A nurse is reviewing laboratory results for a client and notes a serum lithium level of 1.6 mEq/L. Which of the following manifestations should the nurse expect the client to report?.

GI discomfort and poor coordination.

Lip smacking and tongue thrusting.

Blurred vision and jerking motor movements.

Fever and fluctuating blood pressure.

Answer and Explanation

The Correct Answer is A

Choice A rationale:

A serum lithium level of 1.6 mEq/L is above the therapeutic range (0.6-1.2 mEq/L) and can cause symptoms such as GI discomfort and poor coordination.

Choice B rationale:

Lip smacking and tongue thrusting are not typically associated with lithium toxicity.

Choice C rationale:

While blurred vision can be a symptom of lithium toxicity, jerking motor movements are not typically associated with this condition.

Choice D rationale:

Fever and fluctuating blood pressure are not typically symptoms of lithium toxicity.

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Correct Answer is A

Explanation

Choice A rationale:
Having consistent unit routines can provide a sense of stability and predictability, which can be beneficial for a client in the manic phase of bipolar disorder.
Choice B rationale:
Providing a stimulating environment can potentially exacerbate symptoms of mania, making it an inappropriate intervention.
Choice C rationale:
Scheduling daily seclusion times is not typically recommended as it can lead to feelings of isolation.
Choice D rationale:
Discouraging daytime napping can potentially lead to fatigue and worsen symptoms, so it’s not typically recommended.

A. Ask the client direct questions about the hallucination. B. Instruct the client to argue with the voices that are a part of the hallucination. C. Act to the client as if the hallucination is real. D. Tell the client that the hallucination is not a part of reality.

Correct Answer is D

Explanation

Choice A rationale:
Asking direct questions about the hallucination may validate the hallucination as real in the client’s mind.
Choice B rationale:
Instructing the client to argue with the voices could potentially increase the client’s distress.
Choice C rationale:
Acting as if the hallucination is real may reinforce the client’s belief in the hallucination.
Choice D rationale:
Telling the client that the hallucination is not a part of reality can help ground the client in reality.

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A nurse is reviewing laboratory results for a client and notes a serum lithium level of 1.6 mEq/L. Which of the following manifestations should the nurse expect the client to report?.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is planning care for a client who is in the manic phase of bipolar disorder. Which of the following interventions should the nurse include in the client's plan of care?.

Correct Answer is A

Explanation

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Correct Answer is D

Explanation

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