A nurse is reinforcing teaching with a client about a new prescription for lithium.
Which of the following statements should the nurse include in the teaching?

Your provider will prescribe a diuretic while you are taking lithium.

Weight gain is a manifestation of lithium toxicity.

We will need to check your lithium levels in the next 3 to 5 days.

Your lithium will be discontinued in 6 months to prevent addiction.

Answer and Explanation

The Correct Answer is C

Rationale for Choice A:

Diuretics are not routinely prescribed with lithium. While diuretics can increase the excretion of lithium, this can also lead to decreased lithium levels and potentially reduced effectiveness. Therefore, diuretics are generally only used in specific situations, such as when a client has lithium-induced edema or congestive heart failure. In such cases, the client's lithium levels would be closely monitored to ensure they remain within the therapeutic range.

Rationale for Choice B:

Weight gain is not a common manifestation of lithium toxicity. In fact, weight gain is a potential side effect of lithium therapy, but it is not typically associated with lithium levels reaching a toxic range. Other signs and symptoms of lithium toxicity include:

Tremor

Nausea and vomiting

Diarrhea

Confusion

Slurred speech

Ataxia

Seizures

Coma

Rationale for Choice C:

Monitoring lithium levels is essential to ensure that the client is receiving a therapeutic dose and to avoid toxicity. Lithium has a narrow therapeutic index, meaning that there is a small difference between the dose that is effective and the dose that is toxic. Regularly checking lithium levels allows the healthcare provider to adjust the dose as needed to maintain a safe and effective level.

The initial lithium level is typically checked within 3 to 5 days of starting the medication, and then periodically thereafter.

The frequency of monitoring may vary depending on the client's individual factors, such as age, kidney function, and other medications they are taking.

Rationale for Choice D:

Lithium is not typically discontinued after a specific period of time. It is often used as a long-term treatment for bipolar disorder to prevent the recurrence of manic and depressive episodes. The decision to discontinue lithium is made on a caseby-case basis, in consultation with the client and their healthcare provider.

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Correct Answer is A

Explanation

Choice A rationale:

Disorientation is a significant neurological finding that can signal a serious adverse reaction to lorazepam, particularly in older adults. It's crucial to report it immediately to the provider for prompt assessment and intervention.

Lorazepam, a benzodiazepine, can cause central nervous system (CNS) depression, which can manifest as disorientation, confusion, memory impairment, and even delirium.

Older adults are more vulnerable to CNS depressant effects due to age-related physiological changes, such as decreased metabolism and clearance of medications, as well as increased brain sensitivity.

Early identification and management of disorientation can prevent potential complications, such as falls, injuries, and worsening cognitive decline.

Choice B rationale:

Increased anxiety can be a paradoxical reaction to lorazepam, but it's not as immediately concerning as disorientation in terms of potential for serious harm.

The nurse should still monitor anxiety levels and report any significant changes to the provider, as dosage adjustments or alternative medications may be necessary.

Choice C rationale:

Blurred vision is a common side effect of lorazepam, but it's typically mild and transient.

It's important to assess the severity and duration of blurred vision and report it to the provider if it persists or interferes with daily activities.

Choice D rationale:

Anorexia, or loss of appetite, can be a side effect of lorazepam, but it's not as urgent as disorientation.

The nurse should monitor the patient's nutritional intake and weight, and report any significant changes to the provider.

A. “If I wake up at night, I go to another room and read for 20 minutes.” B. “I have stopped taking naps in the afternoon.” C. “I watch the television in my bedroom to help me sleep.” D. “I eat my evening meal at least 3 hours before I go to bed.”

Correct Answer is C

Explanation

A rationale:

Going to another room and reading for 20 minutes when waking up at night is a recommended strategy for managing insomnia. This technique helps to break the cycle of lying in bed awake and worrying, which can worsen insomnia. Reading can be a relaxing activity that can help to promote sleepiness. It's important to choose a book that is not too stimulating and to avoid reading in bright light.

Choice B rationale:

Stopping napping in the afternoon is also a recommended strategy for managing insomnia. Napping can interfere with nighttime sleep by reducing sleep drive. It's best to avoid napping altogether or to limit naps to 30 minutes or less early in the afternoon.

Choice C rationale:

Watching television in the bedroom is not recommended for managing insomnia. The light from the television can suppress the production of melatonin, a hormone that helps to regulate sleep. The noise from the television can also be stimulating and make it difficult to fall asleep. It's best to avoid watching television in the bedroom or to turn off the television at least 30 minutes before bedtime.

Choice D rationale:

Eating the evening meal at least 3 hours before bed is generally a good practice for sleep hygiene. Eating too close to bedtime can lead to indigestion, which can make it difficult to fall asleep. It's best to avoid heavy, fatty, or spicy foods before bed.

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A nurse is reinforcing teaching with a client about a new prescription for lithium. Which of the following statements should the nurse include in the teaching?

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Correct Answer is A

Explanation

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Correct Answer is C

Explanation

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A nurse is reinforcing teaching with a client about a new prescription for lithium.
Which of the following statements should the nurse include in the teaching?