Which patient should be most carefully assessed for fluid and electrolyte imbalance among those receiving the following drugs?

Correct Answer: A

Rationale: Lithium (Eskalith) is the correct choice because it has a narrow therapeutic index and is excreted almost entirely by the kidneys, making patients highly susceptible to fluid and electrolyte imbalances. Lithium levels are directly influenced by sodium and water balance—dehydration or sodium loss can lead to lithium retention and toxicity, manifesting as confusion, tremors, seizures, or even coma. Patients on lithium require strict monitoring of serum levels (typically 0.6–1.2 mEq/L), renal function, and hydration status. Diuretics, excessive sweating, or gastrointestinal losses (e.g., vomiting/diarrhea) further increase the risk, necessitating vigilant assessment. Clozapine (Clozaril) primarily requires monitoring for agranulocytosis, metabolic disturbances (e.g., weight gain, dyslipidemia), and myocarditis, but it does not directly cause electrolyte imbalances. While it may induce hypersalivation or constipation, these side effects are less likely to disrupt fluid or electrolyte homeostasis compared to lithium. Diazepam (Valium), a benzodiazepine, has minimal impact on fluid or electrolyte balance. Its primary risks include sedation, respiratory depression, and dependence. Any fluid-related issues (e.g., dehydration) would be secondary to reduced oral intake due to excessive drowsiness, not a direct pharmacological effect. Amitriptyline, a tricyclic antidepressant, can cause anticholinergic effects (e.g., dry mouth, urinary retention) and orthostatic hypotension, but these do not typically lead to significant electrolyte disturbances. While overdose can cause cardiac arrhythmias due to sodium channel blockade, routine therapeutic use does not necessitate the same level of fluid/electrolyte monitoring as lithium. The critical distinction lies in lithium’s unique pharmacokinetics: its renal excretion and dependence on sodium balance create a direct, dose-dependent risk for life-threatening toxicity if hydration or electrolytes are not meticulously managed. No other drug listed poses such an immediate and predictable threat to fluid-electrolyte equilibrium. Monitoring for clozapine, diazepam, or amitriptyline focuses on entirely different adverse effects, none of which are as intrinsically tied to fluid and electrolyte status.

Correct Answer: C

Rationale: Assessing suicidal thoughts, judgment, insight, and the need for a therapeutic environment are crucial factors in determining the appropriate treatment setting for a patient experiencing psychotic symptoms. Past experiences with mental healthcare facilities do not play a direct role in deciding between a community outpatient or inpatient setting.

Correct Answer: D

Rationale: The correct answer is D because medication adherence being mandated is not a primary rationale for inpatient treatment. The main reasons for recommending inpatient treatment in this scenario include the need for stabilization of multiple symptoms, addressing nutritional and self-care needs, and ensuring safety due to the imminent danger of self-harm. Inpatient settings provide a more intensive level of care and supervision to address these complex issues effectively.

Correct Answer: B

Rationale: **Rationale:** **Correct Answer (B):** This choice reflects a nuanced and professional understanding of nonverbal communication. The nurse actively assesses for congruence between verbal and nonverbal cues, which is critical in healthcare. Patients may say they are "fine" verbally while displaying nonverbal signs of distress (e.g., clenched fists, avoiding eye contact). By cross-validating these signals, the nurse ensures accurate interpretation and avoids misjudgment. This approach aligns with evidence-based practice, where holistic assessment improves patient care. It also acknowledges the complexity of communication, where nonverbal cues (e.g., tone, posture) often reveal unspoken emotions or needs. --- **Incorrect Answers:** **A:** While this statement acknowledges a discrepancy between verbal and nonverbal communication, it lacks the actionable insight demonstrated in **B**. Simply recognizing a difference is insufficient without further exploration. Nurses must actively investigate incongruence to understand underlying issues (e.g., pain, anxiety). The statement also risks oversimplification—nonverbal and verbal communication aren’t "often" different but may be in specific contexts. Without the nurse’s proactive validation, this observation alone doesn’t improve patient care. **C:** This choice reflects a common pitfall: overinterpreting a single nonverbal cue. Slumped posture could indicate fatigue, pain, or even relaxation—not just anger or depression. Nonverbal communication is context-dependent, and assumptions without further assessment can lead to misdiagnosis or inappropriate interventions. Effective nursing requires gathering additional data (e.g., asking open-ended questions) rather than jumping to conclusions based on isolated behaviors. **D:** This statement undervalues the role of nonverbal communication, which is often more revealing than verbal language. Studies show that nonverbal cues (facial expressions, gestures) convey up to 93% of emotional meaning. In healthcare, patients may struggle to articulate distress verbally, making nonverbal signals vital. Dismissing nonverbal communication as "harder to understand" neglects its importance in building trust and identifying unmet needs. Competent nurses prioritize both forms of communication equally. --- **Key Takeaways:** - **B** stands out because it emphasizes *active validation*, a skill that bridges the gap between observation and clinical judgment. - **A** is passive, **C** is presumptive, and **D** misrepresents the complexity of communication. - Effective nursing integrates verbal and nonverbal cues to form a complete picture of the patient’s state, ensuring accurate and empathetic care.

Correct Answer: B

Rationale: Reflection is a communication technique where one person mirrors or restates the content or emotion expressed by another person to demonstrate understanding and encourage further exploration. The goal is to capture the essence of what was said or felt, often paraphrasing or summarizing it to validate the speaker’s experience. **Why B is correct:** "So you are saying that life has no meaning" is a clear example of reflection because it restates or paraphrases an underlying message a speaker might have conveyed. It captures a deeper, potentially implicit meaning and reflects it back, allowing the speaker to confirm, clarify, or expand on their thoughts. This technique is common in active listening and therapeutic communication, where the responder aims to engage with the speaker’s perspective rather than introduce their own interpretations or feelings. **Why A is incorrect:** "I think this feeling will pass" is not reflection because it introduces the responder’s own perspective rather than mirroring the speaker’s words or emotions. This statement offers reassurance or prediction (a form of interpretation or advice), which shifts focus away from the speaker’s experience. Reflection requires staying neutral and closely tied to the speaker’s original expression, which this statement does not do. **Why C is incorrect:** "I'm not sure I understand what you mean" is a request for clarification rather than reflection. While it shows engagement, it does not restate or summarize the speaker’s words or emotions. Instead, it signals confusion and asks the speaker to rephrase or elaborate. Reflection, by contrast, involves actively demonstrating understanding by echoing the speaker’s message, not expressing uncertainty about it. **Why D is incorrect:** "You look sad" is an observation or interpretation of the speaker’s emotional state, not a reflection of their expressed words or feelings. It may be an attempt at empathy, but reflection requires explicitly tying the response to the speaker’s own statements. Without referencing something the speaker said (e.g., "You sound upset when you talk about this"), it remains an external observation rather than a mirrored reflection. In summary, reflection hinges on accurately and neutrally restating the speaker’s message or emotions, which only B accomplishes. The other choices either introduce new perspectives, seek clarification, or make external observations, all of which deviate from the core purpose of reflection in communication.