A nurse in an outpatient mental health setting is collecting a health history from a client who is taking paroxetine for depression. The client reports to the nurse that he also takes herbal supplements. The nurse should advise the client that which of the following supplements interacts adversely with paroxetine?

Choice A reason: Monitoring vital signs is critical in withdrawal delirium, as it is a medical emergency involving autonomic hyperactivity from alcohol or drug cessation. Dehydration and electrolyte imbalances elevate heart rate and blood pressure, risking seizures or cardiovascular collapse. Regular monitoring detects instability early, guiding fluid replacement and medication to stabilize cerebral and systemic function.

Choice B reason: Keeping the room dark may reduce sensory overload in withdrawal delirium, but it does not address physiologic instability like dehydration or autonomic hyperactivity. Darkness may calm agitation but risks disorientation in a confused patient, as visual cues aid reality testing. This choice is less critical than monitoring vital signs for ensuring systemic stability.

Choice C reason: Withholding oral fluids is contraindicated in withdrawal delirium, as dehydration exacerbates symptoms like confusion and autonomic instability. Fluid loss from sweating or vomiting, common in withdrawal, disrupts electrolyte balance and cerebral perfusion. Providing fluids corrects hypovolemia, making this choice scientifically inappropriate for maintaining physiologic stability in this critical condition.

Choice D reason: Applying ice to the tongue may reduce swelling from trauma, but it does not address the systemic instability of withdrawal delirium, such as dehydration or autonomic hyperactivity. Tongue swelling is a secondary issue compared to life-threatening risks like seizures or arrhythmias, which require monitoring vital signs and fluid management for stabilization.

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.