A nurse is providing discharge teaching to a client who has bipolar disorder and will be discharged with a prescription for lithium. The nurse could teach the client which of the following factors puts her at risk for lithium toxicity?

A client runs 4 miles outdoors every afternoon.

The client eats 2 to 3 gm of sodium-containing foods daily.

The client drinks 2 liters of liquids daily.

The client eats foods high in tyramine.

Answer and Explanation

The Correct Answer is A

A. Lithium is excreted through the kidneys, and dehydration and sodium depletion increase the risk of lithium toxicity. A client who runs 4 miles outdoors every afternoon is at risk of excessive sweating and fluid loss, which can lead to dehydration and sodium depletion. This reduces lithium excretion, leading to toxic levels in the blood.

B. A normal sodium intake helps maintain lithium balance. A low sodium intake increases lithium retention, but 2-3 grams/day is within the normal recommended range.

C. Adequate hydration helps prevent lithium toxicity. Clients on lithium should drink 2–3 liters of fluid daily to promote kidney function and lithium excretion.
D. Tyramine-rich foods (e.g., aged cheese, cured meats) are a concern for clients on monoamine oxidase inhibitors (MAOIs), not lithium. Tyramine does not affect lithium levels.

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Correct Answer is D

Explanation

A. Joining a group discussion about a local election: While group discussions can be productive, a person in the manic phase of bipolar disorder may have difficulty focusing and may become overly talkative or agitated. Engaging in a group discussion about a local election may exacerbate their symptoms and lead to increased energy and agitation.

B. Watching a video with a group in the day room: Watching a video in a group setting may not be suitable for a person in the manic phase, as they might find it hard to sit still and concentrate. The fast-paced and changing nature of videos may contribute to increased restlessness and agitation.

C. Participating in a basketball game in the gym: Engaging in physical activities like basketball can be too stimulating for someone in the manic phase. Their heightened energy levels may cause them to become overly competitive, agitated, or impulsive, potentially leading to risky behavior or increased symptoms.

D. Walking with the nurse in the courtyard: Taking a walk in a calm and soothing environment, such as a courtyard, can help a person in the manic phase expend excess energy in a controlled manner. Walking provides physical activity without overstimulating or overwhelming the individual, making it a more appropriate choice to address boredom while managing their symptoms.

A. The client has begun playing basketball with several other clients during the past month. B. The client identifies with problems expressed by other clients. C. The client's behavior has become impulsive in the past few weeks. D. The client states she wants to go home to be with her children and partner.

Correct Answer is C

Explanation

A. The client has begun playing basketball with several other clients during the past month.

Engaging in activities and social interactions can actually be a positive sign, as it suggests involvement and connection with others, which can be protective against suicide.

B. The client identifies with problems expressed by other clients.

Identifying with others' problems may indicate empathy, but it is not necessarily indicative of suicide risk on its own.

C. The client's behavior has become impulsive in the past few weeks.

Explanation: Impulsivity can be a significant risk factor for suicide. A sudden increase in impulsive behavior might indicate that the client is not thinking clearly and is acting without considering the potential consequences. Impulsivity can lead to actions that are harmful or dangerous, including suicidal behaviors.

D. The client states she wants to go home to be with her children and partner.

Expressing a desire to be with loved ones is generally not an indicator of suicide risk. In fact, having a strong support system can be protective against suicidal thoughts.

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A nurse is providing discharge teaching to a client who has bipolar disorder and will be discharged with a prescription for lithium. The nurse could teach the client which of the following factors puts her at risk for lithium toxicity?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is D

Explanation

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Correct Answer is C

Explanation

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