A nurse is providing discharge teaching to a client diagnosed with bipolar disorder who will be discharged with a prescription for lithium. The nurse should teach the client that which of the following is a risk factor for lithium toxicity?

Choice A reason:

Missing a dose of medication that increases serotonin levels does not typically increase the risk of serotonin syndrome. In fact, missing a dose may lead to lower levels of serotonin in the body, which is contrary to the condition of serotonin syndrome that arises from an excess of serotonin.

Choice B reason:

Taking MAOI medication alone does not inherently increase the risk of serotonin syndrome. However, combining MAOIs with other medications that affect serotonin levels can significantly increase the risk. It is crucial to avoid taking MAOIs and other serotonergic drugs concurrently without medical supervision.

Choice C reason:

Taking SNRIs as directed by a healthcare provider generally does not increase the risk of serotonin syndrome. These medications are designed to be taken regularly to manage conditions like anxiety and depression. However, any changes in dosage or frequency should be done under medical guidance to avoid any adverse effects.

Choice D reason:

Combining medications that increase serotonin levels is the primary risk factor for developing serotonin syndrome. This can occur when a patient takes multiple serotonergic drugs, such as combining an SNRI with an SSRI, certain pain medications, or even some over-the-counter drugs and supplements that increase serotonin levels. This combination can lead to an excessive accumulation of serotonin in the body, triggering the symptoms of serotonin syndrome.

Choice A: Turn on a dance video so the client can burn off excess energy.
This intervention might help the client to channel their energy in a safe and controlled manner. However, it might also reinforce the manic behavior, which could be counterproductive in the long term.

Choice B: Take the client to a calm environment and offer snacks.
This intervention could help to distract the client from their manic behavior and provide them with a calming and grounding experience. Offering snacks could also help to stabilize their energy levels.

Choice C: Offer the client a low-calorie snack in return for stopping the behavior.
This intervention could be seen as a form of behavioral reinforcement. However, it might not be effective if the client is not motivated by food or if they perceive it as a form of manipulation.

Choice D: Observe the client closely for the development of aggressive behavior.
This intervention is crucial for ensuring the safety of the client and others in the unit. If the client's behavior escalates to aggression, the nurse would need to take immediate steps to de-escalate the situation and protect everyone involved.