A nurse is preparing to administer medications to a newly admitted client who has bipolar disorder and is experiencing mania. Which of the following medications should the nurse plan to administer?

Choice A reason: Ursodiol is a bile acid used to dissolve gallstones and treat certain liver conditions such as primary biliary cholangitis. It has no therapeutic role in the management of bipolar disorder or mania. Administering this medication would not address the client’s acute psychiatric symptoms and would be inappropriate in this context. Choice B reason: Lithium is a mood stabilizer and is considered the gold standard treatment for bipolar disorder, particularly effective in controlling acute manic episodes. It works by modulating neurotransmitter activity, stabilizing mood fluctuations, and reducing hyperactivity and impulsivity associated with mania. The dosage provided (600 mg PO three times per day) is consistent with therapeutic dosing for acute mania, though serum levels must be monitored closely to avoid toxicity. This makes lithium the correct choice for this scenario. Choice C reason: Haloperidol is a typical antipsychotic that can be used to manage agitation and psychotic symptoms in bipolar disorder. While it can reduce acute agitation, it is not the primary treatment for mania. Its use is generally reserved for short-term control of severe agitation or psychosis, often as an adjunct to mood stabilizers. Long-term use carries risks such as extrapyramidal symptoms and tardive dyskinesia, making it less ideal compared to lithium for sustained management of mania. Choice D reason: Aripiprazole is an atypical antipsychotic that can be used in the treatment of bipolar disorder. However, the formulation listed (400 mg IM every 4 weeks) is a long-acting injectable typically used for maintenance therapy, not for acute management of mania. In a newly admitted client experiencing acute mania, immediate stabilization with oral or short-acting agents is required. Therefore, this option is not appropriate for the acute phase of treatment.