A nurse is collecting data from a client who is taking lithium. Which of the following findings should the nurse identify as early manifestations of lithium toxicity? (Select all that apply.)

Incoordination

Polyuria

Nausea

Convulsions

Confusion

Answer and Explanation

Correct Answer : A,C,E

A.   Incoordination, such as clumsiness or difficulty walking, can be an early sign of lithium toxicity. It reflects the neurological effects of elevated lithium levels on motor coordination.
B.   Polyuria (excessive urination) is a common late symptom of lithium toxicity. Lithium interferes with the kidney's ability to concentrate urine, leading to increased urine output.
C.   Nausea is a gastrointestinal symptom that can occur in the early stages of lithium toxicity. It is often accompanied by other gastrointestinal disturbances such as vomiting and diarrhea.
D.   Convulsions (seizures) are not typically considered early manifestations of lithium toxicity but rather indicate severe toxicity. Seizures can occur at higher levels of lithium toxicity and require immediate medical intervention.
E.   Confusion is another early sign of lithium toxicity. It reflects the impact of elevated lithium levels on the central nervous system, leading to cognitive impairment and altered mental status.

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Correct Answer is D

Explanation

A. Monitoring liver enzymes (AST, ALT) is typically not directly related to lithium therapy. Elevated liver enzymes may indicate liver damage from various causes, such as hepatitis or medication toxicity, but it is not a routine monitoring parameter for lithium.
B. Lithium can decrease the excretion of uric acid, potentially leading to elevated levels. Monitoring uric acid levels helps to detect hyperuricemia, which may contribute to conditions like gout. It's important to monitor this parameter periodically during lithium therapy.
C. ESR is a nonspecific marker of inflammation and is not specifically monitored in relation to lithium therapy. It is used to diagnose or monitor conditions like infections, autoimmune diseases, or certain cancers, but it does not directly relate to lithium use.
D. Monitoring serum sodium levels is crucial during lithium therapy because lithium can affect renal function and electrolyte balance, including sodium levels. Hyponatremia is a potential adverse effect of lithium, and regular monitoring helps detect and manage this condition promptly.

A. Lanugo B. Muscle wasting C. Hypomagnesemia D. Hypokalemia

Correct Answer is D

Explanation

A. Lanugo refers to fine, soft hair that grows on the face, back, and arms as a result of malnutrition. It is more common in anorexia nervosa rather than bulimia nervosa.
B. Muscle wasting is not typically a primary symptom of bulimia.
C. Hypomagnesemia, or low magnesium levels, may occur but is not very characteristic of bulimia nervosa.
D. Hypokalemia, or low levels of potassium in the blood, is a common finding in individuals with bulimia nervosa who engage in purging behaviors such as vomiting or misuse of diuretics. Potassium is crucial for proper muscle and nerve function, and low levels can lead to symptoms such as muscle weakness, fatigue, cardiac arrhythmias, and in severe cases, paralysis.

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A nurse is collecting data from a client who is taking lithium. Which of the following findings should the nurse identify as early manifestations of lithium toxicity? (Select all that apply.)

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