Editing Pharmacology – RN Practice Questions (section)

==Question 10==
A client maintained on lithium for bipolar disorder is newly prescribed hydrochlorothiazide for hypertension. Which instruction is most important for the nurse to provide?
# "Reduce your daily fluid intake to less than one liter."
# "Follow a low sodium diet while taking both drugs."
# "Report nausea, vomiting, diarrhea, coarse tremor, or unsteady walking right away, and keep your lithium level appointments."
# "Take an NSAID such as naproxen if you develop a headache from the new medication."

'''Answer:''' 3 (C) Report nausea, vomiting, diarrhea, coarse tremor, or unsteady walking right away, and keep your lithium level appointments.

''Rationale:'' Thiazide diuretics increase renal reabsorption of lithium and raise the serum level, so the client must recognize early toxicity and have levels monitored more closely. The therapeutic range is roughly 0.6 to 1.2 mEq/L, and levels above 1.5 mEq/L are toxic. Option 1 is dangerous because dehydration concentrates lithium. Option 2 is dangerous because sodium restriction increases lithium reabsorption; intake should be adequate and consistent. Option 4 is wrong because NSAIDs also raise lithium levels.