NGN Unfolding Case Study: Bipolar Disorder & Lithium Toxicity | Varcarolis's Canadian Psychiatric Nursing | Verified Answers & Rationales | Latest 2026

This premium NGN unfolding case study focuses on Bipolar Disorder and Lithium Toxicity, specifically aligned with Varcarolis's Canadian Psychiatric Mental Health Nursing, 3rd Edition by Pollard and Jakubec. Updated for 2026, the document provides a detailed clinical scenario of a client presenting with symptoms of lithium toxicity, including gastrointestinal distress, tremors, and dehydration. It features NGN item types such as Multiple Response (SATA) and Matrix questions, requiring students to recognize cues and evaluate outcomes. Key nursing concepts covered include monitoring therapeutic lithium levels (0.8–1.2 mEq/L), identifying signs of toxicity like hyponatremia, and implementing priority safety interventions. Each section includes verified answers and comprehensive rationales to help nursing students master clinical judgment and excel in psychiatric-mental health exams and Next Generation NCLEX (NGN) assessments. Copyright © 2026, Elsevier Inc. All rights reserved. Pollard: Varcarolis’s Canadian Psychiatric Mental Health Nursing: A Clinical Approach, 3rd Edition Title: Bipolar Disorder Focus: Lithium Toxicity NGN Unfolding Case Study Answer: Which of the following findings require immediate follow-up? Select all that apply. □ Gastrointestinal presentation □ Client orientation □ Tremor □ “Pounding heart” □ Cardiovascular perfusion □ Mucous membranes □ Thirsty Item Type: Multiple Response, Select All Cognitive Skill: Recognize Cues Rationales: The client presents with nausea and vomiting with a past medical history of bipolar illness and taking lithium. Lithium toxicity would be the most important diagnosis for this client. Dehydration leads to sodium depletion, where the kidneys will try to reabsorb sodium along with lithium, increasing the serum levels. Based on Table 14.4, monitoring for signs and symptoms of lithium toxicity would be most important. Neurologically, scattered thoughts and tremors indicate early signs of lithium toxicity. This client would be hyponatremic leading to the complaint of being thirsty. The client should be monitored for prolonged QT leading to arrythmias. Nausea and vomiting are contributing factors to the hospitalization and can be monitored, but does not require immediate follow-up. The client may feel a “pounding heart” espite being bradycardic. The dry mucous membranes should indicate to the student the client is dehydrated as does the blood pressure but not necessary for an immediate follow up. Bradycardia due to dehydration and lithium toxicity. Reference:NGN Case Studies 2 Copyright © 2026, Elsevier Inc. All rights reserved. Pollard, C. L., & Halter-Jordon, M. (2023). Chapter 14: Bipolar disorders. In C. L. Pollard, S. L. Jakubec, & M. J. Halter (Eds.), Varcarolis’s Canadian psychiatric mental health nursing (3rd ed.). Elsevier. Answer: The nurse reviews the Laboratory Values at 1900 h. Identify the most appropriate word choice from below to fill in each blank in the following sentence. The nurse should recognize that the client is potentially experiencing symptoms associated with a(an) . Word Choices Stroke Myocardial infarction Lithium toxicity A urinary tract infection Sepsis inflammatory response syndrome Hypoglycemia Item Type: Drag and Drop Close Cognitive Skill: Analyze Cues Rationales: Based on the symptoms, the client is experiencing lithium toxicity. A student may choose stroke if they are unfamiliar with manifestations associated with lithium toxicity. The client reports no chest pain, so the condition cannot be myocardial infarction. The WBCs are not elevated to indicate a urinary tract infection or SIRS and the client’s blood sugar is normal. Reference: Pollard, C. L., & Halter-Jordon, M. (2023). Chapter 14: Bipolar disorders. In C. L. Pollard, S. L. Jakubec, & M. J. Halter (Eds.), Varcarolis’s Canadian psychiatric mental health nursing (3rd ed.). Elsevier. Answer: Complete the following sentence by choosing from the lists of options.NGN Case Studies 3 Copyright © 2026, Elsevier Inc. All rights reserved. Options 1: Muscle weakness Pulmonary embolism Cardiogenic shock Convulsions Options 2: Right hand tremor Sodium level Need for cardiac monitoring Respiratory rate The client is at highest risk for developing (options 1) as evidenced by the client’s (options 2) Item Type: Drop Down Rationale Cognitive Skill: Prioritize Hypothesis Rationales: Based on the symptoms, the client is experiencing lithium toxicity. The client is hyponatremic which means due to the high sodium count, convulsions are potential with high levels of toxicity. The client is also at risk for developing dysrhythmias such as ventricular tachycardia due to high levels of displaced intracellular potassium. References: Pollard, C. L., & Halter-Jordon, M. (2023). Chapter 14: Bipolar disorders. In C. L. Pollard, S. L. Jakubec, & M. J. Halter (Eds.), Varcarolis’s Canadian psychiatric mental health nursing (3rd ed.). Elsevier. Chien, Sh. C., Liu, K. T., & Wu, Y. H. (2018). Lithium intoxication presenting as altered consciousness and arrhythmia with cardiogenic shock. Medicine, 97(45), e13129. doi:10.1097/MD.. Answer: Body System_Nursing Interventions Neurological □ Sensory exam every 4 hours □ Monitor level of consciousness □ Seizure protocols Cardiovascular □ Vitals signs every 1 hour □ Monitor cardiovascular rhythmNGN Case Studies 4 Copyright © 2026, Elsevier Inc. All rights reserved. for ventricular tachycardia □ Insert arterial line Renal □ Monitor output □ Request 48-hour urine collection □ Urine test strip every morning Item Type: Matrix Grouping Cognitive Skill: Generate Solutions Rationales: This question asks the student to plan a phase of care for the client. The student must take into consideration potential interventions based on their knowledge about the condition. Neurological: The client is at risk for seizures based on lab values and may become more confused depending on the level of lithium in the blood. The nurse should be monitoring for any changes. A sensory test is only performed on clients who have sensory deficits such as in the case of a spinal cord injury or after back surgery. This client would not require sensory testing. Cardiovascular: The client is at risk for prolonged QT requiring the student to monitor for Ventricular tachycardia. The potassium level remains elevated, so even if the student was not aware of the prolonged QT, the elevated potassium should be reason to monitor for ventricular tachycardia. Completing vitals every hour could overwhelm the client. If status changes, vital signs could be taken every four hours and increase in time as needed. An arterial line is not necessary for this client and may exacerbate any confusion. Renal: The client is already dehydrated and hypotensive. Clients with lithium toxicity may develop polyuria, due to the resistance to anti-diuretic hormone potentially leading to nephrogenic diabetes insipidus with chronic lithium toxicity. This would only increase the lithium concentrate for the client. A urine test stick in the morning could identify any glucose or protein in the urine. A 24-hour urine test would be more appropriate assess for renal concentrate. 48-hours is too long. References: Pollard, C. L., & Halter-Jordon, M. (2023). Chapter 14: Bipolar disorders. In C. L. Pollard, S. L. Jakubec, & M. J. Halter (Eds.), Varcarolis’s Canadian psychiatric mental health nursing (3rd ed.). Elsevier. Skidmore-Roth, L., & Richardson, F. (2021). Lithium in Mosby’s Canadian nursing drug reference. Elsevier. Answer: The nurse has received orders from the healthcare provider.NGN Case Studies 5 Copyright © 2026, Elsevier Inc. All rights reserved. Select 3 actions the nurse should perform right away. □ Initiate a large bore peripheral intravenous catheter □ Administer 3% sodium chloride (normal saline) at 25 mL per hour □ Laboratory tests: CBC, electrolytes, lithium level, type and cross-match □ Prepare client for a Computed tomography (CT) Head □ Insert Foley catheter Item Type: Multiple Response, Select N Cognitive Skill: Take Action Rationales: The client requires intravenous fluids as there is hemodynamic unstable but with diabetes insipidus, fluids must be replaced slowly as well as peripheral intravenous access in the event more seizures occur. The client has oxygen applied with appropriate spO2 level. More laboratory levels will need to be drawn to identify if the client is even more hyponatremic due to diabetes insipidus. A CT head is not a priority, and neither is the Foley catheter; however, the Foley catheter would be valuable to monitor urine output. References: Pollard, C. L., & Halter-Jordon, M. (2023). Chapter 14: Bipolar disorders. In C. L. Pollard, S. L. Jakubec, & M. J. Halter (Eds.), Varcarolis’s Canadian psychiatric mental health nursing (3rd ed.). Elsevier. Skidmore-Roth, L., & Richardson, F. (2021). Lithium in Mosby’s Canadian nursing drug reference. Elsevier. Answer: Assessment Finding_Improved No Change Declined Nausea □ □ X Blood pressure X □ □ Hemoglobin □ □ X Oxygen level X □ □ Skin perfused □ X □ Item Type: Matrix Multiple Response Cognitive Skill: Evaluate OutcomesNGN Case Studies 6 Copyright © 2026, Elsevier Inc. All rights reserved. Rationales: Overall the client status has improved despite the return of nausea. The client responded to IV fluids to improve hemodynamic status. The patient’s lab values have improved as well. Reference: Pollard, C. L., & Halter-Jordon, M. (2023). Chapter 14: Bipolar disorders. In C. L. Pollard, S. L. Jakubec, & M. J. Halter (Eds.), Varcarolis’s Canadian psychiatric mental health nursing (3rd ed.). Elsevier.