A client diagnosed with bipolar disease is receiving a maintenance dosage of lithium carbonate. His wife calls the community mental health nurse to report that her husband is displaying mild aggression and poor judgment. Which intervention is appropriate?

  1. administer an extra dose of lithium carbonate
  2. take client to the closest emergency department
  3. measure lithium blood level
  4. arrange for hemodialysis
Number 3 is correct.
Rationale: Assessment of the therapeutic level of lithium in the blood is required to determine the next course of action. An extra dose of lithium carbonate may make the symptoms more pronounced. The client’s behavior does not warrant a trip to the emergency department, although he should seek medical attention. There is not enough information yet to determine whether hemodialysis is necessary.