NUR 256 / NUR256 Exam 1 – Concepts of Mental Health Nursing Guide (Latest 2026/2027 Update) | Galen | Complete Study Guide | Verified Questions & Answers | 100% Correct Solutions | Grade A

NUR 256 / NUR256 Exam 1 – Concepts of Mental Health Nursing Guide (Latest 2026/2027 Update) | Galen | Complete Study Guide | Verified Questions & Answers | 100% Correct Solutions | Grade A Q: A patient who just finished chemotherapy asks for a wig and makeup and says they want to look like themselves again. What does this behavior indicate? Answer Acceptance of body changes — requesting a wig/makeup shows the patient is beginning to accept appearance changes and improve self-esteem. Q: During which phase of the nursing process does the nurse determine whether patient goals were met and whether the plan needs revision? Answer Evaluation — it follows implementation and assesses effectiveness of care and need for changes. Q: A patient refuses a recommended treatment despite the nurse's concerns. Which ethical principle supports honoring the patient's choice? Answer Autonomy — patients have the right to make informed decisions about their care. Q: Before a patient signs informed consent, which ethical action must the nurse ensure has occurred? Answer Veracity/truthfulness — the patient must understand the procedure, risks, and alternatives for consent to be valid. Q: Which circumstance justifies applying physical restraints to a patient? Answer To prevent imminent harm (e.g., pulling at tubes/self-harm) — restraints are used only for safety, not convenience. Q: After a stroke that left the right leg weak, how should the patient use a cane to ambulate safely? Answer Hold the cane on the strong side and advance it with the weak leg — this shifts weight off the weak side and improves balance. Q: An unusual cluster of infections is identified at a long-term care facility. To whom should the facility report this outbreak? Answer Centers for Disease Control and Prevention (CDC) — public health authorities track and help control unusual outbreaks. Q: A patient repeatedly changes the subject during a teaching session. What is the nurse's best response? Answer Slow down, simplify information, and assess for anxiety or confusion — abrupt topic changes often signal those issues. Q: Which recommendation helps prevent constipation in older adults? Answer Increase fluids, fiber, and regular gentle activity — these promote bowel regularity without overusing laxatives. Q: A family requests to take the placenta home for cultural reasons. How should the nurse respond? Answer Respectfully accommodate when safe and use it as a teaching moment about cultural sensitivity — don't judge or refuse without valid safety concerns. Q: Why are opioids a higher fall risk in older adults? Answer They cause sedation and slower reflexes — start low, go slow, and monitor to reduce fall risk. Q: A patient asks to try an herbal therapy alongside prescribed meds. What should the nurse do? Answer Respect beliefs and collaborate with the provider to evaluate safety — avoid dismissing complementary therapies without review. Q: Which patient statement best demonstrates informed consent? Answer The patient states the procedure, why it's needed, and major risks — understanding these elements shows valid consent. Q: A patient with a new physical disability wants to regain independence. What should the nurse emphasize? Answer Focus on abilities and functional goals — promote independence and adaptive strategies despite limitations. Q: In SBAR communication, what does the "S" represent? Answer Situation — a concise statement of the current problem or reason for contact. Q: What is the foundation of evidence-based nursing practice? Answer Research and best-available evidence — nursing care should be based on evidence rather than habit. Q: When is SBAR an appropriate communication tool? Answer For handoffs and transfers (e.g., to radiology) — it standardizes critical information for safety. Q: Which skills are most important for effective care coordination? Answer Clear communication, accurate documentation, and clinical reasoning — these support safe, organized care. Q: Who holds ultimate responsibility for following a health promotion plan? Answer The patient — nurses teach and support, but the patient is responsible for adherence. Q: How should a nurse evaluate whether teaching was effective? Answer Use return-demonstration or teach-back — these confirm actual learning, not just verbal agreement. Q: What is the primary goal of nursing practice? Answer Promote well-being and safety through prevention, education, and evidence-based care — core nursing aims. Q: Which intervention helps improve nighttime sleep in Alzheimer's disease? Answer Encourage daytime activity and limit long naps — this helps restore nighttime sleep drive. Q: What is the most effective prevention for seasonal influenza in older adults? Answer Annual influenza vaccination unless contraindicated — vaccination reduces risk and severity. Q: A patient is anxious before surgery and asks many questions. Which nursing action is most therapeutic? Answer Therapeutic presence — stay, listen, and explore fears rather than giving quick reassurance. Q: Why is an endotracheal tube used during general anesthesia? Answer To secure the airway and allow mechanical ventilation — it maintains oxygenation and airway protection. Which tool verifies readiness for discharge after moderate sedation? Answer Modified Aldrete Scale — it assesses activity, respiration, circulation, consciousness, and oxygen saturation. Which surgical procedure involves removal of the uterus? Answer Hysterectomy — hysterectomy is removal of the uterus. Cisatracurium is used during operative procedures for what purpose? Answer Neuromuscular blockade (nondepolarizing muscle relaxant) — it relaxes skeletal muscles for surgery without providing anesthesia or analgesia. What is the correct order of pain processing in the body? Answer Transduction → Transmission → Perception → Modulation — this sequence describes how pain signals are processed. What is an essential safety step when changing a transdermal fentanyl patch? Answer Remove the old patch before applying a new one — prevents accumulation and overdose. A patient is sleeping but later reports severe pain. What is the nurse's best action? Answer Believe and reassess — sleep does not rule out pain; reassess and treat appropriately. Which patient should the nurse assess first: a post-op patient with new abdominal pain 8/10, a stable IV pump alarm, or a visitor complaint? Answer The patient with new severe abdominal pain — new severe pain may indicate a serious complication and takes priority. Which client should avoid acetaminophen or use caution due to increased liver risk? Answer A patient who consumes alcohol heavily — alcohol increases risk of acetaminophen related hepatotoxicity. A hospitalized patient refuses physical therapy. What is the nurse's priority assessment? Answer Assess for uncontrolled pain — pain is a common barrier to therapy and must be addressed first. Which medication is effective for diabetic neuropathic pain? Answer Duloxetine — it treats neuropathic pain associated with diabetes. What major adverse effect must be monitored with hydromorphone? Answer Respiratory depression — it is the most serious opioid adverse effect. Which action best prevents post-surgical wound infection when caring for a dressing? Answer Handwashing before touching the dressing or drains — hand hygiene is the primary prevention strategy. What is the main purpose of the Post-Anesthesia Care Unit (PACU)? Answer Recovery from anesthesia until the patient is awake, breathing adequately, and hemodynamically stable — PACU ensures safe emergence. Which early signs suggest post-op hemorrhage or shock? Answer Restlessness, pale/clammy skin, hypotension, and tachycardia — these indicate possible hypovolemia and require immediate action. A patient expresses fear about upcoming surgery. Which question is most therapeutic to begin exploration? Answer "Tell me more about what worries you about the surgery." — open-ended questions encourage expression of fears. After spinal cord injury, a patient has reflex incontinence. What is an appropriate nursing intervention? Answer Scheduled toileting and perineal care — prevents skin breakdown and maintains hygiene. Which exercise helps reduce stress urinary incontinence in women? Answer Kegel exercises performed several times daily — strengthen pelvic floor muscles and reduce leakage. A chemotherapy patient has a platelet count of 20,000/mm³. Which sign should the nurse monitor for closely? Bleeding (e.g., nosebleeds, bruising, bleeding gums) — low platelets increase bleeding risk. When a patient has an internal radiation implant (brachytherapy), what visitor guidance is appropriate? Limit time and maintain distance; brief visits and standing back reduce radiation exposure — time and distance minimize dose. Through which routes does cancer commonly metastasize? Lymphatic system and bloodstream — these are primary routes for spread to distant sites. A patient scheduled for cancer surgery reports high anxiety and says they won't remember instructions. What should the nurse provide to improve recall? Written instructions plus verbal teaching — written materials help compensate for anxiety-related memory loss. A chemotherapy patient develops jaundice. Which lab tests should the nurse anticipate the provider ordering? Liver function tests (LFTs) — jaundice suggests hepatic involvement and requires LFT evaluation. How often should an IV chemotherapy infusion site be assessed for signs of infiltration? At least hourly — frequent checks help detect extravasation early. What is apoptosis? Programmed cell death — a normal cellular process that is often dysregulated in cancer. In oncology triage, which patient should be seen first: a chemo patient with new confusion, a stable chemo patient with mild nausea, or a routine med refill request? The patient with new mental-status changes — this may signal infection, metabolic disturbance, or toxicity and needs immediate assessment. Which core test-taking strategy best helps eliminate incorrect NCLEX options? Prioritize ABCs and safety, use the nursing process, and remove options that are unsafe, judgmental, or outside the nurse's role — this narrows choices to the most appropriate answer. What is mental health? State of wellbeing • Able to realize his/her own potential• Cope with normal stressors of life• Work productively• Contribute to the community What is mental illness? All psychiatric disorders• Significant dysfunction The mental health continuum Mental health--(occasional to mild distress with no impairment)--(mild to moderate distress/mild to moderate impairment)--(Marked distress, moderate to disabling, chronic impairment, inpatient/suicidal)--Mental Illness Mental illness risk factors biological, genetics, social, economic, culture, environmental Resilience the ability and capacity for people to secure resources needed for well-being. Does not mean they are unaffected by stress. Diathesis-stress model suggests that a person may be predisposed for a mental disorder that remains unexpressed until triggered by stress DSM-5 Classifies Schizophrenia Spectrum Disorders• Depressive Disorders• Trauma and Stressor-Related Disorders• Feeding and Eating Disorders QSEN COMPETENCIES Quality and Safety Education for Nurses • All healthcare workers must:• Provide patient-centered care• Work in interdisciplinary teams• Employ evidence-based practice• Apply quality improvement• Utilize informatics Nursing Process Assessment Diagnosis Planning Implementation Evaluation Mental Status Exam • Appearance• Behavior• Speech• Mood• D/O of the form of thought• Perceptual Disturbances• Cognition• Ideas of Harming Self or others SOAPIE documentation subjective, objective, assessment, plan, intervention, evaluation documentation legal considerations • Do Chart - Timely, facts, descriptive, pertinent observations, Subjective data (patient's feelings, thoughts) • Do NOT chart - your opinion, false documentation, no blanks, do not chart "incident report filed" Therapeutic Relationship • Focus of the relationship is on the patient's ideas, experience and feelings. • Consistently focused on the patient's needs • Clear boundaries are established • Help the patient developing new coping mechanisms • Supports behavioral change • Roles do not shift Boundaries Boundaries exist to protect the patient. Well established boundaries allow for a safe environment where the patient can explore feelings and treatment concerns Blurred roles: Transference pt transfers feelings & behaviors onto the nurse related to significant figures in the patient's past Blurred roles: Countertransference Nurse transfers feelings and behaviors onto the patient related to significant figures in the nurse's past Peplau's Model of the Nurse-Patient Relationship The nurse-patient relationship "facilitates forward movement" 4 phases: • Preorientation Phase • Orientation Phase • Working Phase • Termination Phase The communication process Stimulus - someone has a need to communicate Sender - the person sending the message Message - information send or expressed Channel - auditory, visual, tactile, olfactory or a combination Receiver - person receiving the message Feedback - validates the accuracy of the sender's message and is EXTREMELY IMPORTANT Nonverbal communication Tone, Facial expression, Body language THERAPEUTIC COMMUNICATION TECHNIQUES Using silence, Active listening, Clarifying techniques: paraphrasing, restating, reflecting, exploring NONTHERAPEUTIC COMMUNICATION TECHNIQUES Excessive questioning Giving approval or disapproval Giving advice Asking "why" questions Cultural considerations Communication Style Use of Eye Contact Perception of Touch Cultural Filters Process recording -Written record of a segment of the nurse-patient session that reflects as closely as possible the verbal and nonverbal behaviors of both patient and nurse -Useful tool for identifying communication patterns FREUD Believed majority of mental issues were the result of from issues unresolved in childhood FREUD Personality Structure • Id - unconscious and impulsive (Screaming infant) • Ego - problem solver and reality tester • Superego FREUD defense mechanisms • Unconscious (except suppression) • Deny, falsify or distort reality • Defense mechanisms can help or maladaptive Interpersonal Therapy • Short term therapy • Goal is to reduce/eliminate sx by improving interpersonal function • Develop satisfaction through social relationships • Tx - Depression • Grief and Loss • Interpersonal Disputes • Role Transition PEPLAU'S THEORY OF INTERPERSONAL RELATIONSHIPS Shift from what nurses "do to" patients - "do with" patients Maslow's Hierarchy of Needs (level 1) Physiological Needs, (level 2) Safety and Security, (level 3) Relationships, Love and Affection, (level 4) Self Esteem, (level 5) Self Actualization Erikson's stages of psychosocial development 1. trust vs. mistrust (Infancy 0-18months) 2. autonomy vs. shame and doubt (Early childhood 2-3) 3. initiative vs. guilt (Preschool 3-5) 4. industry vs. inferiority (School age 6-11) 5. identity vs. role confusion (Adolescence 12-18) 6. intimacy vs. isolation (Young Adult 19-40) 7. generativity vs. stagnation (Middle Adulthood 40-65) 8. integrity vs. despair (Maturity 65-death) Stigma a mark of shame or discredit Outpatient care settings Primary Care Providers Specialized Psychiatric Care Providers Patient-Centered Medical Homes Community Mental Health Centers Psychiatric home care Assertive Community Treatment (ACT) Intensive Outpatient & Partial Hospitalization Emergency Care Primary Care providers May not understand the sx are mental health related More comfortable, less stigma Time constraints, lack of expertise Specialized Psychiatric Care Providers Psychiatrist, Advanced practiced Nurse, Therapist Educational background and experience in Psych Partnering with primary care Patient-Centered Medical Homes Strong in-home support Patient centered, comprehensive care, coordination of care, improved access, system approach Community Mental Health Centers Emergency Services Community/Home based services Outpatient services Psychiatric home care Social workers - provide counseling, linking with services Psychiatric Nurse - evaluation, therapy and teaching - tx adherence Intensive Outpatient & Partial Hospitalization Intermediate step between inpatient and outpatient Structured, Multidisciplinary IOP - Mon - Fri 1/2 day Partial Hosp - Mon - Fri 6 hrs day Emergency Care Triage and Stabilization PREVENTION IN OUTPATIENT CARE Primary: Before any problem occurs Secondary: Reducing the prevalence Early Identification and prompt treatment Tertiary: Tx of disease with focus on preventing deterioration INPATIENT CARE SETTINGS - Crisis Stabilization/Observation Units - General Hospital and Private Hospital - State Hospital Crisis stabilization/observation units Prioritize rapid stabilization and short length of stay (usually 1-3 days) General Hospital and Private Hospital floor or floors of general hospital serve the most severely ill patients State hospital Care has improved over the years Serve the most seriously ill patients National Patient Safety Goals Identify Patients Correctly (2 Identifiers) Use Medicines Safely Prevent Infection Identify Patient Safety Risk (Suicide) Specialty treatment centers Pediatric Psychiatric Care Geriatric Psychiatric Care Veterans Administration Centers Eastern Culture (Balance) • Family is the starting point for identity (group decision making) • Freedom may be more restricted • More conservative and traditional • Disease is cause by lack of balance • Time is circular - reincarnation • May express emotions in a more subtle way. Western Culture (Science) • Self is starting point for identity (Individuality) • Disease has a cause (pathogen) and creates and effect (disease) • Ethics of rights - based on individuals rights • Time is linear - stops for no one • Express emotions openly and directly Indigenous Culture (Harmony) • Community is the starting point for identity • Deep relationship with nature • Mind-Body-Spirit (united) Populations at Risk for mental illness immigrants, refugees, minorities Beneficence Doing good or causing good to be done; kindly action autonomy independence, self control Justice duty to distribute resources equally, regardless of personal attribute (to be fair) fidelity Do no wrong; maintain loyalty, maintain expertise in nursing skills Veracity duty to be truthful CODE OF ETHICS FOR NURSES • Practice with compassion and respect the individual's uniqueness, worth and dignity • Primary Commitment is to the patient • Promote, advocates and strives to protect the patient's rights, health and safety • The nurse has the duty to promote health and provide optimal care • The nurse owes the same duty to self; (promote health, safety, promote competency) voluntary admission Pt understands the need for tx. Willing to be admitted involuntary admission • Court ordered admission • Mentally ill, Danger to self or others, unable to provide for basic needs, In need of tx and the mental illness prevents the pt from seeking tx Conditional release Requires tx for a specified amount of time Unconditional release Termination of patient-institution relationship Release Against Medical Advice Tx would be beneficial but, no reason to seek an involuntary commitment Patient Rights Right to treatment Right to refuse treatment Right to informed consent Rights regarding Psychiatric Advance Directives Rights Regarding Restraint and Seclusion Rights Regarding Confidentiality Restraints ONLY utilized in emergency situations, when the patient is danger to self or others and less-restrictive interventions have failed * least restrictive interventions are always tried first * • Manual hold, mechanical restraint, chemical restraint, seclusion Intentional Tort • Willful or intentional act that violates another person's rights or property • Assault---Intentional threat to make another fearful you will cause harm • Verbal threats • Battery---Actual harmful or offensive touching another • False Imprisonment---Inappropriate Seclusion or restraint unintentional tort • Unintended acts against another that cause harm or injury • Negligence---Failure to use ordinary care in a situation when you have the duty to do so • Malpractice Professional Negligence (5 elements): • Duty • Breach of duty • Cause in fact • Proximate cause • Damages Documentation • Accurate and complete information• Descriptive of the patient's behavior, thought process, etc... • Should demonstrate the patient's reaction to treatment - improvement, decline Dysfunction of the brain • Misinterpreting external sensations • Medications/Conditions can stimulate or suppress respiratory function, affect speech • Inappropriate response to internal stimuli (BP, fluid balance, HR) • Sexual dysfunction, sleep disturbances, increased or decreased appetite • Alterations in problem solving, memory issues, speech/thought disturbances • Difficulty with interpersonal relationships - Social Skills Serotonin • Plays role in sleep regulation, sexual function, hunger, mood, pain • Plays a role in aggression • 90% in the gut - GI side effects Serotonin Syndrome Serotonin Deficiency Depression (Sx sleep disturbance, change in appetite, mood, motivation alterations in sexual function) Dopamine • Pleasure neurotransmitter • Involved in fine motor muscle movement, emotions, thought, pleasure, motivation, Decision making Excess dopamine Schizophrenia, Mania Dopamine deficiency Parkinson's disease, Depression Norepinephrine • Affects mood, attention, arousal • Fight or Flight Response Excess Norepinephrine Anxiety, Schizophrenia, Mania Deficient Norepinephrine Depression GABA - Off switch • Plays a role in inhibition • Reduces aggression, excitation and anxiety • Has anticonvulsant and muscle-relaxing properties • May impair cognition and psychomotor functioning Excess GABA Reduction of Anxiety (Depressant) Deficient GABA Anxiety disorders, Schizophrenia, Mania, Huntington's Disease Glutamate - On Switch • Excitatory • Plays a role in learning and memory Excess glutamate Alzheimer's, improvement of cognitive performance Deficient glutamate Psychosis Brainstem Most primitive area, central to survival (HR, Digestion, Breathing, Sleeping) Hypothalamus • Controls basic drives (hunger, thirst and sex) • Thoughts & emotions • Processing sensory information Cerebellum • Regulates voluntary motor movements • Balance, Equilibrium Cerebrum • Mental Activities • Language and ability to communicate • Conscious perception of the external world, self, emotions, memory Neuro-imaging techniques for the brain • Structural - CT & MRI • Functioning - PET & Singe photon Antianxiety medications Benzodiazepines Buspirone Antidepressants Benzodiazepines • Promote GABA • Risk for abuse and dependence • Inhibit Neurons = useful as anticonvulsant • Alone - Rarely inhibit the brain to respiratory depression • Combined w/other CNS depressants (alcohol, TCAs, opiates) can lead to life threatening CNS depression • Interfere with motor ability, attention, judgement Buspirone • Reduces anxiety w/o strong sedative effect • No risk for addiction or dependence • Scheduled not PRN • Not a CNS depressant Antidepressants • Many antidepressants are also approved for the tx of anxiety • Depression & Anxiety - Sx and Neurotransmitters overlap SSRI's • Blocks the reuptake of Serotonin making more available • 1st line tx, less anticholinergic and sedating SE than tricyclic antidepressants (previous 1st line) • Antianxiety effects • Good efficacy lower SE profile • SE - low libido, GI upset, nausea, vomiting (90% of serotonin in gut) Paroxetine SSRI most anticholinergic of the class. Not for patients who are contraindicated for anticholinergics (ex: narrow angle glaucoma) contraindicated in most elderly pts SNRI's • Mirtazapine (Remeron) • Antianxiety and antidepressant effects • Minimal sexual dysfunction • Improved sleep • Fewer GI SE • Common SE - sedation, appetite stimulation and weight gain Norepinephrine Dopamine Reuptake Inhibitor • Bupropion (Wellbutrin) • Bupropion (Zyban) - Smoking cessation • No sexual side effects • SE - Insomnia, tremor, anorexia, weight loss • Contraindicated - Seizure disorder, bulimia or anorexia or those who are discontinuing the use of Alcohol or sedatives (benzos included) Serontonin Antagonist and Reuptake Inhibitors: Trazodone (Desryl) Common SE - Sedation, dizziness and orthostatic hypotension, anticholinergic effects (priapism) Tricyclic Antidepressants (TCA) • Were 1st line prior to the development of SSRIs • Longer to reach therapeutic effects • Lethal in overdose • More side effects • Anticholinergic SE - dry mouth, blurred vision, tachycardia, urinary retention and constipation • Sedation and drowsiness • Cardiotoxic Monoamine Oxidase Inhibitors (MAOIs) Dietary restrictions • No Tyramine • Aged cheeses, pickled or smoked fish and wine • Can produce significant vasoconstriction - threat of hypertensive crisis Lots of drug interactions • Other antidepressants • Oral decongestants Very important to teach patient about dietary restrictions and medications to avoid Good rule of thumb - never take any medication, vitamin or herbal supplement without speaking to Dr Mood Stabilizer: Lithium • Used for several years to treat Bipolar mania, mechanism of action is still not fully understood • Altering electrical conductivity - potential cardiac effects (sinus bradycardia) • Extreme alterations can cause convulsions • Alterations in nerve conduction can lead to tremor at therapeutic doses and more extreme motor dysfunction with toxic levels • Risk for fluid imbalances (potassium and sodium) Sx: polyuria, edema • Maintain their fluid and Na+ intake • Hyponatremia can lead to lithium toxicity • Long term use - risk for hypothyroidism • Narrow therapeutic range • Requires follow blood draws and monitoring Lithium therapeutic range 0.5 - 1.5 Toxicity can occur if the patient becomes dehydrated. Risk for hyponatremia Pt must be hydrated Anticonvulsants: Valproate (Depakote) • Tx mixed episodes and rapid cycling • SE - tremor, wt gain, sedation • Serious SE - Thrombocytopenia, pancreatitis, hepatic failure, & Birth defects Anticonvulsants: Carbamazepine (Tegretol) • Tx acute mania • SE - anticholinergic effects, orthostasis, sedation and ataxia • Rash -report immediately Stevens-Johnson syndrome (life threatening) • FDA requires genetic testing of anyone who is of Asian descent Anticonvulsants: Lamotrigine (Lamictal) • Maintenance Therapy, Bipolar Depression, • Congruent use with Depakote = double blood level of lamotrigine • Report Rash immediately (Stephens-Johnson syndrome) • Significantly decrease the risk of Stephens-Johnson syndrome - start low and increase slowly Stevens-Johnson Syndrome A severe, possibly fatal reaction that mimics a burn; may be due to a medication. Typical Antipsychotics • Too much dopamine = Psychotic symptoms • Blocks Dopamine • Most effective on delusions, hallucinations Dopamine plays a role movement regulation • SE can include muscle/motor abnormality • Extrapyramidal Symptoms (EPS), Dystonia, Parkinsonian, Tardive Dyskinesia • Monitor for Involuntary Movements (AIMS) Increased Prolactin Secretion • Amenorrhea - women • Galactorrhea - men and women • Gynecomastia - men • Anticholinergic side effects • Drop in BP, orthostatic hypotension • Sedation • Weight Gain Typical Antipsychotic: Thorazine & Haldol SE: extrapyramidal symptoms (Parkinson's-like. dystonia, shuffling gait, tardive dyskinesia) Neuroleptic malignant syndrome (high fever, variable BP, increased HR, muscle rigidity, confusion), orthostatic hypotension, seizures Alzheimer's disease • Insufficient Acetylcholine (Neurotransmitter) • Essential for mood regulation, behavior, memory, learning • Meds - Cholinesterase Inhibitors - Cholinesterase is the enzyme that breaks down Acetylcholine Herbal treatments • Extremely important to obtain detailed Medication list • Misconception of "All natural" = Safe • Efficacy and safety need to be determined • Drug : Drug interactions Lithium toxicity confusion, blurred vision, diarrhea, tinnitus, slurred speech, coma, convulsions Lithium adverse Nausea, vomiting, thirst, polyuria, tremors, weight gain