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?

B. Shake the container vigorously:

This is the correct action. Phenytoin suspension tends to settle over time, leading to non-uniform distribution of the medication in the suspension. Therefore, shaking the container vigorously before administering each dose ensures proper dispersion of the medication and helps maintain consistent drug concentration, thus promoting therapeutic efficacy.

A. Check the child's blood pressure:

Checking the child's blood pressure is not directly related to the administration of phenytoin suspension. Monitoring blood pressure may be indicated in certain clinical situations or with certain medications, but it is not specifically required before administering phenytoin suspension.

C. Be sure the child has not eaten within the hour:

While it's important to consider food-drug interactions with certain medications, such as those affected by food intake, there are no specific dietary restrictions associated with phenytoin suspension administration. Therefore, checking whether the child has eaten within the hour is not a necessary step before administering phenytoin suspension.

D. Perform mouth care:

Performing mouth care is not directly related to the administration of phenytoin suspension. However, oral hygiene is important for overall health, especially in children who may have difficulty performing adequate mouth care independently. While mouth care should be encouraged, it is not specifically required before administering phenytoin suspension.

A. Speaking to the provider about adding an MAOI to the current medication regimen: MAOIs (Monoamine oxidase inhibitors) are typically considered as second- or third-line treatments due to their potential for serious side effects and interactions with other medications. It is not the first-line approach to managing depressive symptoms that have not improved with citalopram alone.

B. Telling the client that the provider will need to change citalopram to a different medication: It's premature to switch medications after only two weeks, as antidepressants often take several weeks to exert their full therapeutic effect. It's essential to allow adequate time for the current medication regimen to work before considering a change.

C. Explaining that antidepressants often take several weeks to be fully effective: This is the most appropriate action. It's important for the nurse to educate the client about the delayed onset of action of antidepressants and reassure them that improvement may take time. Adjustments to the dosage or switching to a different medication would typically be considered if there is no improvement after a sufficient trial period.

D. Recommending a sleep study be done on the client: While sleep disturbances are common in depression, recommending a sleep study would be premature at this stage. It's essential to address the underlying depressive symptoms first, as they may contribute to the sleep disturbance.