Drug Therapy for Bipolar Disorder (ATI Neuro Part 2): Lithium (Practice Questions)

A nurse is reviewing the drug history of a client who is taking lithium carbonate for bipolar disorder. Which of the following findings should indicate to the nurse to monitor for lithium toxicity? A. Furosemide for hypertension B. Acetaminophen for headaches C. Ciprofloxacin for a urinary tract infection D. Montelukast for asthma

A. Furosemide for hypertension Rationale: A. Furosemide, a high-ceiling loop diuretic, increases sodium loss and can cause lithium reabsorption. The nurse should evaluate the client for lithium toxicity. B. Acetaminophen does not increase lithium levels. However, NSAIDs such as ibuprofen can cause lithium reabsorption and toxicity. C. There is no known interaction between lithium and quinolone antibiotics, such as ciprofloxacin. However, the risk of toxicity increases with tetracyclines. D. There is no known interaction between lithium and montelukast. Theophylline preparations, however, can decrease lithium levels.

A nurse is reviewing laboratory findings and notes that a client's plasma lithium level is 2.1 mEq/L. Which of the following is an appropriate action by the nurse? a. Perform immediate gastric lavage. b. Prepare the client for hemodialysis c. Administer an additional oral dose of lithium. d. Request a state repeat of the lab test.

ANSWER: A Rationale: a. CORRECT: Gastric lavage is appropriate for a client who has severe toxicity, as evidenced by a plasma lithium level of 2.1 mEq/L. This action will lower the client's lithium level. Gastric lavage, also commonly called stomach pumping, is an invasive procedure involving cleaning and removing stomach contents. A large tube is inserted through the mouth or nose into the stomach. Stomach contents are subsequently aspirated, and the stomach is later flushed with copious amounts of water or normal saline. During this procedure, the individual may be awake or under general anesthesia. b. INCORRECT: Hemodialysis is appropriate for a client who has a plasma lithium level greater than 2.5 mEq/L. c. INCORRECT: Administering an additional dose of lithium will worsen the level of toxicity. d. INCORRECT: There is no indication that the client needs another lab test, and this action can delay treatment.

A nurse is providing teaching to a client who has a prescription for lithium carbonate about reducing the risk for lithium toxicity. Which of the following instructions should the nurse include? A. Consume a low-sodium diet. B. Reduce fluid intake. C. Avoid taking NSAIDs. D. Take the drug with food.

C. Avoid taking NSAIDs. Rationale: A. Reduced serum sodium decreases lithium excretion, which can lead to toxicity. B. Dehydration increases the risk for lithium toxicity. C. NSAIDs increase renal reabsorption of lithium and sodium. Clients who take lithium should not take NSAIDs. D. Taking lithium with food can reduce gastric irritation, but it does not reduce the risk for lithium toxicity.

A nurse in a primary care clinic is assessing a client who takes lithium carbonate for the treatment of bipolar disorder. The nurse should recognize which of the following findings as a possible indication of toxicity to this medication? a. Severe hypertension b. Coarse tremors c. Constipation d. Urinary retention

ANSWER: B Rationale: a. INCORRECT: Severe hypotension, rather than hypertension, is an indication of toxicity b. CORRECT: Coarse tremors are an indication of toxicity c. INCORRECT: Diarrhea, rather than constipation, is a sign of toxicity d. INCORRECT: Polyuria, rather than retention, is a sign of toxicity.

A nurse is caring for a client who is taking lithium carbonate to treat bipolar disorder. Which of the following diagnostic tests should the nurse recommend that the client undergo periodically? A. Chest x-ray B. Tonometry C. Thyroid function tests D. Endoscopic retrograde cholangiopancreatography (ERCP)

C. Thyroid function tests Rationale: A. Chest x-rays help identify problems with the heart and lungs. Lithium can cause dysrhythmias, but it is unlikely to cause a dysfunction of the heart or lungs that will be detectable on chest x-rays. B. Tonometry is a method of testing for glaucoma. Lithium carbonate is unlikely to cause glaucoma. C. ​Hypothyroidism is an adverse effect of lithium carbonate. Clients should report neck enlargement, weight gain, lethargy, and constipation. They should also have their thyroid function checked before they begin taking lithium and annually thereafter. D. An ERCP helps identify disorders of the liver, gallbladder, bile ducts, and pancreas. Lithium carbonate is unlikely to cause abnormalities of these structures.

A nurse is caring for a client who is about to begin taking lithium carbonate to treat bipolar disorder. The nurse should instruct the client to monitor for which of the following findings as indications of lithium toxicity? (Select all that apply.) A. Tremors B. Confusion C. Bronchospasm D. Nausea E. Muscle weakness

A. Tremors B. Confusion D. Nausea E. Muscle weakness Rationale: A. A fine hand tremor is an early indication of lithium toxicity. A coarse tremor indicates advanced toxicity that can lead to seizure activity. B. Confusion, slurred speech, and ataxia are indications of lithium toxicity that develop because of the drug's narrow therapeutic range. C. Lithium toxicity is unlikely to cause bronchospasm because it does not usually affect the respiratory system. D. Nausea, vomiting, and diarrhea are early indications of lithium toxicity that develop because of the drug's narrow therapeutic range. Clients should report any of these adverse effects. E. Muscle weakness is an early indication of lithium toxicity that develops because of the drug's narrow therapeutic range. The nurse should monitor lithium levels periodically.

A nurse is teaching a female client who has bipolar disorder about her new prescription for lithium carbonate. Which of the following is appropriate for the nurse to include in the teaching? (Select all that apply). a. An adverse effect of this medication is amenorrhea b. An antidepressant is combined with lithium therapy during phases of mania c. Taking this medication with food or a glass of milk d. Avoid pregnancy while taking this medication e. Thyroid function is assessed prior to lithium therapy.

ANSWER: C, D, E Rationale: a. Lithium carbonate does not cause amenorrhea b. An antidepressant, combined with lithium, is effective during phases of depression rather than mania. c. Taking lithium with food or a glass of milk can help reduce gastrointestinal distress d. Lithium is a pregnancy risk category D medication that is teratogenic, especially during the first trimester. Therefore, the client should avoid pregnancy while taking this medication. e. Because lithium can cause goiter and hypothyroidism, the client's thyroid function is assessed prior to lithium toxicity.

A nurse is caring for a client who has a new prescription for lithium carbonate. When teaching the client about ways to prevent lithium toxicity, the nurse should advise the client to do which of the following? a. Avoid the use of acetaminophen for headaches. b. Restrict intake of foods rich in sodium c. Decrease fluid intake to less than 1,500 mL daily. d. Limit aerobic activity in hot weather.

ANSWER: D Rationale: a. INCORRECT: The client should use acetaminophen, rather than NSAIDs, such as ibuprofen, for headaches because NSAIDs interact with lithium and can cause increased blood levels of lithium. b. INCORRECT: The client should increase, rather than decrease, sodium intake to reduce the risk for toxicity. c. INCORRECT: The client should increase, rather than decrease, fluid intake to reduce risk for toxicity. d. CORRECT: The client should avoid activities that have the potential to cause sodium/water depletion, which can increase the risk for toxicity.