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Difficulty: HardPharmacological Therapies

A practical nurse (PN) is assigned to care for a 74-year-old client who receives a daily scheduled dose of oral lithium carbonate. During morning rounds, the client is acutely disoriented, exhibits a coarse bilateral hand tremor, and reports severe nausea. The laboratory report from earlier this morning indicates a serum lithium level of 1.9 mEq/L. Which of the following actions should the PN take first?

  1. Withhold the scheduled dose of lithium carbonate and immediately report the findings to the registered nurse.Answer
  2. B
    Administer the scheduled medication with a small snack and document the coarse tremor in the medical record.
  3. C
    Reorient the client to the facility, assuming the sudden disorientation is a normal age-related change.
  4. D
    Prepare to administer a prescribed intravenous push antiemetic to promptly address the client's severe nausea.

Answer

The correct action is to withhold the scheduled dose of lithium carbonate and immediately notify the registered nurse.
A serum lithium level of 1.9 mEq/L is well above the therapeutic range (0.6 to 1.2 mEq/L) and indicates severe toxicity. The client's symptoms of acute disorientation, coarse tremors, and severe nausea strongly correlate with this dangerous drug level. The priority and safest action within the practical nurse's scope is to hold the next dose to prevent worsening toxicity and to immediately escalate the finding to the registered nurse for further medical orders.

Step-by-Step Solution

1
Analyze the client's serum lithium level.
The level is 1.9 mEq/L, which exceeds the normal therapeutic range of 0.6 to 1.2 mEq/L.
Identifying that the laboratory value represents severe toxicity is the necessary first step in clinical decision-making.
2
Correlate the laboratory data with the client's clinical manifestations.
The acute disorientation, coarse hand tremor, and severe nausea are classic neurological and gastrointestinal signs of advanced lithium toxicity.
Clinical signs confirm the urgency of the elevated laboratory value and rule out a false laboratory reading.
3
Determine the appropriate intervention within the practical nurse scope of practice.
The medication must be withheld to prevent further harm, and the registered nurse must be notified immediately to escalate care.
The PN is responsible for safe medication administration, which includes withholding unsafe doses and reporting critical changes in client status to the supervising RN.

Key Concept

Lithium toxicity recognition and practical nurse scope of practice in prioritizing critical laboratory values.
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Topics

Pharmacological Therapies

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