# Stage 6 — Evaluate outcomes. Review the clinical trend and answer both questions.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=568863&lang=en  
> language: en  
> subject: Psychosocial Integrity  
> category: PSI

## Question

Stage 6 — Evaluate outcomes. Review the clinical trend and answer both questions.

| Time | Data |
| --- | --- |
| Arrival | Lithium 2.3; creatinine 1.8; coarse tremor; ataxia; confusion; bradycardia with PVCs |
| 6 hours | Lithium 1.9; creatinine 1.5; persistent dysarthria and unsteady gait; nephrology begins dialysis |
| After dialysis | Lithium 0.8; alert; speech clearer; rhythm sinus 68/min; repeat level planned for rebound |
| 24 hours | Lithium 0.7; creatinine 1.1; gait steady; no confusion, mania, psychosis, or suicidal intent |

Q1. Which interpretation is best supported at 24 hours?

Neurologic toxicity is progressing
A normal mood exam proves lithium can restart now
Kidney injury is worsening despite treatment
Medical toxicity is resolving without current acute behavioral destabilization

Q2. Which discharge-planning action is most appropriate?

Resume the previous regimen without medication reconciliation
Use coordinated psychiatry and medical follow-up to select and monitor the future mood-stabilizing plan
Advise permanent avoidance of all dietary sodium
Allow independent use of ibuprofen if pain returns

## Explanation

Falling lithium and creatinine with resolution of ataxia, confusion, dysarthria, and ectopy indicate medical recovery. Restarting or replacing mood-stabilizing therapy requires deliberate psychiatry, nephrology, medication-interaction, and follow-up planning rather than automatic resumption.

## In-depth explanation

Quick answer
Medical toxicity is resolving, while future bipolar treatment still needs coordinated, monitored planning.

Why this is correct
Neurologic, cardiac, renal, and serial lithium data all improve. Absence of acute behavioral symptoms is reassuring but does not by itself select the next long-term medication plan.

Easy analogy or mental picture
The emergency fire is out, but the heating system still needs a safer redesign before it is switched back on.

Memory hook
Recovery first; mood-plan restart second and coordinated.

NCLEX decision rule
Evaluate both physiologic recovery and behavioral-health continuity; neither should erase the other.

Why the other choices are wrong
Automatic restart, sodium elimination, and unscreened NSAID use recreate the factors that caused toxicity.

References
1Lithium Carbonate Capsules Prescribing InformationLithium toxicity manifestations, dehydration risk, renal impairment, monitoring, and patient counseling
2Lithium and Lithium Carbonate Full Prescribing InformationDiuretic, NSAID, sodium, hydration, renal clearance, and serum monitoring interactions

## Clinical scenario

Case update
The client receives isotonic fluid and one hemodialysis treatment. Medical and behavioral-health teams evaluate recovery and the future treatment plan.

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