A nurse is providing discharge instructions to a client who has been prescribed Lithium for bipolar disorder. Which of the following statements by the client indicates a need for further teaching?

A. Advise the patient to continue using the nasal decongestant but reduce the frequency to once daily: Continued use, even at a reduced frequency, may not resolve the underlying issue. Prolonged use of topical nasal decongestants can lead to rebound congestion (rhinitis medicamentosa), which won't improve without discontinuation.
B. Suggest increasing the dosage of the current nasal decongestant to manage congestion: Increasing the dosage worsens rebound congestion and the dependence cycle. Higher doses can also raise the risk of systemic side effects such as elevated blood pressure or tachycardia.
C. Educate the patient on discontinuing the nasal decongestant and recommend a saline nasal spray for symptom relief: This is the most appropriate intervention. Rebound congestion is best managed by stopping the decongestant. Saline sprays help moisturize nasal passages and reduce symptoms safely during withdrawal.
D. Prescribe a stronger nasal decongestant to alleviate symptoms more effectively: A stronger formulation would likely exacerbate the problem. The key to managing rhinitis medicamentosa is breaking the cycle of decongestant overuse, not intensifying it.

A. Drugs with strong first-pass metabolism are best administered via an enteral route: Drugs that undergo extensive first-pass metabolism are often less effective when given enterally, as much of the drug is inactivated by the liver before reaching systemic circulation. Non-enteral routes (e.g., sublingual, IV) are preferred to bypass the liver initially.
B. Metabolism alters medications so that they can be excreted from the body: The liver uses enzymatic processes to convert drugs into more water-soluble forms, facilitating their elimination through the kidneys or bile. This process can either activate, inactivate, or detoxify substances depending on the drug.
C. The first-pass effect increases the bioavailability of orally administered drugs: The first-pass effect reduces, not increases, the bioavailability of orally administered drugs. It refers to the initial metabolism in the liver that significantly reduces the active concentration of a drug before it reaches systemic circulation.
D. Metabolism primarily occurs in the kidneys: While the kidneys are essential for drug excretion, metabolism primarily occurs in the liver. Hepatic enzymes, especially those of the cytochrome P-450 system, play the central role in drug biotransformation.