# The nurse reviews follow-up data for clients taking lithium. Which findings require immediate follow-up? Highlight the findings associated with possible lithium toxicity.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=494269&lang=en  
> language: en  
> subject: Medication Administration  
> category: PPT

## Question

The nurse reviews follow-up data for clients taking lithium. Which findings require immediate follow-up? Highlight the findings associated with possible lithium toxicity.

| Treatment context | Current finding |
| --- | --- |
| Lithium was taken this morning at the usual prescribed dose. | Vomiting and diarrhea continue, with little fluid intake today. |
| The client keeps the scheduled laboratory and clinic appointments. | Serum lithium is 0.8 mEq/L, and mood symptoms are improving. |
| The client reports no fever, diarrhea, vomiting, or heavy sweating. | Daily salt intake follows the established meal plan, water is carried throughout each workday, and no dietary change is planned. |
| The client needed support while walking from the waiting room. | A coarse hand tremor and unsteady gait began this afternoon. |
| Renal and thyroid monitoring is already scheduled for next month. | Mild thirst is unchanged, and urine output remains consistent. |
| The client also reports increasing nausea and muscle weakness. | Serum lithium is 1.8 mEq/L after naproxen was started this week. |
| Meals and fluid intake have remained normal for the past week. | Brief nausea on the first treatment day resolved without return. |
| The prescribed dose and serum level have remained unchanged. | A fine hand tremor is unchanged from the previous two visits. |
| A family member reports increasing drowsiness since yesterday. | New confusion and slurred speech are present during the visit. |

## 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.

## In-depth explanation

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.

Memory hook
Dry, drug interaction, coarse tremor, confusion: suspect lithium rising.

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

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