A nurse is caring for a client who has bipolar disorder and is taking lithium carbonate. Which of the following laboratory tests should the nurse monitor for this client? (Select all that apply.).

The client exhibits signs of akathisia, which is a common extrapyramidal side effect of haloperidol and other first-generation antipsychotics.Akathisia is characterized by restlessness, agitation, and difficulty staying still.

Choice A is wrong because it does not identify the specific type of movement disorder the client is experiencing.

Choice C is wrong because tardive dyskinesia is a different type of extrapyramidal side effect that involves involuntary movements of the tongue, lips, face, and limbs.

Choice D is wrong because neuroleptic malignant syndrome is a rare but life-threatening reaction to antipsychotics that causes high fever, muscle rigidity, altered mental status, and autonomic instability.

“I will take this medication in the morning to avoid insomnia.” Fluoxetine is a type of antidepressant that belongs to the class of selective serotonin reuptake inhibitors (SSRIs). It works by increasing the level of serotonin, a neurotransmitter that regulates mood, sleep, and appetite, in the brain.Fluoxetine can cause insomnia as a side effect, so it is recommended to take it in the morning.

Some of the other choices are wrong because:

• Choice B. “I will stop taking this medication if I have sexual dysfunction.” Fluoxetine can also cause sexual dysfunction as a side effect, such as reduced libido, difficulty with orgasm, or erectile dysfunction.

However, stopping the medication abruptly can cause withdrawal symptoms, such as nausea, headache, dizziness, and anxiety.Therefore, it is important to consult with the doctor before stopping or changing the dose of fluoxetine.

• Choice C. “I will increase my intake of cheese and red wine while taking this medication.” Fluoxetine can interact with foods that contain high levels of tyramine, a compound that can affect blood pressure and cause headaches.

Tyramine is found in aged cheeses, red wine, beer, cured meats, soy sauce, and other fermented or pickled foods.Consuming these foods while taking fluoxetine can increase the risk of a hypertensive crisis, which is a medical emergency that requires immediate attention.

• Choice D. “I will taper off this medication slowly when I feel better.” Fluoxetine should not be stopped or tapered off without the doctor’s guidance.

Although fluoxetine has a long half-life and is less likely to cause withdrawal symptoms than other SSRIs, some people may still experience them if they stop taking it too quickly.Withdrawal symptoms can include mood changes, irritability, agitation, confusion, insomnia, fatigue, flu-like symptoms, and electric shock sensations.

The doctor will advise on how to gradually reduce the dose of fluoxetine over several weeks or months to avoid these effects.