A client with bipolar disorder is admitted to the psychiatric unit with acute mania and dehydration. Which prescription does the nurse question?

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11ecbb05_ccb2_4b0f_b433_b34bda75fc38_MD0009_00 Lithium is a mood stabilizer commonly prescribed for mania (eg, bipolar disorder) as long-term maintenance therapy. Because lithium has a narrow therapeutic range (eg, 0.6-1.2 mEq/L [0.6-1.2 mmol/L]), serum levels should be monitored regularly (eg, following dose changes) to prevent toxicity (>1.5 mEq/L [1.5 mmol/L]). Lithium is excreted through the kidneys. To prevent toxicity the nurse should hold doses and clarify prescriptions for clients who have: Conditions/illnesses in which the kidneys try to conserve sodium (eg, hyponatremia, dehydration) as sodium and lithium are absorbed in proximal tubules simultaneously (Option B) Decreased glomerular filtration rate (eg, severe renal dysfunction) as less of the drug is filtered into the urine Consistent amounts of fluid (2-3 L/day) and sodium prevent fluctuations in serum lithium. Clients should report signs (eg, weight changes, dizziness) and precipitating factors (eg, vomiting, diarrhea, increased sweating) of fluid and electrolyte imbalance. (Option A) Zolpidem (Ambien) is a hypnotic medication that induces sleep for clients with sleep disturbances (eg, acute mania). (Option C) Haloperidol (a first-generation antipsychotic) and lorazepam (a benzodiazepine) are commonly administered together to depress the central nervous system and decrease aggressive behaviors. (Option D) Isotonic IV fluid boluses (eg, normal saline) are often required to reverse moderate to severe dehydration and prevent lithium toxicity. Educational objective: Lithium, a mood stabilizer commonly prescribed for clients with mania, has a narrow therapeutic range. Clients with conditions that increase serum lithium levels (eg, dehydration, hyponatremia, severe renal dysfunction) are at increased risk for toxicity (>1.5 mEq/L [1.5 mmol/L]).

A Client with Bipolar Disorder Is Admitted to the Psychiatric