For 2 weeks a patient has taken lithium (Lithane) and risperidone (Risperdal) daily for mani
a. The patient now reports diarrhea, vomiting, and blurred vision. The nurse observes a coarse hand tremor. Select the nurse's priority action.
a. Administer a PRN dose of benztropine (Cogentin) to relieve extrapyramidal symptoms (EPSEs).
b. Hold the next dose of risperidone to prevent further drug–drug interaction.
c. Reassure the patient that these side effects will decrease with time.
d. Notify the prescribing physician immediately.
D
The symptoms the patient is experiencing are consistent with a serum lithium level above the therapeutic level. The nurse should withhold the next dose, arrange for a stat serum lithium level determination, and notify the health care provider. Risperidone can be continued because this is not a drug–drug interaction problem. Administration of benztropine is inappropriate because these are not EPSE symptoms. Reassurance would be appropriate, but the patient should not be told that these symptoms will decrease with time and continued dosing.
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