The registered nurse supervises a student nurse who is caring for a client newly prescribed lithium for the treatment of bipolar disorder. Which action by the student indicates a need for further teaching?

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11ecbb05_ccb1_399e_b433_a5e295bc0a16_MD0009_00 Lithium carbonate is a mood stabilizer used for the treatment of bipolar disorder. Lithium levels take some time to reach therapeutic levels, often up to a few weeks (Option D). Clients will need to have their lithium levels carefully monitored when starting therapy, as the therapeutic range is narrow (0.6-1.2 mEq/L [0.6-1.2mmol/L]). Blood sodium levels affect the renal excretion of lithium, as lithium and sodium are excreted in a parallel mechanism by the kidney. If sodium intake is limited or the body is depleted of its normal sodium (eg, excessive perspiration, vomiting, diarrhea), lithium is reabsorbed by the kidneys, increasing the possibility of toxicity (Option C). Therefore, clients on lithium must consume adequate sodium in the diet. Care should be taken to avoid dehydration, so diuretic medications and substances with a diuretic effect (eg, coffee, cola, tea, alcoholic beverages) must be limited or avoided, and clients are advised to drink 2-3 liters of water each day (Options A and B). Educational objective: Clients initiating lithium therapy should be instructed that therapeutic effects may take several weeks to achieve. Clients taking lithium should maintain a normal dietary sodium intake, consume 2-3 liters of fluids per day, and be advised to avoid diuretics or products with diuretic effects (eg, coffee, cola, tea).

The Registered Nurse Supervises a Student Nurse Who Is Caring