A nurse is evaluating client understanding following teaching about lithium therapy for bipolar disorder. Which of the following statements by the client should alert the nurse to the need for further teaching?

Choice A reason: Limiting sun exposure to prevent dehydration is appropriate. Dehydration increases lithium reabsorption in the kidneys, which can elevate serum lithium levels and increase the risk of toxicity. By avoiding prolonged sun exposure, the client reduces the likelihood of fluid loss through sweating, thereby maintaining stable hydration and safer lithium levels. This demonstrates correct understanding of lithium therapy precautions. Choice B reason: Continuing lithium during illness when fluid and food intake are reduced is unsafe. Illnesses such as influenza can cause dehydration and electrolyte imbalance, which increase lithium retention and risk of toxicity. The correct action would be to contact the provider immediately if unable to maintain adequate hydration or nutrition. This statement reflects a misunderstanding of lithium safety and requires further teaching to prevent dangerous outcomes. Choice C reason: Avoiding a low-sodium diet is correct. Lithium and sodium compete for reabsorption in the renal tubules. A low-sodium diet increases lithium reabsorption, raising serum levels and toxicity risk. Maintaining consistent sodium intake helps stabilize lithium levels. This statement demonstrates accurate understanding of dietary precautions. Choice D reason: Regular monitoring of lithium blood levels is essential for safe therapy. Lithium has a narrow therapeutic range (0.6–1.2 mEq/L), and levels must be checked every few months or more frequently depending on clinical status. This ensures early detection of toxicity and appropriate dose adjustments. This statement reflects correct understanding of monitoring requirements.