A 32-Year-Old Man Is Brought to the Emergency Department Due

question 277

Multiple Choice

A 32-year-old man is brought to the emergency department due to confusion and fever for 2 days.  Medical history is significant for bipolar disorder diagnosed a year ago.  The patient has been treated with lithium and an antipsychotic medication, and the doses have not changed over the last 2 months.  In the emergency department, temperature is 38.8 C (101.8 F) , blood pressure is 160/100 mm Hg, pulse is 116/min, and respirations are 22/min.  Pulse oximetry is 99% on room air.  The patient is not oriented to time, place, or person.  Mucous membranes are dry.  The lungs are clear to auscultation.  Muscle tone is markedly increased.  Deep tendon reflexes are 2+.  Mild dysarthria and hand tremors are present.  Laboratory results are as follows: Serum lithium level is 0.9 mEq/L (normal: 0.6-1.2) .  Which of the following is the most appropriate next step in management of this patient?

• A)Discontinue antipsychotic
• B)Discontinue lithium
• C)Initiate hemodialysis
• D)Start benztropine
• E)Start intravenous acyclovir

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Definitions:

Paradoxical Theory of Change

A theory suggesting that genuine change occurs not when an individual attempts to be who they are not but rather when they become more fully who they already are.

Person of the Counselor

Refers to how a counselor's personality, beliefs, values, and life experiences influence their professional practice.

Authentic Expression

The genuine and honest sharing of thoughts, feelings, and experiences, often considered crucial for meaningful interpersonal connections and mental health.

Confront

To face or challenge something directly, often used in therapeutic contexts to describe addressing difficult or painful emotions and realities.