Review the client's changing hydration, renal, neurologic, and lithium data and determine the priority response.
Trend
Choose your responses, then check the answer.
Explanation
Volume and sodium depletion increase renal lithium reabsorption, and worsening kidney function reduces lithium clearance. NSAIDs can further increase lithium exposure. The progression from gastrointestinal illness to coarse tremor, vomiting, ataxia, and confusion with rising lithium and creatinine indicates toxicity. The nurse should hold lithium, notify the prescriber urgently, begin indicated isotonic fluid support, obtain serial lithium, renal, electrolyte, neurologic, and cardiac assessments, and escalate for toxicology or dialysis consultation when severity or trajectory warrants. Giving the next dose or treating tremor alone is unsafe.
Correct Answer The client has worsening lithium toxicity promoted by dehydration, sodium depletion, NSAID exposure, and renal impairment.
Why It Fits Neurologic and gastrointestinal symptoms intensify while lithium and creatinine rise after volume loss and ibuprofen use.
Clinical Picture The serum value supports the diagnosis, but treatment urgency also depends on symptoms, renal function, chronicity, and trajectory.
Memory Link Lithium follows sodium and kidney clearance; dry kidneys retain it.
NCLEX Rule Hold lithium and urgently correct volume and electrolyte disturbances while monitoring neurologic, renal, cardiac, and serial drug data; severe cases need expert dialysis evaluation.
Why the Alternatives Fail Continuing lithium, adding an NSAID, or focusing only on the tremor allows systemic toxicity to progress.
Sources
1DailyMed Lithium Carbonate Prescribing Information
2NCSBN 2026 NCLEX-RN Test Plan
Medical unitAn adult takes lithium carbonate for bipolar disorder. The client develops gastroenteritis, continues the usual lithium dose, and takes over-the-counter ibuprofen for fever. The nurse reviews serial findings.
Lithium toxicity — A potentially serious toxic state with gastrointestinal, neurologic, renal, and cardiac manifestations from excessive lithium exposure.
Coarse tremor — A prominent, irregular tremor that is more concerning for lithium toxicity than a mild fine tremor.
Renal clearance — Removal of a substance by the kidneys; declining clearance increases lithium accumulation.