A nurse is caring for an adolescent.

Exhibits

For each potential provider's prescription, click to specify if the potential prescription is anticipated, nonessential, or contraindicated for the client.

Rationale for Correct Answers:

• Lithium toxicity: The client’s lithium level is 1.8 mEq/L, which exceeds the therapeutic range of 0.8 to 1.2 mEq/L. Combined with symptoms like diarrhea, vomiting, coarse tremors, confusion, and ataxia, this strongly suggests lithium toxicity, a medical emergency that requires immediate intervention.
• Hypothyroidism: The thyroid profile shows low T3 (71 ng/dL) and free T4 (0.6 ng/dL), along with low-normal TSH (0.3 mu/mL). These values are consistent with hypothyroidism, which can be a side effect of long-term lithium use. Symptoms such as lethargy and disorientation may also reflect thyroid dysfunction.

Rationale for Incorrect Choices:

• Hyperglycemia: The glucose level is 100 mg/dL, which is within the normal reference range. The client has no symptoms of hyperglycemia such as polyuria, polydipsia, or blurred vision.
• Acute kidney injury: The client’s BUN (18 mg/dL) and creatinine (0.9 mg/dL) are within normal limits, indicating that kidney function is preserved at this time and does not meet the criteria for acute kidney injury.

Rationale for Correct Answers:

• Metabolic acidosis: The client’s ABG shows a low pH of 7.33 and bicarbonate (HCO3) of 19 mEq/L, indicating primary metabolic acidosis, likely due to prolonged diarrhea and bicarbonate loss through the GI tract.
• Hypernatremia: Serum sodium is elevated at 149 mEq/L, likely resulting from fluid loss due to persistent diarrhea and poor fluid intake, which concentrates serum sodium.

Rationale for Incorrect Answers:

• Hypermagnesemia: The magnesium level is 1.8 mEq/L, which is within the normal range. There is no indication of magnesium excess, and the client has not received supplements or renal impairment.
• Hypervolemia: The client shows signs of volume depletion, including hypotension, dry mucous membranes, and poor skin turgor. Urine output is low, supporting fluid loss rather than overload.
• Hyperkalemia: Although potassium is at the upper normal limit (5.0 mEq/L), there’s no current evidence of cellular lysis, renal failure, or acidosis severe enough to cause clinically significant hyperkalemia.
• Metabolic alkalosis: The client’s ABG values do not support metabolic alkalosis. There is no vomiting or gastric suction to suggest bicarbonate retention; instead, the client has diarrhea leading to acid loss.