A firefighter survived a fire after escaping a blaze. Several other firefighters were trapped in the burning building and died. After working with this firefighter in counseling, the nurse evaluates which as positive outcomes for this client? Select all that apply.

Somatic symptom disorders involve the manifestation of physical symptoms that are exacerbated by psychological distress rather than a primary organic etiology. This condition involves the brain-body axis, where emotional stressors are converted into physiological sensations, such as pain or gastrointestinal upset. The patient's experience is characterized by genuine suffering, and the nurse must address the physical symptoms as valid while simultaneously exploring the underlying psychological triggers and coping mechanisms.

Rationale:

A. Contradicting the client by stating that the doctor thinks differently creates a non-therapeutic confrontation. This approach dismisses the client's experience and severely damages the nurse-client trust. It focuses on an external professional disagreement rather than the client's immediate need for validation and psychological support regarding their physical pain.

B. Sitting quietly without speaking may be interpreted as disinterest or agreement with the physician's potentially stigmatizing label. Although silence is sometimes therapeutic, in this specific context, the client is seeking explicit validation of their physical suffering. Failing to provide a verbal response can leave the client feeling isolated and misunderstood during a moment of distress.

C. Providing privacy and leaving the room can be perceived as emotional abandonment. Clients experiencing psychosomatic symptoms often feel judged or ignored by healthcare providers, and withdrawing at this moment reinforces those negative perceptions. The nurse should remain present to help the client process their feelings rather than leaving them alone to escalate.

D. Acknowledging that the pain is real is the most therapeutic intervention. This response validates the client’s subjective experience without contradicting the physician’s diagnosis. By confirming the reality of the sensation, the nurse reduces the client's defensiveness, which is a necessary prerequisite for later exploring the psychological factors contributing to the physiological response.

Lithium carbonate is an antimanic agent that stabilizes glutamatergic neurotransmission. It effectively manages acute mania and prevents bipolar relapse by modulating intracellular signaling pathways. Therapeutic serum levels are narrow, typically 0.6 to 1.2 mEq/L, requiring consistent renal function monitoring and adequate sodium intake to prevent toxicity.

Rationale:

A. Increased feelings of self-worth can signal a return to grandiosity seen in manic or hypomanic episodes. Lithium's purpose is to suppress such manic symptoms rather than enhance them. The nurse should assess if the client is experiencing a breakthrough of symptoms despite the medication.

B. Feeling sleepy and less energetic can be an adverse effect or a sign of lithium toxicity. While lithium modulates activity, excessive lethargy is not the desired therapeutic goal of treatment. This symptom requires further evaluation of the client's serum drug levels and thyroid function.

C. Lithium is effective when the client achieves emotional stability with minimal mood swings. The drug regulates mood fluctuations without causing significant cognitive clouding or sedation. Maintenance of a euthymic state indicates that the dosage is sufficient to control the cycling of bipolar disorder.

D. Weight gain is a common metabolic side effect of lithium therapy but does not indicate efficacy. Significant weight changes can lead to non-compliance and metabolic syndrome. The nurse evaluates clinical success based on psychological stability, not the presence of known adverse reactions.