Difficulty: Medium
Average Score: 62%
Simulated
Passage / Scenario
Graphic RecordAdmission weight 74.8 kg (165 lb)
Current weight 74.38 kg (164 lb)
Provider Prescriptions
Lisinopril 10 mg daily
Lithium 600 mg BID
Omeprazole 40 mg daily
I&O
Prior Day Intake and Output
0800:
Intake 30 mL orange juice
Output 800 mL clear urine
1200:
Intake 60 ml water with lunch
Output 300 ml clear urine
1800
Intake 120 ml. water with dinner
Output 500 mL clear urine
2100:
Intake 30 ml dark soda
Output 200 ml. clear urine
Nurses Notes
0800:
A client who has bipolar disorder is admitted to the inpatient psychiatric unit. During the morning assessment, the client reports blurred vision and an increase in urine output. It is noted that the client is having clonic jerking of upper extremities. Provider notified and laboratory tests ordered. Skin is warm and dry without rash.
Laboratory Results
0900:
Creatinine 0.9 mg/dL (0.5 to 1.1 mg/dL)
Lithium level 2.5 mEq/L (0.6 to 1.2 mEq/L)
Fasting blood glucose 80 mg/dL (74 to 106 mg/dL)
Urinalysis:
Appearance: clear (clear)
Color: faint yellow (amber yellow)
Specific gravity 1.32 (adult client 1.01 to 1.025)
Nitrites: none (none)
Ketones: none (none)
Bilirubin: none (none)
Complete the following sentence by using the lists of options. The nurse understands that the patient has likely developed-----and will need to be monitored for-------
Correct answer
A,D
Rationale
The correct answer is A and D. Lithium toxicity and nephrotoxicity are commonly associated with the use of lithium. The nurse needs to monitor the patient for signs and symptoms of lithium toxicity, such as tremors, confusion, and increased thirst, as well as signs of nephrotoxicity, like decreased urine output and electrolyte imbalances. Hyponatremia (B), cardiac dysrhythmias (C), metabolic alkalosis (E), and hypertension (F) are not directly related to lithium use. Monitoring for these conditions would not be the priority in a patient who has likely developed lithium toxicity and nephrotoxicity.