ATI RN Mental Health and Psychiatric NursingTestbank with answers & Rationale(Comprehensive Mental Health and Psychiatric Nursing)
(Set 10)
1. Tristan
... [Show More] is on Lithium and has suffered from diarrhea and vomiting. What should the nursein- charge do first:
A. Recognize this as a drug interaction. B. Give the client Cogentin. C. Reassure the client that these are common side effects of lithiumtherapy. D. Hold the next dose and obtain an order for a stat serum lithiumlevel. Correct Answer: D. Hold the next dose and obtain an order for a stat serum lithiumlevel
Diarrhea and vomiting are manifestations of Lithium toxicity. The next dose of lithiumshould be
withheld and a test is done to validate the observation. Monitoring of therapeutic levels includes troughplasma levels drawn 8 to 12 hours after the last dose. The therapeutic range is 1.0 to 1.5 mEq/L for
acute treatment and 0.6 to 1.2 mEq/L for chronic therapy. Monitoring should be done every 1 to2weeks until reaching the desired therapeutic levels. Then, check lithium levels every 2 to 3 months for
six months. It is also important to monitor patients for dehydration and lower the dose when therearesigns of infection, excessive sweating, or diarrhea. Toxic levels are when the drug level is more than2mEq/L. Option A: The manifestations are not due to drug interaction. Lithium has a very narrowtherapeuticindex, and toxic levels are when the drug is above 2 mEq/L, which is very close to its therapeutic
range. Lithium toxicity can cause interstitial nephritis, arrhythmia, sick sinus syndrome, hypotension, T wave abnormalities, and bradycardia. Rarely, toxicity can cause pseudotumor cerebri and seizures. Lithium toxicity has no antidote. Option B: Cogentin is used to manage the extrapyramidal symptom side effects of antipsychotics. Benztropine is used to treat symptoms of Parkinson’s disease or involuntary movements due totheside effects of certain psychiatric drugs (antipsychotics such as chlorpromazine/haloperidol). Benztropine belongs to a class of medication called anticholinergics that work by blocking a certainnatural substance (acetylcholine). This helps decrease muscle stiffness, sweating, and the
production of saliva, and helps improve walking ability in people with Parkinson’s disease. Option C: The common side effects of Lithium are fine hand tremors, nausea, polyuria, and
polydipsia. Lithium can cause several adverse effects. Typically the side effects are dose-related. Treatment for lithium toxicity is primarily hydration and to stop the drug. Give hydration withnormal saline, which will also enhance lithium excretion. Avoid all diuretics. If the patient has severerenal dysfunction or failure, or severely altered mental status, then start with hemodialysis. 20to30mg of propranolol given 2 to 3 times per day may help reduce tremors. [Show Less]