Comprehensive exams for Mental Health Q 177
Dennis has a lithium level of 2.4 mEq/L. The nurse immediately would assess the client for which of the following signs or symptoms?
A. Weakness
B. Diarrhea
C. Blurred vision
D. Fecal incontinence
Correct Answer: C. Blurred vision
At lithium levels of 2 to 2.5 mEq/L the client will experience blurred vision, muscle twitching, severe hypotension, and persistent nausea and vomiting. Intoxication degree is of utmost importance for understanding lithium toxicity diagnosis and management. The severity of lithium toxicity is often divided into the following three grades: mild, moderate, and severe. In mild, there is nausea, vomiting, lethargy, tremor, and fatigue (Serum lithium concentration between 1.5-2.5 mEq/L).
Option A: Symptoms of intoxication include coarse tremor, hyperreflexia, nystagmus, and ataxia. Patients often show varying consciousness levels, ranging from mild confusion to delirium. Although the neurological symptoms are mostly reversible, some reports indicate that symptoms might persist for 12 months and never resolve.
Option B: With levels between 1.5 and 2 mEq/L the client experiencing vomiting, diarrhea, muscle weakness, ataxia, dizziness, slurred speech, and confusion. Symptoms typically occur within 1 hour of ingestion and are more common in the acute overdose setting. To determine the extent of lithium toxicity, one must determine the ingested amount, time of ingestion, whether there are coingestants, and if the ingestion was intentional or unintentional. It is worth noting that lithium toxicity signs do not often conform to the measured lithium level.
Option D: At lithium levels of 2.5 to 3 mEq/L or higher, urinary and fecal incontinence occurs, as well as seizures, cardiac dysrhythmias, peripheral vascular collapse, and death. Renal toxicity is more common in patients on chronic lithium treatment. Toxicity includes impaired urinary concentrating ability, nephrogenic diabetes insipidus (the most common cause of drug-induced NDI), sodium-losing nephritis, nephrotic syndrome along other manifestations.