Which of the following typifies the speech of a person in the acute phase of mania?

Choice A reason: Expecting dementia clients to consistently ask for needed items is incorrect, as short-term memory loss from hippocampal degeneration impairs their ability to articulate needs. Cognitive deterioration disrupts executive function and communication, making this assumption inaccurate and reflecting a misunderstanding of dementia’s neurobiological impact on memory and expression.

Choice B reason: Assuming ambulatory dementia clients can independently perform activities of daily living is incorrect. Dementia’s progressive neuronal loss, particularly in the cortex and hippocampus, impairs planning and execution of tasks like dressing or hygiene, despite physical mobility. This reflects a misunderstanding of cognitive versus motor function in dementia’s pathology.

Choice C reason: Expecting dementia clients to know meal times is incorrect, as temporal disorientation from hippocampal and prefrontal cortex damage impairs memory and time perception. Cognitive deterioration disrupts routine recall, making this assumption inaccurate. It fails to recognize the neurobiological basis of memory deficits central to dementia’s progression.

Choice D reason: Not recognizing family is a common dementia symptom, as long-term memory impairment from cortical and hippocampal neurodegeneration disrupts autobiographical memory. This reflects accurate understanding of dementia’s progressive impact on memory systems, where familiar faces become unrecognizable, aligning with the disease’s neurobiological effects on recognition and recall.

Choice A reason: Lithium’s therapeutic range for maintenance in bipolar disorder is 0.5–1.2 mEq/L, balancing mood stabilization via sodium channel modulation and neuroprotection with safety. This range minimizes toxicity risks like tremors or renal damage, ensuring effective serotonin and dopamine regulation while maintaining safe serum concentrations.

Choice B reason: A 10–50 mEq/L lithium level is far above the therapeutic range, causing severe toxicity, including seizures or coma, due to excessive sodium channel inhibition and neuronal dysfunction. This range is lethal, disrupting renal and neurological function, making it scientifically inaccurate for maintenance or safety.

Choice C reason: A 0.1–1 mEq/L range is partially subtherapeutic, as levels below 0.5 mEq/L are ineffective for mood stabilization in bipolar disorder. Lithium requires 0.5–1.2 mEq/L to modulate sodium channels and serotonin, making this range inadequate for therapeutic efficacy while still posing minor toxicity risks.

Choice D reason: A 50–100 mEq/L lithium level is exponentially above safe limits, causing fatal toxicity, including renal failure and neurological damage, due to extreme sodium channel disruption. This range is not viable for maintenance, as it far exceeds the therapeutic window, leading to severe neurobiological and systemic harm.