A client with bipolar disorder has been taking lithium, and today ...

[armygirl]

A client with bipolar disorder has been taking lithium, and today his serum blood level is 2.0 mEq/L. What effects would the nurse expect to see?
 
  A) Constipation and postural hypotension
  B) Fever, muscle rigidity, and disorientation
  C) Nausea, diarrhea, and confusion
  D) None since the serum level is in therapeutic range

Question 2

One week after beginning therapy with thiothixene (Navane), the client demonstrates muscle rigidity, a temperature of 103F, an elevated serum creatinine phosphokinase level, stupor, and incontinence.
 
  The nurse should notify the physician because these symptoms are indicative of: A) Acute dystonic reaction
  B) Extrapyramidal side effects
  C) Neuroleptic malignant syndrome
  D) Tardive dyskinesia

[djpooyouma]

Answer to Question 1

C
Feedback: The client would show signs of toxicity with a lithium level of 2.0 mEq/L. Toxic effects of lithium are severe diarrhea, vomiting, drowsiness, muscle weakness, and lack of coordination. The serum level is not in therapeutic range.

Answer to Question 2

C
Feedback: The client demonstrates all the classic signs of neuroleptic malignant syndrome. Dystonia involves acute muscular rigidity and cramping, a stiff or thick tongue with difficulty swallowing, and in severe cases, laryngospasm and respiratory difficulties. Extrapyramidal side effects are reversible movement disorders induced by antipsychotic or neuroleptic medication. Tardive dyskinesia is a late-onset, irreversible neurologic side effect of antipsychotic medications, characterized by abnormal, involuntary movements such as blinking, chewing, and grimacing.

[armygirl]

Excellent

[sailorcrescent]

TYSM