Lithium practice test NCLEX

A client prescribed lithium for bipolar disorder asks what to do at home. Which instructions should the nurse include? (Select all that apply.)

A. Maintain consistent salt intake
B. Drink 2–3 L of fluid daily (unless restricted)
C. Stop lithium if mild nausea occurs
D. Avoid NSAIDs unless provider approves
E. Report coarse tremor, confusion, or unsteady gait
F. Take a “double dose” if a dose is missed

A. Maintain consistent salt intake

B. Drink 2–3 L of fluid daily (unless restricted)

D. Avoid NSAIDs unless provider approves

E. Report coarse tremor, confusion, or unsteady gait

Which lab value is within the typical therapeutic range for lithium maintenance?

A. 0.2 mEq/L
B. 0.8 mEq/L
C. 1.8 mEq/L
D. 2.6 mEq/L

B. 0.8 mEq/L

A client taking lithium reports vomiting, diarrhea, and new tremors. What is the nurse’s priority?

A. Administer the next scheduled dose with food
B. Hold lithium and notify the provider
C. Encourage low-sodium diet
D. Teach that GI upset is expected and temporary

B. Hold lithium and notify the provider

Which medications can increase lithium levels and risk toxicity? (Select all that apply.)

A. Ibuprofen
B. Hydrochlorothiazide
C. Lisinopril
D. Acetaminophen
E. Furosemide
F. Naproxen

A. Ibuprofen
B. Hydrochlorothiazide

C. Lisinopril'

F. Naproxen

EHR excerpt:

• Med: lithium carbonate 300 mg TID

• Symptoms: slurred speech, ataxia, confusion

• Lithium level: 2.1 mEq/L

• Na: 136 mEq/L, BUN/Cr elevated

What is the best nursing action?

A. Give the next dose and recheck level tomorrow
B. Hold lithium, start seizure precautions, notify provider urgently
C. Give normal saline at KVO and reassure
D. Encourage caffeine to reduce fatigue

B. Hold lithium, start seizure precautions, notify provider urgently

Lithium use in pregnancy is most associated with risk for:

A. Neural tube defects
B. Ebstein anomaly (cardiac defect)
C. Cleft palate
D. Pulmonary hypoplasia

B. Ebstein anomaly (cardiac defect)

Which assessments/labs are important for a client on long-term lithium? (Select all that apply.)

A. Creatinine/BUN
B. Thyroid function tests
C. Fasting lipid panel only
D. Lithium trough levels
E. Urinalysis and hydration status
F. Serum calcium

A. Creatinine/BUN

B. Thyroid function tests

D. Lithium trough levels

E. Urinalysis and hydration status

A client taking valproate reports severe abdominal pain radiating to the back and vomiting. What complication is most concerning?

A. Tardive dyskinesia
B. Pancreatitis
C. Hyperthyroidism
D. Serotonin syndrome

B. Pancreatitis

Which teaching points are appropriate for valproate/divalproex? (Select all that apply.)

A. Report jaundice or dark urine immediately
B. Avoid pregnancy; use reliable contraception
C. Expect gum hyperplasia as common effect
D. Routine CBC/platelets may be needed
E. Stop medication abruptly once mood improves
F. Report unusual bruising/bleeding

A. Report jaundice or dark urine immediately

B. Avoid pregnancy; use reliable contraception

D. Routine CBC/platelets may be needed

F. Report unusual bruising/bleeding

Which lab is most important to monitor for valproate safety?

A. Amylase only
B. AST/ALT
C. Troponin
D. BNP

B. AST/ALT

Can administer benstropine to reduce symptoms?

A. Take acetaminophen and rest
B. Stop the medication and come in for CBC evaluation
C. Decrease sodium intake
D. Continue medication; symptoms are expected early effects

B. Stop the medication and come in for CBC evaluation

Which instructions should the nurse include for carbamazepine? (Select all that apply.)

A. Avoid grapefruit juice
B. Use backup contraception (may reduce OCP effectiveness)
C. Report rash immediately
D. Expect increased INR if taking warfarin
E. Monitor for dizziness/drowsiness and avoid driving until known
F. Do not take with food

A. Avoid grapefruit juice

B. Use backup contraception (may reduce OCP effectiveness)

C. Report rash immediately

E. Monitor for dizziness/drowsiness and avoid driving until known

Carbamazepine can cause:

A. Hypernatremia
B. Hyponatremia (SIADH)
C. Hypercalcemia
D. Hypokalemia

B. Hyponatremia (SIADH)

EHR excerpt: carbamazepine started 2 weeks ago

• Na: 124 mEq/L

• Symptoms: headache, confusion, nausea

What is the priority nursing action?

A. Encourage free water intake
B. Hold medication and notify provider; implement seizure precautions

C. Give hypotonic IV fluids

D. Teach Client to increase potassium intake

B. Hold medication and notify provider; implement seizure precautions

Which findings require immediate follow-up for a client taking lamotrigine? (Select all that apply.)

A. New rash with fever
B. Mouth sores or blistering skin
C. Mild headache after first dose
D. Swollen lymph nodes
E. Fatigue after a late night
F. Dark urine and jaundice

A. New rash with fever

B. Mouth sores or blistering skin

D. Swollen lymph nodes

F. Dark urine and jaundice

Why is lamotrigine dose typically increased slowly?

A. To prevent serotonin syndrome
B. To prevent severe rash (SJS/TEN)
C. To prevent kidney stones
D. To prevent hypertensive crisis

B. To prevent severe rash (SJS/TEN)

A client takes valproate and is newly prescribed lamotrigine. What should the nurse anticipate? (Select all that apply.)

A. Higher risk of serious rash
B. Lamotrigine dose may need to be lower
C. Valproate will decrease lamotrigine level
D. Close monitoring during titration
E. No interaction; standard dosing applies

A. Higher risk of serious rash

B. Lamotrigine dose may need to be lower

D. Close monitoring during titration

A client with bipolar disorder is on a mood stabilizer but has not slept for 3 nights, is pacing, and says, “I’m invincible!” What is the priority nursing goal?

A. Help the client process childhood trauma
B. Promote safety and decrease stimulation
C. Encourage group therapy participation
D. Teach meditation for long-term coping

B. Promote safety and decrease stimulation

Which situation puts a client at greatest risk for lithium toxicity?

A. Eating salty foods at dinner
B. Running a fever with poor fluid intake
C. Taking lithium with meals
D. Exercising lightly for 20 min

B. Running a fever with poor fluid intake

Which are consistent with lithium toxicity? (Select all that apply.)

A. Coarse tremor
B. Ataxia/unsteady gait
C. Metallic taste and muscle rigidity with hyperthermia
D. Slurred speech
E. Severe diarrhea
F. Hyperreflexia and clonus

A. Coarse tremor

B. Ataxia/unsteady gait
D. Slurred speech
E. Severe diarrhea

EHR excerpt: Lithium ordered. Provider requests “lithium level in the morning.”
When should the nurse schedule the blood draw for the most accurate trough?

A. 30 minutes after the dose
B. 2 hours after the dose
C. 12 hours after the last dose
D. Anytime during the day

B. 2 hours after the dose

A manic client is extremely agitated and at risk of harming others. Which PRN is most appropriate?

A. Stimulant medication
B. Benzodiazepine or antipsychotic per order
C. SSRI antidepressant
D. Opioid analgesic

B. Benzodiazepine or antipsychotic per order

The nurse is teaching a client with bipolar disorder about starting an antidepressant. Which points should be included? (Select all that apply.)

A. Antidepressants can trigger mania/hypomania
B. Report racing thoughts and decreased need for sleep
C. Antidepressants prevent manic episodes reliably
D. Mood stabilizer adherence helps reduce relapse risk
E. Stop medication once you feel better

A. Antidepressants can trigger mania/hypomania

B. Report racing thoughts and decreased need for sleep

D. Mood stabilizer adherence helps reduce relapse risk

Valproate exposure during pregnancy is most associated with:

A. Ebstein anomaly
B. Neural tube defects
C. Cataracts
D. Renal agenesis

B. Neural tube defects

The nurse reviews morning meds. Which client should the nurse see first before giving lithium?

A. Client with mild hand tremor at baseline
B. Client with BP 118/70 and eating breakfast
C. Client with diarrhea since yesterday and poor oral intake
D. Client requesting medication education handout

C. Client with diarrhea since yesterday and poor oral intake

Which findings in a client on carbamazepine require urgent follow-up? (Select all that apply.)

A. Easy bruising
B. Fever
C. Sore throat
D. Mild nausea after meals
E. Rash
F. WBC trending down

A. Easy bruising

B. Fever
C. Sore throat

E. Rash

F. WBC trending down

Which statement by a client on lithium indicates correct understanding?

A. “I will follow a low-salt diet to protect my heart.”
B. “If I sweat a lot, I’ll drink extra water and keep my salt intake steady.”
C. “I can take ibuprofen daily for headaches.”
D. “I should restrict fluids to avoid swelling.”

B. “If I sweat a lot, I’ll drink extra water and keep my salt intake steady.”

EHR excerpt: Client history includes chronic kidney disease and hypothyroidism. Provider is considering a mood stabilizer.

Which medication is most likely to worsen BOTH conditions?

A. Lithium
B. Lamotrigine
C. Valproate
D. Carbamazepine

A. Lithium

Which general discharge instructions apply to most mood stabilizers? (Select all that apply.)

A. Do not stop suddenly without provider guidance
B. Keep follow-up appointments for lab monitoring if ordered
C. Avoid alcohol and other sedatives unless approved
D. Report suicidal thoughts or worsening mood
E. Double the dose if you miss one
F. Expect immediate full effect within 1–2 hours

A. Do not stop suddenly without provider guidance
B. Keep follow-up appointments for lab monitoring if ordered
C. Avoid alcohol and other sedatives unless approved
D. Report suicidal thoughts or worsening mood

EHR excerpt: Client on lithium is prescribed a new medication at urgent care for ankle pain: naproxen.

What should the nurse do first?

A. Tell client to take naproxen with food
B. Teach client to limit salt
C. Notify provider and recommend alternative analgesic plan
D. Document the medication and take no action

C. Notify provider and recommend alternative analgesic plan