Tomas is a 21-year-old male with a recent diagnosis of schizophrenia. Tomas's nurse recognizes that self-medicating with excessive alcohol is common in this disease and can co-occur along with:

Correct Answer: C

Rationale: Individuals with schizophrenia often turn to excessive alcohol consumption as a way to manage symptoms of anxiety and depression. This maladaptive coping mechanism can exacerbate the challenges associated with schizophrenia and may hinder effective treatment outcomes. Recognizing the presence of anxiety and depression alongside alcohol abuse is crucial for providing holistic care and support to individuals with schizophrenia.

Correct Answer: C

Rationale: **Rationale:** **Correct Answer (C) - "Lithium may help me lose the few extra pounds I tend to carry around."** This statement is incorrect and demonstrates a misunderstanding of lithium therapy. Lithium is not associated with weight loss; in fact, it is widely documented to cause **weight gain** as a common side effect. The mechanism involves increased thirst and fluid retention, metabolic changes, and potential hypothyroidism, all of which can contribute to higher body weight. Patients are often counseled about this side effect to manage expectations and adopt strategies like dietary modifications. Thus, the idea that lithium aids weight loss is factually wrong and reflects a lack of proper education about the medication’s effects. **Incorrect Choices:** **A: "I remind myself to consistently drink six 12-ounce glasses of fluid every day."** This statement is accurate and reflects proper understanding. Lithium requires **adequate hydration** to maintain therapeutic serum levels and reduce the risk of toxicity. Dehydration can lead to elevated lithium concentrations, increasing the likelihood of adverse effects like tremors, confusion, or renal damage. Patients are typically advised to consume 2–3 liters of fluids daily and maintain consistent salt intake. The specificity of "six 12-ounce glasses" aligns with general guidelines, showing the patient’s awareness of this critical requirement. **B: "I discussed the diuretic prescribed by my cardiologist with my psychiatric care provider."** This statement is correct and demonstrates **appropriate medication management**. Diuretics (especially thiazides) can significantly increase lithium levels by reducing renal excretion, posing a risk of toxicity. Coordination between healthcare providers is essential to adjust lithium doses or monitor levels closely when diuretics are used. The patient’s proactive communication reflects an understanding of the importance of interdisciplinary care and lithium’s narrow therapeutic index. **D: "I take my lithium on an empty stomach to help with absorption."** While this statement contains a common misconception, it is not entirely incorrect. Lithium is generally **well-absorbed** regardless of food, though taking it with food may reduce gastrointestinal side effects like nausea. However, the belief that empty stomach administration enhances absorption is not clinically significant enough to be harmful, as bioavailability is not drastically affected. Thus, this choice does not reflect a critical misunderstanding like option C does. **Conclusion:** Option C stands out as the only choice that directly contradicts evidence-based knowledge about lithium, while the others reflect either correct practices (A, B) or minor, non-critical inaccuracies (D). The focus on weight loss is particularly misleading, as it could delay interventions for actual side effects like weight gain or electrolyte imbalances.

Correct Answer: C

Rationale: Lithium is a mood stabilizer commonly used for bipolar disorder, but it has a narrow therapeutic index, making early recognition of toxicity crucial. The correct answer is C (Improved vision) because this is never listed as a sign of lithium toxicity in clinical guidelines or pharmacological literature. Vision changes associated with lithium are typically **blurred vision** (a sign of severe toxicity) rather than improved vision, which has no pathophysiological basis in lithium's mechanism of action or side effect profile. **Why the other options are incorrect:** **A: Increased attentiveness** – While this may seem unrelated, it can actually be an early sign of mild lithium toxicity. Lithium affects the central nervous system (CNS), and subtle cognitive changes, including unusual alertness or cognitive hyperactivity, can precede more severe neurological symptoms like tremors or confusion. Early toxicity may manifest as paradoxical effects before progressing to impairment. **B: Getting up at night to urinate** – Polyuria (excessive urination) is a classic **early** side effect of lithium due to its interference with renal concentrating ability, often leading to nephrogenic diabetes insipidus. Patients frequently report nocturia (nighttime urination) before other symptoms arise. This is a well-documented and clinically significant warning sign. **D: An upset stomach for no apparent reason** – Gastrointestinal disturbances (nausea, vomiting, diarrhea) are among the **earliest** and most common signs of lithium toxicity. These symptoms result from lithium's irritation of the gastric mucosa and its impact on the CNS at higher serum levels. Patients are routinely advised to monitor for unexplained GI distress as a potential red flag. **Why C is correct:** Improved vision is not associated with lithium toxicity or its therapeutic effects. While blurred vision or difficulty focusing can occur in severe toxicity, **enhanced** visual acuity has no physiological correlation with lithium’s pharmacological actions (e.g., altered sodium transport in neurons and kidneys). This distractor is included to test the student’s ability to differentiate between plausible side effects and unrelated, implausible symptoms. The question reinforces the importance of recognizing **early** versus **late** and **severe** toxicity signs. Nocturia, GI upset, and subtle CNS changes precede life-threatening symptoms (ataxia, seizures, coma), whereas improved vision is irrelevant to lithium’s adverse effects. Students must prioritize memorizing clinically validated symptoms and disregarding distractors without a pathophysiological basis.

Correct Answer: B

Rationale: A lithium level of 1.7 mEq/L is above the therapeutic range, indicating a potential risk of toxicity. The initial nursing intervention should be to instruct the patient to hold the next dose of medication and promptly contact the prescriber for further guidance and management. This action aims to prevent adverse effects and ensure the patient's safety by addressing the elevated lithium level appropriately.

Correct Answer: B

Rationale: When caring for a patient demonstrating manic behavior, it is crucial to monitor vital signs frequently to ensure the patient's physical health is stable. Providing nutrition, such as milkshakes and protein drinks, is essential to meet the patient's dietary needs. Diminishing environmental stimuli by reducing the volume on the television and dimming bright lights can help create a calmer environment. However, keeping the patient distracted with group-oriented activities may not be the most appropriate intervention as it could potentially exacerbate the manic behavior by overstimulating the patient. Therefore, this choice is the one that doesn't apply in managing manic behavior effectively.