# A client taking lithium calls after several days of vomiting and diarrhea. Which action should the nurse take first?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=522090&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

A client taking lithium calls after several days of vomiting and diarrhea. Which action should the nurse take first?

History

Vitals

Labs

Orders

Notes

Bipolar disorder treated with lithium; vomiting and diarrhea for 3 days

(데이터 없음)

Creatinine 1.9 mg/dL from 0.9 mg/dL; sodium 130 mEq/L; urgent lithium level pending

(데이터 없음)

(데이터 없음)

1

Take the scheduled lithium with ibuprofen and reduce oral fluids.

✕

2

Hold lithium and obtain urgent evaluation for toxicity and renal and electrolyte abnormalities.

✕

3

Double the next lithium dose after the vomiting stops.

✕

4

Continue lithium and wait for a future routine level.

✕

## Explanation

Volume and sodium depletion, NSAID use, coarse tremor, ataxia, confusion, and renal impairment strongly suggest lithium toxicity and require withholding and urgent evaluation.

## In-depth explanation

Quick answer
Stop for dehydration plus neurologic lithium toxicity.

Why this is correct
Lithium has a narrow therapeutic range. Dehydration and NSAIDs can reduce renal clearance and increase serum lithium concentrations.

Easy analogy or mental picture
Treat medication safety like airway triage: identify the threat, interrupt exposure, support physiology, and verify a durable response.

Memory hook
Cue, risk, action, response, recurrence check.

NCLEX decision rule
Choose the action that prevents the most immediate medication-related harm while preserving reassessment and escalation.

Why the other choices are wrong
Options that normalize deterioration, add interacting medication, or delay rescue leave the safety loop open.References
1DailyMed: Lithium CarbonateToxicity with dehydration, renal impairment, sodium depletion, NSAIDs, and neurologic symptoms

## Clinical scenario

Medication safety review
Verify the indication, current assessment, respiratory and neurologic status, interactions, authorized rescue action, and measurable follow-up.

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