A client admitted for injuries from a motor vehicle crash has a history of bipolar disorder for which he takes lithium. What is a major concern of the nurse?
Lithium toxicity is likely in the client’s treatment
Lithium is completely metabolized by the liver so liver function tests are indicated
Lithium requirements increase with stress so additional lithium may be required
Lithium has a very narrow therapeutic range so lithium levels should be obtained
The Correct Answer is D
Choice A reason: Lithium toxicity is a concern but not inevitable. It occurs with levels above 1.5 mEq/L, often due to dehydration or drug interactions, common in trauma settings. However, routine monitoring of levels is a more immediate nursing priority than assuming toxicity, as early detection prevents severe outcomes like seizures or renal damage.
Choice B reason: Lithium is primarily excreted by the kidneys, not metabolized by the liver. Liver function tests are not indicated for lithium monitoring, as it does not undergo hepatic metabolism. This statement is inaccurate, as renal function tests are critical to assess lithium clearance and prevent toxicity in trauma patients.
Choice C reason: Stress does not directly increase lithium requirements. Trauma-related dehydration or renal impairment can elevate lithium levels, risking toxicity, but this is due to reduced clearance, not increased need. This statement is inaccurate, as dosing adjustments should be based on serum levels, not stress alone.
Choice D reason: Lithium has a narrow therapeutic range (0.6-1.2 mEq/L), and trauma-related factors like dehydration or medications can alter levels, risking toxicity or subtherapeutic effects. Regular serum level monitoring is critical, especially in acute settings, to ensure safety and efficacy, making this statement accurate and a priority nursing concern.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: Phenazopyridine is a urinary analgesic that relieves pain, burning, and irritation in the urinary tract by exerting a topical anesthetic effect on the uroepithelium. It is commonly used for symptomatic relief in UTIs, making this statement accurate, as it directly addresses its therapeutic role in managing urinary discomfort.
Choice B reason: Phenazopyridine is used short-term (typically 2 days) for symptom relief, not necessarily until an antibiotic course is completed. Antibiotics treat the underlying UTI, while phenazopyridine addresses symptoms. This statement is inaccurate, as their durations are independent, based on clinical need, not synchronized completion.
Choice C reason: Phenazopyridine is not contraindicated in UTIs; it is specifically indicated for symptomatic relief in these infections. It does not treat the infection but alleviates discomfort. This statement is inaccurate, as phenazopyridine is a standard adjunctive therapy in UTI management for pain relief.
Choice D reason: Phenazopyridine provides relief within hours, not almost immediately. Its onset requires absorption and distribution to the urinary tract, typically taking 1-2 hours. This statement is inaccurate, as the relief, while rapid, is not instantaneous, and patients should be informed of the expected timeframe.
Correct Answer is B
Explanation
Choice A reason: Monoamine oxidase inhibitors (MAOIs) require dietary restrictions to avoid tyramine-rich foods (e.g., aged cheese), which can cause hypertensive crisis by increasing norepinephrine release. MAOIs inhibit monoamine breakdown, amplifying tyramine’s effects. This statement is accurate, as dietary caution is critical to prevent serious adverse reactions.
Choice B reason: MAOIs, like phenelzine, take 2-6 weeks to improve depressive symptoms by increasing monoamine levels (serotonin, norepinephrine, dopamine). Immediate improvement does not occur due to gradual synaptic changes. This statement is inaccurate, as the delayed onset is a key characteristic of MAOIs, similar to other antidepressants.
Choice C reason: MAOIs are reserved for treatment-resistant depression when newer drugs like SSRIs fail, due to their side effect profile and dietary restrictions. They effectively increase monoamine availability but are less preferred due to safety concerns. This statement is accurate, reflecting their role in refractory cases.
Choice D reason: MAOIs can cause hypertensive crisis via drug interactions (e.g., with SSRIs or sympathomimetics), as they inhibit monoamine breakdown, leading to excessive norepinephrine. This can result in severe blood pressure elevation. This statement is accurate, as drug interactions are a significant risk with MAOI therapy.
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