QLexNursing

🧠 Blank 1: Lithium toxicity

🧠 This client has just been prescribed lithium 600 mg PO twice daily, and several current findings increase the risk that lithium could accumulate to toxic levels.

🧠 Lithium is handled by the kidneys in a way that closely parallels sodium, so anything that lowers sodium or reduces circulating volume can cause the body to retain lithium.

🧠 The client is showing vomiting, minimal oral intake, and requires prompting to drink—these raise the risk for dehydration and electrolyte imbalance, both of which predispose to lithium toxicity.

🧠 Early signs of lithium-related neurologic effect can include coarse tremor, and this client already has coarse hand tremors noted, which makes close monitoring especially important.

🧠 Blank 2: Sodium level

🧠 The client’s sodium is 132 mEq/L, which is below normal and is a major risk factor for lithium accumulation.

🧠 When sodium is low, the kidneys attempt to conserve sodium by increasing reabsorption in the tubules, and lithium gets reabsorbed along with sodium.

🧠 This increases serum lithium concentration and can push the client from therapeutic levels into toxicity, especially if fluid intake remains poor or vomiting continues.

🧠 For clients taking lithium, maintaining normal hydration and sodium balance is a key safety priority.

❌ Other Options (Elaborated Broadly):

❌ Hypersalivation

❌ Hypersalivation is not supported by the current findings and is not the most critical risk in this scenario.

❌ In fact, lithium is more commonly associated with dry mouth or mild GI effects rather than prominent hypersalivation.

❌ The client’s major current concern is vomiting, low sodium, and poor intake, which point more strongly toward lithium accumulation risk.

❌ There is no documentation of drooling or excessive salivation to make this the best condition.

❌ Fluid volume excess

❌ The client has had poor oral intake, vomiting, and has consumed only 160 mL of water, which does not indicate fluid excess.

❌ Fluid volume excess would present with findings such as edema, crackles, weight gain, and hypertension worsening due to overload, none of which are documented.

❌ The current pattern is more consistent with risk for dehydration, not excess.

❌ Therefore, this is not the most appropriate condition.

❌ Thrombocytopenia

❌ Explanation:

❌ The platelet count is 280,000/mm³, which is within normal range and does not indicate risk for thrombocytopenia at this time.

❌ Thrombocytopenia would be suggested by low platelets, bleeding tendencies, or petechiae—none are present.

❌ The medications ordered (risperidone, lithium, lorazepam) are not primarily linked to acute platelet suppression in the typical clinical scenario.

❌ This is not the priority risk supported by the data.

❌ Hypertensive crisis

❌ Although the client’s blood pressure is elevated (144/96 then 138/94), it is not in the range of a hypertensive crisis (typically ≥180 systolic or ≥120 diastolic).

❌ The readings are more consistent with stress-related elevation during acute mania and hospitalization.

❌ There are no signs of acute target-organ damage (e.g., chest pain, neurologic deficits, pulmonary edema) documented.

❌ This makes hypertensive crisis an unlikely immediate risk compared with lithium-related concerns.

❌ Findings (Why the other “Finding” options are not the best match):

❌ Fluid intake

❌ Low fluid intake is important, but in lithium therapy, the more direct driver of lithium retention shown here is hyponatremia.

❌ Fluid intake contributes to dehydration risk, but the lab-confirmed sodium level provides a clearer mechanism for lithium accumulation.

❌ The best match pairs the condition with the most specific and clinically linked finding.

❌ Therefore, “fluid intake” is less precise than “sodium level” for the blank.

❌ Lorazepam

❌ Lorazepam does not cause lithium toxicity and is prescribed PRN for anxiety/agitation.

❌ Its main concerns include sedation, respiratory depression (at high doses), and falls—not lithium accumulation.

❌ There is no evidence lorazepam is causing the client’s vomiting or electrolyte imbalance.

❌ It does not explain the condition in the stem.

❌ Lithium level (0.6 mEq/L)

❌ The current lithium level is below therapeutic range, so it does not indicate toxicity at this moment.

❌ The question asks what the client is at risk for developing, not what they have now.

❌ Risk is driven by changes that can cause lithium to rise—especially low sodium and dehydration.

❌ Therefore, the lithium level itself is not the key factor creating risk; it is the sodium imbalance and intake issues.