A physician orders Lithium 1.2 grams/day in three divided doses PO for a client with bipolar disorder. The medication is supplied as 300 mg/5 mL. How much will the nurse administer per dose?

(Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)

Choice A Reason: 0.8 mEq/L

The therapeutic range for lithium is typically between 0.6 and 1.2 mEq/L. A level of 0.8 mEq/L falls within this range and is considered normal. Therefore, it is unlikely that a client with this lithium level would present with symptoms such as mental confusion, frequent urination, and coarse tremors. These symptoms are more indicative of lithium toxicity, which occurs at higher levels.

Choice B Reason: 2.3 mEq/L

A lithium level of 2.3 mEq/L is significantly above the therapeutic range and indicates lithium toxicity. Symptoms of lithium toxicity include mental confusion, frequent urination, and coarse tremors, which match the client’s presentation. Severe toxicity can occur at levels above 2.0 mEq/L and can be life-threatening if not treated promptly. Therefore, this is the most likely lithium level for the client described.

Choice C Reason: 1.8 mEq/L

A lithium level of 1.8 mEq/L is above the therapeutic range but below the level typically associated with severe toxicity. While some symptoms of toxicity might appear at this level, they are generally less severe than those described in the scenario. The client’s symptoms suggest a more severe level of toxicity, making this choice less likely.

Choice D Reason: 1.2 mEq/L

A lithium level of 1.2 mEq/L is at the upper limit of the therapeutic range. While it is possible for some mild side effects to occur at this level, the severe symptoms described (mental confusion, frequent urination, and coarse tremors) are more indicative of a higher, toxic level of lithium. Therefore, this choice is also less likely.

Choice A Reason:

When a client with a personality disorder engages in self-destructive behavior, it is crucial for the staff to observe this behavior closely to ensure the safety of both the client and others around them. Self-destructive behaviors can include actions such as self-harm, substance abuse, or reckless activities that pose a significant risk to the individual’s well-being. By monitoring these behaviors, staff can intervene promptly to prevent harm and provide necessary support. Ensuring safety is a fundamental aspect of care in mental health settings, as it helps to stabilize the client and create a secure environment for their treatment and recover.

Choice B Reason:

Indulging the client’s wishes is not a recommended approach when dealing with self-destructive behavior. While it is important to understand and validate the client’s feelings, indulging their wishes can reinforce negative behaviors and hinder their progress towards healthier coping mechanisms. Instead, staff should focus on providing appropriate interventions and support that address the underlying issues contributing to the self-destructive behavior. This approach helps the client develop more constructive ways of meeting their needs and managing their emotions.

Choice C Reason:

While self-destructive behavior may provide a temporary outlet for feelings of anger and frustration, it is not a healthy or sustainable way to cope with these emotions. Encouraging or allowing such behavior can lead to further harm and exacerbate the client’s mental health issues. Staff should work with the client to identify and implement healthier coping strategies that effectively address their emotional needs without causing harm. This can include therapeutic interventions, counseling, and skills training to help the client manage their anger and frustration in more constructive ways.

Choice D Reason:

Assuming responsibility for the client’s behavior is not an effective way to reduce their anger and anxiety. In fact, it can create a dependency on staff and prevent the client from developing their own coping skills and sense of autonomy. It is important for staff to support the client in taking responsibility for their actions and learning how to manage their emotions independently. This empowerment is a key component of the therapeutic process and contributes to the client’s long-term recovery and well-being.