In communicating with the psychiatric patient, which nurse responses could block effective communication with a client? (Select all that apply)

Choice A rationale: Both sodium and chloride are important for fluid balance but chloride has no effect on the blood lithium levels.
Choice B rationale: sodium has an effect on the blood lithium levels by competing with lithium for reabsorption in the kidneys but vitamins do not influence the lithium levels in blood.
Choice C rationale: dehydration increases the risk of lithium toxicity since it will result in oliguria hence increasing the risk of lithium toxicity since the drug is primarily excreted in urine. Sodium and lithium compete for reabsorption in the kidneys, so low sodium levels can increase lithium retention and lead to toxicity. Therefore, the client should maintain an adequate intake of sodium and water to prevent dehydration and sodium loss and to keep the lithium level within the therapeutic range.
Choice D rationale: water has an influence on blood lithium levels since adequate intake minimizes the risk of toxicity by increasing the drug’s excretion in urine.
However, potassium does not compete with lithium for reabsorption.

Choice A rationale: absence of physical and mental movement refers to catatonia that can occur in severe depression or schizophrenia.
Choice B rationale: akinesia refers to the absence of voluntary movement and can be seen in individuals with Parkinson’s disease or as a side effect of some antipsychotic medications.
Choice C rationale: these are signs and symptoms of tardive dyskinesia which is a serious side effect of antipsychotic therapy resulting from the damage of nerve cells controlling movement and is irreversible especially when detected late.
Choice D rationale: this refers to dystonia which is a condition characterized by abnormal muscle tone resulting in painful muscle spasms and abnormal postures. This is a side effect of some antipsychotic medications.