A nurse is caring for a client who has bipolar disorder and has been taking lithium for 1 year. Before administering the medication, the nurse should check to see that which of the following tests have been completed?

A. "It doesn't really matter what time you take your medications as long as you don't skip any doses": This statement is incorrect because adherence to the prescribed dosing schedule is crucial for the effectiveness of medications. Inconsistent timing of doses can lead to suboptimal therapeutic outcomes or potential adverse effects.

B. "Let's work together to devise a time schedule that is convenient for you on a daily basis": This is the most appropriate instruction. Collaborating with the client to establish a medication schedule that aligns with their daily routine increases the likelihood of adherence. It promotes patient autonomy and empowers the client to take ownership of their medication regimen.

C. "You really shouldn't change the schedule we established here in the facility": While maintaining consistency in medication administration times is important, rigidly adhering to a schedule established during the facility stay may not always be feasible or practical for the client at home. Flexibility in adjusting the schedule to fit the client's lifestyle is essential for long-term adherence.

D. "We'll have to talk to your provider about switching to an alternative schedule": Switching to an alternative schedule should be considered only if the current schedule is not feasible for the client or if it compromises medication adherence. However, exploring options for adapting the existing schedule to better suit the client's needs should be attempted first before considering a switch.

Answer: D. "I’ll take this medicine first thing in the morning."

A. "I should expect to feel better after 24 hours of starting this medication."
This statement indicates a misunderstanding of the medication's pharmacodynamics. Fluoxetine, a selective serotonin reuptake inhibitor (SSRI), generally requires a minimum of 4 to 6 weeks to exhibit therapeutic effects in treating depression. Clients may initially experience side effects, such as nausea or changes in sleep patterns, before noticing any improvement in mood. It's crucial to educate clients about this timeline to manage expectations and encourage adherence to the medication regimen.

B. "I should not take this medicine with grapefruit juice."
This statement is incorrect. While grapefruit juice can affect the metabolism of many medications due to its action on cytochrome P450 enzymes, fluoxetine is not significantly impacted by grapefruit juice. Therefore, clients can consume grapefruit juice without the risk of altering the effectiveness or safety of fluoxetine. Providing accurate dietary information is essential to ensure clients feel confident in their dietary choices while on medication.

C. "I’ll take this medicine with food."
While clients may take fluoxetine with food to help minimize potential gastrointestinal upset, it is not strictly necessary. The medication can be effective whether taken with or without food. This flexibility allows clients to choose the method that works best for their individual tolerance and lifestyle, which can improve adherence and comfort.

D. "I’ll take this medicine first thing in the morning."
This is the correct understanding. Taking fluoxetine in the morning is generally recommended because the medication can cause insomnia or increased alertness in some individuals, particularly when initiated. By taking it in the morning, clients can avoid potential sleep disturbances at night, which is important for maintaining a regular sleep-wake cycle and overall well-being. Additionally, consistent timing can help improve adherence to the treatment plan.