Which of the following would indicate an increased suicidal risk? (Select all that apply)

Statements such as "Everything will be better soon"

Feeling overwhelmed by simple daily tasks

Calling family members to make amends

An abrupt improvement in mood

Answer and Explanation

Correct Answer : B,C,D

ideation, as some clients express relief anticipating death. While concerning, it is less specific than other indicators, as it may not always reflect serotonin-driven despair or intent, requiring further assessment to confirm risk.

Choice B reason: Feeling overwhelmed by simple tasks indicates severe depression, linked to serotonin and prefrontal cortex dysfunction, impairing executive function. This heightens suicidal risk, as cognitive overload and hopelessness increase impulsivity and despair, making it a critical neurobiological marker requiring immediate intervention to prevent self-harm.

Choice C reason: Calling family to make amends signals high suicidal risk, often reflecting intent to resolve relationships before death, driven by serotonin dysregulation and prefrontal cortex deficits. This behavior indicates advanced planning, a neurobiological marker of serious ideation, necessitating urgent safety measures to prevent completion.

Choice D reason: An abrupt mood improvement can indicate suicidal risk, as it may reflect relief from deciding to end life, linked to serotonin and dopamine shifts. This neurobiological change reduces despair temporarily, increasing energy for action, making it a critical warning sign requiring immediate assessment and intervention.

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Correct Answer is A

Explanation

Choice A reason: In severe PTSD exacerbation, flashbacks and hypervigilance indicate amygdala hyperactivity and impaired prefrontal cortex regulation, increasing risk of impulsive or self-harming behaviors. Ensuring safety addresses immediate dangers, as heightened arousal can lead to disorientation or panic, necessitating a secure environment to stabilize the client’s neurobiological stress response.

Choice B reason: Promoting self-esteem is valuable in PTSD but secondary to safety. Low self-esteem may stem from trauma-related guilt, linked to serotonin dysregulation, but does not pose immediate risk. Flashbacks and hypervigilance, driven by amygdala overactivity, require urgent safety measures to prevent harm during acute episodes.

Choice C reason: Helping cope with stress and emotions is important in PTSD management, addressing cortisol dysregulation and amygdala hyperactivity. However, during severe exacerbation with flashbacks, safety is the priority, as acute episodes can lead to disorientation or self-harm. Coping strategies are secondary to stabilizing the immediate neurobiological crisis.

Choice D reason: Establishing a community support system aids long-term PTSD recovery by enhancing oxytocin-mediated emotional regulation. However, during acute exacerbation with flashbacks, immediate safety is critical due to heightened amygdala-driven arousal. Community support is a secondary intervention, as it does not address the urgent risk of harm in acute episodes.

A. A client who has a BUN of 18 mg/dL B. A client who has a fasting blood glucose of 80 mg/dL C. A client who has a potassium level of 3.6 mEq/L D. A client who has a sodium level of 128 mEq/L

Correct Answer is D

Explanation

Choice A reason: A BUN of 18 mg/dL is within normal range (7–20 mg/dL) and does not indicate lithium toxicity. Lithium is renally excreted, and normal renal function, as reflected by BUN, suggests adequate clearance. Toxicity arises from sodium imbalances or dehydration, not directly from normal BUN levels, making this unremarkable.

Choice B reason: A fasting blood glucose of 80 mg/dL is normal (70–100 mg/dL) and unrelated to lithium toxicity. Lithium affects sodium and water balance, not glucose metabolism. Toxicity involves neurological symptoms from elevated serum lithium due to impaired renal clearance, not glycemic changes, so this value requires no further assessment.

Choice C reason: A potassium level of 3.6 mEq/L is within normal range (3.5–5.0 mEq/L) and does not indicate lithium toxicity. Lithium primarily affects sodium reabsorption in renal tubules, not potassium. Toxicity symptoms like tremors or confusion stem from sodium imbalances or high lithium levels, not normal potassium levels.

Choice D reason: A sodium level of 128 mEq/L (normal 135–145 mEq/L) indicates hyponatremia, increasing lithium toxicity risk. Lithium is reabsorbed in renal tubules like sodium; low sodium reduces lithium excretion, elevating serum levels, causing neurological symptoms like tremors or seizures. This requires immediate assessment to prevent toxicity.

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Which of the following would indicate an increased suicidal risk? (Select all that apply)

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Naxlex Comprehensive Predictor Exams

The nurse is caring for a client admitted with severe exacerbation of posttraumatic stress disorder that is experiencing flashbacks and hypervigilance. Which is the priority for the nurse to address when caring for this client?

Correct Answer is A

Explanation

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?

Correct Answer is D

Explanation

When assessing a client with delirium, the nurse will expect to see (Select all that apply)

Which of the following principles should the nurse apply when planning nursing care for a client who was admitted after a suicide attempt?

Which nursing diagnosis should be most useful for clients with anxiety disorders for whom the following defining characteristics have been identified: avoidance, poor concentration, nightmares, hypervigilance, exaggerated startle response, detachment, numbing, and flashbacks?

Identify the serum lithium level for maintenance and safety.

A client has been admitted in withdrawal delirium. He is dehydrated and has a bruised, swollen tongue. He is experiencing illusions and auditory hallucinations and is confused. In developing a care plan for this client, what measure should the nurse include to ensure physiologic stability?

Which of the following would indicate an increased suicidal risk? (Select all that apply)

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