A client is admitted with bipolar disorder and lithium carbonate is prescribed. Before administering the daily dose, the practical nurse (PN) plans to monitor the client’s serum lithium levels. Which physiologic action necessitates frequent monitoring of serum lithium levels?

Serum levels reflect client compliance and support behavior changes

Sodium influences a narrow margin between therapeutic and toxic levels

Myelosuppression and agranulocytosis are common side effects

Foods containing tyramine influence the drug’s metabolism

Answer and Explanation

The Correct Answer is B

Choice A reason: Serum lithium levels indicate compliance but do not directly explain the need for frequent monitoring. Lithium’s therapeutic effect stabilizes mood, but monitoring is primarily due to its narrow therapeutic index, where small changes in blood levels can cause toxicity, not just behavioral changes or compliance.

Choice B reason: Sodium levels affect lithium excretion, as both compete for renal reabsorption. Low sodium increases lithium retention, risking toxicity, while high sodium increases excretion, reducing efficacy. Lithium’s narrow therapeutic range (0.6–1.2 mEq/L) necessitates frequent monitoring to prevent toxic levels, which can cause neurological or cardiac issues.

Choice C reason: Myelosuppression and agranulocytosis are not common lithium side effects. Lithium may cause mild leukocytosis, not suppression. Toxicity risks, like neurological or renal effects, drive monitoring needs, not hematologic issues. This choice is incorrect, as it misrepresents lithium’s side effect profile.

Choice D reason: Tyramine, relevant to monoamine oxidase inhibitors, does not influence lithium metabolism. Lithium’s pharmacokinetics are affected by sodium and renal function, not dietary tyramine. This choice is incorrect, as it falsely links a dietary factor to lithium’s monitoring requirements.

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Correct Answer is A

Explanation

Choice A reason: Montelukast is a leukotriene receptor antagonist that inhibits leukotrienes, mediators of inflammation in allergic responses. By blocking these, it reduces airway inflammation, bronchoconstriction, and mucus production, preventing asthma or allergic rhinitis symptoms. This prophylactic action targets the immune response to allergens, stabilizing respiratory function before symptoms escalate.

Choice B reason: Montelukast does not increase mucus production. Instead, it reduces mucus by inhibiting leukotriene-driven inflammation in the airways. Increased mucus is a symptom of uncontrolled asthma or allergies, which montelukast aims to prevent. This choice is incorrect as it contradicts the drug’s mechanism of reducing inflammatory responses in the lungs.

Choice C reason: Montelukast does not contract respiratory smooth muscles. It prevents bronchoconstriction by blocking leukotrienes, which cause smooth muscle contraction in asthma. By inhibiting this pathway, it promotes airway relaxation, not contraction. This choice is incorrect, as it misrepresents the drug’s role in maintaining open airways.

Choice D reason: Montelukast does not repair damaged lung tissue. Its primary role is to prevent inflammation and bronchoconstriction caused by allergens. Lung tissue repair involves other physiological processes, not influenced by montelukast. This choice is incorrect, as it falsely attributes tissue regeneration to a drug focused on immune modulation.

A. Monitor for visual changes each morning using an Amsler grid test B. Instill prescribed eye drops now and then three times a day C. Encourage wearing dark glasses when outside to protect the eyes D. Report the symptoms to the healthcare provider (HCP) immediately

Correct Answer is D

Explanation

Choice A reason: Using an Amsler grid monitors macular degeneration, not sildenafil-related visual changes, which include color tinting or blurred vision due to PDE5 inhibition affecting retinal blood flow. This is not a standard monitoring tool for sildenafil side effects, making it inappropriate for this context.

Choice B reason: Instilling eye drops is irrelevant, as sildenafil’s visual changes are systemic, caused by its effect on retinal phosphodiesterase, not a local eye condition treatable with drops. No evidence supports eye drops for this side effect, making this choice incorrect and ineffective.

Choice C reason: Wearing dark glasses may reduce light sensitivity but does not address sildenafil’s visual side effects, like blue-green color distortion, caused by altered retinal signaling. This is a temporary, drug-induced effect, and glasses do not mitigate the underlying issue, making this choice inadequate.

Choice D reason: Reporting visual changes immediately is critical, as sildenafil can cause rare but serious effects like non-arteritic anterior ischemic optic neuropathy, impairing retinal blood flow. Prompt reporting allows the provider to assess severity, adjust dosing, or discontinue the drug to prevent permanent vision loss.

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A client is admitted with bipolar disorder and lithium carbonate is prescribed. Before administering the daily dose, the practical nurse (PN) plans to monitor the client’s serum lithium levels. Which physiologic action necessitates frequent monitoring of serum lithium levels?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client receives a new prescription for montelukast. Which information should the practical nurse (PN) include when reinforcing the client's teaching?

Correct Answer is A

Explanation

A client who is taking sildenafil 50 mg PO PRN reports experiencing visual changes to the practical nurse (PN). Which instruction should the PN give to the client?

Correct Answer is D

Explanation

A client reports confusion and blurred vision after receiving a dose of glipizide. Which action should the practical nurse (PN) implement?

A client with overactive bladder starts a new prescription for oxybutynin. When assessing the client prior to medication administration, which finding should the practical nurse (PN) report to the charge nurse?

The practical nurse (PN) is discharging a client who had an anaphylactic reaction following administration of ampicillin. Which instruction is most important for the PN to provide this client?

At the start of the shift, the practical nurse (PN) reviews a client’s medication administration record and notes that a client has a new prescription for a diuretic to be administered at bedtime. Which action should the PN take?

The practical nurse (PN) administers a skeletal muscle relaxant to a client with left leg pain. Which assessment provides data related to the effectiveness of the medication?

The practical nurse (PN) is assisting with the plan of care (POC) for a client with costochondritis who is now experiencing increased discomfort in breathing. The client receives a prescription for meloxicam. Which intervention should the PN include in the client’s POC?

The practical nurse (PN) is providing discharge instructions to a client who had a partial thyroidectomy. When explaining the actions of the prescribed thyroid supplement levothyroxine sodium, which parameter should the PN tell the client is most important to monitor for potential side effects?

A client with a history of anaphylactic reaction to penicillin receives a prescription for cephalexin 500 mg by mouth twice daily. Which action should the practical nurse (PN) take?