For a client with major depressive disorder reporting persistent insomnia, what should the nurse assess next?

Choice A reason: Encouraging the cessation of medication is contraindicated for bipolar disorder, which typically requires lifelong mood-stabilizing pharmacotherapy. Abruptly stopping medications like lithium or valproate during the maintenance phase significantly increases the risk of an acute manic or depressive relapse and potential rebound symptoms.

Choice B reason: While managing stress is important, social isolation can be a trigger for depressive episodes and reduces the client's support system. The goal of the maintenance phase is to help the client return to a high level of social and occupational functioning, rather than withdrawing from life to avoid potential stressors.

Choice C reason: The maintenance phase focuses on long-term stability and relapse prevention. Educating the client on identifying early "prodromal" symptoms, such as decreased need for sleep or increased irritability, allows for early intervention. Stressing medication adherence is vital, as non-compliance is the leading cause of recurrent cycles in bipolar patients.

Choice D reason: Daily therapy sessions are typically reserved for the acute phase of illness or partial hospitalization programs. During the maintenance phase, therapy is usually less frequent, focusing on lifestyle management and coping strategies. Over-utilization of resources in a stable phase may foster dependency rather than promoting independent self-management.

Choice A reason: To calculate the correct volume, the nurse uses the standard formula: Desired dose (5 mg) divided by the dose on hand (10 mg) multiplied by the volume (1 mL). Therefore, 5 divided by 10 equals 0.5. Administering 0.5 mL provides exactly the 5 mg prescribed.

Choice B reason: Administering 2 mL would result in the patient receiving 20 mg of haloperidol. This is four times the prescribed dose and could lead to severe extrapyramidal side effects, acute dystonia, or neuroleptic malignant syndrome, representing a significant and dangerous medication administration error by the nurse.

Choice C reason: A volume of 0.25 mL would only deliver 2.5 mg of the medication. This sub-therapeutic dose would likely be ineffective in managing the patient's acute psychiatric symptoms or agitation, failing to meet the clinical objectives established by the prescribing healthcare provider's original medication order.

Choice D reason: Administering 1 mL would deliver 10 mg of haloperidol, which is double the intended 5 mg dose. Overdosing a patient on high-potency antipsychotics increases the risk of cardiac complications, such as QTc prolongation, and requires immediate reporting and monitoring for adverse neurological reactions.