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: One-to-one observation is the priority after a suicide attempt, as the adolescent’s recent action indicates high risk of recurrence due to serotonin dysregulation and prefrontal cortex deficits. Continuous monitoring prevents self-harm by ensuring immediate intervention, addressing the acute neurobiological risk of impulsivity and suicidal ideation in this critical period.

Choice B reason: Encouraging peer interaction supports long-term mental health but is secondary in an acute post-suicide attempt phase. The adolescent’s serotonin imbalances and heightened impulsivity increase self-harm risk, requiring immediate safety measures over social engagement, which could overwhelm or trigger distress in a neurobiologically vulnerable state.

Choice C reason: Attending a support group aids long-term recovery by fostering social connection and coping skills. However, post-suicide attempt, the adolescent’s acute risk, driven by serotonin dysregulation and prefrontal dysfunction, prioritizes safety. Groups may be premature, as emotional instability could exacerbate distress, making observation the immediate need.

Choice D reason: Administering antidepressants addresses underlying depression but takes weeks to affect serotonin levels. Post-suicide attempt, immediate safety is critical due to ongoing impulsivity and neurobiological instability. Observation prevents harm during this high-risk period, making medication secondary until the acute crisis is stabilized.

Choice A reason: Tylenol with Codeine (acetaminophen and codeine) in tablet form (1T) typically refers to a standard dose, but in liquid form, the concentration varies. Assuming a common elixir (120 mg acetaminophen/12 mg codeine per 5 mL), 15 mL delivers the standard dose. 15.5 mL slightly exceeds this, risking overdose and potential hepatotoxicity from acetaminophen, making it incorrect.

Choice B reason: Tylenol with Codeine elixir is commonly 120 mg acetaminophen and 12 mg codeine per 5 mL. One tablet equivalent (1T) typically corresponds to 15 mL, delivering 360 mg acetaminophen and 36 mg codeine, aligning with standard dosing for pain relief. This volume ensures therapeutic efficacy without exceeding safe limits, matching pharmacological guidelines.

Choice C reason: A 40 mL dose of Tylenol with Codeine elixir (120 mg acetaminophen/12 mg codeine per 5 mL) would deliver 960 mg acetaminophen and 96 mg codeine, far exceeding safe single-dose limits. This risks acetaminophen-induced liver toxicity and opioid-related respiratory depression, as it disrupts the therapeutic window, making this choice scientifically inappropriate.

Choice D reason: A 30 mL dose of Tylenol with Codeine elixir (120 mg acetaminophen/12 mg codeine per 5 mL) provides 720 mg acetaminophen and 72 mg codeine, doubling a typical single dose. This excessive amount increases the risk of hepatotoxicity and opioid side effects like sedation or respiratory depression, rendering it unsuitable for standard administration.