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Difficulty: MediumPharmacological Therapies

A client with bipolar disorder is prescribed oral lithium carbonate. The practical nurse is implementing the client's plan of care. Which of the following actions should the practical nurse take to ensure safe pharmacological therapy? (Select all that apply.)

  1. Reinforce teaching with the client about the importance of maintaining a consistent daily dietary sodium intake.Answer
  2. Notify the registered nurse immediately if the client develops coarse hand tremors and confusion.Answer
  3. C
    Formulate an initial discharge teaching plan regarding long-term medication side effects.
  4. D
    Withhold the morning dose if the client's most recent serum lithium level is 0.9 mEq/L0.9\text{ mEq/L}.
  5. Verify the client's name and date of birth against the medication administration record before providing the drug.Answer
  6. F
    Bypass barcode scanning of the medication if the client has been receiving the same dosage safely for several days.

Answer

The practical nurse should reinforce teaching about consistent sodium intake, notify the registered nurse of coarse tremors and confusion, and verify two client identifiers before administration.
Safe pharmacological therapy for a client on lithium requires maintaining a consistent dietary sodium intake, as decreased sodium levels can lead to lithium retention and subsequent toxicity. Coarse hand tremors and confusion are severe manifestations of advanced lithium toxicity and must be reported to the registered nurse immediately. Additionally, standard medication safety protocols mandate that the nurse verify two distinct client identifiers (such as name and date of birth) before every medication administration, ensuring the right drug reaches the right client.

Step-by-Step Solution

1
Recall the pharmacological principles of lithium therapy.
Lithium is a mood stabilizer with a narrow therapeutic index (0.60.6 to 1.2 mEq/L1.2\text{ mEq/L}). Its excretion is heavily dependent on normal sodium levels, and toxicity presents with severe neurological symptoms.
Understanding the drug's physiological action is necessary to monitor for adverse effects and provide accurate client education.
2
Determine the appropriate legal scope of practice for the practical nurse (PN).
The PN can safely administer medications using established safety checks, reinforce prior teaching, and monitor/report adverse effects, but cannot formulate initial teaching plans.
Maintaining practice within the legal scope ensures safe and effective delegation and care delivery.
3
Evaluate each option against safety standards and the PN scope of practice.
Reinforcing sodium consistency, reporting signs of severe toxicity (tremors/confusion), and performing two-identifier checks are correct PN actions. Withholding a normal lithium level, formulating initial teaching, and skipping barcode scans are incorrect.
Systematic evaluation of each choice guarantees all appropriate clinical interventions are selected.

Key Concept

Lithium Toxicity, Safe Medication Administration, and Practical Nurse Scope of Practice
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Topics

Pharmacological Therapies

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