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: Famotidine, an H2 receptor blocker, reduces gastric acid production, alleviating epigastric pain caused by acid-related conditions like gastritis or ulcers. Decreased pain indicates the drug’s effectiveness in lowering acid levels, protecting the gastric mucosa, and promoting healing, making this the primary clinical outcome.

Choice B reason: Weight loss of 3 pounds is not a direct indicator of famotidine’s effectiveness. It may result from unrelated factors like diet or illness. Famotidine targets acid reduction, not weight, so this finding is irrelevant to assessing the drug’s therapeutic impact on gastric conditions.

Choice C reason: Decreased nighttime awakenings may occur with reduced pain but are not a specific measure of famotidine’s effectiveness. Awakenings could relate to other factors, like sleep disorders. Pain reduction is a more direct indicator of the drug’s action on acid-related symptoms.

Choice D reason: A positive stool antigen test indicates Helicobacter pylori infection, not famotidine’s effectiveness. Famotidine reduces acid but does not eradicate H. pylori, which requires antibiotics. This finding is unrelated to the drug’s primary role in acid suppression and symptom relief.

A. Ankle circumference B. Heart rate C. Dietary intake D. Urinary output

Correct Answer is D

Explanation

Choice A reason: Ankle circumference monitors edema, which mannitol reduces by drawing fluid from tissues. However, this is secondary to urinary output, as mannitol’s primary action is diuresis, increasing urine production to reduce intracranial or intraocular pressure, making edema measurement less critical.

Choice B reason: Heart rate is relevant for overall monitoring but not the primary outcome for mannitol, which acts as an osmotic diuretic. Cardiovascular effects are secondary, and mannitol’s efficacy is better assessed by urine output, which directly reflects its diuretic mechanism.

Choice C reason: Dietary intake is unrelated to mannitol’s therapeutic effect. Mannitol pulls fluid into the bloodstream, increasing urine output, not influenced by diet. Monitoring intake may be relevant for other conditions, but it is not critical for assessing mannitol’s diuretic action.

Choice D reason: Urinary output is the most important outcome, as mannitol, an osmotic diuretic, increases urine production by drawing fluid into the renal tubules, reducing intracranial or intraocular pressure. Adequate output (e.g., >30 mL/hour) confirms efficacy, preventing fluid overload or renal complications.

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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 prescription for intravenous (IV) famotidine. Which finding indicates to the practical nurse (PN) the medication is effective?

Correct Answer is A

Explanation

When caring for a client receiving a 20% mannitol IV solution at the rate of 100 grams/24 hours (or 70 mg/min), which outcome data is most important for the practical nurse (PN) to collect?

Correct Answer is D

Explanation

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