A nurse is reviewing routine laboratory values for several clients who are taking lithium carbonate. Which of the following clients should the nurse assess further for findings indicating lithium toxicity?

Choice A reason: Previous psychiatric history increases PTSD risk, as pre-existing conditions like depression or anxiety indicate heightened amygdala sensitivity and dysregulated stress responses. These predispose individuals to exaggerated fear responses post-trauma, as the brain’s stress circuitry is already compromised, amplifying the impact of traumatic events on neural pathways.

Choice B reason: PTSD is not associated only with personal characteristics; it requires exposure to a traumatic event, as defined by DSM-5 criteria. Trauma triggers neurobiological changes, including amygdala hyperactivity and hippocampal volume reduction, causing symptoms like flashbacks. Personal characteristics modulate risk, but event exposure is essential, making this statement false.

Choice C reason: A causative trauma is required for PTSD, per DSM-5, involving exposure to actual or threatened death, serious injury, or sexual violence. This triggers neurobiological changes, such as elevated cortisol and amygdala activation, leading to intrusive memories and hyperarousal. This criterion is fundamental to the disorder’s pathophysiology and diagnosis.

Choice D reason: Lack of social support increases PTSD risk, as it exacerbates stress responses by reducing oxytocin-mediated emotional regulation and prefrontal cortex modulation. Social isolation heightens amygdala activity, prolonging trauma-related symptoms. Support systems buffer stress responses, making this a scientifically valid factor in the etiology of PTSD.

Choice A reason: Mild delirium involves acute confusion and impaired judgment due to cerebral dysfunction, often from metabolic or infectious causes. Accompanying the client ensures safety, as disorientation increases wandering or injury risk. Supervision mitigates risks from altered cognition while allowing mobility, supporting cerebral recovery without exacerbating confusion.

Choice B reason: Restricting the client to the unit may increase agitation, as delirium’s neurochemical imbalances, like acetylcholine deficiency, heighten restlessness. While safety is critical, blanket restriction ignores the potential benefits of supervised movement, which can reduce stress and improve cerebral perfusion, making this less appropriate than supervised accompaniment.

Choice C reason: Assessing motives may clarify intent but delays addressing immediate safety in delirium, where confusion stems from cerebral dysfunction, such as hypoxia or electrolyte imbalance. The client’s impaired judgment requires supervision over exploration of motives, as disorientation increases risk of harm, making this a secondary action.

Choice D reason: Allowing an unsupervised walk is unsafe in delirium, as acute cognitive impairment from neurotransmitter imbalances or metabolic disturbances increases wandering or injury risk. Without supervision, the client may become disoriented or lost, exacerbating cerebral stress. Accompanied walks better balance safety and mobility in this condition.