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?

ideation, as some clients express relief anticipating death. While concerning, it is less specific than other indicators, as it may not always reflect serotonin-driven despair or intent, requiring further assessment to confirm risk.

Choice B reason: Feeling overwhelmed by simple tasks indicates severe depression, linked to serotonin and prefrontal cortex dysfunction, impairing executive function. This heightens suicidal risk, as cognitive overload and hopelessness increase impulsivity and despair, making it a critical neurobiological marker requiring immediate intervention to prevent self-harm.

Choice C reason: Calling family to make amends signals high suicidal risk, often reflecting intent to resolve relationships before death, driven by serotonin dysregulation and prefrontal cortex deficits. This behavior indicates advanced planning, a neurobiological marker of serious ideation, necessitating urgent safety measures to prevent completion.

Choice D reason: An abrupt mood improvement can indicate suicidal risk, as it may reflect relief from deciding to end life, linked to serotonin and dopamine shifts. This neurobiological change reduces despair temporarily, increasing energy for action, making it a critical warning sign requiring immediate assessment and intervention.

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.