A nurse is teaching a client who has bipolar disorder and a prescription for lithium to recognize the manifestations of toxicity.
Which of the following statements by the client indicates an understanding of the teaching?
"Increased flatulence is an indication of toxicity.”.
"Vomiting is an indication of toxicity.”.
"I will report any loss of appetite.”.
"I will call my provider if I experience any headaches.”.
The Correct Answer is B
Choice A rationale:
Increased flatulence is not typically associated with lithium toxicity.
Choice B rationale:
Vomiting is a common symptom of lithium toxicity, indicating the client understands the teaching.
Choice C rationale:
While loss of appetite can occur in various conditions, it’s not a specific indicator of lithium toxicity.
Choice D rationale:
Headaches can be caused by various factors and are not specifically associated with lithium toxicity.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","C","D","G","H","I"]
Explanation
Choice A rationale:
Financial situation is a concern but it does not require immediate follow-up in a medical context.
Choice B rationale:
Increased use of mood-altering substances is a serious concern. The client has been drinking heavily and asking for their “nerve” pill, which could indicate substance misuse.
Choice C rationale:
The client’s sexual behaviors, specifically having multiple partners and not using condoms, pose a risk for sexually transmitted infections.
Choice D rationale:
The positive Hepatitis Viral Study (HAA) indicates the presence of a viral hepatitis infection, which requires immediate medical attention.
Choice E rationale:
The BUN level is within the normal range (10 to 20 mg/dL), so it does not require immediate follow-up.
Choice F rationale:
The Hgb level is within the normal range (12 to 18 g/dL), so it does not require immediate follow-up.
Choice G rationale:
The sodium level is below the normal range (136 to 145 mEq/L), indicating hyponatremia, which requires immediate medical attention.
Choice H rationale:
The frequency of facility admissions indicates that the client’s condition is not being managed effectively and requires immediate reassessment.
Choice I rationale:
The recent loss of a parent is a significant life event that could exacerbate the client’s mental health issues and substance misuse, requiring immediate follow-up.
Correct Answer is D
Explanation
Choice A rationale:
While educating the client about policies upon admission to the unit is important, it may not have the greatest impact on both the management of care and on milieu environment.
Choice B rationale:
Instructing the client that intrusive behaviors are not appropriate is important, but it may not have the greatest impact on both the management of care and on milieu environment.
Choice C rationale:
Ensuring that the client’s medication therapy is administered in a timely manner is crucial, but it may not have the greatest impact on both the management of care and on milieu environment.
Choice D rationale:
Setting and maintaining consistent unit policies that are enforced by all staff can create a stable and predictable environment, which can have a significant impact on both the management of care and on milieu environment.
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