A nurse is reviewing discharge instructions with a client who has bipolar disorder and is taking lithium. Which of the following manifestations should the nurse include as an indication of mild toxicity?
Muscle weakness.
Constipation.
Urinary retention.
Hyperactivity.
The Correct Answer is A
Choice A rationale:
Muscle weakness is a manifestation of mild lithium toxicity. Lithium toxicity can occur at therapeutic levels, so clients should be monitored for adverse effects.
Choice B rationale:
Constipation is not typically associated with lithium toxicity. Diarrhea, not constipation, is a symptom of lithium toxicity.
Choice C rationale:
Urinary retention is not a typical symptom of lithium toxicity. Increased urination and thirst are common side effects of lithium.
Choice D rationale:
Hyperactivity is not a typical symptom of lithium toxicity. Lithium is used to manage bipolar disorder and can help reduce hyperactivity.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale:
Continuing to abstain from alcohol is a positive step towards maintaining mental health, not a sign of suicidal ideation.
Choice B rationale:
Finding therapeutic activities like walking around the hospital grounds is a positive coping mechanism, not a sign of suicidal ideation.
Choice C rationale:
Looking forward to future events like seeing grandchildren is a positive sign and not indicative of suicidal ideation.
Choice D rationale:
Giving away possessions, like a pottery collection, can be a sign of suicidal ideation as it may indicate the client is putting their affairs in order.
Correct Answer is B
Explanation
Choice A rationale:
Placing the client on 12-hour observation may not be sufficient as suicidal thoughts can persist beyond this timeframe.
Choice B rationale:
Removing harmful objects from the client’s room is a crucial step in ensuring the safety of a client experiencing suicidal thoughts. This action helps to minimize the risk of self-harm.
Choice C rationale:
While social support can be beneficial, it’s important to regulate visitors as they could unintentionally bring harmful objects or substances.
Choice D rationale:
Encouraging visitors to bring items could pose a risk as they might unknowingly bring in objects that could be used for self-harm.
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