A nurse is assessing a client who is grieving. The nurse suspects that the client is experiencing complicated bereavement based on which statement by the client?

Choice A reason: Acute stress disorder involves trauma-related symptoms like dissociation or hyperarousal following a traumatic event, driven by amygdala hyperactivity and cortisol dysregulation. The nurse’s symptoms stem from emotional overload, not personal trauma, making this diagnosis inappropriate, as it does not involve direct exposure to a traumatic stressor.

Choice B reason: Derealization disorder involves persistent feelings of unreality or detachment, linked to altered temporoparietal neural activity. The nurse’s symptoms of worry and intrusive thoughts about the patient’s family reflect emotional exhaustion, not perceptual distortions, making derealization unrelated to the described empathetic overload.

Choice C reason: Compassion fatigue results from chronic exposure to patients’ suffering, leading to emotional exhaustion and intrusive thoughts. It involves burnout-related changes in cortisol and serotonin signaling, impairing emotional regulation in the prefrontal cortex. The nurse’s excessive worry about the patient’s family aligns with this stress-induced condition.

Choice D reason: Dissociative disorder involves disruptions in identity or memory, often linked to trauma and altered hippocampal-amygdala connectivity. The nurse’s symptoms are emotional, not dissociative, stemming from empathetic overload rather than trauma-induced neural changes, making this diagnosis irrelevant to the described scenario.

Choice A reason: Strenuous outdoor activities increase dehydration risk with lithium, which has a narrow therapeutic index and affects renal sodium handling. No changes are unsafe, as dehydration elevates lithium levels, risking toxicity via neuronal and renal sodium-potassium ATPase disruption.

Choice B reason: Sunscreen is unrelated to lithium’s mechanism, which stabilizes mood via sodium channel modulation and inositol depletion. Lithium does not cause photosensitivity, and this advice does not address the critical risk of dehydration impacting renal lithium clearance.

Choice C reason: Lithium’s renal excretion depends on hydration, as it disrupts sodium-potassium ATPase, risking toxicity with dehydration. Increased fluid intake during heavy perspiration prevents elevated lithium levels, protecting neuronal and renal function, making this the most appropriate response.

Choice D reason: Reducing fluid intake increases lithium toxicity risk by decreasing renal clearance. Lithium’s effect on sodium-potassium ATPase heightens neuronal and renal sensitivity to dehydration, potentially causing toxic levels, making this advice dangerous and inappropriate for safe lithium use.