A nurse in an acute care mental health facility is sitting with a client who has schizophrenia.

The client whispers to the nurse, “I’m being kept in this prison against my will.

Please try to get me out.” Which of the following responses should the nurse make?

Choice A rationale:

Insomnia is a common symptom of anxiety, but it is not typically seen in mild cases. It is more often associated with moderate to severe anxiety.

When anxiety is mild, individuals may experience difficulty falling asleep or staying asleep, but they are not typically unable to sleep at all.

Other sleep-related symptoms of mild anxiety may include restlessness, nightmares, or early morning awakening.

Choice B rationale:

Chest pain is a serious symptom that can be caused by a variety of medical conditions, including anxiety. However, it is not a common manifestation of mild anxiety.

Chest pain associated with anxiety is typically described as a sharp, stabbing pain or a feeling of tightness in the chest. It may be accompanied by other symptoms such as shortness of breath, palpitations, or sweating.

If a client with anxiety is experiencing chest pain, it is important to rule out other potential causes, such as heart disease or a pulmonary embolism.

Choice D rationale:

Incoherent speech is a sign of severe anxiety or a panic attack. It is not typically seen in mild anxiety.

When a person is experiencing incoherent speech, they may have difficulty speaking in complete sentences or making sense of their thoughts. They may also slur their words or speak in a rapid, disjointed manner.

Choice C rationale:

Irritability is a common manifestation of mild anxiety. It is often characterized by a feeling of being easily annoyed or angered.

Individuals with mild anxiety may also be more impatient, short-tempered, or argumentative than usual.

They may also have a lower tolerance for frustration and stress.

Rationale for Choice A:

Diuretics are not routinely prescribed with lithium. While diuretics can increase the excretion of lithium, this can also lead to decreased lithium levels and potentially reduced effectiveness. Therefore, diuretics are generally only used in specific situations, such as when a client has lithium-induced edema or congestive heart failure. In such cases, the client's lithium levels would be closely monitored to ensure they remain within the therapeutic range.

Rationale for Choice B:

Weight gain is not a common manifestation of lithium toxicity. In fact, weight gain is a potential side effect of lithium therapy, but it is not typically associated with lithium levels reaching a toxic range. Other signs and symptoms of lithium toxicity include:

Tremor

Nausea and vomiting

Diarrhea

Confusion

Slurred speech

Ataxia

Seizures

Coma

Rationale for Choice C:

Monitoring lithium levels is essential to ensure that the client is receiving a therapeutic dose and to avoid toxicity. Lithium has a narrow therapeutic index, meaning that there is a small difference between the dose that is effective and the dose that is toxic. Regularly checking lithium levels allows the healthcare provider to adjust the dose as needed to maintain a safe and effective level.

The initial lithium level is typically checked within 3 to 5 days of starting the medication, and then periodically thereafter.

The frequency of monitoring may vary depending on the client's individual factors, such as age, kidney function, and other medications they are taking.

Rationale for Choice D:

Lithium is not typically discontinued after a specific period of time. It is often used as a long-term treatment for bipolar disorder to prevent the recurrence of manic and depressive episodes. The decision to discontinue lithium is made on a caseby-case basis, in consultation with the client and their healthcare provider.