Practice Question
A nurse in an outpatient psychiatric clinic is speaking with the significant other a client who was started on lithium for bipolar disorder. The significant other states, "He has been on lithium for 5 days and still has no change in his behaviors." What response by the nurse is most appropriate?
Answer Choices:
Correct Answer:
"This medication will take a week to two weeks before therapeutic effects begin."
Rationale:
💎 Lithium is a mood stabilizer used for bipolar disorder, especially acute mania, but its onset of action is not immediate.
💎 Therapeutic effects typically start to appear within about 7–14 days, as steady-state levels are reached in the body.
💎 At 5 days, it is expected that the client may show minimal or no behavioral improvement yet, so reassurance and education are appropriate.
💎 Explaining the expected timeframe helps manage the significant other’s anxiety and expectations, promoting adherence.
💎 This response is accurate, therapeutic, and educational, aligning with the pharmacokinetics of lithium.
“a few months before effects begin”
💎 Saying lithium takes “a few months” to work is inaccurate and misleading, as its onset is usually within 1–2 weeks, not months.
💎 Such a long timeframe might discourage the client and family, leading to poor adherence and doubt about the treatment plan.
💎 While full stabilization of mood may evolve over several weeks, some improvement is usually seen much earlier than “months.”
💎 Providing incorrect information violates the principle of evidence-based client education.
💎 Therefore, this option overestimates the delay and is not appropriate teaching.
“Another medication may need to be added…”
💎 At only 5 days of therapy, it is too early to judge lithium as ineffective or to suggest adding another medication.
💎 Prematurely focusing on adding medications may create unnecessary worry and implies the regimen is failing when it is still within an expected window.
💎 Good teaching explains time to effect before suggesting treatment escalation.
💎 Providers might use other medications (e.g., antipsychotics, benzodiazepines) for acute symptoms, but this decision is based on clinical assessment, not just impatience.
💎 The nurse’s role here is to educate about expected onset, not to imply treatment failure.
“You should have seen therapeutic effects by now…”
💎 Stating that improvement “should” have occurred by day 5 is incorrect, as lithium generally takes longer to show clinical benefits.
💎 This statement may increase anxiety and erode trust in the treatment and care team.
💎 It reflects a misunderstanding of lithium’s onset of action, which is critical knowledge for safe psychiatric nursing.
💎 Encouraging a medication change at this early point goes against evidence-based practice and proper medication trial duration.
💎 Therefore, this response is not accurate, not therapeutic, and not aligned with lithium pharmacology.
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This question is from ☑️Custom-25Q4 218 Exam 5 which contains 30 questions.
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Question Details
- Category: RN Nursing Exam(s)
- Subcategory: ATI Exam(s)
- Domain: RN ATI MedSurg
- Answer Choices: 4