A nurse in the emergency department is caring for a 14-year-old who has anorexia nervosa.

• The client was brought to the emergency department by a parent due to fainting at home earlier this evening.
• The parent reports that the client has been worried about their weight and has been refusing to eat.
• The parent also reports the client has been spending several hours at the local gym.
• Vital signs were obtained and labs were drawn as requested by the provider.

Which of the following 5 assessment findings require immediate follow-up?

The correct answer is choice b. Administer the morning dose of lithium.

Choice A rationale:

Preparing for gastric lavage is unnecessary because a lithium level of 1.0 mEq/L is within the therapeutic range (0.6-1.2 mEq/L) and does not indicate toxicity.

Choice B rationale:

Administering the morning dose of lithium is appropriate as the current lithium level is within the therapeutic range, indicating that the medication is being managed correctly.

Choice C rationale:

Holding the medication and assessing for early manifestations of toxicity is not necessary since the lithium level is not indicative of toxicity. Toxicity typically occurs at levels above 1.5 mEq/L.

Choice D rationale:

Checking the client’s medication record to assess whether the client has been refusing her lithium is not relevant in this scenario because the lithium level is within the therapeutic range, suggesting compliance with the medication regimen.

The correct answer/s is Choice/s A, E, and G.

Choice A rationale: Administering 0.9% sodium chloride IV is a common practice in emergency departments to ensure the patient is well-hydrated. This is particularly important for patients experiencing acute mania, as they may have neglected their physical health, including hydration, during their manic episode.

Choice B rationale: Flumazenil is an antagonist for benzodiazepines and is typically used to reverse the sedative effects of benzodiazepines. It is not typically used in the treatment of bipolar disorder or acute mania.

Choice C rationale: Preparing the client for intubation is usually reserved for situations where the patient is unable to maintain their own airway or adequate ventilation. This is not typically necessary in cases of acute mania unless there are other complicating factors.

Choice D rationale: Beginning chest compressions is a response to cardiac arrest. There is no indication in the that the patient is experiencing cardiac arrest, so this would not be a typical anticipation for a patient experiencing acute mania.

Choice E rationale: Administering IV naloxone is done in cases of suspected opioid overdose. While it’s not directly related to treating acute mania, it’s possible that the patient could have comorbid substance use issues, given the high rate of comorbidity between bipolar disorder and substance use disorders.

Choice F rationale: Administering activated charcoal is done in cases of certain types of poisoning or drug overdose. It is not typically used in the treatment of bipolar disorder or acute mania.

Choice G rationale: Preparing the client for electroconvulsive therapy (ECT) could be an appropriate anticipation for a patient experiencing acute mania. ECT is considered a highly effective treatment for severe mania, particularly when other treatments have failed or when rapid stabilization is required.