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Neuro/Psych - Priority Sheet
Lithium Toxicity NCLEX Priority Sheet
Lithium has a narrow therapeutic index. NCLEX commonly tests early GI toxicity, worsening neurologic signs, dehydration, sodium changes, renal function, and interacting drugs.
Study aid - not medical advice. Not a clinical decision tool. For NCLEX pharmacology review only.
Priority 1
What to do first
1. Assess for GI symptoms, tremor, ataxia, confusion, slurred speech, or seizure activity.
2. Check when the lithium level was drawn; trough levels are commonly drawn about 12 hours after the last dose.
3. Review hydration, sodium intake, renal function, and recent NSAID, ACE inhibitor, or diuretic use.
Safety
Hold If
Notify the provider and hold per protocol for suspected toxicity, severe diarrhea or vomiting, dehydration, confusion, ataxia, coarse tremor, seizure, or lithium level above the ordered safe range.
Do not independently adjust sodium, fluids, or lithium dose. Anticipate ordered labs and supportive treatment.
Monitoring
Labs to Watch
Serum lithium: NCLEX memory range is commonly 0.6-1.2 mEq/L for maintenance therapy; toxicity concern rises around 1.5 mEq/L and above.
Watch BUN/Cr, sodium, thyroid function, urine output, and hydration status.
Review Details
NCLEX Review Notes
Key Signs
Early: nausea, vomiting, diarrhea, thirst, polyuria, fine tremor.
Progressing toxicity: coarse tremor, ataxia, confusion, slurred speech, muscle weakness, severe diarrhea.
Severe: seizure, coma, dysrhythmias, or renal injury.
NCLEX Trap
Trap: a patient taking lithium develops vomiting after starting a thiazide diuretic.
Safer answer: recognize dehydration and interacting medication risk, hold per protocol, notify the provider, and anticipate a lithium level and renal labs as ordered.
Sodium Pattern
Memory rule: low sodium or dehydration can increase lithium reabsorption and raise toxicity risk.
Teach consistent fluid and sodium intake. Sudden salt restriction, sweating, vomiting, diarrhea, or diuretic changes are NCLEX warning clues.
Mini Quiz
Question: A patient taking lithium has diarrhea, coarse hand tremor, and new confusion. What should the nurse do first?
Answer: hold lithium per protocol, assess safety and hydration, notify the provider, and anticipate ordered lithium and renal labs.
References
Saunders Comprehensive Review for the NCLEX-RN Examination; Davis's Drug Guide for Nurses; DailyMed lithium carbonate labeling.
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