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Difficulty: HardPharmacological Therapies

A practical nurse (PN) is assigned to care for a 7474-year-old client who is prescribed daily oral lithium carbonate for the management of bipolar disorder. The client's morning laboratory panel reveals a serum lithium level of 1.91.9 mEq/L and a serum sodium level of 130130 mEq/L. During data collection, the PN notes that the client is exhibiting a coarse hand tremor, ataxia, and new-onset acute confusion. Which of the following is the priority action for the PN?

  1. Withhold the scheduled medication dose and immediately notify the registered nurse (RN) of the clinical findings.Answer
  2. B
    Proceed with administering the prescribed dose because the laboratory values are within the expected therapeutic range.
  3. C
    Document the cognitive changes in the medical record as an expected manifestation of the normal aging process.
  4. D
    Describe the medical procedures required to treat toxicity and obtain the client's signature on a procedural consent form.

Answer

The correct action is to withhold the scheduled medication dose and immediately notify the registered nurse (RN) of the clinical findings.
The client is exhibiting clear physiological and laboratory signs of lithium toxicity, which constitutes a medical emergency. The therapeutic range for maintenance lithium is 0.60.6 to 1.21.2 mEq/L; a level of 1.91.9 mEq/L is highly toxic. Furthermore, the client's hyponatremia (sodium level of 130130 mEq/L) causes the kidneys to resorb lithium instead of excreting it, worsening the toxicity. The safest and most appropriate action within the PN scope of practice is to withhold the scheduled dose and immediately report these critical, life-threatening findings to the supervising RN or provider.

Step-by-Step Solution

1
Analyze the client's laboratory results in the context of the prescribed medication.
The serum lithium level of 1.91.9 mEq/L is critically high (therapeutic range is 0.60.6 to 1.21.2 mEq/L). The serum sodium level of 130130 mEq/L indicates hyponatremia.
Hyponatremia causes the kidneys to retain lithium, significantly increasing the risk and severity of lithium toxicity.
2
Correlate the laboratory data with the client's physical assessment findings.
The client exhibits coarse hand tremors, ataxia, and acute confusion.
These are classic, dangerous neurological manifestations of advanced lithium toxicity that require immediate medical intervention.
3
Determine the safest appropriate intervention within the practical nurse (PN) scope of practice.
The PN must withhold the medication to prevent further harm and urgently report the findings to the RN or healthcare provider.
Administering the medication would worsen the toxicity, and managing a toxic overdose requires RN and provider-level interventions.

Key Concept

Monitoring Narrow Therapeutic Index Medications and Scope of Practice
Estimated Time:1m 30s
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Topics

Pharmacological Therapies

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