A client with bipolar disorder begins taking lithium carbonate, 300 mg four times a day. After 3 days of therapy, the client says, "My hands are shaking." The best response by the nurse is which of the following?

Fine motor tremors are an early effect of lithium therapy that usually subsides in a few weeks

It is nothing to worry about unless it continues for the next month

You can expect tremors with lithium. You seem very concerned about such a small tremor

Tremors can be an early sign of toxicity, but we'll keep monitoring your lithium level to make sure you're okay

The correct answer is: a) Fine motor tremors are an early effect of lithium therapy that usually subsides in a few weeks

Answer and Explanation

The Correct Answer is A

Choice A reason: Fine motor tremors are a common early side effect of lithium, affecting cerebellar function due to its narrow therapeutic index and sodium channel interactions. These typically subside within weeks as the body adjusts to stable serum levels (0.5–1.2 mEq/L), making this an accurate, reassuring response.

Choice B reason: Dismissing tremors as unimportant unless persistent for a month is incorrect. Lithium tremors, linked to cerebellar effects, often resolve sooner, but persistent tremors may indicate toxicity (levels >1.5 mEq/L), risking neurological damage. This response delays necessary monitoring, ignoring the drug’s neuropharmacological impact.

Choice C reason: Acknowledging tremors but implying the client’s concern is excessive is dismissive. Tremors result from lithium’s cerebellar effects, a legitimate side effect. This response fails to educate about the expected resolution timeline or need for monitoring, risking patient distrust and ignoring the drug’s neurobiological effects.

Choice D reason: Labeling tremors as a potential toxicity sign is misleading, as early fine tremors are typically benign, not indicative of toxicity (>1.5 mEq/L), which involves severe symptoms like confusion. This overstates risk, causing unnecessary alarm, and does not address the common, transient cerebellar effect of lithium.

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Correct Answer is A

Explanation

Choice A reason: Depression involves slowed cognitive processing due to serotonin and prefrontal cortex dysfunction, causing delayed responses. Allowing time respects this neurobiological delay, reducing pressure and potential withdrawal. This supports engagement, as the client may formulate a goal with patience, aligning with therapeutic strategies for depressive cognitive deficits.

Choice B reason: Prompting for a response may increase anxiety in depression, where serotonin dysregulation impairs cognitive fluency. Immediate pressure risks disengagement, as the client’s slowed prefrontal processing struggles to respond quickly. Allowing time is more effective, as it accommodates the neurobiological delays characteristic of depressive cognitive function.

Choice C reason: Moving to the next client dismisses the depressed client’s engagement, exacerbating feelings of worthlessness linked to serotonin and dopamine imbalances. This risks reinforcing social withdrawal, a common depressive symptom, as the client’s prefrontal cortex struggles with participation. Allowing time supports inclusion and respects cognitive delays.

Choice D reason: Offering a goal suggestion may reduce autonomy in depression, where prefrontal cortex dysfunction already impairs decision-making. This risks dependency rather than empowering the client, whose serotonin-related cognitive delays require patience to formulate personal goals, making this less effective than allowing time for self-directed thought.

A. Mutism B. Flight of ideas C. Hesitant D. Psychomotor retardation

Correct Answer is B

Explanation

Choice A reason: Mutism, the absence of speech, is not typical in acute mania, where dopamine-driven hyperactivity increases verbal output. Mutism is more associated with catatonia or severe depression, where psychomotor inhibition or serotonin deficits reduce communication, making this inconsistent with mania’s neurobiological profile.

Choice B reason: Flight of ideas, characterized by rapid, disjointed speech, typifies acute mania due to dopamine and norepinephrine hyperactivity in the prefrontal cortex and limbic system. This leads to accelerated thought processes and pressured speech, reflecting the manic state’s heightened neural excitability and reduced inhibitory control.

Choice C reason: Hesitant speech is not characteristic of acute mania, where dopamine-driven hyperactivity results in rapid, pressured speech. Hesitancy may occur in anxiety or depression, linked to serotonin dysregulation or prefrontal inhibition, contrasting with mania’s uninhibited, accelerated verbal output driven by neurochemical overstimulation.

Choice D reason: Psychomotor retardation, slowed speech and movement, is typical of depression, driven by serotonin and dopamine deficits. In acute mania, heightened dopamine and norepinephrine activity cause rapid speech and agitation, making psychomotor retardation incompatible with the neurobiological profile of manic speech patterns.

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A client with bipolar disorder begins taking lithium carbonate, 300 mg four times a day. After 3 days of therapy, the client says, "My hands are shaking." The best response by the nurse is which of the following?

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Correct Answer is A

Explanation

Which of the following typifies the speech of a person in the acute phase of mania?

Correct Answer is B

Explanation

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