A nurse is caring for a 72-year-old client who suddenly becomes weak and lightheaded. The cardiac monitor shows second-degree AV block Type II. The client is pale and diaphoretic with a blood pressure of 82/48 mm Hg and a heart rate of 42 beats per minute. Which collaborative intervention should the nurse anticipate implementing?

Choice A reason: Buspirone is a non-benzodiazepine anxiolytic that takes weeks to achieve therapeutic effects, making it ineffective for acute panic attacks. It does not provide immediate relief, so administering it during a panic attack does not promote safety or address the client’s acute distress.

Choice B reason: Offering therapy during a panic attack may be overwhelming, as the client’s heightened anxiety impairs their ability to engage in therapeutic dialogue. Safety-focused interventions, like reducing stimuli or staying with the client, are more effective in managing acute panic and ensuring immediate safety.

Choice C reason: Turning off televisions or music reduces environmental stimuli, which can exacerbate a panic attack by overwhelming the client’s heightened sympathetic nervous system response. Minimizing sensory input helps de-escalate anxiety, creating a calmer environment and promoting safety during the acute episode.

Choice D reason: Remaining with the client during a panic attack provides reassurance and ensures safety by monitoring for escalating symptoms or self-harm risks. The nurse’s presence helps stabilize the client emotionally and physically, reducing feelings of isolation and supporting de-escalation of the panic state.

Choice E reason: A calm nursing approach prevents further escalation of the client’s panic by modeling stability and reducing perceived threats. A calm demeanor lowers the client’s sympathetic arousal, fostering a sense of safety and helping to de-escalate the acute anxiety episode effectively.

Choice A reason: A lithium level of 1.2 mEq/L is within the therapeutic range (0.6–1.5 mEq/L) for bipolar disorder. Symptoms like confusion, ataxia, polyuria, and blurred vision indicate toxicity, which occurs at higher levels, typically above 1.5 mEq/L, making this level unlikely for these severe symptoms.

Choice B reason: A lithium level of 1.4 mEq/L is at the upper end of the therapeutic range. While mild side effects may occur, severe symptoms like mental confusion, ataxia, and polyuria suggest toxicity, which typically occurs at levels above 1.5 mEq/L, ruling out this option.

Choice C reason: A lithium level of 2.3 mEq/L indicates toxicity, causing neurological symptoms (confusion, ataxia), polyuria due to nephrogenic diabetes insipidus, and blurred vision from central nervous system effects. These symptoms align with lithium toxicity, which occurs at levels above 1.5 mEq/L, making this the expected level.

Choice D reason: A lithium level of 1.8 mEq/L is slightly above therapeutic range and may cause mild toxicity symptoms, such as tremor or nausea. However, the severe symptoms described (confusion, ataxia, polyuria) are more consistent with higher toxic levels, such as 2.3 mEq/L, making this less likely.