The nurse is caring for a client who has been placed on hospice care. Which statement by the client indicates a need for further education?

a. Tell me more about what unpleasant effects you have been experiencing

Explanation of Choices

Choice A Reason: Tell Me More About What Unpleasant Effects You Have Been Experiencing

This response is the most appropriate because it opens a dialogue between the nurse, the client, and the parent. Understanding the specific side effects the client is experiencing allows the nurse to gather detailed information, which is crucial for assessing the situation accurately. This approach shows empathy and concern for the client’s well-being and can help identify whether the side effects are manageable or if an alternative treatment plan is needed. It also ensures that the client feels heard and supported.

Choice B Reason: Stop Taking the Medication Immediately

Advising the client to stop taking the medication immediately is not appropriate without a thorough assessment and consultation with the prescribing physician. Abruptly discontinuing ADHD medication can lead to withdrawal symptoms and a resurgence of ADHD symptoms, which can negatively impact the client’s daily functioning and overall health. Medication changes should always be made under medical supervision to ensure safety and effectiveness.

Choice C Reason: I’ll Get the Physician to Discuss This Situation

While involving the physician is an important step, this response alone does not address the immediate concerns of the client and parent. It is essential for the nurse to first understand the specific issues before referring to the physician. This ensures that the physician has all the necessary information to make an informed decision about the client’s treatment plan. Additionally, this response may come across as dismissive if not coupled with an initial assessment by the nurse.

Choice D Reason: It’s Important to Take the Medication as Prescribed

While it is true that taking medication as prescribed is important, this response does not acknowledge the client’s and parent’s concerns about side effects. It may come across as dismissive and could damage the trust between the client, parent, and healthcare provider. Addressing the side effects and exploring possible solutions or alternatives is crucial for maintaining adherence to the treatment plan and ensuring the client’s well-being.

Choice A Reason: 0.8 mEq/L

The therapeutic range for lithium is typically between 0.6 and 1.2 mEq/L. A level of 0.8 mEq/L falls within this range and is considered normal. Therefore, it is unlikely that a client with this lithium level would present with symptoms such as mental confusion, frequent urination, and coarse tremors. These symptoms are more indicative of lithium toxicity, which occurs at higher levels.

Choice B Reason: 2.3 mEq/L

A lithium level of 2.3 mEq/L is significantly above the therapeutic range and indicates lithium toxicity. Symptoms of lithium toxicity include mental confusion, frequent urination, and coarse tremors, which match the client’s presentation. Severe toxicity can occur at levels above 2.0 mEq/L and can be life-threatening if not treated promptly. Therefore, this is the most likely lithium level for the client described.

Choice C Reason: 1.8 mEq/L

A lithium level of 1.8 mEq/L is above the therapeutic range but below the level typically associated with severe toxicity. While some symptoms of toxicity might appear at this level, they are generally less severe than those described in the scenario. The client’s symptoms suggest a more severe level of toxicity, making this choice less likely.

Choice D Reason: 1.2 mEq/L

A lithium level of 1.2 mEq/L is at the upper limit of the therapeutic range. While it is possible for some mild side effects to occur at this level, the severe symptoms described (mental confusion, frequent urination, and coarse tremors) are more indicative of a higher, toxic level of lithium. Therefore, this choice is also less likely.