A client says to the nurse, "You are the best nurse I've ever met. I want you to remember me." What is an appropriate response by the nurse?

Choice A reason: Lithium’s therapeutic range for maintenance in bipolar disorder is 0.5–1.2 mEq/L, balancing mood stabilization via sodium channel modulation and neuroprotection with safety. This range minimizes toxicity risks like tremors or renal damage, ensuring effective serotonin and dopamine regulation while maintaining safe serum concentrations.

Choice B reason: A 10–50 mEq/L lithium level is far above the therapeutic range, causing severe toxicity, including seizures or coma, due to excessive sodium channel inhibition and neuronal dysfunction. This range is lethal, disrupting renal and neurological function, making it scientifically inaccurate for maintenance or safety.

Choice C reason: A 0.1–1 mEq/L range is partially subtherapeutic, as levels below 0.5 mEq/L are ineffective for mood stabilization in bipolar disorder. Lithium requires 0.5–1.2 mEq/L to modulate sodium channels and serotonin, making this range inadequate for therapeutic efficacy while still posing minor toxicity risks.

Choice D reason: A 50–100 mEq/L lithium level is exponentially above safe limits, causing fatal toxicity, including renal failure and neurological damage, due to extreme sodium channel disruption. This range is not viable for maintenance, as it far exceeds the therapeutic window, leading to severe neurobiological and systemic harm.

Choice A reason: Understanding the medication regimen is important for long-term bipolar management, stabilizing mood via dopamine and serotonin modulation. In acute mania, however, hyperactivity and reduced intake increase dehydration risk, which exacerbates cerebral dysfunction. Hydration is a more immediate physiological need than cognitive understanding during an acute episode.

Choice B reason: Acute mania in bipolar disorder involves hyperactivity and reduced self-care, driven by dopamine dysregulation, leading to dehydration. This impairs cerebral perfusion and electrolyte balance, risking seizures or organ damage. Maintaining hydration is the priority, as it stabilizes physiological function, supporting neural recovery during the acute manic phase.

Choice C reason: Practicing problem-solving skills aids long-term bipolar management by enhancing prefrontal cortex function. In acute mania, however, impaired insight and hyperactivity from dopamine excess limit cognitive engagement. Dehydration poses a greater immediate risk to cerebral and systemic stability, making this goal secondary during an acute episode.

Choice D reason: Identifying relapse indications supports long-term bipolar management by recognizing dopamine-driven mood shifts. In acute mania, immediate physiological risks like dehydration from hyperactivity take precedence, as they threaten cerebral and systemic stability. This goal is less urgent, as it addresses future prevention rather than current physiological needs.