A client who has been taking lithium for 6 months has had severe vomiting and diarrhea from a gastrointestinal flu. The nurse will assess for which potential problem at this time?
Anxiety
Chest pain
Agitation
Dehydration
The Correct Answer is D
Lithium is a mood stabilizer with a narrow therapeutic range. Because lithium is primarily excreted by the kidneys, conditions that alter fluid and electrolyte balance, such as vomiting and diarrhea, can rapidly increase the risk for lithium toxicity. Nurses must assess hydration status and monitor for signs of toxicity in patients experiencing fluid loss.
D. Dehydration — Severe vomiting and diarrhea can lead to fluid depletion, which reduces renal clearance of lithium, increasing the risk of elevated lithium levels and toxicity. Assessment should include monitoring vital signs, intake and output, and signs of hypotension or dizziness.
A. Anxiety — While lithium can affect mood, acute gastrointestinal illness does not directly cause anxiety related to lithium therapy and is less urgent than fluid status.
B. Chest pain — Not a common complication of lithium therapy or fluid loss from GI illness. Any chest pain would warrant separate cardiac evaluation.
C. Agitation — Although agitation can be a symptom of lithium toxicity, in this scenario the primary concern is dehydration that may precipitate toxicity; agitation would be secondary if toxicity develops.
Take-Home Points:
- Monitor for dehydration and electrolyte imbalance in patients on lithium during illness.
- Understand that fluid loss can precipitate lithium toxicity.
- Prompt assessment and intervention can prevent life-threatening complications.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is {"A":{"answers":"A"},"B":{"answers":"B"},"C":{"answers":"A"},"D":{"answers":"B"},"E":{"answers":"B"},"F":{"answers":"A"},"G":{"answers":"A"}}
Explanation
Patient remarking that the patient had a plan and was intent on carrying it out → Significant Finding
Expressing a specific plan and intent is a major suicide risk indicator, requiring immediate safety interventions.
Poor hygiene → Unrelated Finding
Poor hygiene can reflect depression, but it is a nonspecific finding and does not directly indicate imminent suicidal intent.
Comments from the patient such as, “Things will get better after I’m gone.” → Significant Finding
Statements implying hopelessness or anticipating absence strongly suggest suicidal ideation and need urgent assessment.
Pacing in the room → Unrelated Finding
Pacing may indicate anxiety, restlessness, or agitation, but it is not a direct marker of suicidal ideation.
Excessive appetite → Unrelated Finding
Appetite changes occur with mood disorders, but alone they do not indicate suicidal intent.
Sleeping throughout the day → Unrelated Finding
Hypersomnia is common in depression, but by itself, it is not a red-flag suicidal behavior.
Patient’s relative indicated that the patient has recently given away a collection of expensive dishes → Significant Finding
Giving away prized possessions is a common pre-suicide behavior, showing preparation and finality.
Take-home Points:
- Direct verbal cues and a plan are the strongest indicators of suicide risk.
- Behavioral clues like giving away possessions signal possible preparation for suicide.
- Depressive symptoms (sleep, appetite, hygiene) raise concern but are not definitive for suicidal ideation.
Correct Answer is ["A","B","C"]
Explanation
- GI upset, confusion, and polyuria are early warning signs of lithium toxicity.
- Severe symptoms such as ataxia and seizures occur in advanced toxicity.
- Continuous monitoring of serum lithium levels and client symptoms is essential to maintain safety.
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