Option 2 dry mouth and thirst are common and expected

(Option 2) Dry mouth and thirst are common and expected side effects of lithium when treatment is
initiated. They will resolve spontaneously and lithium need not be discontinued.
(Option 3) Hyperactivity and auditory hallucinations are clinical findings associated with bipolar mania.
Because lithium may take up to 3 weeks to become effective, it would not be unusual for a client to
experience these symptoms after only 7 days of treatment.
(Option 4) Lithium has a very narrow range of therapeutic serum levels; the usual ranges are 1.0-1.5
mEq/L (1.0-1.5 mmol/L) for treatment of acute mania and 0.6-1.2 mEq/L (0.6-1.2 mmol/L) for maintenance
therapy.
Educational objective:
Acute lithium toxicity (>1.5 mEq/L [1.5 mmol/L]) presents primarily with gastrointestinal side effects such

as persistent nausea and vomiting and diarrhea. Neurological symptoms typically manifest later and
include tremor, confusion, ataxia, and sluggishness. The health care provider must be notified at the
earliest indication of lithium toxicity.
Block Time Remaining: 00:00:40
TUTOR
Test Id: 80944027
QId: 30218 (921666)
20 of 54
A A A
A client is admitted to the ambulatory care unit for an endoscopic procedure. The gastroenterologist
administers midazolam 1 mg intravenously for sedation and titrates the dosage upward to 3.5 mg. The
client becomes hypotensive (86/60 mm Hg), develops severe respiratory depression (SpO2 86%), and
has periods of apnea. The nurse anticipates the administration of which antidote drug?
1. Benztropine [10%]
2. Flumazenil [36%]
3. Naloxone [46%]
4. Phentolamine [7%]
Omitted
Correct answer
2
Answered correctly
36% Time: 2 seconds
Updated: 04/26/2017
Explanation:
Midazolam (Versed) is a benzodiazepine commonly used to induce conscious sedation in clients
undergoing endoscopic procedures. The initial dose is 1 mg and is titrated up slowly (eg, 2 minutes before
each 1-mg increment) until speech becomes slurred. Usually no more than 3.5 mg is necessary to induce
conscious sedation. It is commonly administered with an opioid analgesic (eg, morphine, Fentanyl)
because of their synergistic effects. Side effects can include airway occlusion, apnea, hypotension
(especially in the presence of an opioid), and oxygen desaturation with resultant respiratory arrest.
Flumazenil (Romazicon) is the antidote drug used to reverse the sedative effects of benzodiazepines.
(Option 1) Benztropine (Cogentin) is used in the treatment of extrapyramidal side effects associated with
antipsychotic medications or metoclopramide.
(Option 3) Naloxone (Narcan) is the antidote drug to reverse the effects of opioids.
(Option 4) Phentolamine (Regitine) is the antidote drug used to treat a norepinephrine (Levophed)
extravasation.
Educational objective:
Flumazenil is a drug used to reverse the sedative effects of benzodiazepines such as midazolam.
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