A client prescribed lithium carbonate 300 mg twice daily a month ago comes to the Emergency Department with mental confusion, frequent urination in large amounts, and coarse tremors. Which lithium level would the nurse expect?

Choice A Reason:

When a client with a personality disorder engages in self-destructive behavior, it is crucial for the staff to observe this behavior closely to ensure the safety of both the client and others around them. Self-destructive behaviors can include actions such as self-harm, substance abuse, or reckless activities that pose a significant risk to the individual’s well-being. By monitoring these behaviors, staff can intervene promptly to prevent harm and provide necessary support. Ensuring safety is a fundamental aspect of care in mental health settings, as it helps to stabilize the client and create a secure environment for their treatment and recover.

Choice B Reason:

Indulging the client’s wishes is not a recommended approach when dealing with self-destructive behavior. While it is important to understand and validate the client’s feelings, indulging their wishes can reinforce negative behaviors and hinder their progress towards healthier coping mechanisms. Instead, staff should focus on providing appropriate interventions and support that address the underlying issues contributing to the self-destructive behavior. This approach helps the client develop more constructive ways of meeting their needs and managing their emotions.

Choice C Reason:

While self-destructive behavior may provide a temporary outlet for feelings of anger and frustration, it is not a healthy or sustainable way to cope with these emotions. Encouraging or allowing such behavior can lead to further harm and exacerbate the client’s mental health issues. Staff should work with the client to identify and implement healthier coping strategies that effectively address their emotional needs without causing harm. This can include therapeutic interventions, counseling, and skills training to help the client manage their anger and frustration in more constructive ways.

Choice D Reason:

Assuming responsibility for the client’s behavior is not an effective way to reduce their anger and anxiety. In fact, it can create a dependency on staff and prevent the client from developing their own coping skills and sense of autonomy. It is important for staff to support the client in taking responsibility for their actions and learning how to manage their emotions independently. This empowerment is a key component of the therapeutic process and contributes to the client’s long-term recovery and well-being.

Choice A Reason: Grandiose sense of self-importance

This is the hallmark characteristic of narcissistic personality disorder (NPD). Individuals with NPD often have an exaggerated sense of their own importance and abilities. They may believe they are superior to others and expect special treatment. This grandiosity is a core feature of the disorder and is often accompanied by fantasies of unlimited success, power, brilliance, beauty, or ideal love.

Choice B Reason: Pattern of intense and chaotic relationships

While individuals with NPD may have problematic relationships, this characteristic is more commonly associated with borderline personality disorder. People with NPD may exploit relationships for personal gain, but their relationships are not typically described as chaotic in the same way as those with borderline personality disorder.

Choice C Reason: Submissive and clinging behaviors

Submissive and clinging behaviors are characteristic of dependent personality disorder, not narcissistic personality disorder. Individuals with NPD are more likely to exhibit domineering and controlling behaviors rather than submissive ones.

Choice D Reason: Odd beliefs and magical thinking

Odd beliefs and magical thinking are more characteristic of schizotypal personality disorder. While individuals with NPD may have grandiose fantasies, these do not typically include the bizarre or eccentric beliefs seen in schizotypal personality disorder.