A nurse is administering morphine sulfate to a postoperative patient. Which are appropriate nursing actions when giving this drug? (Select all that apply)

Therapeutic drug monitoring is essential when using lithium because it has a narrow therapeutic index and a high risk of toxicity. Plasma levels must be carefully maintained within a defined therapeutic range to ensure effectiveness in mood stabilization while preventing adverse effects. Levels are routinely checked to guide dosing and prevent accumulation. Toxic effects become more likely as serum concentrations rise above the safe threshold.

Rationale:
A. Lithium levels should generally be kept below 1.5 mEq/L because concentrations above this range are associated with toxicity. At higher levels, patients may develop neurologic, gastrointestinal, and cardiovascular symptoms that can rapidly progress to severe toxicity. Maintaining levels below this threshold reduces the risk of serious complications.

B. 0.4 mEq/L is below the therapeutic range and would likely be ineffective for mood stabilization in Lithium therapy. Subtherapeutic levels may result in poor control of manic or depressive symptoms and increase the risk of relapse.

C. 0.2 mEq/L is significantly below therapeutic levels and is insufficient for clinical efficacy. At this concentration, lithium would not provide adequate mood stabilization or prophylaxis against bipolar episodes. It is far under the expected therapeutic range.

D. 0.8 mEq/L represents a typical maintenance therapeutic level rather than a maximum limit. Lithium is often maintained between approximately 0.6–1.2 mEq/L depending on clinical indication and patient response. This reflects a target range, not an upper toxicity threshold.

Tension-type headache is the most common form of primary headache and is typically associated with muscle tension, stress, and fatigue. It presents as a bilateral, dull, pressure-like pain often described as a tight band around the head. Management focuses on symptomatic relief using nonopioid analgesics and combination medications. Unlike migraines or cluster headaches, it usually lacks significant neurological or autonomic features.

Rationale:
A. "Stress headache" is a colloquial term often used by patients to describe a tension headache, but it is not the formal medical classification. While stress is a primary trigger for tension-type headaches, the pharmacological protocols used, such as aspirin or butalbital combinations, are specifically categorized under the clinical heading of "Tension Headache",

B. Cluster headache is characterized by severe unilateral periorbital pain accompanied by autonomic symptoms such as lacrimation, nasal congestion, and ptosis. Treatment typically involves oxygen therapy and triptans rather than simple analgesics. Nonopioid analgesics are generally ineffective due to the intensity of the pain.

C. Tension headache is appropriately treated with nonopioid analgesics such as aspirin, NSAIDs like ibuprofen or naproxen, and combination products like aspirin with butalbital (e.g., Fiorinal). These medications target mild to moderate pain and muscle tension. Sedative combinations may also help relieve associated stress and muscle contraction contributing to the headache.

D. Migraine headache involves moderate to severe unilateral throbbing pain often associated with nausea, photophobia, and phonophobia. While NSAIDs may be used in mild cases, treatment often requires triptans, antiemetics, or preventive medications. The use of butalbital combinations is generally discouraged due to the risk of rebound headaches and dependency.