A nurse is reinforcing discharge teaching with a client who has bipolar disorder. Which of the following statements should the nurse identify as an indication that the client understands the instructions?

Introduction: Bipolar disorder is characterized by cyclic mood fluctuations between mania and depression. Effective disease management relies on the recognition of prodromal symptoms, which are early warning signs that indicate a shift in the client’s neurobiological stability, allowing for prompt clinical intervention to prevent a full-blown mood episode. A. Electroconvulsive therapy (ECT) is typically used for acute, treatment-resistant depression or mania rather than as a standard weekly discharge maintenance plan. While some clients receive "maintenance ECT," it is not the primary teaching point for a standard discharge compared to self-monitoring and medication adherence. B. Sleep disturbance, particularly a decreased need for sleep, is one of the most reliable and earliest indicators of an impending manic episode. Recognizing that "having trouble sleeping" is a sign of relapse demonstrates that the client understands how to monitor their own physiological state to maintain stability and seek help early. C. Group therapy is a valuable psychosocial adjunct to treatment, but it does not replace the need for pharmacotherapy in bipolar disorder. Bipolar disorder is a biological condition requiring mood stabilizers (like lithium). Suggesting that therapy reduces the need for medication indicates a misunderstanding of the disease's pathophysiology. D. Clients with bipolar disorder should be instructed to avoid alcohol entirely. Alcohol is a central nervous system depressant that can trigger depressive episodes, destabilize mood, and interact dangerously with medications like lithium or anticonvulsants, potentially leading to increased toxicity or decreased therapeutic efficacy.