A client has begun a long-term maintenance therapy with lithium, which has a narrow therapeutic index. Which adverse effect is most important for the nurse to include in the teaching plan?

Choice A reason: Withholding the dose delays glucose control, risking hyperglycemia. Obtaining regular insulin ensures accurate dosing, as 70/30 cannot be separated. Timely administration is critical, per diabetes management and insulin therapy protocols in nursing practice for glycemic control.

Choice B reason: Withdrawing regular insulin from a 70/30 vial is impossible, as it’s a fixed mixture. Obtaining a regular insulin vial ensures precise 10-unit dosing, preventing errors, per medication safety and insulin administration standards in diabetes nursing care.

Choice C reason: Pulling 30 units of 70/30 and giving one third is unsafe, as it delivers mixed insulins, not just regular insulin. Obtaining regular insulin ensures accurate dosing, per insulin therapy and patient safety protocols in diabetes management nursing practice.

Choice D reason: Obtaining a new vial of regular insulin ensures the precise 10-unit dose, as 70/30 is a fixed mixture unsuitable for separating regular insulin. This prevents dosing errors, per evidence-based insulin administration and medication safety standards in diabetes nursing care.

Choice A reason: Orientation to person and place only suggests confusion, common in right hemisphere stroke affecting non-dominant cognition. This is not immediately life-threatening. Pupillary dilation indicates increased intracranial pressure (ICP) or herniation, a critical emergency requiring urgent intervention to prevent brain stem damage or death.

Choice B reason: Unequal hand grip strengths indicate hemiparesis, typical in right hemisphere stroke affecting left-sided motor function. This is expected and not acutely life-threatening. Pupillary dilation signals rising ICP or herniation, necessitating immediate intervention to prevent catastrophic neurological decline, making it the priority finding.

Choice C reason: Left-sided facial drooping and dysphagia are common in right hemisphere stroke, reflecting contralateral cranial nerve deficits. These are serious but not immediately life-threatening. Pupillary dilation indicates potential herniation from ICP, requiring urgent intervention like mannitol to prevent brain stem compression and fatal outcomes.

Choice D reason: Ipsilateral pupillary dilation in right hemisphere stroke signals increased ICP or herniation, compressing the oculomotor nerve (CN III), impairing pupillary constriction. This life-threatening emergency indicates impending brain stem compromise, requiring immediate intervention with ICP-lowering measures or surgery to prevent irreversible damage or death.