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Difficulty: MediumPharmacological Therapies

A practical nurse (PN) is assigned to care for a client who has a prescription for a scheduled dose of oral lithium carbonate. Prior to administration, the PN reviews the client's most recent laboratory report, which reveals a serum lithium level of 2.3 mEq/L. Which of the following actions should the PN take in response to this finding?

  1. Withhold the medication and promptly notify the supervising registered nurse or healthcare provider.Answer
  2. B
    Proceed with administering the scheduled dose since the laboratory value is within the expected therapeutic range.
  3. C
    Administer a partial dose of the medication to slowly lower the serum level back to the baseline.
  4. D
    Provide the client with a large glass of water along with the medication to help dilute the elevated serum level.

Answer

The correct action is to withhold the medication and promptly notify the supervising registered nurse or healthcare provider.
The therapeutic range for serum lithium is generally 0.6 to 1.2 mEq/L. A level of 2.3 mEq/L indicates severe toxicity. The priority and safest action for the practical nurse is to withhold the dose to prevent further harm and immediately report the critical laboratory value to the supervising registered nurse or healthcare provider for further medical intervention.

Step-by-Step Solution

1
Analyze the client's laboratory results in relation to the prescribed medication.
The serum lithium level of 2.3 mEq/L is identified as being significantly above the normal therapeutic range (0.6 to 1.2 mEq/L).
Safe medication administration requires knowing therapeutic ranges and recognizing laboratory values that indicate drug toxicity.
2
Determine the appropriate nursing intervention based on the practical nursing scope of practice.
The medication must be withheld to prevent further toxicity, and the abnormal finding must be escalated.
A level of 2.3 mEq/L indicates severe lithium toxicity, which is a critical finding that requires immediate medical evaluation and intervention.

Key Concept

Recognizing medication toxicity and escalating critical laboratory values.
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Topics

Pharmacological Therapies

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