The client’s lithium level is 1.8 mEq/L. The first appropriate nursing action is to:

Observe the client for signs of toxicity

Document the laboratory results in the medical record

Notify the client’s physician immediately

Hold the next dose of lithium

Answer and Explanation

The Correct Answer is C

Choice A reason: Observing for toxicity is important, but a lithium level of 1.8 mEq/L, above the therapeutic range (0.6–1.5 mEq/L), requires immediate action. Observation alone delays critical intervention, as symptoms like confusion or ataxia may already be present, necessitating urgent medical evaluation.

Choice B reason: Documenting results is necessary but not the first action. A lithium level of 1.8 mEq/L indicates potential toxicity, requiring immediate physician notification to adjust dosing or provide treatment, as delays could worsen neurological or renal complications.

Choice C reason: A lithium level of 1.8 mEq/L is above the therapeutic range, indicating early toxicity, which can cause neurological and renal damage. Notifying the physician immediately ensures prompt dose adjustment or discontinuation, preventing progression to severe toxicity, making this the priority action.

Choice D reason: Holding the next dose without physician guidance is risky, as abrupt cessation may destabilize mood in bipolar disorder. A level of 1.8 mEq/L requires medical evaluation to determine safe dose adjustments, making physician notification the first step.

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Correct Answer is B

Explanation

Choice A reason: Weight gain is not a common side effect of buspirone, which affects serotonin and dopamine receptors to reduce anxiety. It is more associated with antidepressants like SSRIs or mirtazapine, which alter metabolism or appetite, making this incorrect.

Choice B reason: Buspirone commonly causes dizziness due to its effects on serotonin and dopamine pathways, which can alter blood pressure or central nervous system function. This side effect is significant, as it impacts safety and requires client awareness, making it a key teaching point.

Choice C reason: Dry skin is not a recognized side effect of buspirone. This medication primarily affects neurological and gastrointestinal systems, not dermatological conditions, making this an irrelevant and incorrect side effect to include in client education.

Choice D reason: Increased appetite is not typically associated with buspirone. While some psychotropic medications affect appetite, buspirone’s primary side effects include dizziness and nausea, not appetite changes, making this an incorrect focus for client education.

A. Feelings of grandiosity B. Total loss of interest in activities C. Decreased need for sleep D. Severe depressive moods

Correct Answer is C

Explanation

Choice A reason: Feelings of grandiosity are more characteristic of mania in bipolar I disorder. Hypomania in bipolar II involves milder elevated mood, energy, and confidence without extreme grandiosity, making this symptom less consistent with a hypomanic episode.

Choice B reason: Total loss of interest in activities is a depressive symptom, not hypomania. Hypomanic episodes involve increased energy and engagement in activities, often with heightened productivity or creativity, making this inconsistent with the client’s current state.

Choice C reason: Decreased need for sleep is a hallmark of hypomania in bipolar II, where clients feel rested after minimal sleep due to heightened energy from altered dopamine and norepinephrine activity. This is highly consistent with hypomanic episodes, distinguishing it from mania.

Choice D reason: Severe depressive moods characterize the depressive phase of bipolar II, not hypomania. Hypomanic episodes involve elevated mood and energy, contrasting with the low mood and fatigue of depression, making this inconsistent.

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The client’s lithium level is 1.8 mEq/L. The first appropriate nursing action is to:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client with generalized anxiety disorder is prescribed buspirone. Which side effect should the nurse include in the client’s education?

Correct Answer is B

Explanation

A nurse is caring for a client diagnosed with bipolar II disorder. The client is experiencing a hypomanic episode. Which of the following symptoms is most consistent with this phase of bipolar disorder?

Correct Answer is C

Explanation

The nurse is caring for a client with obsessive-compulsive disorder (OCD). Which action by the nurse will increase the client’s sense of security?

A client with heart failure is taking an angiotensin-converting enzyme inhibitor (ACE-I) and reports a nagging cough. Which replacement medication will the nurse expect to be prescribed for this client?

A client with depression is prescribed phenelzine (Nardil). The client says to the nurse, “I will need to watch my diet with this medication. What food options should I avoid?” Which of the following is the correct response by the nurse?

The nurse is caring for a client experiencing mania who is pacing, cannot sit, with pressured speech. Which meal will the nurse provide to best meet the nutritional needs of this client?

The nurse is evaluating the progress of a client with bulimia. Which behavior would indicate that the client is making positive progress?

A client was admitted to the inpatient unit for depression and is prescribed a selective serotonin reuptake inhibitor (SSRI). Which sign or symptom would the nurse include in the teaching session about serotonin syndrome?

A client with anorexia nervosa is admitted to the unit. Which is the most appropriate short-term outcome?

A client with a long history of bulimia nervosa is seen in the emergency department. The client is seeing things that others do not see, is restless, and has dry mucous membranes. Which is most likely the cause of this client's symptoms?