D449 Psychology and Mental Health - Set 5 - Part 2

Correct Answer: Early signs of lithium toxicity

Option b is correct because nausea, vomiting, slurred speech, and muscle weakness at a serum level of 1.8 mEq per L represent classic early toxicity signs, occurring just above the therapeutic ceiling of 1.5 on the toxicity progression scale. Option a is incorrect because while mild nausea and fine hand tremors can be expected common side effects at therapeutic levels, the combination of vomiting, slurred speech, and muscle weakness with a level of 1.8 indicates early toxicity rather than normal medication effects. Option c is incorrect because advanced lithium toxicity presents with more severe symptoms including coarse hand tremors, persistent gastrointestinal upset, confusion, and coordination changes, which are not yet described in this patient's current clinical presentation at this level. Option d is incorrect because severe life-threatening lithium toxicity manifests as ataxia, large output of dilute urine, seizures, severe hypotension, clonic movements, and potential coma,

Correct Answer: Toxicity has progressed to advanced stage

Option c is correct because coarse hand tremors, persistent vomiting, confusion, and incoordination at a level of 2.1 represent advanced lithium toxicity, a dangerous progression from the earlier fine tremors that were within normal side effect range. Option a is incorrect because lithium does not develop tolerance in a way that worsens side effects over time, and the progression from fine to coarse tremors with confusion indicates advancing toxicity from elevated serum levels rather than any tolerance-related medication adaptation. Option b is incorrect because missing doses would decrease lithium blood levels and reduce symptoms rather than worsen them, and the elevated level of 2.1 confirms excessive lithium accumulation rather than insufficient dosing as the cause of worsening symptoms. Option d is incorrect because lithium side effects do not simply worsen proportionally with treatment duration, and the specific combination of coarse tremors, confusion, and elevated serum levels i

Correct Answer: Maintain adequate sodium intake daily

Option d is correct because decreased sodium intake directly causes increased lithium retention in the body, raising blood levels toward toxicity, so patients must maintain adequate sodium and avoid low-sodium diets to keep lithium within therapeutic range. Option a is incorrect because switching to a high-protein diet does not address the critical sodium-lithium relationship that puts this patient at risk, and protein intake is not a primary factor in lithium level regulation or toxicity prevention for patients on this medication. Option b is incorrect because increasing caffeine intake is not a recommended intervention for lithium safety, and caffeine can act as a diuretic that may contribute to dehydration and electrolyte shifts, potentially complicating lithium level management rather than protecting against toxicity. Option c is incorrect because continuing a low-sodium diet while taking lithium is dangerous because the kidneys retain lithium when sodium levels are low, directly i

Correct Answer: Contact the prescriber immediately

Option a is correct because severe dehydration from three days of vomiting and diarrhea dramatically increases lithium concentration in the blood, creating a dangerous toxicity risk that requires immediate prescriber notification to adjust or temporarily hold the medication. Option b is incorrect because doubling the lithium dose during a period of severe dehydration would dangerously increase already-elevated lithium blood levels due to reduced fluid volume, creating an extreme risk of acute lithium toxicity with potentially life-threatening complications. Option c is incorrect because taking lithium with extra water does not adequately address the danger when a patient cannot retain fluids due to active vomiting, as the medication would likely not be absorbed properly and the underlying dehydration still increases toxicity risk. Option d is incorrect because while holding lithium may ultimately be the prescriber's decision, the nurse should not independently advise stopping medi

Correct Answer: Severe life-threatening toxicity

Option c is correct because ataxia, large volumes of dilute urine, blurred vision, and clonic movements at a lithium level of 3.0 represent severe life-threatening toxicity that requires emergency intervention including possible dialysis and intensive care monitoring. Option a is incorrect because a lithium level of 3.0 is far above the therapeutic range of 0.6 to 1.2, and symptoms including ataxia and clonic movements are never part of a normal therapeutic response but rather indicate a medical emergency requiring immediate intervention. Option b is incorrect because although advanced toxicity does include coarse tremors and confusion, the presence of ataxia, clonic movements, and a level of 3.0 indicates the patient has progressed beyond advanced toxicity into the severe life-threatening stage requiring emergency care. Option d is incorrect because lithium side effects at therapeutic doses include mild symptoms like fine hand tremors and increased thirst, not the severe neurological

Correct Answer: Mild anxiety with slight discomfort

Option c is correct because mild anxiety presents with slight discomfort, fidgeting, and mild irritability while cognitive function remains intact, which matches this patient's ability to follow directions and answer questions clearly after a stressful event. Option a is incorrect because moderate anxiety is characterized by concentration difficulty, reduced perception, elevated heart and respiratory rates, and insomnia, which are more significant impairments than the mild discomfort and fidgeting this patient is currently demonstrating. Option b is incorrect because severe anxiety presents with distorted perception, rapid speech, absent learning and problem-solving abilities, and a sense of impending doom, none of which are described in this patient who can still communicate clearly and follow directions. Option d is incorrect because panic-level anxiety involves losing touch with reality, extreme fright, tremors, hallucinations, abdominal distress, and dilated pupils, which repr

Correct Answer: Severe anxiety

Option a is correct because the mnemonic DREAD captures severe anxiety features: distorted perception, rapid speech, elevated vital signs, absent learning and problem solving, and doom impending, which matches every symptom this patient is currently displaying. Option b is incorrect because mild anxiety is characterized by only slight discomfort, minor fidgeting, and mild irritability with intact cognitive function, which does not match this patient's rapid speech, distorted perception, and inability to solve simple problems. Option c is incorrect because panic-level anxiety involves losing touch with reality entirely, extreme fright or horror, tremors, hallucinations, abdominal distress, and dilated pupils, which represents a further escalation beyond this patient's current severe presentation. Option d is incorrect because moderate anxiety is characterized by concentration difficulty, reduced perception, insomnia, and elevated vital signs while still being able to take dire

Correct Answer: Panic-level anxiety with reality detachment

Option d is correct because the LETHAL mnemonic describes panic anxiety: losing touch with reality, extreme fright, tremors, hallucinations, abdominal distress, and large dilated pupils, which precisely matches every symptom this patient is exhibiting right now. Option a is incorrect because severe anxiety includes distorted perception and rapid speech but does not involve complete loss of reality contact, hallucinations, or the extreme physiological responses like trembling, dilated pupils, and abdominal cramping seen in this presentation. Option b is incorrect because moderate anxiety may include elevated vital signs and reduced concentration but does not produce hallucinations, extreme fright, trembling, dilated pupils, or complete inability to communicate rationally, which are all hallmarks of panic-level anxiety. Option c is incorrect because while hallucinations can occur in psychotic episodes, this patient's full clinical picture including extreme fright, trembling, dilated

Correct Answer: Moderate still allows taking direction

Option c is correct because the key distinguishing feature of moderate anxiety is that patients can still take direction from others despite having concentration difficulty and reduced perception, whereas severe anxiety eliminates the ability to learn or problem-solve. Option a is incorrect because both moderate and severe anxiety can present with elevated heart rate, and heart rate alone does not reliably distinguish between the two levels, as the critical differentiating factor is cognitive function and ability to follow directions. Option b is incorrect because physical tremors are associated with panic-level anxiety rather than being a distinguishing feature of severe anxiety, and severe anxiety is primarily characterized by distorted perception, rapid speech, and absent problem-solving ability. Option d is incorrect because hallucinations are a feature of panic-level anxiety described in the LETHAL mnemonic rather than severe anxiety, and the presence of hallucinations would indic

Correct Answer: Moderate anxiety

Option a is correct because the CRIED mnemonic captures moderate anxiety: concentration difficulty, reduced perception, insomnia, elevated heart and respiratory rates, and direction can still be taken, which matches every feature described in this assessment. Option b is incorrect because panic-level anxiety involves losing touch with reality, extreme fright, tremors, hallucinations, and dilated pupils, which is a dramatically more severe presentation than this patient who can still follow the nurse's instructions during assessment. Option c is incorrect because severe anxiety is characterized by distorted perception, rapid speech, absent learning and problem solving, and a sense of impending doom, whereas this patient's perception is reduced but not distorted and they can still follow directions. Option d is incorrect because mild anxiety presents with only slight discomfort, mild irritability, and fidgeting with fully intact cognitive function, and would not include the con

Correct Answer: Strict protein and caloric intake tracking

Option d is correct because patients admitted for anorexia-related malnutrition require strict documentation of protein and caloric intake to ensure gradual weight gain, prevent refeeding complications, and provide objective data for the treatment team's ongoing assessment. Option a is incorrect because exercise is explicitly contraindicated for patients hospitalized with anorexia nervosa and malnutrition, as physical activity further depletes already-compromised energy stores and directly opposes the treatment goal of safe, gradual weight restoration. Option b is incorrect because patients with anorexia nervosa require one-on-one supervision during meals and for at least one hour afterward to prevent food hiding, disposal, or purging behaviors that would undermine the critical refeeding process during early treatment. Option c is incorrect because the standard protocol for anorexia patients is to obtain morning weights prior to any oral intake rather than weighing after each meal

Correct Answer: Monitor electrolytes for hypokalemia

Option c is correct because bulimic patients who purge are at high risk for hypokalemia from repeated vomiting, and potassium levels below 3.5 can cause life-threatening dysrhythmias, making electrolyte monitoring the most critical priority for patient safety. Option a is incorrect because confronting a patient about denial during initial assessment can damage the therapeutic relationship and increase resistance to treatment, and the nurse's immediate priority should be addressing the physiological dangers of purging behavior first. Option b is incorrect because nutritional education is an appropriate long-term intervention but does not address the immediate physiological danger of electrolyte imbalances caused by purging, which can lead to cardiac dysrhythmias and require urgent monitoring before educational goals. Option d is incorrect because patients with bulimia nervosa typically maintain a normal body weight, so weight restoration protocols are not indicated for this patient

Correct Answer: One hour after each meal

Option b is correct because the standard nursing intervention for hospitalized anorexia patients includes remaining with the client during each meal and for one hour afterward to prevent food disposal, purging, or other compensatory behaviors that undermine treatment. Option a is incorrect because thirty minutes of post-meal observation is insufficient to prevent compensatory behaviors in hospitalized patients with anorexia nervosa, as purging and food disposal attempts may occur beyond this abbreviated timeframe during the early treatment phase. Option c is incorrect because while bulimia protocols may involve one to two hours of post-meal observation, the established standard for anorexia nervosa during hospitalization specifies one hour of supervision after meals to balance safety monitoring with patient autonomy. Option d is incorrect because fifteen minutes of post-meal observation is far too brief to effectively prevent the compensatory behaviors that patients with anorexia nervo

Correct Answer: Body weight presentation at assessment

Option a is correct because the most reliable clinical distinguishing feature between anorexia nervosa and bulimia nervosa is body weight at presentation, as anorexia involves significantly low body weight while bulimia patients typically maintain normal or near-normal weight. Option b is incorrect because purging behavior can occur in both anorexia nervosa and bulimia nervosa, as the binge-purge subtype of anorexia also involves compensatory purging, making purging alone an unreliable feature for distinguishing between these two eating disorders. Option c is incorrect because both anorexia and bulimia patients may demonstrate limited insight about their disorder, and insight level varies significantly among individuals within each diagnosis rather than serving as a reliable distinguishing feature between the two conditions. Option d is incorrect because cognitive behavioral therapy is used as a treatment modality for both anorexia nervosa and bulimia nervosa, and response to therapy v

Correct Answer: Search belongings and increase monitoring

Option d is correct because discovering hidden laxatives indicates active covert purging behavior that requires immediate intervention through thorough belongings searches and increased observation to prevent dangerous ongoing electrolyte depletion and maintain treatment integrity. Option a is incorrect because completely restricting bathroom access is not therapeutic or practical and can violate patient rights, whereas increasing monitoring during and around bathroom use provides safety while maintaining the patient's dignity and basic physiological needs. Option b is incorrect because while extending post-meal supervision may be appropriate as part of a comprehensive response, it does not address the immediate discovery of hidden laxatives in belongings, which requires direct intervention through search and confiscation to prevent further use. Option c is incorrect because confronting a patient about covert purging behavior in a group setting violates confidentiality and can cau

Correct Answer: Indicators of elder abuse or neglect

Option b is correct because the combination of poor hygiene, weight loss, expired medications, broken assistive devices, pressure ulcers, and poor eye contact with vague responses about the caregiver represents a classic pattern of elder abuse or neglect indicators. Option a is incorrect because while aging can affect mobility and health, the constellation of expired medications, broken assistive devices, pressure ulcers, poor hygiene, and the patient's evasive behavior about the caregiver collectively suggest neglect rather than normal aging-related decline. Option c is incorrect because medication nonadherence alone does not explain the broken walker, poor hygiene, pressure ulcers, weight loss, and the patient's avoidance of eye contact with guarded responses about the caregiver, all of which point toward an abusive or neglectful caregiving situation. Option d is incorrect because financial hardship might explain some resource limitations but does not account for the patien

Correct Answer: Interview the patient privately alone

Option c is correct because abuse victims may be unable to disclose when the suspected abuser is present, and established protocol requires the nurse to separate the patient from the accompanying person to conduct a safe, confidential assessment. Option a is incorrect because simply documenting injuries and accepting the accident-prone explanation without a private interview ignores classic abuse indicators including patterned bruising at various ages, a controlling partner answering questions, and repeated injury presentations. Option b is incorrect because calling law enforcement before conducting a private assessment may escalate danger for the patient, and the nurse must first interview the patient alone to gather information and assess safety before determining the appropriate course of action. Option d is incorrect because confronting the suspected abuser directly in the patient's presence can escalate violence, endanger the patient, and violate the therapeutic approach requ

Correct Answer: Perforated eardrum with neck stiffness

Option a is correct because a perforated eardrum combined with neck stiffness in a pregnant patient is highly specific to blunt force trauma consistent with a strike to the head and physical restraint, which is unlikely to result from a simple fall. Option b is incorrect because anxiety during a clinical assessment can have multiple causes including general medical anxiety, and while it may contribute to the overall clinical picture, it is a nonspecific finding that does not independently confirm physical abuse as strongly as the injury pattern. Option c is incorrect because while a jealous and impulsive partner description is a significant contextual risk factor for intimate partner violence, it describes the alleged perpetrator's personality traits rather than providing direct physical evidence of abuse like the specific injury combination. Option d is incorrect because while inconsistent explanations for injuries raise suspicion, the patient's stated mechanism of a stair f

Correct Answer: Report suspected abuse to authorities

Option b is correct because nurses are mandatory reporters obligated by law to report suspected child abuse to appropriate authorities when indicators are present, without waiting for disclosure or gathering additional evidence before filing the report. Option a is incorrect because mandatory reporting laws do not require a child's verbal disclosure before action is taken, and waiting for disclosure places the child at continued risk while the nurse has already observed sufficient physical and behavioral indicators requiring a report. Option c is incorrect because contacting the parents of a potentially abused child could alert the suspected abuser, increase danger to the child, and compromise any investigation, and mandatory reporting obligations require notifying authorities rather than the family first. Option d is incorrect because documenting findings without reporting suspected abuse violates mandatory reporting laws, and continued monitoring alone leaves the child in a pote

Correct Answer: Ongoing intimate partner violence

Option b is correct because repeated ambulatory visits with new complaints, descriptions of a physically aggressive partner who uses alcohol, and symptoms of trauma including violent nightmares and extreme fatigue represent a classic pattern of ongoing intimate partner violence. Option a is incorrect because somatic symptom disorder involves physical complaints without medical explanation, but this patient has identified a specific source of trauma through describing an aggressive alcoholic partner, which points toward abuse rather than somatization. Option c is incorrect because while the patient demonstrates anxiety-related symptoms, the context of repeated visits with escalating concerns, a physically aggressive partner, and violent nightmares points specifically to intimate partner violence rather than a primary generalized anxiety diagnosis. Option d is incorrect because the patient's presentation centers on being the victim of a partner's aggression with resulting traum