tyramine-containing foods in the same way. Tyramine-rich foods are associated with a "cheese effect" when combined with MAOIs, but this is not relevant to lithium toxicity.

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Correct Answer is A

Explanation

The highest priority assessment in this situation is to determine if the client has psychotic thinking. Psychotic thinking can indicate a severe mental health condition that requires immediate attention and intervention. If the client is experiencing psychotic symptoms, they might be at risk of harming themselves or others. Identifying and addressing psychotic thinking is crucial to ensure the safety and well-being of the client and those around them.

B. Asking the client to identify the cause of the crisis.

While understanding the cause of the crisis is important for providing appropriate care, it is not the highest priority. Psychotic thinking or risk of harm takes precedence over understanding the cause.

C. Identifying the client's coping skills.

Coping skills are important for managing the crisis and promoting the client's well-being, but assessing for psychotic thinking and immediate safety concerns comes before evaluating coping skills.

D. Identifying the client's support systems.

Support systems are valuable for the client's overall recovery, but they are not as time-sensitive as assessing for psychotic thinking or imminent safety risks. Identifying support systems can come after addressing the immediate concerns.

A. "It doesn't really matter what time you take your medications as long as you don't skip any doses." B. "We'll have to talk to your provider about switching to an alternative schedule." C. "You really shouldn't change the schedule we established here in the facility." D. Let's work together to devise a time schedule that is convenient for you on a daily basis."

Correct Answer is D

Explanation

A. "It doesn't really matter what time you take your medications as long as you don't skip any doses."

While it's important not to skip doses, taking medications at specific intervals is often necessary for maintaining therapeutic blood levels and optimal treatment outcomes. Disregarding specific timing can affect the effectiveness of the medications.

B. "We'll have to talk to your provider about switching to an alternative schedule."

This response may not consider the client's preferences and might not be necessary if the client's current schedule can be adjusted to suit their routine. Collaboration between the nurse and the client is essential.

C. "You really shouldn't change the schedule we established here in the facility."

While continuity in medication schedules is important, if the established schedule doesn't align with the client's daily life, there should be flexibility to adjust it in a way that still maintains the effectiveness of the medications.

D. "Let's work together to devise a time schedule that is convenient for you on a daily basis."

Explanation: It's important to consider the client's lifestyle and routines when developing a medication schedule to ensure optimal adherence. Collaboratively working with the client to create a schedule that fits their daily activities increases the likelihood that they will consistently take their medications as prescribed.

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A nurse is providing discharge teaching to a client who has bipolar disorder and will be discharged with a prescription for lithium. The nurse could teach the client which of the following factors puts her at risk for lithium toxicity?

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