The nurse has been teaching the caregiver about Aricept. The nurse knows teaching has been effective by which of the following statements?

Choice A reason: Fine motor tremors are a common early side effect of lithium, affecting cerebellar function due to its narrow therapeutic index and sodium channel interactions. These typically subside within weeks as the body adjusts to stable serum levels (0.5–1.2 mEq/L), making this an accurate, reassuring response.

Choice B reason: Dismissing tremors as unimportant unless persistent for a month is incorrect. Lithium tremors, linked to cerebellar effects, often resolve sooner, but persistent tremors may indicate toxicity (levels >1.5 mEq/L), risking neurological damage. This response delays necessary monitoring, ignoring the drug’s neuropharmacological impact.

Choice C reason: Acknowledging tremors but implying the client’s concern is excessive is dismissive. Tremors result from lithium’s cerebellar effects, a legitimate side effect. This response fails to educate about the expected resolution timeline or need for monitoring, risking patient distrust and ignoring the drug’s neurobiological effects.

Choice D reason: Labeling tremors as a potential toxicity sign is misleading, as early fine tremors are typically benign, not indicative of toxicity (>1.5 mEq/L), which involves severe symptoms like confusion. This overstates risk, causing unnecessary alarm, and does not address the common, transient cerebellar effect of lithium.

Choice A reason: Valproic acid does not typically require thyroid function tests, as it primarily affects liver metabolism via glucuronidation and mitochondrial pathways. Thyroid dysfunction is not a common side effect, unlike with lithium, which impacts thyroid hormone synthesis. This instruction is irrelevant, as valproic acid’s toxicity risks are hepatic, not thyroid-related.

Choice B reason: Expecting a gradual decrease in valproic acid dosage is incorrect, as it is titrated to therapeutic levels for conditions like seizures or bipolar disorder, based on serum levels (50–100 mcg/mL). Dosage adjustments depend on efficacy, not routine reduction, as stable neural excitability is needed, making this scientifically inaccurate.

Choice C reason: Taking aspirin for pain with valproic acid is risky, as both inhibit platelet function, increasing bleeding risk via synergistic effects on prostaglandin synthesis. Valproic acid’s hepatic metabolism also raises hepatotoxicity concerns, making aspirin inappropriate. Alternative analgesics like acetaminophen are safer, rendering this instruction incorrect.

Choice D reason: Valproic acid requires regular liver function monitoring, as it is hepatically metabolized and can cause hepatotoxicity, particularly in the first 6 months, due to mitochondrial dysfunction and oxidative stress. Elevated liver enzymes or rare fulminant hepatitis necessitate early detection to prevent liver failure, making this a critical instruction.