Practice Question
A nurse reviews the laboratory report for a client who is receiving lithium three times daily PO. The client's current blood lithium level is 1.8 mEq/L. The number of identified infections that this lab value indicates which of the following?
Answer Choices:
Correct Answer:
The lithium level is at the toxic level.
Rationale:
💠 The usual therapeutic range for lithium is approximately 0.6–1.2 mEq/L, with maintenance often closer to 0.6–1.0 mEq/L.
💠 A level of 1.8 mEq/L is above the therapeutic range and is considered toxic in most clinical and exam references.
💠 At this level, clients are at risk for early lithium toxicity symptoms such as coarse tremors, nausea, vomiting, diarrhea, and muscle weakness.
💠 If levels continue to rise, more severe toxicity can cause confusion, ataxia, seizures, and even coma.
💠 The nurse must withhold the next dose, notify the provider, assess the client, and anticipate interventions such as IV fluids or possible hemodialysis depending on severity.
Below therapeutic treatment level
💠 A lithium level that is below therapeutic would be less than about 0.6 mEq/L and would not adequately control manic symptoms.
💠 At 1.8 mEq/L, the value is clearly higher than the upper therapeutic limit and cannot be described as “below” therapeutic.
💠 Mislabeling a toxic level as subtherapeutic could lead the nurse to incorrectly administer more lithium, worsening toxicity.
💠 Nurses must be very familiar with the specific therapeutic range for mood stabilizers like lithium.
💠 Because 1.8 is higher than 1.2, this option is physiologically inaccurate and unsafe.
Within the maintenance treatment level
💠 The maintenance level for lithium is usually between 0.6–1.0 mEq/L, which helps control manic and depressive episodes long term.
💠 A level of 1.8 mEq/L is nearly double the upper limit of maintenance range, so it cannot be considered safe or stable.
💠 Calling 1.8 mEq/L a maintenance level would ignore the risk for toxicity manifestations such as GI upset, tremor, and neurologic changes.
💠 This misunderstanding could prevent the nurse from quickly intervening to protect the client.
💠 For exam safety, anything at or above about 1.5 mEq/L should immediately trigger “toxic” in your mind.
Within the therapeutic level for initial treatment
💠 The acute or initial therapeutic range for lithium is often cited up to about 1.5 mEq/L, still lower than 1.8 mEq/L.
💠 While some sources may allow slightly higher levels during acute mania, 1.8 mEq/L is consistently regarded as toxic for NCLEX-style questions.
💠 Describing this level as “therapeutic” would delay treatment, risking serious neurologic complications.
💠 Nurses must err on the side of safety, recognizing that higher levels correlate with toxicity.
💠 Thus, this option is misleading and not acceptable for safe clinical practice.
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This question is from ☑️Custom-25Q4 218 Exam 5 which contains 30 questions.
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Question Details
- Category: RN Nursing Exam(s)
- Subcategory: ATI Exam(s)
- Domain: RN ATI MedSurg
- Answer Choices: 4