A nurse is caring for a client who is taking lithium and reports experiencing lethargy, muscle weakness, and blurred vision. Which of the following responses should the nurse make?
"These symptoms will improve over time."
"You will need to have your blood drawn."
"You should decrease your intake of sodium."
"Continue the medication as prescribed."
The Correct Answer is B
Choice A reason: Telling the client that the symptoms will improve over time without further assessment could be misleading. These symptoms could indicate lithium toxicity, which requires immediate medical attention.
Choice B reason: Lethargy, muscle weakness, and blurred vision can be signs of lithium toxicity. The nurse should recommend blood tests to check lithium levels and kidney function to rule out toxicity.
Choice C reason: Decreasing sodium intake is not recommended without a healthcare provider's advice, as sodium levels can affect lithium levels in the body. Sudden changes in sodium intake should be avoided unless directed by a healthcare provider.
Choice D reason: Continuing the medication as prescribed without addressing the symptoms could be dangerous. The symptoms reported by the client need to be evaluated to ensure they are not due to lithium toxicity.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: While attending support group meetings can be beneficial for individuals with borderline personality disorder by providing a sense of community and shared experiences, it is not the immediate priority. Support groups can offer emotional support and coping strategies, but they do not directly address the urgent safety concerns that may arise with this disorder.
Choice B reason: Discussing the use of assertive behavior is an important aspect of therapy for individuals with borderline personality disorder, as it can help them express their needs and feelings in a healthy way. However, this is part of a long-term strategy for improving interpersonal relationships and communication skills, rather than an immediate safety concern.
Choice C reason: Implementing measures to prevent intentional self-inflicted injury is the priority when planning care for a client with borderline personality disorder. Due to the high risk of self-harm and suicidal behaviors associated with this disorder, ensuring the client's safety is the most critical and immediate concern. This may include creating a safe environment, developing a crisis plan, and closely monitoring the client.
Choice D reason: Assisting the client to maintain awareness of their thoughts and feelings is a key component of therapy for borderline personality disorder, as it can help them understand and manage their emotions more effectively. However, while this is important for long-term management, it is not the immediate priority when compared to ensuring the client's safety.
Correct Answer is B
Explanation
Choice A reason: Lack of empathy is not a characteristic finding in OCPD. While individuals with OCPD may appear insensitive or less responsive to the needs and feelings of others due to their focus on rules and productivity, this does not equate to a true lack of empathy.
Choice B reason: Preoccupation with details is a hallmark of OCPD. Individuals with this disorder have an excessive concern with orderliness, perfectionism, and control over their environment and tasks. They may become so involved in making every detail perfect that it can hinder task completion and efficiency.
Choice C reason: Exploitative behavior is more characteristic of other personality disorders, such as narcissistic personality disorder, and is not a typical feature of OCPD. People with OCPD are more likely to be overly conscientious and fair in their dealings with others.
Choice D reason: Excessive clinging is not typically associated with OCPD. Instead, individuals with OCPD may have difficulty delegating tasks or working with others unless things are done precisely their way, which stems from their need for control rather than a need for closeness or reassurance.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.