# A client taking lithium for bipolar disorder reports vomiting and diarrhea for 2 days. The client also started ibuprofen for back pain. The nurse notes coarse hand tremor and unsteady gait. Which action should the nurse take first?

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375323&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A client taking lithium for bipolar disorder reports vomiting and diarrhea for 2 days. The client also started ibuprofen for back pain. The nurse notes coarse hand tremor and unsteady gait. Which action should the nurse take first?

## Option

1. Administer the next lithium dose early to prevent acute mood relapse; encourage oral fluids for rehydration.
2. Teach the client to take lithium with meals to lessen nausea and recheck the lithium level at the next appointment.
3. Hold lithium and notify the prescriber; anticipate serum lithium, BMP, hydration, and toxicity evaluation. **✔ Correct answer**
4. Recommend a low-sodium diet to reduce lithium-associated fluid retention; monitor daily weights and edema.

**Correct answer: 3**

## Explanation

Vomiting, diarrhea, dehydration, NSAID use, coarse tremor, and ataxia are red flags for lithium toxicity. NSAIDs can reduce renal lithium clearance. The priority is to hold the medication, notify the prescriber, check lithium level and renal/electrolyte labs, and correct dehydration.

## In-depth explanation

Caution Lithium behaves like sodium in the kidney. Dehydration, sodium depletion, NSAIDs, ACE inhibitors, ARBs, and thiazides can increase lithium levels.

## Clinical scenario

Scenario Lithium + GI fluid loss + ibuprofen + coarse tremor/ataxia.

## Key concepts

- **Lithium toxicity** — Early toxicity includes GI upset and fine tremor; worsening toxicity includes coarse tremor, confusion, ataxia, dysarthria, and seizures.
- **NSAID interaction** — NSAIDs decrease renal perfusion/prostaglandins and can reduce lithium clearance, increasing toxicity risk.
- **Hydration and sodium** — Consistent fluid and sodium intake helps prevent lithium level swings; low-sodium diets can increase lithium reabsorption.

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