Share This Link

Noting that “voices are quieter” reflects a change in auditory hallucinations, which are positive symptoms of schizophrenia. Positive symptoms involve the presence of abnormal experiences (hallucinations, delusions, disorganized thought), whereas negative symptoms involve the absence or reduction of normal functions (motivation, affect, speech). Reduced intensity of voices suggests improved control of positive symptoms, typically through antipsychotic efficacy or coping strategies, but does not directly evidence improvement in negative symptom domains like avolition or alogia. Therefore, while clinically valuable, it does not answer the question’s focus on negative symptoms.

Stating uncertainty about the date or reason for hospitalization reflects disorientation or impaired insight. This suggests ongoing cognitive deficits or poor illness awareness rather than improvement. It does not indicate progress in negative symptoms—there is no demonstration of increased motivation, engagement, or initiation of daily tasks. Clinically, this would prompt reassessment of orientation, education about the plan of care, and possible evaluation for delirium, medication effects, or exacerbation of illness, but it does not represent effective intervention outcomes for negative symptoms.

Reporting medication adherence is important for overall treatment, especially for controlling positive symptoms and preventing relapse; however, adherence alone does not demonstrate improvement in negative symptoms. Negative symptoms are assessed through observable functional changes—engagement in ADLs, social interaction, emotional expression, and goal-directed behavior. Taking medication as prescribed supports stability and may indirectly facilitate improvement, but without a direct behavioral manifestation (e.g., performing self-care or initiating tasks), it is not evidence that negative symptom-focused interventions have been effective.

Polydipsia can occur with lithium due to its effect on renal concentrating ability, leading to excessive thirst and polyuria; however, urinary retention is not characteristic of lithium’s renal side effects. Early toxicity is classically associated with gastrointestinal disturbances (nausea, vomiting, diarrhea) and neurological changes (worsening tremor), not retention. The mismatch of polydipsia with urinary retention makes this option inconsistent with the known early toxicity profile, and the renal manifestations of lithium more commonly present as polyuria and nephrogenic diabetes insipidus rather than retention.

Generalized seizures and hypotension are severe, late manifestations of significant lithium toxicity, often occurring at markedly elevated serum levels. These findings signal medical emergency and central nervous system compromise beyond early warning signs. Early toxicity typically presents before such catastrophic events, allowing intervention when symptoms are milder and more reversible. Thus, while these can occur with advanced toxicity, they are not early indicators appropriate for prompt recognition in routine assessments.

Severe (coarse) hand tremors and confusion are more consistent with moderate to advanced toxicity rather than early toxicity. These neurologic findings indicate central nervous system involvement that typically follows earlier GI symptoms if not addressed. At this stage, patients may also develop ataxia, slurred speech, muscle rigidity, and worsening mental status, necessitating urgent intervention. Therefore, while clinically significant, these are not the earliest signs the nurse should detect to prevent escalation.

Sodium intake does affect lithium levels because lithium and sodium compete for reabsorption in the kidneys. However, increasing sodium intake is not the immediate intervention for a client with a lithium level of 1.4 mEq/L, which is above the therapeutic range (0.6–1.2 mEq/L). The priority is to prevent further administration and notify the provider.

Simply documenting and reassessing later delays necessary intervention. Lithium toxicity can progress quickly, and waiting 4 hours without action risks worsening symptoms. This option does not address the immediate safety concern.

Continuing the medication as prescribed would worsen toxicity. Administering lithium at this level is unsafe and contraindicated. This option disregards the abnormal laboratory finding and places the client at risk.

This client has risk factors, including a recent suicide attempt and feelings of hopelessness. However, they deny current intent or plan. While they require close monitoring and support, they are not the most urgent case compared to someone with a specific plan and means.

This client expresses vague suicidal thoughts but shows ambivalence and willingness to discuss coping strategies. While they are at risk, their openness to intervention reduces immediate urgency compared to someone with a concrete plan and means.

This client has a history of suicide attempts during manic episodes, but currently denies suicidal thoughts. Although impulsivity in mania increases risk, the absence of current suicidal ideation makes them less urgent than the client with a specific plan and means.

This statement is coercive and threatening. It undermines autonomy and therapeutic rapport, potentially escalating resistance or agitation. It is not therapeutic communication.

Ignoring self-care deficits fails to address the client’s needs. Poor hygiene is a common negative symptom of schizophrenia, and therapeutic intervention should encourage self-care in a supportive manner.

This statement is confrontational and judgmental. It may increase defensiveness and shame, which can worsen withdrawal and resistance. It is not therapeutic.

Limiting sun exposure to prevent dehydration is appropriate. Dehydration increases lithium reabsorption in the kidneys, which can elevate serum lithium levels and increase the risk of toxicity. By avoiding prolonged sun exposure, the client reduces the likelihood of fluid loss through sweating, thereby maintaining stable hydration and safer lithium levels. This demonstrates correct understanding of lithium therapy precautions.

Avoiding a low-sodium diet is correct. Lithium and sodium compete for reabsorption in the renal tubules. A low-sodium diet increases lithium reabsorption, raising serum levels and toxicity risk. Maintaining consistent sodium intake helps stabilize lithium levels. This statement demonstrates accurate understanding of dietary precautions.

Regular monitoring of lithium blood levels is essential for safe therapy. Lithium has a narrow therapeutic range (0.6–1.2 mEq/L), and levels must be checked every few months or more frequently depending on clinical status. This ensures early detection of toxicity and appropriate dose adjustments. This statement reflects correct understanding of monitoring requirements.

A basketball game is highly stimulating, competitive, and physically demanding. For a manic client, this can escalate hyperactivity, impulsivity, and risk-taking behaviors. It increases the likelihood of injury and agitation, making it inappropriate.

Group discussions about elections involve complex, stimulating, and potentially controversial topics. A manic client may become argumentative, intrusive, or unable to regulate speech and thought processes. This option risks worsening disorganized thinking and agitation.

Watching a video in a group setting provides some structure but still involves stimulation that may overwhelm a manic client. They may struggle to sit still, interrupt others, or become restless. While calmer than sports or debates, it does not provide the therapeutic outlet of controlled physical activity.

Lip smacking and tongue thrusting are extrapyramidal symptoms (EPS), often associated with antipsychotic medications, not lithium toxicity. These are signs of tardive dyskinesia rather than lithium-related effects.

Fever and fluctuating blood pressure are characteristic of neuroleptic malignant syndrome, a rare but serious reaction to antipsychotics. They are not typical of lithium toxicity.

Blurred vision and jerking motor movements may occur with seizure activity or severe neurological impairment, but they are not early or expected manifestations of lithium toxicity at 1.6 mEq/L.