# A client taking lithium develops vomiting, a coarse tremor, ataxia, and confusion. Place the nurse's actions in priority order.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=395534&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

A client taking lithium develops vomiting, a coarse tremor, ataxia, and confusion. Place the nurse's actions in priority order.

Institute fall and seizure precautions and reduce environmental stimulation.

Notify the provider or rapid response team according to instability and obtain lithium, electrolyte, and renal studies as ordered.

Stay with the client and assess airway, breathing, circulation, vital signs, neurologic status, hydration, and urine output.

Continue frequent reassessment, document the response, and communicate the updated plan during handoff.

Hold the due lithium dose and prevent additional lithium exposure.

## Explanation

The nurse first assesses and stabilizes the client, then prevents additional lithium exposure. Safety precautions reduce injury from ataxia, confusion, or seizures. Urgent escalation and laboratory evaluation determine severity and treatment. Ongoing reassessment, documentation, and handoff follow.

## In-depth explanation

Correct sequence
Assess and stabilize → hold lithium → protect from injury → escalate and obtain studies → reassess and communicate.

Why this is correct
Vomiting, coarse tremor, ataxia, and confusion are not expected mild effects. Dehydration, sodium loss, reduced renal clearance, diuretics, ACE inhibitors, and NSAIDs can raise lithium exposure. The therapeutic and toxic ranges are close, and symptoms may be serious even before a level returns. The due dose should not be given while toxicity is suspected.

NCLEX decision rule
With suspected medication toxicity, assess immediate stability, stop further exposure when safe within nursing authority, protect the client, escalate, and trend objective response data.Reference
1DailyMed: lithium carbonateNeurologic toxicity, dehydration and sodium risk, renal interactions, and discontinuation or dose reduction

## Clinical scenario

Suspected lithium toxicity
The client recently had diarrhea and started an NSAID. The next lithium dose is due now.

## Key concepts

- **Lithium Toxicity** — Excess lithium effect that can cause GI and neurologic symptoms.
- **Ataxia** — Impaired coordination that can increase fall risk.
- **Serum Lithium Level** — A blood concentration used to monitor lithium therapy and toxicity.

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