Before administering lithium to a patient, it is most important for the nurse to assess which laboratory value?

Choice A rationale

When mixing insulin lispro (rapid-acting) with NPH (intermediate-acting), it is a standard and crucial procedure to draw the clear rapid-acting insulin first, followed by the cloudy NPH insulin. This is to prevent the contamination of the rapid-acting vial with the NPH suspension, which could alter the rapid-acting insulin's predictable onset and peak.

Choice B rationale

While unopened insulin vials should be stored in the refrigerator, the patient's current in-use vials can be stored at room temperature for up to 28 days to make injections more comfortable. Injecting cold insulin can cause discomfort and lipohypertrophy at the injection site. However, the refrigerator is where all unopened vials are stored.

Choice C rationale

Shaking the insulin for a full minute is not recommended. Vigorous shaking can cause foaming and bubble formation, which can lead to inaccurate dosing. NPH insulin, a suspension, should be gently rolled between the palms to ensure uniform mixing and proper suspension of the particles, which prevents clumping and allows for accurate dosing.

Choice D rationale

Administering an injection at a 30-degree angle is not standard practice for subcutaneous insulin injections. Insulin is injected into the subcutaneous fat layer. A 90-degree angle is commonly used for most patients, and a 45-degree angle may be used for very thin individuals or for injections into the arms. A 30-degree angle is not correct.

Choice A rationale

Selective serotonin reuptake inhibitors (SSRIs) inhibit the reuptake of serotonin, leading to increased serotonin concentrations in the synaptic cleft. However, this process and the subsequent downregulation of presynaptic receptors require time. Tricyclic antidepressants also have a delayed onset of action, and SSRIs do not work faster; they are generally preferred due to a more favorable side effect profile.

Choice B rationale

The therapeutic effects of SSRIs are not immediate. It takes time for the central nervous system to adapt to the increased serotonin levels. This process involves changes in receptor sensitivity and gene expression. Patients must be taught that it can take several weeks for the full antidepressant effects to become apparent, and they should not be discouraged if they don't feel better right away.

Choice C rationale

SSRIs are a first-line treatment for a variety of depressive disorders, including severe depression. Their efficacy is well-established in clinical practice and they are often used in conjunction with psychotherapy. The notion that they are not effective for severe cases is inaccurate; they have demonstrated efficacy across a spectrum of depression severity.

Choice D rationale

The therapeutic effect of SSRIs is not immediate because it takes time for the brain to adapt to the increased serotonin levels in the synapse. This process involves neuroplastic changes, including the downregulation of presynaptic autoreceptors, which can take several weeks to occur. Therefore, it is crucial to inform patients that it may take 4 to 6 weeks to experience the full beneficial effect.