# A 27-year-old client taking lithium for bipolar disorder calls the clinic after a positive home pregnancy test. Which response by the nurse is most appropriate?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375325&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A 27-year-old client taking lithium for bipolar disorder calls the clinic after a positive home pregnancy test. Which response by the nurse is most appropriate?

## Option

1. Advise the client to contact the prescriber promptly to review fetal risk, relapse risk, and safer treatment planning. **✔ Correct answer**
2. Recommend that the client stop taking lithium immediately to minimize the risk of teratogenic harm to the fetus.
3. Instruct the client to begin taking a high-dose folic acid supplement to counteract lithium's fetal effects.
4. Inform the client that lithium use during pregnancy poses minimal risk to the fetus, so she can continue the current dose.

**Correct answer: 1**

## Explanation

Lithium exposure in pregnancy, especially early pregnancy, is associated with fetal cardiac risk, but abrupt discontinuation can trigger severe mood relapse. The nurse should escalate promptly for shared decision-making and medication planning rather than giving unilateral stop/continue instructions.

## In-depth explanation

Caution Pregnancy questions with mood stabilizers require balanced risk thinking: fetal exposure risk and maternal relapse risk both matter. Do not advise abrupt self-discontinuation without prescriber guidance.

## Clinical scenario

Scenario Lithium therapy + positive pregnancy test.

## Key concepts

- **Lithium and pregnancy** — First-trimester exposure has been associated with congenital cardiac risk; individualized risk-benefit review is needed.
- **Mood relapse risk** — Abrupt mood stabilizer discontinuation can lead to mania, depression, suicidality, or impaired prenatal care.
- **Shared decision-making** — Provider, psychiatry, and obstetric teams should weigh maternal stability, fetal risk, alternatives, and monitoring.

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