The client is to take lithium regularly after she is discharged from the hospital. The nursing care plan includes discharge planning. The most important information to impart to the client and his family is that the client should have:

Appeared in: AIIMS Delhi NO - 2018

Explanation

Lithium is a mood stabilizer with a narrow therapeutic range (0.6-1.2 mEq/L), making it susceptible to toxicity.
The kidneys process lithium and sodium similarly. A decrease in sodium intake causes the kidneys to reabsorb more lithium, leading to increased serum lithium levels and a high risk of toxicity.
Therefore, maintaining a consistent and adequate dietary sodium intake is the most critical instruction to prevent dangerous fluctuations in lithium levels.
Patients should also maintain adequate fluid intake (2-3 L/day) as dehydration can also concentrate lithium in the blood.

Option B: Limiting fluid intake leads to dehydration. Dehydration concentrates lithium in the blood, significantly increasing the risk of toxicity.
Option C: A limited or low-sodium diet is dangerous for a patient on lithium. It causes the kidneys to retain lithium, which can lead to toxic levels.
Option D: The restriction of tyramine-rich foods is necessary for patients taking Monoamine Oxidase Inhibitors (MAOIs), not lithium. Ingesting tyramine with an MAOI can cause a life-threatening hypertensive crisis.

Clinical Relevance

Nursing practice connection: Safe nursing care depends on performing Patient education for lithium therapy in the correct sequence, documenting the action clearly, and monitoring for the expected response.
Patient education is a primary nursing responsibility to ensure medication safety. For lithium, this education can be life-saving by preventing toxicity.
Nurses must assess the patient's diet, fluid intake, and use of other medications (like diuretics or NSAIDs) that can affect lithium levels.
What if? A patient on lithium decides to start a low-sodium diet for hypertension. The nurse must instruct the patient to inform their psychiatrist immediately. The lithium dose will likely need to be reduced and levels monitored more frequently to prevent toxicity.

How to Approach the Question

First, identify the key medication in the question: lithium.
Recall the core pharmacological principles of lithium, specifically its narrow therapeutic index and its relationship with electrolytes and fluid balance.
Evaluate each option based on these principles. Ask yourself, 'How does this action affect lithium levels?'
Option A: Adequate sodium. This stabilizes lithium levels. This is a positive, safe action.
Option B: Limit fluids. This causes dehydration and concentrates lithium, increasing toxicity risk. This is unsafe.
Option C: Limit sodium. This causes the body to retain lithium, increasing toxicity risk. This is unsafe.

Concept Tested & Keywords

Concept Tested: Patient education for lithium therapy
Stem keywords: lithium, discharge planning, nursing care plan, most important information
Lead-in keywords: most important

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Practise the full AIIMS Delhi NO - 2018

Attempt every question from this paper in a timed mock, then review the full solution for each one.