A physician orders Lithium 1.2 grams/day in three divided doses PO for a client with bipolar disorder. The medication is supplied as 300 mg/5 mL. How much will the nurse administer per dose?

(Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)

Choice A Reason: Assist the client to identify the triggering situation and choose a coping strategy

This is the correct answer. Assisting the client to identify the triggering situation and choose a coping strategy is a therapeutic approach that empowers the client to understand and manage their emotions. This intervention helps the client develop skills to cope with distressing feelings and reduces the likelihood of self-harm. It is essential to address the underlying issues and provide support in a constructive manner.

Choice B Reason: Send the client to the crisis intervention unit for 23 hours of observation

While sending the client to a crisis intervention unit may be necessary in some cases, it is not the first step. Immediate therapeutic intervention to help the client understand and manage their emotions is crucial. Observation alone does not address the underlying issues or provide the client with coping mechanisms.

Choice C Reason: Restrain the client to prevent self-harm

Restraint should be a last resort and only used when there is an immediate risk of harm that cannot be managed through other means. It is important to first attempt less restrictive interventions that help the client manage their emotions and behaviors.

Choice D Reason: Advise the client to take an anxiolytic to decrease their anxiety level

While medication can be part of the treatment plan, it should not be the first intervention. Addressing the client’s immediate emotional needs and helping them develop coping strategies is crucial. Medication can be considered as part of a comprehensive treatment plan but should not replace therapeutic interventions.

d. Do not reduce normal dietary sodium intake.

Explanation of Choices

Choice A Reason: Limit Fluid Intake to 1,000 mL of Fluid per Day

Limiting fluid intake to 1,000 mL per day is not recommended for clients taking lithium carbonate. Adequate hydration is crucial because lithium can affect kidney function and fluid balance. Dehydration can increase lithium levels in the blood, leading to toxicity. Therefore, clients should maintain normal fluid intake to ensure proper hydration and avoid complications.

Choice B Reason: Adjust the Dose if You Feel Out of Control

Clients should never adjust their lithium dose on their own. Lithium has a narrow therapeutic range, meaning the difference between an effective dose and a toxic dose is small. Any changes in dosage should be made under the supervision of a healthcare provider to avoid the risk of lithium toxicity or subtherapeutic levels. Self-adjusting the dose can lead to serious health risks.

Choice C Reason: Have Serum Lithium Levels Checked Every 6 Months

While regular monitoring of serum lithium levels is essential, checking levels every 6 months may not be sufficient. Initially, serum lithium levels should be checked more frequently, such as every 1 to 2 weeks, until stable therapeutic levels are achieved. After stabilization, levels are typically monitored every 3 to 6 months, depending on the patient’s clinical status and any changes in medication or health condition. Regular monitoring helps ensure the medication remains within the therapeutic range and prevents toxicity.

Choice D Reason: Do Not Reduce Normal Dietary Sodium Intake

Maintaining normal dietary sodium intake is crucial for clients taking lithium. Sodium levels in the body can affect lithium levels; a decrease in sodium intake can lead to higher lithium levels and increase the risk of toxicity. Conversely, an increase in sodium intake can lower lithium levels, reducing its effectiveness. Therefore, clients should be advised to maintain a consistent sodium intake to help stabilize lithium levels in the blood.