A client with depression is prescribed phenelzine (Nardil). The client says to the nurse, “I will need to watch my diet with this medication. What food options should I avoid?” Which of the following is the correct response by the nurse?

Choice A reason: Serum lithium levels are monitored periodically (e.g., weekly initially, then monthly), not every four hours, as levels stabilize over time. Frequent monitoring is unnecessary and impractical, and this instruction is incorrect for managing lithium therapy safely and effectively.

Choice B reason: Holding a lithium dose due to feeling “out of control” is dangerous, as abrupt cessation can destabilize mood in bipolar disorder. Symptoms should be reported to the provider for dose adjustment, making this an incorrect and unsafe instruction.

Choice C reason: Normal dietary sodium intake is critical with lithium, as low sodium increases lithium reabsorption in the kidneys, raising serum levels and toxicity risk. Maintaining consistent sodium intake prevents fluctuations in lithium levels, making this the correct teaching point.

Choice D reason: Limiting fluid intake to 400 mL daily is dangerous and incorrect, as lithium can cause polyuria and dehydration. Adequate hydration (2–3 L/day) is needed to prevent toxicity and maintain kidney function, making this instruction harmful.

Choice A reason: Assessing past suicide attempts provides risk context but is not the immediate priority. Current suicidal ideation requires urgent action to ensure safety, as past history does not address the acute risk of self-harm, making this secondary to implementing protective measures.

Choice B reason: Notifying the treatment team and initiating suicide precautions is the priority to ensure immediate safety. Suicidal ideation indicates a high risk of self-harm, requiring team coordination, constant observation, and environmental safety measures to prevent harm and ensure timely intervention.

Choice C reason: Identifying coping mechanisms is part of long-term suicide prevention but is not the priority during active suicidal ideation. Immediate safety measures, such as precautions and team notification, are critical to prevent harm before addressing coping strategies in therapy.

Choice D reason: Determining a specific suicide plan is important for risk assessment but is secondary to initiating immediate safety measures. Suicide precautions and team notification ensure the client’s safety first, allowing for subsequent detailed evaluation of the ideation’s specificity and intent.