In a client with bipolar disorder experiencing a manic episode who is being treated with haloperidol and lithium, which action should the nurse take to minimize risk?

• A. Administer haloperidol as ordered.
• B. Monitor lithium levels and monitor for extrapyramidal side effects.
• C. Increase the lithium dosage to achieve rapid stabilization.
• D. Discontinue haloperidol immediately if agitation subsides.

Answer: (B)

In bipolar mania treated with haloperidol and lithium, the main idea is to prevent two key risks: lithium toxicity and movement disorders from the antipsychotic. Lithium has a narrow therapeutic range, so its serum level must be checked regularly, especially in a manic patient who may have fluctuating intake or hydration. Elevated lithium levels can cause tremor, confusion, ataxia, GI symptoms, and, in severe cases, seizures or coma. At the same time, haloperidol can produce extrapyramidal symptoms such as acute dystonia, akathisia, parkinsonism, or tardive dyskinesia. By monitoring lithium levels, the nurse can detect and prevent toxicity, and by watching for EPS, the nurse can identify early motor side effects and intervene promptly (adjust dosage, hydration, or add antiparkinsonian measures if needed). This combined monitoring approach minimizes overall risk. Increasing the lithium dose without monitoring risks toxicity, stopping haloperidol once agitation subsides can lead to relapse or withdrawal of control, and simply administering haloperidol without ongoing assessment does not address the safety concerns inherent to this polypharmacy.