A nurse is caring for a client prescribed Lithium. Which nur… | MyMerci
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Adverse Effects/Contraindications/InteractionsPPT
Question
A nurse is caring for a client prescribed Lithium. Which nursing action is most appropriate regarding monitoring serum lithium levels and maintaining adequate fluid and sodium intake?
1Mix in normal saline only, infuse at no more than 50 mg/min through a large vein with continuous ECG monitoring
2Mix in dextrose 5% in water and infuse at 100 mg/min through a small peripheral vein with pulse oximetry monitoring✓ Correct answer
3Administer undiluted as an IV push over 2 minutes, using a peripheral line with intermittent blood pressure checks
4Infuse concurrently through a Y-site with maintenance IV fluids containing potassium chloride to maintain line patency
Explanation
When administering Lithium, key nursing considerations include monitoring patient status, checking critical laboratory values, and providing appropriate safety education. Unsafe practices such as stopping medications abruptly or doubling missed doses are incorrect.
Memory Tip Phenytoin IV = "Saline, Slow, Strong-vein, Strip (ECG)." Fosphenytoin is the safer alternative — water-soluble, faster infusion permitted, less local injury.
Clinical scenario
Scenario 38-year-old in status epilepticus; provider orders phenytoin 1000 mg IV loading dose. The client has a dedicated 18-gauge antecubital IV.
Key concepts
Purple glove syndrome — Limb ischemia and discoloration from phenytoin extravasation; treat by stopping infusion and elevating the limb.
Status epilepticus — Continuous seizure activity >5 minutes or recurrent seizures without recovery; medical emergency requiring rapid anticonvulsant load.