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Extract:

The nurse in the behavioral health clinic is caring for a 48-year-old male client.
• Diagnostic Results
Diagnostic, Result ,Reference Range
Calcium, 10.5 mg/di (2.75mmol/I), 9.0-10.5 mg/dL (2.25-2.75 mmol/L)
Chloride, 99 mEq/1 (99 mmol/l), 98 to 106 mEq/L (98 to 106 mmol/l)
Creatinine, 0.9 mg/dI (79.6mcmol/L), 0.6 to 1.2 mg/di (53-106 mcmol/L)
Potassium, 3.8 mEq/1 (3.8, mmol/D), 3.5-5.0 mEq/L (3.5-5.0 mmol/L)
Sodium,137 mEq/1 (137mmol/l), 135 to 145 mEq/1 (135 to 145 mmol/I)
Blood urea nitrogen,12 mg/di (4.2mmol/I), 10-20 mg/dL (3.6-7.1 mmol/L)
Fasting glucose ,202 mg/dL (11.2mmol/L), 70-110 mg/dL (4-6 mmol/L)
White blood cell, 11,000/mm3 (11 × 109 /L), 5,000-10,000/mm 3 (5-10 × 109 /L)
Hemoglobin (Hgb), 15 g/dL (150 g/L), Male: 14-18 g/dL (140-180 g/L) Female: 12-16 g/dL (120-160 g/L)
Hematocrit (Hct), 45% (0.47), Male: 42%-52% (0.42-0.52) Female: 37%-47% (0.37-0.47)
Lithium level, 0.4 mEg/L , 0.6-1.2 mEg/L
• Nurses’ Notes
1230: Client presents for a follow-up appointment. He reports 100% adherence with prescribed ziprasidone. Two weeks ago, he was prescribed lithium, for which he reports a mild thirst. This thirst is causing him to go to the bathroom more frequently overnight. He reports that he recently got a second job to save for a vacation. On assessment, the client is alert and completely oriented. He had a logical thought process. Lung sounds clear bilaterally, and peripheral pulses were 2+. Skin is warm, dry, and normal for ethnicity. Rapid eye blinking and persistent chewing motions in his mouth despite not eating any food or gum. He reports that this started two weeks ago. Current weight is 128 kg (282 pounds). Current BMI is 26kg/m2. Previous weight one month ago was 126 kg (277 pounds). The most recent hospitalization was one month ago for a manic episode. Laboratory data reviewed.


Question 1 of 5

Complete the following sentence by choosing from the list of options.The nurse should first address the client’s------------------

Correct Answer: A

Rationale: The nurse needs to first address the client’s involuntary motor movements, as these suggest tardive dyskinesia. TD is a potentially irreversible side effect of long-term antipsychotic use, such as ziprasidone. Early recognition and intervention are critical to prevent progression. If left unaddressed, these symptoms can become permanent and significantly impair quality of life.
The client’s blood glucose and weight suggest worsening metabolic status. However, this should not be addressed first, as TD may cause irreversible neurological impairments.
The client’s white blood cell count does not require follow-up, as the elevation is common with lithium treatment.

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Question 2 of 5

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Question 3 of 5

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Question 4 of 5

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Question 5 of 5

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