The nurse is caring for a client who reports periods of exacerbations and remissions of bloody diarrhea and abdominal pain. A recent X-ray indicated a continuous pattern of lesions in the large bowel. What underlying condition does the nurse suspect?

Choice A reason: Lithium toxicity is a concern but not inevitable. It occurs with levels above 1.5 mEq/L, often due to dehydration or drug interactions, common in trauma settings. However, routine monitoring of levels is a more immediate nursing priority than assuming toxicity, as early detection prevents severe outcomes like seizures or renal damage.

Choice B reason: Lithium is primarily excreted by the kidneys, not metabolized by the liver. Liver function tests are not indicated for lithium monitoring, as it does not undergo hepatic metabolism. This statement is inaccurate, as renal function tests are critical to assess lithium clearance and prevent toxicity in trauma patients.

Choice C reason: Stress does not directly increase lithium requirements. Trauma-related dehydration or renal impairment can elevate lithium levels, risking toxicity, but this is due to reduced clearance, not increased need. This statement is inaccurate, as dosing adjustments should be based on serum levels, not stress alone.

Choice D reason: Lithium has a narrow therapeutic range (0.6-1.2 mEq/L), and trauma-related factors like dehydration or medications can alter levels, risking toxicity or subtherapeutic effects. Regular serum level monitoring is critical, especially in acute settings, to ensure safety and efficacy, making this statement accurate and a priority nursing concern.

Choice A reason: A 30-year-old male with occasional alcohol use and normal BMI (25) has minimal osteoporosis risk. Alcohol in moderation and normal weight do not significantly reduce bone density. Peak bone mass is typically preserved at this age, making him less at risk compared to glucocorticoid users.

Choice B reason: A 22-year-old female post-pregnancy may experience temporary bone density loss due to calcium demands during pregnancy and lactation, but young age and ongoing bone remodeling reduce long-term osteoporosis risk. Recovery is likely with adequate nutrition, making her less at risk than the glucocorticoid-treated patient.

Choice C reason: Glucocorticoids, used for inflammatory bowel disease, significantly increase osteoporosis risk by inhibiting osteoblast activity, reducing calcium absorption, and increasing bone resorption. This 40-year-old male faces accelerated bone loss, especially with chronic use, making him the highest risk among the options due to medication-induced bone density reduction.

Choice D reason: A 35-year-old female running marathons engages in weight-bearing exercise, which promotes bone density through mechanical stress and osteoblast stimulation. This reduces osteoporosis risk compared to glucocorticoid use, as exercise enhances bone remodeling and strength, making her less likely to develop osteoporosis than the male on steroids.