A client with bipolar disorder has advanced lithium toxicity with a lithium level of 1.7 mEq/L. Which symptom would the nurse expect to assess?

Clonic movements.

Muscle hyperirritability.

Polyuria.

Fine tremor.

Answer and Explanation

The Correct Answer is C

Choice A reason: Clonic movements are not typical of advanced lithium toxicity (levels >1.5 mEq/L). Lithium affects sodium-potassium ATPase, disrupting neuronal signaling, leading to renal and neurological symptoms, but clonic movements are more associated with seizures from other causes, not lithium’s mechanism.

Choice B reason: Muscle hyperirritability is not a hallmark of advanced lithium toxicity. Lithium’s disruption of renal tubular function and neuronal signaling causes symptoms like polyuria and confusion. Muscle-related symptoms are less prominent compared to renal or neurological effects at toxic levels.

Choice C reason: Polyuria is a common symptom of advanced lithium toxicity due to impaired renal concentrating ability from disrupted aquaporin-2 expression in the collecting ducts. Lithium’s interference with sodium-potassium ATPase also contributes, leading to excessive urine output, a key clinical sign at toxic levels.

Choice D reason: Fine tremor occurs in therapeutic lithium levels (0.6-1.2 mEq/L) due to mild neuronal excitability. In advanced toxicity (>1.5 mEq/L), symptoms escalate to severe neurological and renal effects like confusion and polyuria, making fine tremor less prominent.

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Correct Answer is A

Explanation

Choice A reason: Availability and lethality of suicide means are critical, as they determine immediate risk. Serotonin deficits and amygdala-driven impulsivity heighten the likelihood of acting on accessible, lethal methods, making this the priority to prevent fatal outcomes in suicidal patients.

Choice B reason: Insight into suicidal motivation is important but secondary to immediate risk. Serotonin dysregulation drives impulsivity, and without addressing access to lethal means, insight alone cannot prevent action, making it less urgent in acute suicide assessment.

Choice C reason: Abuse history increases suicide risk via trauma-related amygdala hyperactivity but is not the priority. Immediate access to lethal means poses a greater acute risk, as serotonin deficits drive impulsivity, necessitating focus on preventing action first.

Choice D reason: Social support is a protective factor but secondary to immediate risk. Serotonin-driven impulsivity and amygdala hyperactivity make access to lethal means the priority, as support cannot prevent action if means are readily available.

A. Offer to taste each portion on the tray for the patient. B. Obtain a doctor's order for tube feedings or total parenteral nutrition. C. Allow the patient to telephone a local restaurant to deliver meals. D. Allow the patient to have supervised access to food vending machines.

Correct Answer is A

Explanation

Choice A reason: Delusions of persecution in schizophrenia involve hyperactive dopamine pathways in the mesolimbic system, leading to irrational fears like poisoning. Tasting food directly addresses the delusion by demonstrating safety, potentially reducing anxiety and engaging the patient’s trust, which can modulate amygdala hyperactivity and promote acceptance of nutrition without invasive measures.

Choice B reason: Tube feedings or parenteral nutrition are invasive and may reinforce the patient’s delusional fears of harm, as they bypass voluntary control. Schizophrenia’s dopamine dysregulation heightens suspicion, and forced interventions could exacerbate paranoia by stimulating the amygdala, increasing stress responses and potentially worsening the patient’s mental state and compliance.

Choice C reason: Allowing restaurant delivery does not directly address the poisoning delusion, as external food sources may still be perceived as unsafe due to hyperactive dopamine-driven paranoia in schizophrenia. This option fails to engage the patient’s trust or reduce amygdala-driven fear responses, making it unlikely to resolve the refusal to eat.

Choice D reason: Supervised vending machine access may not alleviate the patient’s delusional belief in poisoning, as the source remains external and unverified. Schizophrenia’s dopamine excess in the mesolimbic pathway sustains mistrust, and this intervention does not directly counter the delusion, potentially leaving amygdala-driven fear responses unaddressed, reducing its effectiveness.

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A client with bipolar disorder has advanced lithium toxicity with a lithium level of 1.7 mEq/L. Which symptom would the nurse expect to assess?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is A

Explanation

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Correct Answer is A

Explanation

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