# A client taking lithium reports vomiting, coarse hand tremors, and new confusion. Which action should the nurse take first?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=394022&lang=en  
> language: en  
> subject: Medication Administration  
> category: PPT

## Question

A client taking lithium reports vomiting, coarse hand tremors, and new confusion. Which action should the nurse take first?

## Option

1. Hold the lithium and notify the health care provider. **✔ Correct answer**
2. Give the next dose with a full glass of water.
3. Tell the client these effects are expected during early therapy.
4. Encourage the client to restrict sodium intake.

**Correct answer: 1**

## Explanation

Vomiting, coarse tremor, and confusion are concerning for lithium toxicity. The nurse should hold lithium, assess the client, and notify the provider for lithium level and treatment orders. Restricting sodium can increase lithium retention and worsen toxicity risk.

## In-depth explanation

Clinical Judgment
Lithium has a narrow safety margin, so neurologic change plus gastrointestinal symptoms is a medication-safety alarm.

Memory Tip
Lithium toxicity: GI upset, tremor, confusion.

KR vs US
NCLEX medication questions expect holding a potentially toxic medication before giving the next dose.

## Clinical scenario

Clinical Practice Guide
MedlinePlus lists lithium toxicity symptoms such as vomiting, tremor, confusion, and slurred speech, and describes the need for timely help and lithium level evaluation.

Caution
Dehydration, sodium changes, kidney problems, and interacting drugs can raise lithium toxicity risk.

## Key concepts

- **Lithium** — A mood stabilizer used for bipolar disorder that requires monitoring because toxicity can occur.
- **Therapeutic Index** — The margin between an effective dose and a toxic dose.
- **Coarse Tremor** — A larger, more obvious tremor that may signal medication toxicity or neurologic compromise.

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