A patient who takes lithium phones the nurse at the clinic to say, “I’ve had diarrhea for 4 days. I feel weak and unsteady when I walk. My usual hand tremor has gotten worse. What should I do?” Which instruction by the nurse is appropriate?

Correct Answer: A

Rationale: The correct answer is A: "Have someone bring you to the clinic immediately." This is the appropriate instruction because the patient is experiencing symptoms of lithium toxicity, such as diarrhea, weakness, unsteadiness, and worsening hand tremor. Lithium toxicity is a serious condition that can lead to life-threatening complications if not treated promptly. Bringing the patient to the clinic immediately allows for proper evaluation, monitoring, and treatment by healthcare professionals. Summary: - Choice B: "Restrict food and fluids for 24 hours and stay in bed" is incorrect as it does not address the urgency of the situation and may worsen dehydration. - Choice C: "Drink a large glass of water with 1 teaspoon of salt added" is incorrect as it can exacerbate the electrolyte imbalance caused by lithium toxicity. - Choice D: "Take antidiarrheal medication hourly until the diarrhea subsides" is incorrect as it does not address the root cause of the symptoms and may delay necessary medical intervention.

Correct Answer: A

Rationale: The correct answer is A: dry mouth. Muscarinic receptor blockade inhibits parasympathetic nervous system activity, leading to decreased secretion of saliva. This causes dry mouth. Gynecomastia (choice B) is unrelated to muscarinic receptor blockade. Pseudoparkinsonism (choice C) is associated with dopamine receptor blockade, not muscarinic receptors. Orthostatic hypotension (choice D) is more commonly seen with alpha-adrenergic receptor blockade.

Correct Answer: C

Rationale: The correct answer is C: Cerebellum. The cerebellum is responsible for fine motor coordination as it coordinates muscle movements, balance, and posture. It receives input from sensory systems and integrates this information to regulate motor movements accurately. The medulla (A) controls vital functions like breathing and heart rate. The thalamus (B) acts as a relay station for sensory information. The temporal lobe (D) is mainly involved in auditory processing and memory. Therefore, the cerebellum is the most appropriate choice for fine motor coordination due to its specific functions in motor control.

Correct Answer: C

Rationale: The correct answer is C: Respiration rate of 6 breaths/minute. Opioid overdose can cause respiratory depression, leading to a dangerously low respiration rate. This is a hallmark sign of opioid toxicity as opioids depress the central nervous system, including the respiratory center. Dilated pupils (A) are more characteristic of stimulant overdose. Restlessness (B) is not a typical symptom of opioid overdose, as opioids usually cause sedation. While opioids can lower heart rate (D), it is not as specific or as life-threatening as severe respiratory depression.

Correct Answer: A

Rationale: The correct answer is A because rapid chewing of nicotine gum releases an immediate dose of nicotine, providing quick relief during cravings. This immediate effect helps manage withdrawal symptoms effectively. Option B is incorrect as transdermal patches provide a steady release of nicotine over time, not quick relief. Option C is incorrect; compliance is similar for both gum and patches. Option D is incorrect as the nicotine gum can be used up to 20-30 times per day, not just six.