The nurse's teaching plan for a client taking lithium should include instructions to:

Maintain normal salt and fluid intake in the diet.

Drink twice the usual amount of fluids daily.

Avoid eating aged cheese, processed meats, and red wine.

Double the lithium dose if diarrhea or vomiting occurs.

Answer and Explanation

The Correct Answer is A

Choice A Reason:
Maintaining normal salt and fluid intake is crucial for patients on lithium. Lithium can affect sodium levels in the body, and consistent sodium intake helps to keep lithium levels stable. Patients should be advised to drink adequate fluids to prevent dehydration but avoid excessive fluid intake, which could alter lithium levels and potentially lead to toxicity¹²³⁴.

Choice B Reason:
Drinking twice the usual amount of fluids daily is not recommended for patients on lithium unless directed by a healthcare provider. Excessive fluid intake can lead to changes in lithium levels and increase the risk of lithium toxicity. Patients should aim to consume a sufficient amount of fluids to stay hydrated, especially in situations that may lead to dehydration, such as during hot weather or illness.

Choice C Reason:
Avoiding aged cheese, processed meats, and red wine is generally advised for patients taking monoamine oxidase inhibitors (MAOIs), not lithium. These foods can contain high levels of tyramine, which can interact with MAOIs. However, there are no specific dietary restrictions for lithium regarding these foods. Patients should follow a balanced diet and consult with their healthcare provider for personalized dietary advice.

Choice D Reason:
Doubling the lithium dose if diarrhea or vomiting occurs is incorrect and potentially dangerous. If a patient experiences diarrhea or vomiting, it can affect lithium absorption and increase the risk of toxicity. Instead, patients should contact their healthcare provider for guidance. Adjustments to the medication regimen should only be made under medical supervision.

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Correct Answer is A

Explanation

Choice A Reason:
Switching to heparin is not the standard response for a high INR. Heparin may be used in conjunction with warfarin when starting anticoagulation therapy, but it is not typically used as a substitute in response to an elevated INR.

Choice B Reason:
Giving the dose as prescribed would not be appropriate when the INR is significantly above the therapeutic range. Continuing the same dose could increase the risk of bleeding complications.

Choice C Reason:
Increasing the dose would be contraindicated as the INR is already too high. Increasing the warfarin dose would further elevate the INR and increase the risk of bleeding.

Choice D Reason:
Holding the dose is the correct action when the INR is significantly above the therapeutic range, which is generally between 2.0 to 3.0 for most indications. The healthcare provider should be notified, and the warfarin dose should be held until the INR returns to the therapeutic range. Vitamin K may also be administered to help lower the INR more quickly if necessary.

A. Glucose level at least 600 mg/dL B. Fruity, acetone smell to the breath C. Absence of ketones in the urine D. Polyuria and polydipsia E. Rapid, deep breathing.

Correct Answer is ["B","D","E"]

Explanation

Choice A Reason:
A glucose level of at least 600 mg/dL is more indicative of hyperglycemic hyperosmolar state (HHS) rather than diabetic ketoacidosis (DKA). While both conditions involve high blood sugar levels, DKA is typically characterized by blood glucose levels that are high but not as extreme as those seen in HHS1.

Choice B Reason:
A fruity, acetone smell to the breath is a classic sign of DKA. This odor is due to the presence of ketones, particularly acetone, which is exhaled. It’s one of the key clinical manifestations that can help in the diagnosis of DKA.

Choice C Reason:
The absence of ketones in the urine would not be consistent with a diagnosis of DKA. One of the hallmarks of DKA is the presence of ketones in the urine, resulting from the breakdown of fats due to a lack of insulin.

Choice D Reason:
Polyuria (excessive urination) and polydipsia (excessive thirst) are symptoms of DKA. They occur as the body tries to eliminate excess glucose through the urine, which can lead to dehydration and the need to drink more fluids.

Choice E Reason:
Rapid, deep breathing, also known as Kussmaul respiration, is a compensatory mechanism for the acidosis seen in DKA. The body attempts to correct the acidic pH by exhaling more carbon dioxide.

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The nurse's teaching plan for a client taking lithium should include instructions to:

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The nurse has administered warfarin 2.5 mg orally daily for three days to a client who has deep vein thrombosis. The client's International Normalized Ratio (INR) today is 5.0. The nurse notifies the healthcare provider because today's dose of the medication should be:

Correct Answer is A

Explanation

The nurse would assess for which clinical manifestations in a client suspected of having diabetic ketoacidosis? (Select all that apply)

Correct Answer is ["B","D","E"]

Explanation

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