A client prescribed lithium carbonate 300 mg twice daily three months ago comes to the emergency department with mental confusion, ataxia, excessive diluted urine (polyuria), and blurred vision. Which lithium level would the nurse expect?

1.2 mEq/L

1.4 mEq/L

2.3 mEq/L

1.8 mEq/L

Answer and Explanation

The Correct Answer is C

Choice A reason: A lithium level of 1.2 mEq/L is within the therapeutic range (0.6–1.5 mEq/L) for bipolar disorder. Symptoms like confusion, ataxia, polyuria, and blurred vision indicate toxicity, which occurs at higher levels, typically above 1.5 mEq/L, making this level unlikely for these severe symptoms.

Choice B reason: A lithium level of 1.4 mEq/L is at the upper end of the therapeutic range. While mild side effects may occur, severe symptoms like mental confusion, ataxia, and polyuria suggest toxicity, which typically occurs at levels above 1.5 mEq/L, ruling out this option.

Choice C reason: A lithium level of 2.3 mEq/L indicates toxicity, causing neurological symptoms (confusion, ataxia), polyuria due to nephrogenic diabetes insipidus, and blurred vision from central nervous system effects. These symptoms align with lithium toxicity, which occurs at levels above 1.5 mEq/L, making this the expected level.

Choice D reason: A lithium level of 1.8 mEq/L is slightly above therapeutic range and may cause mild toxicity symptoms, such as tremor or nausea. However, the severe symptoms described (confusion, ataxia, polyuria) are more consistent with higher toxic levels, such as 2.3 mEq/L, making this less likely.

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Correct Answer is B

Explanation

Choice A reason: Assessing past suicide attempts provides risk context but is not the immediate priority. Current suicidal ideation requires urgent action to ensure safety, as past history does not address the acute risk of self-harm, making this secondary to implementing protective measures.

Choice B reason: Notifying the treatment team and initiating suicide precautions is the priority to ensure immediate safety. Suicidal ideation indicates a high risk of self-harm, requiring team coordination, constant observation, and environmental safety measures to prevent harm and ensure timely intervention.

Choice C reason: Identifying coping mechanisms is part of long-term suicide prevention but is not the priority during active suicidal ideation. Immediate safety measures, such as precautions and team notification, are critical to prevent harm before addressing coping strategies in therapy.

Choice D reason: Determining a specific suicide plan is important for risk assessment but is secondary to initiating immediate safety measures. Suicide precautions and team notification ensure the client’s safety first, allowing for subsequent detailed evaluation of the ideation’s specificity and intent.

A. Set limits on aggressive and intimidating behaviors B. Offer to hold a group about healthy coping skills C. Administer the client’s PRN medications D. Insist the client take a “time-out” in their room

Correct Answer is A

Explanation

Choice A reason: Setting limits on aggressive behavior during mania ensures safety by addressing the immediate threat. Mania involves elevated mood and impulsivity, which can lead to harmful actions. Clear boundaries reduce escalation, protect others, and help de-escalate the client’s heightened state without immediate medication or isolation.

Choice B reason: Offering a group on coping skills is inappropriate during acute mania with threatening behavior, as the client’s impulsivity and agitation impair their ability to engage in group therapy. Safety and de-escalation are priorities before addressing long-term coping strategies.

Choice C reason: Administering PRN medications, such as antipsychotics or benzodiazepines, may help calm mania but is not the initial action. Setting limits addresses immediate safety concerns first, allowing for safer medication administration if needed, as medications take time to act.

Choice D reason: Insisting on a “time-out” may escalate agitation in a manic client, as isolation can increase feelings of persecution or agitation. This approach is less effective than setting clear, calm limits to de-escalate threatening behavior and ensure unit safety.

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A client prescribed lithium carbonate 300 mg twice daily three months ago comes to the emergency department with mental confusion, ataxia, excessive diluted urine (polyuria), and blurred vision. Which lithium level would the nurse expect?

Nursing Test Bank

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