The nurse reviews follow-up data for clients taking lithium. Which findings require immediate follow-up? Highlight the findings associated with possible lithium toxicity.
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Choose your responses, then check the answer.
Explanation
Dehydrating illness, coarse tremor with ataxia, an elevated level after NSAID use, and new confusion with slurred speech can indicate lithium toxicity. Stable levels and consistent fluid and sodium intake are safer findings.
Quick answer Follow up immediately on vomiting and diarrhea with reduced intake, coarse tremor with an unsteady gait, a lithium level of 1.8 mEq/L after starting naproxen, and new confusion with slurred speech.
Why this is correct Lithium has a narrow safety margin. Dehydration and sodium loss can raise lithium exposure, NSAIDs may increase the concentration, and worsening neurologic findings can signal toxicity.[2]
Easy analogy or mental picture Picture lithium traveling in a narrow canal beside water and sodium. When water or sodium drops, or kidney clearance slows, the lithium level can rise over the canal wall. This picture organizes risk but does not replace a serum level and clinical assessment.
NCLEX decision rule For a medication with a narrow therapeutic range, connect new illness, hydration or sodium change, interacting medicines, laboratory results, and neurologic status. Escalate the pattern rather than judging one isolated symptom.
Why the other choices are wrong A level within the prescribed range, consistent salt and fluid intake, stable mild thirst with planned monitoring, resolved early nausea, and an unchanged fine tremor do not show the same acute toxic pattern. Continue routine monitoring and teaching.
References
[1]
NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing
[2]
DailyMed: Lithium CarbonateU.S. National Library of Medicine