A 26-year-old woman with bipolar disorder has been stable on lithium for 2 years. She presents to the PMHNP with mild confusion, a tremor, and nausea. Upon questioning, she states she recently fell while running and injured her ankle in the fall. Which of the following is most likely to be the cause of her current symptoms?
Acetaminophen
Vicodin
Aspirin
Ibuprofen
The Correct Answer is D
Choice A reason: Acetaminophen is generally safe to use with lithium and does not interfere with renal function or lithium clearance. It is unlikely to cause lithium toxicity or contribute to the symptoms described.
Choice B reason: Vicodin contains hydrocodone and acetaminophen. While opioids can cause sedation and nausea, they do not typically interact with lithium in a way that would cause toxicity. However, they should still be used cautiously in patients with mood disorders.
Choice C reason: Aspirin is an NSAID but has a lesser impact on renal prostaglandins compared to other NSAIDs. It is less likely to impair lithium clearance and cause toxicity, although caution is still advised.
Choice D reason: Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that can reduce renal clearance of lithium by inhibiting prostaglandin synthesis in the kidneys. This can lead to elevated lithium levels and toxicity, especially in older adults or those with compromised renal function. The client’s symptoms—confusion, tremor, and nausea—are consistent with lithium toxicity, making ibuprofen the most likely culprit.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Escitalopram has a relatively short half-life and typically requires a 2-week washout period before initiating an MAOI to avoid serotonin syndrome.
Choice B reason: Sertraline also has a shorter half-life and does not require a 5-week washout. A 2-week period is generally sufficient.
Choice C reason: Fluoxetine has the longest half-life among SSRIs, with active metabolites that persist in the body for weeks. Due to this extended duration, a 5-week washout period is recommended before starting an MAOI to prevent serotonin toxicity.
Choice D reason: Paroxetine has a short half-life and would not necessitate a 5-week washout. A 2-week interval is typically adequate.
Correct Answer is D
Explanation
Choice A reason: The forming phase is the initial stage of group development where members are polite, cautious, and focused on orientation. Communication is limited and guarded.
Choice B reason: The storming phase involves conflict and competition as members assert their opinions and challenge group norms. Communication may be intense but not yet open or spontaneous.
Choice C reason: The norming phase is marked by increased cohesion and collaboration. Communication improves, but spontaneity and openness are still developing.
Choice D reason: The performing phase is the most advanced stage of group development. Members communicate openly and spontaneously, trust is established, and the group functions effectively toward shared goals.
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