A nurse in an acute care mental health facility is preparing to administer morning medication for a client who has been taking lithium for 2 weeks and has a current lithium level of 1.0 mEq/L. Which of the following actions should the nurse take?
A.
Prepare for gastric lavage due to an extremely elevated lithium level.
B.
Administer the morning dose of lithium.
C.
Check the client’s medication record to assess whether the client has been refusing her lithium.
D.
Hold the medication and assess for early manifestations of toxicity.
The Correct answer and Explanation is:
Correct Answer: B. Administer the morning dose of lithium.
Explanation:
Lithium is a mood stabilizer commonly used to treat bipolar disorder, particularly in managing the manic episodes associated with the condition. It is crucial for nurses to monitor lithium levels closely due to the narrow therapeutic range, typically between 0.6 and 1.2 mEq/L. A lithium level of 1.0 mEq/L falls within the therapeutic range, indicating that the medication is at an appropriate concentration in the client’s bloodstream to exert its therapeutic effects without causing toxicity.
Option A: Prepare for gastric lavage due to an extremely elevated lithium level. This action would be appropriate only if the client’s lithium level were excessively high, typically above 2.0 mEq/L, where there is a significant risk of toxicity. Symptoms of severe lithium toxicity may include severe tremors, seizures, confusion, and even coma, necessitating emergency interventions like gastric lavage or hemodialysis. However, with a lithium level of 1.0 mEq/L, this action is unnecessary and inappropriate.
Option B: Administer the morning dose of lithium. Since the client’s lithium level is within the therapeutic range, the nurse should continue the prescribed lithium treatment regimen. Administering the morning dose as scheduled is essential to maintain stable serum lithium levels and manage the client’s symptoms effectively. Continuing the medication as prescribed helps prevent fluctuations in mood and reduces the risk of relapse into mania or depression.
Option C: Check the client’s medication record to assess whether the client has been refusing her lithium. While it is always a good practice to review a client’s medication record, there is no specific indication in this scenario that the client has been refusing medication. The current lithium level suggests that the client has likely been compliant with the medication regimen, and therefore, this action is not necessary in this situation.
Option D: Hold the medication and assess for early manifestations of toxicity. Holding the medication would be indicated if there were signs of toxicity or if the lithium level were approaching or exceeding the upper limit of the therapeutic range. However, with a level of 1.0 mEq/L, there is no indication of toxicity, and withholding the medication could disrupt the therapeutic process.
In summary, the most appropriate action is to administer the morning dose of lithium to maintain the therapeutic level and continue managing the client’s condition effectively. This action ensures that the client remains within the therapeutic range, minimizing the risk of both relapse and toxicity.