When developing the plan of care for a client who is receiving lithium therapy, which nursing diagnosis would the nurse most likely identify as a priority?
A) Self-Care Deficit
B) Disturbed Sleep Pattern
C) Imbalanced Nutrition: Less Than Body Requirements
D) Imbalanced Fluid Volume
Ans: D
Feedback:
Fluid balance determines the concentration of lithium in the blood and thus the client's risk for toxicity. Therefore, imbalanced fluid volume is a priority. Self-care deficit, disturbed sleep pattern, and imbalanced nutrition also may apply, but imbalanced fluid volume would be the priority.
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