A patient diagnosed with bipolar disorder has rapidly changing mood cycles. The health care provider prescribes an anticonvulsant medication. Which drug should the nurse anticipate will be prescribed?

Choice A reason: Neuroleptic malignant syndrome is associated with antipsychotics, not SSRIs like paroxetine, causing muscle rigidity and hyperthermia via dopamine blockade. The client’s symptoms, including hyperreflexia and diarrhea, align with serotonin excess, not dopamine-related issues, making this condition unlikely.

Choice B reason: Agranulocytosis, a severe reduction in white blood cells, is unrelated to paroxetine’s mechanism. SSRIs increase serotonin, not affecting hematopoiesis. The client’s symptoms like hyperpyrexia and hyperreflexia indicate serotonin toxicity, not an immunological or bone marrow disorder.

Choice C reason: Acute dystonic reactions involve muscle spasms from antipsychotics’ dopamine antagonism, not SSRIs. Paroxetine’s serotonin increase causes hyperreflexia and hyperpyrexia, consistent with serotonin syndrome, not extrapyramidal symptoms, making this diagnosis inappropriate for the described clinical presentation.

Choice D reason: Serotonin syndrome results from excessive serotonin due to paroxetine, an SSRI, overstimulating 5-HT receptors, causing hyperreflexia, hyperpyrexia, and autonomic instability. These symptoms reflect serotonin-driven neural excitation, particularly in the brainstem and spinal cord, matching the client’s clinical presentation accurately.

Choice A reason: Exploring past interests is therapeutic but does not directly address the immediate suicide risk implied by hopelessness. Depression’s serotonin deficit heightens amygdala-driven despair, and assessing suicidal ideation is critical to prioritize safety over general exploration of interests.

Choice B reason: Reassuring the patient about reasons to live is dismissive and risks alienating them. Hopelessness in depression reflects serotonin and prefrontal cortex dysregulation, and this response fails to assess suicide risk, missing critical amygdala-driven warning signs.

Choice C reason: Asking about suicidal thoughts directly assesses risk, critical in depression with low serotonin and heightened amygdala activity driving hopelessness. This prioritizes safety, engaging prefrontal cortex reflection to identify immediate danger and guide intervention, making it the most appropriate response.

Choice D reason: Encouraging hope is vague and does not assess suicide risk. Depression’s serotonin deficit and amygdala hyperactivity require direct evaluation of suicidal ideation, as hopelessness signals potential danger, making this response inadequate for ensuring patient safety.