The nurse and the client are using therapeutic communication skills. Which statements are true of concrete and abstract messages? Select all that apply.

Family systems theory suggests that anorexia nervosa often develops within a specific homeodynamic environment characterized by enmeshment and overprotection. In these families, the adolescent may feel a lack of autonomy, leading them to use food restriction as a way to exert sovereignty over the only thing they feel they can govern, that is, their own body.

Rationale:

A. Although issues of maturation and the physical changes of puberty are often central to the client's internal struggle, sexual identity is generally not the primary systemic issue addressed in family therapy for anorexia. The focus is more on the transition from childhood to independent adolescence.

B. Clients with anorexia typically possess an extreme, pathological level of self-discipline. The goal of therapy is often to decrease this rigid internal regulation rather than address a lack of it. High self-discipline is a symptom of the disorder's ego-syntonic nature, not the underlying familial conflict.

C. Control is the core psychological issue in the family of a client with anorexia. The family often struggles with allowing the client to develop a separate identity. By controlling their caloric intake to a life-threatening degree, the client is making a bid for individualization in a system that feels suffocatingly restrictive.

D. Codependence is a term more frequently associated with substance use disorders and "enabling" behaviors. The family of an anorexic client is often enmeshed, but the clinical priority is addressing the power struggles and the need for personal agency rather than the rescue-victim cycles typical of codependency.

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.