The nurse is caring for a client who has a lithium level of 2.2 mEq/L. Based on this lab value, what would the nurse anticipate to do in order to care for this client?

Select all that apply.
  1. prepare to administer IV fluids
  2. notify the health care provider
  3. order a mechanical soft diet for the client
  4. administer the next dose of lithium when it is due
  5. observe the client for confusion and slurred speech
Numbers 1, 2, and 5 are correct.
Rationale: Lithium has a narrow therapeutic range of 0.6 to 1.2 mEq/L. A level of 2.2 mEq/L indicates moderate toxicity. The nurse should notify the health care provider immediately, as severe toxicity can cause tonic-clonic seizures, coma, or death. Treatment typically involves administering IV fluids to dilute the concentration of the medication, holding the medication, and possible hemodialysis in severe cases. The client may exhibit signs of toxicity such as confusion, slurred speech, and severe diarrhea. A mechanical soft diet will not treat the toxicity. The nurse would hold the next dose and prepare to draw lab work, including lithium and electrolyte levels, BUN and creatinine, and a CBC.