A nurse is caring for a client who has schizophrenia.

Exhibits

Select the "3" findings that should indicate to the nurse the client is experiencing negative symptoms related to their schizophrenia.

A. Notify the provider of potential medication interactions: Furosemide, a loop diuretic, and NSAIDs like ibuprofen can increase lithium levels, contributing to toxicity. Notifying the provider is essential to reassess the medication regimen, especially with current signs of toxicity.
B. Discuss contraception with the client: There is no indication in the scenario that contraception counseling is an immediate priority or concern for this client at this time.
C. Set up a dietary consult for a low-sodium diet: Low-sodium diets can increase lithium reabsorption, worsening lithium toxicity. In fact, the client has hyponatremia (Na+ 131) already, so a low-sodium diet is contraindicated.
D. Educate the client about the need for hemodialysis: While hemodialysis may be required in severe lithium toxicity, this decision should be made by the provider. The nurse should monitor and report symptoms but not initiate education about dialysis unless prescribed.
E. Administer prochlorperazine: This is appropriate PRN medication for nausea and vomiting, which are symptoms of lithium toxicity and are present in this client.
F. Withhold next dose of lithium: The client’s current lithium level (2.2 mEq/L) is above the toxic range (>2.0 mEq/L). Continuing lithium could worsen toxicity, so the nurse should withhold the next dose and notify the provider.

A. Tell the client that the provider will need to change citalopram to a different medication is not the best action at this time. Citalopram, like many antidepressants, can take 4 to 6 weeks to show full therapeutic effects. Changing the medication too soon may not be warranted unless there are signs of significant side effects or no improvement after an adequate trial period.
B. Explain that antidepressants often take several weeks to be fully effective is the correct action. It is important to educate the client that antidepressants, including selective serotonin reuptake inhibitors (SSRIs) like citalopram, often take several weeks to produce significant changes in mood and sleep. Some improvements, such as an increased appetite, may occur earlier, but full therapeutic effects typically take longer.
C. Speak to the provider about adding an MAOI to the current medication regimen is not recommended at this stage. Monoamine oxidase inhibitors (MAOIs) are typically not used as first-line treatment for depression due to their potential side effects and dietary restrictions. Moreover, it is more appropriate to allow the prescribed SSRI time to take effect.
D. Recommend a sleep study be done on the client is not immediately necessary. While sleep disturbances are common in depression, a sleep study is generally not needed unless there is evidence of a specific sleep disorder, such as sleep apnea. The client’s sleep issues may improve as their depression treatment becomes more effective.