Correct Answer: A

Rationale: The correct answer is A: Fear of impending doom. Panic attacks are characterized by intense fear or discomfort, often accompanied by physical symptoms like palpitations and sweating. The fear of impending doom is a hallmark symptom of panic attacks, reflecting the overwhelming sense of dread and anxiety experienced during an episode.
Choice B, obsessions, refers to persistent, intrusive thoughts and is not typically a primary symptom of panic attacks.
Choice C, apathy, signifies a lack of interest or emotion and is not a common feature of panic attacks.
Choice D, fever, is a symptom associated with infections or other medical conditions, not panic attacks.

Correct Answer: C

Rationale: The correct answer is C: Skin rash. Lamotrigine is known to cause a serious skin reaction called Stevens-Johnson syndrome. This can manifest as a rash that can progress to a life-threatening condition. Prompt reporting and discontinuation of the medication are crucial. Nausea (
A), tremors (
B), and drowsiness (
D) are common side effects of lamotrigine but are not typically considered urgent or life-threatening. It is important for the nurse to prioritize educating the patient on recognizing and reporting the potentially severe adverse effect of skin rash.

Correct Answer: C

Rationale: The correct answer is C: Collaborate with the client to set realistic goals for behavior change. This intervention is most appropriate because it involves working together with the client to establish achievable objectives for modifying the compulsive behavior. By collaborating with the client, it promotes empowerment and active participation in the treatment process, increasing the likelihood of successful outcomes.


Choice A, assisting the client in developing a structured schedule, may not directly address the underlying issue of compulsive behavior.
Choice B, providing education about the irrationality of the behavior, may not be effective as individuals with OCD often already know their behaviors are irrational but feel compelled to engage in them.
Choice D, encouraging the client to resist the urge to rearrange items, may increase distress and may not be sustainable in the long run.

Correct Answer: D

Rationale: The correct answer is D: The lithium level is at the toxic level. A blood lithium level of 1.8 mEq/L is considered toxic as it exceeds the therapeutic range of 0.6-1.2 mEq/L. At this level, the client is at risk for lithium toxicity, which can lead to serious complications such as tremors, confusion, seizures, and even death. It is crucial for the nurse to recognize this and take appropriate actions, such as notifying the healthcare provider and adjusting the dosage.

Summary of other choices:
A: The lithium level is not within the therapeutic level for initial treatment.
B: Incorrect, as 1.8 mEq/L is above the maintenance treatment level.
C: Incorrect, as the level is not below the therapeutic range.
E, F, G: No information provided, so cannot be evaluated.

Correct Answer: A

Rationale: The correct answer is A: "Come with me. Here is a milkshake to drink." This response acknowledges the client's current behavior, offers a solution to address the situation, and provides a positive alternative to support the client's nutritional needs. Offering a milkshake encourages fluid and caloric intake, addressing the client's energy expenditure during calisthenics. It also redirects the client's focus from excessive exercise to a more balanced approach to self-care.

Option B is incorrect because the client in acute mania may not be able to make a rational decision about their activities. Option C may escalate the situation by abruptly stopping the client's behavior without providing an alternative. Option D is incorrect as it shames the client for their behavior and does not offer a constructive solution.