A nurse is planning care for a client who is to undergo electroconvulsive therapy (ECT). Which of the following actions should the nurse include in the plan?

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: Echinacea is used for immune support and has no significant interaction with paroxetine, an SSRI that increases serotonin by inhibiting reuptake. Echinacea’s effects on cytokine production do not alter serotonin metabolism or CYP450 enzymes, which paroxetine relies on for clearance, making it a safe supplement in this context.

Choice B reason: Ginkgo enhances cerebral blood flow but has minimal interaction with paroxetine. It may affect platelet aggregation, but paroxetine’s serotonin reuptake inhibition is primarily metabolized via CYP2D6, unaffected by ginkgo’s mechanisms. No significant pharmacodynamic or pharmacokinetic interactions occur, making this supplement safe for concurrent use with paroxetine.

Choice C reason: St. John’s Wort induces CYP3A4 and P-glycoprotein, accelerating paroxetine metabolism, an SSRI reliant on CYP2D6. This reduces paroxetine’s efficacy, lowering serotonin levels and risking treatment failure for depression. It also increases serotonin syndrome risk due to additive serotonergic effects, making it a critical interaction to avoid.

Choice D reason: Saw palmetto, used for prostate health, has no significant interaction with paroxetine. It primarily affects androgen pathways, not serotonin metabolism or CYP2D6, which paroxetine uses for clearance. No pharmacodynamic or pharmacokinetic conflicts arise, making saw palmetto a safe supplement for clients taking paroxetine for depression.