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: Avoiding strong or aged cheese applies to MAOIs due to tyramine interactions causing hypertensive crises. Most antidepressants, like SSRIs or SNRIs, do not require this dietary restriction, as they do not affect monoamine oxidase, making this information incorrect.

Choice B reason: Antidepressants, such as SSRIs, typically require 4-6 weeks to achieve full therapeutic effects by increasing neurotransmitter levels (serotonin, norepinephrine) in the brain. This delay is critical for patient expectations and adherence, making this the most appropriate information to provide.

Choice C reason: Antidepressants can be safely combined with antianxiety agents, such as benzodiazepines, under medical supervision for co-occurring anxiety and depression. This statement is incorrect, as combination therapy is common and does not require avoidance, depending on the clinical context.

Choice D reason: Hypomania, weight gain, and increased sleep are possible side effects of some antidepressants (e.g., mirtazapine), but they are not universal. SSRIs may cause insomnia or weight loss, making this information less broadly applicable than the therapeutic delay information.

A. An untidy house and yard B. A single path throughout the yard and house C. A complaint from the neighbors about the cats D. A collection of magazines scattered in the living room

Correct Answer is B

Explanation

Choice A reason: An untidy house and yard may indicate poor organization or neglect but is not specific to hoarding. It could result from various factors, such as depression or physical limitations, and does not inherently pose a dangerous safety risk associated with hoarding behaviors.

Choice B reason: A single path through the yard and house indicates severe accumulation of items, characteristic of hoarding disorder. This creates significant safety hazards, such as fire risks, tripping hazards, or blocked exits, which can impede emergency access and pose immediate dangers to the client’s well-being.

Choice C reason: Neighbor complaints about cats may suggest pet hoarding, a subtype of hoarding disorder. However, without evidence of excessive clutter or unsafe living conditions, this alone is less indicative of dangerous hoarding compared to physical obstructions like a single path through the home.

Choice D reason: A collection of scattered magazines may suggest early hoarding tendencies but does not necessarily indicate a dangerous level of hoarding. It lacks the severity of safety risks, such as blocked pathways or fire hazards, associated with a single path through the home.

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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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Correct Answer is B

Explanation

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