A nurse is assessing a client who has bipolar disorder and is taking lithium carbonate. Which of the following findings should the nurse recognize as an early indication of lithium toxicity?

Polydipsia and urinary retention

Generalized seizures and hypotension

Fine hand tremors and gastrointestinal upset

Severe hand tremors and confusion

Answer and Explanation

The Correct Answer is C

Choice A reason: Polydipsia can occur with lithium due to its effect on renal concentrating ability, leading to excessive thirst and polyuria; however, urinary retention is not characteristic of lithium’s renal side effects. Early toxicity is classically associated with gastrointestinal disturbances (nausea, vomiting, diarrhea) and neurological changes (worsening tremor), not retention. The mismatch of polydipsia with urinary retention makes this option inconsistent with the known early toxicity profile, and the renal manifestations of lithium more commonly present as polyuria and nephrogenic diabetes insipidus rather than retention.

Choice B reason: Generalized seizures and hypotension are severe, late manifestations of significant lithium toxicity, often occurring at markedly elevated serum levels. These findings signal medical emergency and central nervous system compromise beyond early warning signs. Early toxicity typically presents before such catastrophic events, allowing intervention when symptoms are milder and more reversible. Thus, while these can occur with advanced toxicity, they are not early indicators appropriate for prompt recognition in routine assessments.

Choice C reason: Gastrointestinal upset (nausea, vomiting, diarrhea) is a classic early sign of lithium toxicity, often appearing when levels begin to exceed the therapeutic range. Fine hand tremor can occur at therapeutic levels, but the persistence or worsening of tremor alongside GI symptoms should raise concern for early toxicity. Early recognition hinges on identifying these subtle but characteristic changes, prompting serum level checks, hydration, dose evaluation, and clinical monitoring before progression to more severe neurologic symptoms.

Choice D reason: Severe (coarse) hand tremors and confusion are more consistent with moderate to advanced toxicity rather than early toxicity. These neurologic findings indicate central nervous system involvement that typically follows earlier GI symptoms if not addressed. At this stage, patients may also develop ataxia, slurred speech, muscle rigidity, and worsening mental status, necessitating urgent intervention. Therefore, while clinically significant, these are not the earliest signs the nurse should detect to prevent escalation.

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Correct Answer is B

Explanation

Choice A reason: Tardive dyskinesia is a late-onset adverse effect of antipsychotic medications characterized by involuntary, repetitive movements such as lip smacking, tongue protrusion, or grimacing. It develops gradually after prolonged use of antipsychotics and does not present with acute systemic symptoms like hyperpyrexia or blood pressure instability. Therefore, this does not match the acute presentation described.

Choice B reason: Neuroleptic malignant syndrome is a rare but life-threatening reaction to antipsychotic medications. It presents with hyperpyrexia (extremely high fever), autonomic instability such as blood pressure fluctuations, diaphoresis, muscle rigidity, and altered mental status. These symptoms align exactly with the findings in the question stem, making this the correct answer. Immediate recognition and intervention are critical to prevent complications such as rhabdomyolysis and renal failure.

Choice C reason: Pseudoparkinsonism is an extrapyramidal side effect that mimics Parkinson’s disease, with symptoms such as tremors, shuffling gait, bradykinesia, and rigidity. It does not involve systemic signs like fever or autonomic instability. Thus, it does not explain the acute illness described.

Choice D reason: Acute dystonia is an extrapyramidal reaction characterized by sudden, severe muscle spasms, often of the neck, face, or back. While distressing, it does not cause systemic symptoms such as hyperpyrexia or diaphoresis. Therefore, this is not the correct adverse effect in this scenario.

A. Adaptive defense mechanisms are typically seen in individuals with mature functioning. B. Maladaptive defense mechanisms have been shown to improve mental well-being. C. Adaptive defense mechanisms help a person to accept a situation and transform it into something less stressful. D. Individuals develop certain defense mechanisms based on neurological and psychological growth as they age. E. Defense mechanisms help a client positively deal with their stress. F. Defense mechanisms and coping strategies are the same and can be used interchangeably.

Correct Answer is ["A","C","D","E"]

Explanation

Choice A reason: Adaptive defense mechanisms, such as humor, sublimation, and suppression, are associated with mature psychological functioning. They allow individuals to manage stress in ways that preserve reality testing and relationships. These mechanisms are considered healthy because they reduce anxiety without distorting reality, and they are often observed in individuals who have developed emotional maturity and resilience.

Choice B reason: Maladaptive defense mechanisms, such as denial, projection, or regression, may temporarily reduce anxiety but do not improve long-term mental well-being. They often distort reality and interfere with healthy functioning, leading to impaired relationships, poor coping, and perpetuation of psychological distress. Therefore, this statement is incorrect because maladaptive defenses do not enhance mental health.

Choice C reason: Adaptive defense mechanisms help individuals reframe stressful situations into less threatening experiences. For example, sublimation allows channeling unacceptable impulses into socially acceptable activities, while humor can reduce tension in difficult circumstances. These mechanisms promote acceptance and transformation of stress, making them effective tools for psychological resilience.

Choice D reason: Defense mechanisms evolve with neurological and psychological development. For instance, children may rely more on primitive defenses like denial or projection, while adults with mature functioning use advanced defenses like suppression or altruism. This developmental trajectory reflects the integration of cognitive growth, emotional regulation, and social learning across the lifespan.

Choice E reason: Defense mechanisms serve as unconscious strategies to manage stress and protect the ego. When adaptive, they help individuals positively cope with stressors by reducing anxiety and maintaining psychological balance. This makes them essential components of mental health functioning, especially in stressful or threatening situations.

Choice F reason: Defense mechanisms and coping strategies are not the same. Coping strategies are conscious, deliberate efforts to manage stress, while defense mechanisms are unconscious processes. Equating them ignores the distinction between intentional coping behaviors and automatic psychological defenses. Therefore, this statement is incorrect.

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A nurse is assessing a client who has bipolar disorder and is taking lithium carbonate. Which of the following findings should the nurse recognize as an early indication of lithium toxicity?

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Naxlex Comprehensive Predictor Exams

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Correct Answer is B

Explanation

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Correct Answer is ["A","C","D","E"]

Explanation

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