NVS Staff Nurse - 2019
Psychiatric Nursing
Hard
Which of the following nurse's advice is the most important for a female patient who takes lithium for manic episodes?
Appeared in: NVS Staff Nurse - 2019
Explanation
- The most critical advice is to maintain adequate hydration because lithium has a narrow therapeutic range (0.6-1.2 mEq/L), making toxicity a significant risk.
- Lithium is cleared by the kidneys, and its reabsorption is directly linked to the body's sodium and water balance.
- Dehydration from any cause (e.g., sweating, illness, inadequate intake) prompts the kidneys to conserve sodium. Because the body handles lithium like sodium, lithium is also reabsorbed, causing its blood levels to rise to potentially toxic levels.
- Maintaining a consistent and adequate fluid intake of 2-3 liters per day is the most fundamental safety measure to ensure stable lithium excretion and prevent life-threatening toxicity.
Why Other Options Were Wrong
- Option B: This is a helpful suggestion to minimize fluid loss from heat but is not the most important advice. The core principle is to maintain hydration regardless of the environment or activity, which is a more comprehensive and critical instruction.
- Option C: This advice is unnecessarily restrictive. Patients on lithium can and should engage in regular physical activity. The correct approach is to educate them on how to exercise safely by replacing fluids and electrolytes lost through sweat.
- Option D: This statement provides false and dangerous reassurance. Due to its narrow therapeutic index, lithium toxicity is a well-known, serious, and potentially fatal risk that requires vigilant monitoring and patient education.
Related Visual
Clinical Relevance
- Nursing practice connection: Use the key finding related to Patient education and safety for lithium therapy to guide bedside assessment, documentation, and the next nursing action.
- A primary nursing responsibility is educating patients on lithium about the critical importance of maintaining a consistent fluid intake (2-3 L/day) and a stable sodium intake to prevent life-threatening toxicity.
- Nurses must teach patients and their families to recognize and immediately report early signs of toxicity, such as persistent nausea, vomiting, diarrhea, and increasing tremors.
- What if? If the patient is prescribed a new medication, especially a diuretic (like a thiazide) or an NSAID (like ibuprofen), the risk of lithium toxicity increases dramatically. The nurse must ensure all prescribing providers are aware of the lithium therapy and that lithium levels are monitored more frequently.
How to Approach the Question
- First, identify the key terms in the question: "most important," "nurse's advice," and "lithium."
- Recall the core pharmacological principle of lithium: it is a salt cleared by the kidneys, and its blood level is highly sensitive to the body's fluid and sodium status.
- Evaluate each option based on this principle. The option that directly addresses the primary mechanism of toxicity (fluid/sodium balance) will be the most critical piece of safety advice.
- Eliminate options that are factually incorrect (e.g., "toxicity is very rare") or unnecessarily restrictive (e.g., "stop walking").
- Compare the remaining valid options. The most comprehensive and fundamental principle (maintaining hydration) is a better answer than a specific, situational tactic (staying in the shade).
Concept Tested & Keywords
- Concept Tested: Patient education and safety for lithium therapy.
- Stem keywords: lithium, manic episodes, nurse's advice
- Lead-in keywords: most important
- Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.
- Negative lead-in flag: false
Question ID
QsSAeYRiAF5rds2QLcHCwt
Reference Book
E6 Guide to Mental Health & PSYCHIATRIC NURSING R Sreevani— Part 1 (pp 26-289 of 579) p. 134-136
E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) p. 10768-10770
E6 Pharmacology Nursing Lilley 11e Part 1 p. 272-274
Practise the full NVS Staff Nurse - 2019
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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