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.

Nursing Test Bank

Quiz #1: RN Exams Pharmacology Exams Quiz #2: RN Exams Medical-Surgical Exams Quiz #3: RN Exams Fundamentals Exams Quiz #4: RN Exams Maternal-Newborn Exams Quiz #5: RN Exams Anatomy and Physiology Exams Quiz #6: RN Exams Obstetrics and Pediatrics Exams Quiz #7: RN Exams Fluid and Electrolytes Exams Quiz #8: RN Exams Community Health Exams Quiz #9: RN Exams Promoting Health across the lifespan Exams Quiz #10: RN Exams Multidimensional care Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

Free Nursing Study Resources

Correct Answer is A

Explanation

Choice A reason: Cephalexin, a cephalosporin, has a 5–10% cross-reactivity risk with penicillin allergies due to similar beta-lactam structures. An anaphylactic history increases the risk of severe reactions. Contacting the provider ensures safety, potentially leading to an alternative antibiotic to prevent life-threatening allergic responses.

Choice B reason: Monitoring for rash or hives is reactive and insufficient for a client with a penicillin anaphylaxis history. Cephalexin’s cross-reactivity risk requires proactive avoidance, not just observation, as anaphylaxis can occur rapidly, making this choice inadequate compared to provider consultation.

Choice C reason: Giving cephalexin with an antihistamine does not prevent anaphylaxis, which can be rapid and severe in penicillin-allergic clients. Antihistamines mitigate mild allergies but are ineffective against severe reactions. This choice is unsafe without confirming the drug’s appropriateness first.

Choice D reason: Administering cephalexin as prescribed ignores the significant risk of cross-reactivity with penicillin, given the client’s anaphylactic history. This could trigger a life-threatening reaction, as cephalosporins share structural similarities with penicillins, making immediate administration without verification dangerous.

A. Less frequent urinary incontinence B. Diminished urinary urgency C. Decreased urinary output D. Reduced urinary frequency

Correct Answer is C

Explanation

Choice A reason: Less frequent urinary incontinence is a desired effect of oxybutynin, an antimuscarinic that relaxes bladder muscles, reducing involuntary contractions. This indicates therapeutic success in managing overactive bladder, not a concern requiring reporting, as it aligns with the drug’s intended action.

Choice B reason: Diminished urinary urgency is an expected outcome of oxybutynin, which inhibits bladder spasms by blocking acetylcholine receptors. This reduces the urge to urinate, improving overactive bladder symptoms, and does not warrant reporting, as it reflects the medication’s efficacy.

Choice C reason: Decreased urinary output is concerning, as oxybutynin’s anticholinergic effects may cause urinary retention by overly relaxing the bladder. This risks bladder distension or infection, requiring reporting to assess for obstruction or adjust dosing, making this the critical finding to address.

Choice D reason: Reduced urinary frequency is a therapeutic effect of oxybutynin, which decreases bladder contractions, allowing longer intervals between urination. This is a goal of overactive bladder treatment and does not require reporting, as it indicates the drug is working as intended.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

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 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?

Correct Answer is A

Explanation

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?

Correct Answer is C

Explanation

Which symptom reported by a client alerts the practical nurse (PN) to withhold a scheduled dose of hydrochlorothiazide and notify the healthcare provider?

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?

A client is receiving diazepam IV, a benzodiazepine anticonvulsant, for status epilepticus. Which intervention is most important for the practical nurse (PN) to implement?

A client with depression who is taking a tricyclic antidepressant (TCA) reports frequent early morning awakening and difficulty going back to sleep. Which information from the client is important for the practical nurse (PN) to obtain to improve the client’s sleep pattern?

The practical nurse (PN) is checking the insulin dose drawn up by another PN and notes that the amount of insulin is 2 units more than the amount indicated for the glucose level written on the client’s medication record. Which action should the PN take?

Which of the following is a characteristic of a chemical reaction?

The practical nurse (PN) is caring for a client receiving a prescription for paroxetine who suddenly exhibits restlessness, tachycardia, fever, and elevated blood pressure. Which action should the PN implement first?

The practical nurse (PN) is administering the 0900 medications to a client who was admitted during the night. Which client statement indicates that the PN should further assess the prescription?