1. A 9-year-old child has been prescribed with lithium as a mood stabilizer. His lab results shows his lithium level of 1.5 mmol/L. The priority nursing diagnosis for this child should be: A. Activity Intolerance B. Risk for Aspiration C. Ineffective Therapeutic Regimen Management D. Disturbed Thought Process - ANS-Answer: B Children who develop lithium toxicity are prone to seizures and coma. Due to the seizures that can occur the child is at risk for aspiration during seizure. This can also occur if the child is comatose. Based on Maslow's hierarchy of needs, maintaining a paten airway is the priority nursing diagnosis. 2. A client receiving lithium therapy for the treatment of his bipolar disorder has a lithium level of 0.85 mEq/L. The appropriate nursing action is: A. Notify the physician immediately B. Observe the client for signs of toxicity C. Record the laboratory result in the client's chart D. Hold the next dose of lithium - ANS-Answer: C The client's laboratory result of lithium is within the therapeutic rage 0.4 - 1 mEq/L. 3. A nurse was giving health teaching to a client newly prescribed with lithium medication. Which of the following statement of the client indicates understanding about the medication? A. "When my mood fluctuates, I can increase the dosage of the medication" B. "I can still eat my favorite salty food" C. "I can crush an extended-release tablet, if ever it will be difficult for me to take it whole by mouth" D. "Drinking too much cranberry juice will help maintain a desirable lithium level" - ANS-Answer: B Clients under lithium therapy don't need to limit their sodium intake, instead it is recommended to keep salt intake the same as before prescription of the lithium medication. Increasing the dose of lithium without evaluating the client's lab works can cause lithium toxicity, overdose, and renal failure. Extended-releasetablet should be taken whole, it is uniquely made to release the medication slowly in the body, breaking the pill would cause the drug to be release at one time. Watermelon, cantaloupe, grapefruit juice, and cranberry juice will not therapeutically help in maintaining desirable lithium level because of its diuretic effect. 4. A client diagnosed with bipolar disorder has been prescribed with lithium (carbonate) by his physician. Which question will help the nurse identify signs of early lithium toxicity? A. Have you been experiencing any nausea, vomiting or diarrhea? B. Do you have frequent headache? C. Have you been urinating excessively/frequently? D. Do you experience leg aches over the past few days? - ANS-Answer: A The most common early signs of lithium toxicity is gastrointestinal (GI) disturbance including nausea,vomiting, or diarrhea. B, C, D assessment question is unrelated to lithium toxicity. 5. A client who has been taking lithium medication for the past few years, recently got pregnant, and she is so concerned of the effects of the medication to her child. Which of the following statement is true that would address the client's concern? A. Lithium does not cross the placental barrier and poses no risk for the fetus B. Pregnant woman with diagnosed with bipolar disorder should not take lithium meds C. Oral contraceptive and lithium medication may result to a false-positive pregnancy test. D. Lithium should be avoided during the latter part of the first trimester if possible. - ANS-Answer: D Lithium crosses placental barrier and poses the risk for developing birth defects to a fetus. To minimize any risk to the fetus, lithium should be avoided in the latter part of the first trimester if possible. Option B is incorrect because it can help control the mother's manic symptoms with little risk to the fetus in the second and third trimester. Option C is also incorrect because it is only true with carbamazepine (Tegretol). 6. A client newly diagnosed with bipolar disorder was prescribed with lithium meds. While giving the health teaching the client keeps asking about why there is a need for frequent blood works. Which of the following statement of the nurse addressing the client's question is true: A. "It will help determine if the medication dosage is still within the therapeutic level" B. "Frequent blood works is unnecessary once medication is taken as ordered" C. "It will help identify if the liver has been working properly" D. "It will monitor if the medication already pass the blood brain barrier" - ANSAnswer: A Lithium levels determine whether an effective dose of lithium is being given to maintain a therapeutic level of the drug. Lithium blood work aren't drawn for the reason of figuring out whether the drug pass through the blood brain barrier or if the liver is working properly. Taking the medication as ordered doesn't kill the requirement for blood work. 7. A client under lithium medication reduce his dietary salt intake. Which of the following is expected to show in his blood work? A. Decreased lithium level B. Increased lithium level C. Increased then decrease in the next result of the lithium blood work D. No significant changes - ANS-Answer: B There is a direct relationship between the amount of salt and the plasma levels of lithium. Lithium plasma levels increase when there is a decrease in dietary salt. Increase in dietary salt causes the opposite effect of decreasing lithium plasma. That's why it is important that the nurse monitor dietary sodium intake. 8. A female client was prescribed with lithium carbonate 600 mg p.o t.i.d to manage her bipolar disorder. The nurse would be aware that the teaching given to the client with regards to the medication side effects was understood when the client make which of the following statement? "I will call my doctor immediately once I notice any: A. Sensitivity to bright light or sun B. Fine hand tremors or slurred speech C. Sexual dysfunction or breast enlargement D. Inability to urinate or difficulty when urinating - ANS-Answer: B These are the common adverse effects of lithium carbonate 9. A client receiving lithium carbonate has a lithium level of 2.3 mEq/L. The nurse will immediately assess the client for which of the following symptoms? A. Weakness B. Diarrhea C. Blurred Vision