Brian is seeking treatment for PTSD following his tour of duty in a combat zone. He reports to the assessment nurse that he has been smoking marijuana and drinking alcohol daily for the past 4 days because he just can't stand feeling depressed all the time. Which of these assessments is the nurse's highest priority?

Choice A reason: Gastric lavage is typically not the first-line treatment for lithium toxicity due to the risk of aspiration and potential complications. It is usually reserved for cases where the ingestion was recent and massive.

Choice B reason: When a client presents with an extremely elevated lithium level, it is crucial to hold further doses to prevent exacerbation of toxicity. The nurse should monitor for early signs of toxicity, which include gastrointestinal symptoms like nausea, vomiting, diarrhea, and neurological symptoms such as tremors, confusion, and ataxia. The normal therapeutic range for lithium is 0.6 to 1.2 mmol/L, and levels above 1.5 mmol/L are considered toxic.

Choice C reason: While it is important to review the medication record, the immediate concern with an extremely elevated lithium level is addressing the toxicity. Checking the medication record can be part of the assessment process but is not the priority action.

Choice D reason: Administering the morning dose of lithium could worsen the client's condition by increasing the lithium level further, which is already extremely elevated. This could lead to severe toxicity or even fatal consequences.

Choice A reason: This choice does not typically relate to illness anxiety disorder, as the concern is usually about having an illness, not the aftermath of confirmed physical health issues.

Choice B reason: Constant worry about the undiagnosed presence of an illness is a hallmark of illness anxiety disorder, where individuals are preoccupied with having or acquiring a serious illness despite medical evaluation and reassurance.

Choice C reason: Sudden loss of peripheral sensation is more indicative of a neurological condition rather than illness anxiety disorder.

Choice D reason: An obsession over a fictitious defect in physical appearance is characteristic of body dysmorphic disorder, not illness anxiety disorder.