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

A. Lithium is excreted through the kidneys, and dehydration and sodium depletion increase the risk of lithium toxicity. A client who runs 4 miles outdoors every afternoon is at risk of excessive sweating and fluid loss, which can lead to dehydration and sodium depletion. This reduces lithium excretion, leading to toxic levels in the blood.

B. A normal sodium intake helps maintain lithium balance. A low sodium intake increases lithium retention, but 2-3 grams/day is within the normal recommended range.

C. Adequate hydration helps prevent lithium toxicity. Clients on lithium should drink 2–3 liters of fluid daily to promote kidney function and lithium excretion.
D. Tyramine-rich foods (e.g., aged cheese, cured meats) are a concern for clients on monoamine oxidase inhibitors (MAOIs), not lithium. Tyramine does not affect lithium levels.

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Correct Answer is D

Explanation

While preventing injury is important, it is not the highest priority when the client's respiratory and neurological functions are compromised. Managing the client's breathing takes precedence.

B. Applying a cooling blanket.

While hyperthermia (high fever) is a symptom of serotonin syndrome, the immediate concern is ensuring the client's breathing and neurological stability. Cooling measures can be beneficial, but they come after addressing the more critical issues.

C. Administering an anticonvulsant.

While anticonvulsants might be used to control seizures, preparing for artificial ventilation takes priority, as the client's airway and oxygenation must be secured before addressing other symptoms.

D. Preparing for artificial ventilation.

Explanation: Serotonin syndrome is a potentially life-threatening condition caused by an excess of serotonin in the body, often resulting from interactions between medications that affect serotonin levels. Severe manifestations of serotonin syndrome can include high fever, muscle rigidity, agitation, seizures, and even coma. In cases of severe serotonin syndrome, the client's neurological and respiratory functions can be compromised, making it crucial to ensure adequate ventilation and oxygenation.

A. A pretreatment electroencephalogram (EEG) will be done. B. High serum sodium levels can cause toxic levels of valproate. C. Liver function tests must be monitored. D. Thyroid function tests should be performed every 6 months

Correct Answer is C

Explanation

A. A pretreatment electroencephalogram (EEG) will be done.

An EEG is not typically necessary when starting valproate for bipolar disorder. EEGs are more commonly used to assess brain activity in the context of epilepsy.

B. High serum sodium levels can cause toxic levels of valproate.

Sodium levels are not directly related to the toxic levels of valproate. The primary concern with valproate is its impact on liver function and potential for hepatotoxicity.

C. Liver function tests must be monitored.

Explanation: Valproate is an antiepileptic and mood-stabilizing medication commonly used to treat bipolar disorder. One of the potential side effects of valproate is hepatotoxicity (liver damage). Therefore, monitoring liver function tests (such as serum transaminases) is important to assess the medication's impact on the liver and to ensure the client's safety.

D. Thyroid function tests should be performed every 6 months.

While thyroid function tests might be important for some medications, monitoring thyroid function is not a primary consideration when using valproate. The main focus with valproate is on liver function monitoring.

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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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Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who is exhibiting severe manifestations of serotonin syndrome. Which of the following is the priority nursing intervention?

Correct Answer is D

Explanation

A nurse is caring for a client who has bipolar disorder and a new prescription for valproate. Which of the following instructions should the nurse give the client about the use of this medication?

Correct Answer is C

Explanation

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