A client with bipolar disorder in the manic phase is started on lithium (Eskalith). The client's current lithium level is 0.4 mEq/L. What will the nurse expect to assess in this client?
1. A return to baseline behavior: calm and rational
2. Signs and symptoms of depression
3. Hyperactivity and pressured speech
4. A decrease in manic behavior
Correct Answer: 3
Rationale 1: The client will not return to baseline behavior but will continue in the manic phase until the lithium level is within a therapeutic range.
Rationale 2: The client will not exhibit signs and symptoms of depression but will continue in the manic phase.
Rationale 3: At the start of therapy, the lithium level should be maintained within the range of 0.8 to 1.4 mEq/L. Since this client's level is low, behaviors will indicate mania—i.e., hyperactivity and pressured speech.
Rationale 4: There will be no decrease in manic behavior, because the lithium level is too low.
Global Rationale: At the start of therapy, the lithium level should be maintained within the range of 0.8 to 1.4 mEq/L. Since this client's level is low, behaviors will indicate mania—i.e., hyperactivity and pressured speech. The client will not return to baseline behavior but will continue in the manic phase until the lithium level is within a therapeutic range. The client will not exhibit signs and symptoms of depression but will continue in the manic phase. There will be no decrease in manic behavior, because the lithium level is too low.
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