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.

Rationale for Correct Options:

Substance use: Early and recurrent substance use is a common behavior in conduct disorder and is also seen in adults with ASPD.

Comorbidities in childhood: Childhood conditions like ADHD, oppositional defiant disorder (ODD), or depression are often comorbid with CD and may contribute to antisocial behaviors later.

Treatment of animals: Cruelty to animals is one of the hallmark symptoms of conduct disorder per DSM-5 and a strong predictor of ASPD.

School history: A history of truancy, expulsion, or academic problems due to behavior issues is often present in CD and may indicate early defiance of societal norms.

Parental history: A family history of antisocial behavior, criminal activity, or substance use increases the risk of conduct problems and eventual ASPD.

Rationale for Incorrect Options:

Living with grandmother in childhood: May indicate instability, but not in itself a diagnostic indicator.

Employment history: Relevant in adults with ASPD (e.g., poor work history), but not a hallmark of CD.

Living arrangements: Doesn’t directly relate to conduct or antisocial behaviors.

Interactions with other clients: Social withdrawal may be seen, but ASPD typically features aggressive or manipulative interaction, not isolation.

Engagement in physical activity: This is an irrelevant to diagnosis.

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.