A nurse is caring for a client who has an extremely elevated lithium level. Which of the following actions should the nurse take?

Prepare for gastric lavage.

Hold the medication and assess for early manifestations of toxicity.

Check the client's medication record to assess whether the client has been refusing her lithium.

Administer the morning dose of lithium.

Answer and Explanation

The Correct Answer is B

Choice A reason: Gastric lavage is typically not the first-line treatment for lithium toxicity due to the risk of aspiration and potential complications. It is usually reserved for cases where the ingestion was recent and massive.

Choice B reason: When a client presents with an extremely elevated lithium level, it is crucial to hold further doses to prevent exacerbation of toxicity. The nurse should monitor for early signs of toxicity, which include gastrointestinal symptoms like nausea, vomiting, diarrhea, and neurological symptoms such as tremors, confusion, and ataxia. The normal therapeutic range for lithium is 0.6 to 1.2 mmol/L, and levels above 1.5 mmol/L are considered toxic.

Choice C reason: While it is important to review the medication record, the immediate concern with an extremely elevated lithium level is addressing the toxicity. Checking the medication record can be part of the assessment process but is not the priority action.

Choice D reason: Administering the morning dose of lithium could worsen the client's condition by increasing the lithium level further, which is already extremely elevated. This could lead to severe toxicity or even fatal consequences.

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Correct Answer is A

Explanation

Choice A reason: A family environment characterized by high levels of criticism and perfectionism can contribute to the development of eating disorders like Bulimia Nervosa. Such an environment may lead to feelings of inadequacy and a focus on appearance, which are risk factors for Bulimia Nervosa.

Choice B reason: A supportive and nurturing environment is generally protective against the development of eating disorders.

Choice C reason: While a family history of similar disorders can be a risk factor due to genetic predisposition, it is not a family dynamic.

Choice D reason: Lack of boundaries and control within a family can contribute to various behavioral issues, but high criticism and perfectionism are more directly related to Bulimia Nervosa.

A. Risperidone (Risperdal) to address the positive symptom. B. Haloperidol (Haldol) to address the negative symptom. C. Clonazepam (Klonopin) to address the positive symptom. D. Clozapine (Clozaril) to address the negative symptom.

Correct Answer is A

Explanation

Choice A reason: Risperidone is an antipsychotic medication commonly used to treat positive symptoms of schizophrenia, such as hallucinations or delusions.

Choice B reason: Haloperidol can be used to treat positive symptoms, but it is not as commonly used as risperidone due to its side effect profile.

Choice C reason: Clonazepam is typically used for anxiety or seizure disorders and is not the primary medication for treating schizophrenia symptoms.

Choice D reason: Clozapine is often reserved for treatment-resistant schizophrenia and is used to treat both positive and negative symptoms, but it is not the first-line treatment due to its potential side effects.

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A nurse is caring for a client who has an extremely elevated lithium level. Which of the following actions should the nurse take?

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Naxlex Comprehensive Predictor Exams

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