Which of the following instructions regarding lithium therapy ...

[jparksx]

Which of the following instructions regarding lithium therapy should be included in a nurse's discharge teaching? Select all that apply.
 
  A. Avoid excessive use of beverages containing caffeine.
  B. Maintain a consistent sodium intake.
  C. Consume at least 2,500 to 3,000 mL of fluid per day.
  D. Restrict sodium content.
  E. Restrict fluids to 1,500 mL per day.

Question 2

A client has been taking lithium for several years with good symptom control. The client presents in the emergency department with blurred vision, tinnitus, and severe diarrhea. The nurse should correlate these symptoms with which lithium level?
 
  A. 1.3 mEq/L
  B. 1.7 mEq/L
  C. 2.3 mEq/L
  D. 3.7 mEq/L

[emsimon14]

Answer to Question 1

ANS: A, B, C
The nurse should instruct the client taking lithium to avoid excessive use of caffeine, maintain a consistent sodium intake, and consume at least 2,500 to 3,000 mL of fluid per day. The risk of developing lithium toxicity is high due to the narrow margin between therapeutic doses and toxic levels.

Answer to Question 2

ANS: B
The therapeutic level of lithium carbonate is 1.0 to 1.5 mEq/L for acute mania and 0.6 to 1.2 mEq/L for maintenance therapy. There is a narrow margin between the therapeutic and toxic levels. The symptoms presented in the question can be correlated with a lithium level of 1.7 mEq/L. Levels of 2.3 mEq/L and 3.7 mEq/L would produce more extreme symptoms of intensified toxicity, eventually leading to death.