The nurse is caring for a client experiencing mania who is pacing, cannot sit, with pressured speech. Which meal will the nurse provide to best meet the nutritional needs of this client?

Choice A reason: A lithium level of 1.2 mEq/L is within the therapeutic range (0.6–1.5 mEq/L) for bipolar disorder. Symptoms like confusion, ataxia, polyuria, and blurred vision indicate toxicity, which occurs at higher levels, typically above 1.5 mEq/L, making this level unlikely for these severe symptoms.

Choice B reason: A lithium level of 1.4 mEq/L is at the upper end of the therapeutic range. While mild side effects may occur, severe symptoms like mental confusion, ataxia, and polyuria suggest toxicity, which typically occurs at levels above 1.5 mEq/L, ruling out this option.

Choice C reason: A lithium level of 2.3 mEq/L indicates toxicity, causing neurological symptoms (confusion, ataxia), polyuria due to nephrogenic diabetes insipidus, and blurred vision from central nervous system effects. These symptoms align with lithium toxicity, which occurs at levels above 1.5 mEq/L, making this the expected level.

Choice D reason: A lithium level of 1.8 mEq/L is slightly above therapeutic range and may cause mild toxicity symptoms, such as tremor or nausea. However, the severe symptoms described (confusion, ataxia, polyuria) are more consistent with higher toxic levels, such as 2.3 mEq/L, making this less likely.

Choice A reason: Increased sleep may occur with sertraline due to its sedative effects, but it is not the priority assessment. Early in treatment, SSRIs can increase energy before mood improvement, heightening suicide risk, making suicidal ideation a more urgent concern.

Choice B reason: Sertraline, an SSRI, can initially increase energy in severe depression before fully improving mood, potentially increasing suicide risk. Assessing suicidal ideation is the priority to ensure safety, as this risk is highest early in treatment, requiring immediate intervention if present.

Choice C reason: Emotional changes are expected with sertraline as it improves mood over weeks. However, this is less urgent than assessing suicidal ideation, which poses an immediate safety risk, especially in severe depression during the early phase of SSRI treatment.

Choice D reason: Increased socialization may indicate improved depressive symptoms but is a secondary outcome. The priority is assessing suicidal ideation, as SSRIs can paradoxically increase suicide risk early in treatment due to improved energy without full mood stabilization, requiring vigilant monitoring.