# A client on lithium for bipolar disorder reports coarse hand tremor, nausea, and diarrhea. Serum lithium level is 1.8 mEq/L. For each group, select all responses that apply.

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=620040&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

A client on lithium for bipolar disorder reports coarse hand tremor, nausea, and diarrhea. Serum lithium level is 1.8 mEq/L. For each group, select all responses that apply.

Nursing actions

Hold the next dose of lithium

Notify the healthcare provider

Administer the scheduled lithium

Encourage increased sodium intake

Client teaching to prevent recurrence

Maintain consistent sodium and fluid intake

Report vomiting or diarrhea promptly

Take lithium on an empty stomach

Use over-the-counter NSAIDs for headaches

## Explanation

Lithium level 1.8 mEq/L indicates toxicity (therapeutic range 0.6-1.2 mEq/L). The nurse should hold the dose and notify the provider. Increasing sodium intake is not an immediate action and may be harmful. To prevent recurrence, clients should maintain stable sodium and fluid intake because dehydration or low sodium increases lithium levels, and report vomiting or diarrhea which can cause dehydration. Lithium should be taken with food to reduce GI upset, and NSAIDs can increase lithium levels by reducing renal clearance.

## In-depth explanation

Quick answer
Lithium level 1.8 mEq/L indicates toxicity (therapeutic range 0.6-1.2 mEq/L). The nurse should hold the dose and notify the provider. Increasing sodium intake is not an immediate action and may be harmful. To prevent recurrence, clients should maintain stable sodium and fluid intake because dehydration or low sodium increases lithium levels, and report vomiting or diarrhea which can cause dehydration. Lithium should be taken with food to reduce GI upset, and NSAIDs can increase lithium levels by reducing renal clearance.
Key cues
Use the client-specific assessment findings and timing in the scenario rather than a memorized diagnosis label.
Clinical reasoning
Connect the relevant cues to the safest nursing interpretation and action for this exact care setting.
Why the alternatives do not fit
The distractors are plausible in another context but are unsupported, mistimed, lower priority, or incomplete for the findings presented.
Priority and safety
Address immediate threats first, stay within nursing scope, and reassess the client after the selected intervention.
Takeaway
For lithium toxicity, select responses that are both clinically supported and appropriate at this point in care.
**Sources**
- FDA Drug Safety Information

## Clinical scenario

A client on lithium for bipolar disorder reports coarse hand tremor, nausea, and diarrhea. Serum lithium level is 1.8 mEq/L. For each group, select all responses that apply.

## Key concepts

- **lithium toxicity** — Adverse effects occurring at serum levels above therapeutic range, including GI, neurologic, and renal symptoms.
- **therapeutic range** — Serum concentration range where drug is effective and safe; for lithium, 0.6-1.2 mEq/L.
- **NSAIDs** — Nonsteroidal anti-inflammatory drugs that can increase lithium levels by decreasing renal excretion.

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