RUHS, Jaipur, M.Sc Nursing Entrance Exam-2019
Pharmacology
Easy
The therapeutic effect of serum lithium concentration level is monitored?
Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2019
Explanation
- The correct time frame for monitoring serum lithium is 12-24 hours after the last dose.
- This timing is based on the need to measure the 'trough level'—the lowest concentration of the drug in the blood before the next dose.
- The standard clinical practice is to draw the blood sample exactly 12 hours post-dose to get the most accurate measure of the steady-state therapeutic level.
- This 12-hour mark falls squarely within the 12-24 hour option, making it the correct choice.
Why Other Options Were Wrong
- Option A: Drawing blood 'within 12 hours' would measure the peak or near-peak drug concentration, not the stable trough level. This would result in a falsely elevated reading.
- Option C: Waiting 24-48 hours is too long. By this time, the drug level would be significantly lower than the true trough level, giving a falsely low reading and an inaccurate picture of the patient's therapeutic status.
- Option D: This time frame is far too long after the last dose. The lithium level would be extremely low or undetectable, providing no useful clinical information for dose adjustment.
Related Visual
Clinical Relevance
- Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Pharmacology: Therapeutic Drug Monitoring of Lithium as background academic context rather than a clinical decision trigger.
- A core nursing responsibility in medication administration is ensuring that therapeutic drug monitoring is performed correctly. For lithium, this means educating the patient to hold their morning dose until after the blood draw to prevent a falsely high reading.
- Nurses must continuously monitor for signs of lithium toxicity due to its narrow therapeutic index. Early signs include worsening tremors, GI upset, and confusion. Prompt reporting is critical to prevent severe complications.
- Patient teaching about maintaining consistent sodium and fluid intake is a key safety measure. Dehydration or a low-sodium diet can quickly lead to toxic lithium levels.
How to Approach the Question
- First, identify the core of the question: it's asking for the correct timing of a blood draw to monitor lithium levels.
- Recall that for drugs with a narrow therapeutic index like lithium, monitoring is crucial and is usually done at the 'trough' level to ensure a stable, safe concentration.
- Think about what 'trough' means: it's the lowest point of concentration, right before the next dose is due.
- Consider a typical dosing schedule (e.g., twice daily). A blood draw 12 hours after the evening dose and before the morning dose would accurately capture this trough level.
- Evaluate the options based on this 12-hour standard. The '12-24 hours' option is the only one that correctly encompasses this timing.
- Eliminate other options: 'Within 12 hours' is too early (measures peak), and '24-48 hours' or more is too late (falsely low).
Concept Tested & Keywords
- Concept Tested: Pharmacology: Therapeutic Drug Monitoring of Lithium
- Stem keywords: serum lithium, concentration level, monitored
- Lead-in keywords: BEST, MOST RELEVANT CLUE
Question ID
QfjDUXndfTq-TjJdwJT0At
Reference Book
E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) p. 3495-3497
E6 Kaplan Sadock's Synopsis of Psychiatry-2022 (pp 1-3768 of 3768) p. 2064-2066
Practise the full RUHS, Jaipur, M.Sc Nursing Entrance Exam-2019
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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