A client prescribed lithium carbonate 300 mg twice daily 3 months ago comes to the Emergency Department with nausea, diarrhea, muscle weakness, and coarse tremors. They notified the provider that they have had flu like symptoms and have not been able to eat or drink. The nurse suspects the client is exhibiting signs of:

toxicity from the lithium carbonate.

developing a tolerance to the lithium carbonate.

stopping their prescribed lithium carbonate.

consuming foods high in tyramine while taking lithium carbonate.

Answer and Explanation

The Correct Answer is A

A. Lithium carbonate is a medication commonly used to treat bipolar disorder. Symptoms of lithium toxicity can include nausea, vomiting, diarrhea, muscle weakness, tremors, and flu-like symptoms. If a client is experiencing these symptoms after taking lithium carbonate, it could indicate lithium toxicity
B. Lithium is a mood stabilizer, and tolerance, in the sense of needing increasing doses to achieve the same effect, is not commonly observed.
C. Suddenly stopping lithium carbonate can lead to withdrawal symptoms, but the symptoms described— nausea, diarrhea, muscle weakness, and tremors—are more indicative of toxicity rather than withdrawal.
D. Tyramine is a compound found in certain foods and beverages, and interactions between tyramine-rich foods and certain medications, such as monoamine oxidase inhibitors (MAOIs), can lead to hypertensive crises. However, lithium carbonate is not known to have interactions with tyramine-rich foods.

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Correct Answer is D

Explanation

D. Pepperoni pizza and red wine are both high in tyramine and should be avoided when taking MAOIs. The aging and fermentation processes involved in the production of pepperoni and red wine increase the tyramine content, which can lead to a dangerous increase in blood pressure when combined with MAOIs.
A. Potato chips are generally considered safe to eat in moderation with MAOIs, as they do not contain high levels of tyramine. Diet Coke is also considered safe as it does not contain tyramine.
B. Bagels with cream cheese typically do not contain high levels of tyramine, and tea is generally considered safe to consume with MAOIs.
C. Apple pie may contain moderate levels of tyramine, particularly if it contains aged or fermented apples. However, the tyramine content in apple pie is generally not high enough to pose a significant risk when consumed in moderation. Coffee, on the other hand, contains tyramine, but the amount is usually not enough to cause a severe reaction.

A. Have serum lithium levels checked every 6 months. B. Adjust the dose if you feel out of control. C. Do not reduce normal dietary sodium intake. D. Limit fluid intake to 1,000 mL of fluid per day.

Correct Answer is C

Explanation

C. Sodium intake can influence lithium excretion and affect serum lithium levels. Maintaining a consistent and adequate sodium intake is important for stabilizing serum lithium levels and optimizing the medication's therapeutic effects.
A. Patients should have their serum lithium levels checked regularly, typically every 3 months, not just every 6 months as suggested.
B. Clients should never adjust their lithium dose without consulting their healthcare provider. Lithium dosage adjustments should be made only under the guidance and supervision of a healthcare professional based on the client's clinical response, serum lithium levels, and overall treatment plan.
D. Adequate hydration is essential for overall health and well-being, and dehydration can increase the risk of lithium toxicity.

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Naxlex Comprehensive Predictor Exams

A psychiatrist prescribes a monoamine oxidase inhibitor (MAOI) for a client. When teaching the client about the effects of tyramine, which foods will the nurse caution the client to avoid?

Correct Answer is D

Explanation

A client who is prescribed lithium carbonate is being discharged from inpatient care. Which medication information should the nurse teach this client?

Correct Answer is C

Explanation

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