A client has been given the diagnosis of bulimia. An appropriate medication used in the treatment of bulimia is which of the following?

A. Lithium is excreted primarily by the kidneys, and its clearance can be affected by changes in fluid balance. It's important for clients taking lithium to maintain a stable and adequate fluid intake to help regulate lithium levels in the body. Stable fluid intake helps maintain electrolyte balance, which is crucial for the proper function of lithium and prevention of adverse effects.

B. Lithium can affect sodium reabsorption in the kidneys. High levels of sodium intake can alter lithium levels in the body, potentially leading to toxicity. Therefore, clients on lithium therapy are often advised to maintain a consistent and moderate level of sodium intake. Excessive dietary salt can interfere with lithium's therapeutic effects.

C. Restricting fluid intake is not recommended unless there are specific medical reasons to do so. Lithium therapy generally requires adequate hydration to maintain kidney function and prevent dehydration, which can affect lithium levels.

D. Exercising in hot weather can lead to increased sweating and fluid loss, which can potentially affect lithium levels by altering hydration status. However, the primary concern during exercise in hot weather is maintaining adequate hydration rather than restricting it.

B. This is the most appropriate initial action. One-to-one observation ensures constant monitoring of the client's safety and prevents further harm, such as another suicide attempt or self-harm. Given the client's history of depression and recent suicide attempt, ensuring their safety is paramount.

A. This option is not the first priority because while addressing anorexia nervosa is important, safety concerns related to the suicide attempt and potential substance abuse take precedence. Making a weight gain contract requires the client's cooperation and readiness, which may not be feasible immediately upon admission.

C. While assessing the severity of depression is crucial, it is secondary to ensuring immediate safety in this context. The client's safety must be established first through continuous observation and intervention.

D. While important to understand the substances involved in the suicide attempt, this action is secondary to ensuring ongoing safety through direct observation. Toxicology results can guide subsequent treatment decisions but are not as urgent as immediate safety measures.