Lithium belongs to the drug class: antimanic agents and it is sold under the US brand names: Lithobid, Eskalith, Eskalith-CR. More than 5.7 million American adults or 2.6 percent of the population age 18 or older in any given year have bipolar disorder. Lithium is helping some of this American. It has become one of the first and widely used psychiatric drugs for the treatment of bipolar disorder in the United States, since its approval in the 1970s. It also has become one of the most studied psychiatric medications.
See below for additional resources including:
- 25 new NCLEX style questions, also includes the 3 in the video.
- Written Summery of Beta Blockers
- An audio recording of the video, which you can find here:
1. A 9-year-old child has been prescribed with lithium as a mood stabilizer. His lab results shows his lithium
level of 1.5 mmol/L. The priority nursing diagnosis for this child should be:
A. Activity Intolerance
B. Risk for Aspiration
C. Ineffective Therapeutic Regimen Management
D. Disturbed Thought Process
Children who develop lithium toxicity are prone to seizures and coma. Due to the seizures that can occur the
child is at risk for aspiration during seizure. This can also occur if the child is comatose. Based on Maslow’s
hierarchy of needs, maintaining a paten airway is the priority nursing diagnosis.
2. A client receiving lithium therapy for the treatment of his bipolar disorder has a lithium level of 0.85 mEq/L.
The appropriate nursing action is:
A. Notify the physician immediately
B. Observe the client for signs of toxicity
C. Record the laboratory result in the client’s chart
D. Hold the next dose of lithium
The client’s laboratory result of lithium is within the therapeutic rage 0.6 – 1.5 mEq/L.
3. A nurse was giving health teaching to a client newly prescribed with lithium medication. Which of the
following statement of the client indicates understanding about the medication?
A. “When my mood fluctuates, I can increase the dosage of the medication”
B. “I can still eat my favorite salty food”
C. “I can crush an extended-release tablet, if ever it will be difficult for me to take it whole by mouth”
D. “Drinking too much cranberry juice will help maintain a desirable lithium level”
Clients under lithium therapy don’t need to limit their sodium intake, instead it is recommended to keep salt
intake the same as before prescription of the lithium medication. Increasing the dose of lithium without
evaluating the client’s lab works can cause lithium toxicity, overdose, and renal failure. Extended-release
tablet should be taken whole, it is uniquely made to release the medication slowly in the body, breaking the
pill would cause the drug to be release at one time. Watermelon, cantaloupe, grapefruit juice, and cranberry
juice will not therapeutically help in maintaining desirable lithium level because of its diuretic effect.
4. A client diagnosed with bipolar disorder has been prescribed with lithium (carbonate) by his physician.
Which question will help the nurse identify signs of early lithium toxicity?
A. Have you been experiencing any nausea, vomiting or diarrhea?
B. Do you have frequent headache?
C. Have you been urinating excessively/frequently?
D. Do you experience leg aches over the past few days?
The most common early signs of lithium toxicity is gastrointestinal (GI) disturbance including nausea,
vomiting, or diarrhea. B, C, D assessment question is unrelated to lithium toxicity.
5. A client who has been taking lithium medication for the past few years, recently got pregnant, and she is so
concerned of the effects of the medication to her child. Which of the following statement is true that would
address the client’s concern?
A. Lithium does not cross the placental barrier and poses no risk for the fetus
B. Pregnant woman with diagnosed with bipolar disorder should not take lithium meds
C. Oral contraceptive and lithium medication may result to a false-positive pregnancy test.
D. Lithium should be avoided during the latter part of the first trimester if possible.
Lithium crosses placental barrier and poses the risk for developing birth defects to a fetus. To minimize any
risk to the fetus, lithium should be avoided in the latter part of the first trimester if possible. Option B is
incorrect because it can help control the mother’s manic symptoms with little risk to the fetus in the second
and third trimester. Option C is also incorrect because it is only true with carbamazepine (Tegretol).
6. A client newly diagnosed with bipolar disorder was prescribed with lithium meds. While giving the health
teaching the client keeps asking about why there is a need for frequent blood works. Which of the following
statement of the nurse addressing the client’s question is true:
A. “It will help determine if the medication dosage is still within the therapeutic level”
B. “Frequent blood works is unnecessary once medication is taken as ordered”
C. “It will help identify if the liver has been working properly”
D. “It will monitor if the medication already pass the blood brain barrier”
Lithium levels determine whether an effective dose of lithium is being given to maintain a therapeutic level of
the drug. Lithium blood work aren’t drawn for the reason of figuring out whether the drug pass through the
blood brain barrier or if the liver is working properly. Taking the medication as ordered doesn’t kill the
requirement for blood work.
7. A client under lithium medication reduce his dietary salt intake. Which of the following is expected to show in
his blood work?
A. Decreased lithium level
B. Increased lithium level
C. Increased then decrease in the next result of the lithium blood work
D. No significant changes
There is a direct relationship between the amount of salt and the plasma levels of lithium. Lithium plasma
levels increase when there is a decrease in dietary salt. Increase in dietary salt causes the opposite effect of
decreasing lithium plasma. That’s why it is important that the nurse monitor dietary sodium intake.
8. A female client was prescribed with lithium carbonate 600 mg p.o t.i.d to manage her bipolar disorder. The
nurse would be aware that the teaching given to the client with regards to the medication side effects was
understood when the client make which of the following statement? “I will call my doctor immediately once I
A. Sensitivity to bright light or sun
B. Fine hand tremors or slurred speech
C. Sexual dysfunction or breast enlargement
D. Inability to urinate or difficulty when urinating
These are the common adverse effects of lithium carbonate
9. A client receiving lithium carbonate has a lithium level of 2.3 mEq/L. The nurse will immediately assess the
client for which of the following symptoms?
C. Blurred Vision
D. Fecal incontinence
At lithium levels of 2 -2.5 mEq/L the client will experience blurred vision, muscle twitching, severe
hypotension, and persistent nausea and vomiting. With levels between 1.5 and 2 mEq/L the
client experiencing vomiting, diarrhea, muscle weakness, ataxia, dizziness, slurred speech, and confusion.
At lithium levels of 2.5 to 3 mEq/L or higher, urinary and fecal incontinence occurs, as well as seizures,
cardiac dysrhythmias, peripheral vascular collapse, and death.
10. A client under lithium medication suffered from diarrhea and vomiting. Which of the following nursing
intervention should the nurse in charge do first?
A. Recognize this as a drug interaction
B. Give the client Cogentin
C. Reassure the client that these are common side effects of lithium therapy
D. Hold the next dose and obtain an order for a stat serum lithium level
Diarrhea and vomiting are manifestations of Lithium toxicity. The next dose of lithium should be withheld and
test is done to validate the observation. A. The manifestations are not due to drug interaction. B. Cogentin is
used to manage the extrapyramidal symptom side effects of antipsychotics. C. The common side effects of
Lithium are fine hand tremors, nausea, polyuria and polydipsia.
11. A client’s latest lab result shows her plasma lithium level is 0.2 mEq/L. The nurse can expect to implement
which of the following nursing interventions?
A. Administer an additional oral dose of lithium
B. Infuse 1 L of 0.9% sodium chloride over 4 hr
C. Prepare to give emergency resuscitation
D. Prepare the client immediate for another laboratory draw
This plasma level is subtherapeutic and the client should be given an additional dose. Emergency
resuscitation may be indicated if the client’s laboratory value indicates toxicity. There is no indication that the
client need supplemental fluids. There is no reason to question the laboratory results.
12. A client under your care as a nurse was newly prescribed with lithium carbonate. To prevent lithium toxicity,
the nurse should advise the client to do which of the following?
A. Avoid the use of acetaminophen for headaches
B. Decrease fluid intake to less than 1,500 mL daily
C. Restrict intake of foods rich in sodium
D. Limit aerobic activity in hot weather
Activities that could cause sodium/water depletion should be avoided in order to prevent lithium carbonate
toxicity. Acetaminophen, rather than NSAIDs such as ibuprofen, should be used for headaches because
NSAIDs interact with lithium and could cause increased blood levels of lithium. The client should make sure
to take in enough sodium and increase, rather than decrease fluid intake to prevent toxicity
13. Which of the following is an adverse effect of lithium carbonate taken by a client with bipolar disorder.
C. Urinary retention
Fine hand tremors are a common adverse effect in clients who take lithium. Alopecia is not an adverse
effect of lithium. Diarrhea and polyuria are side effects of lithium.
14. A client has been taking lithium carbonate for the management of bipolar disorder. Which of the following
adverse reaction does the client need to report?
A. Black tongue
B. Increased lacrimation
C. Periods of disorientation
D. Persistent GI upset
Persistent GI upset indicates a mild-to-moderate toxic reaction. Black tongue is an adverse reaction of
mirtazapine (Remeron), not lithium. Increased lacrimation isn’t an adverse effect of lithium. Periods of
disorientation don’t tend to occur with the use of lithium.
15. What information is important to include in the nutritional counseling of a family with a member who has
A. If sufficient roughage isn’t eaten while taking lithium, bowel problems will occur.
B. If the intake of carbohydrate increases, the lithium level will increase
C. If the intake of calories is reduced, the lithium level will increase
D. If the intake of sodium increases, the lithium level will decrease.
Any time the level of sodium increases, such as with a change in dietary intake, the level of lithium will
decrease. The intake of roughage and carbohydrates in the diet isn’t related to metabolism of lithium.
Reducing the number of calories the client eats don’t affect the lithium level in the body.
16. A client with bipolar disorder has been receiving lithium (Eskalith) for 2 weeks. She also has been taking
chemotherapeutic drugs that cause her to feel nauseated and anorexic, making it difficult to distinguish early
signs of lithium toxicity. Which of the following signs would indicate lithium toxicity at serum drug levels
below 1.5 mEq/L?
B. Marked analgesics and lethargy
C. Hypotonic reflexes with muscle weakness
Lithium alters sodium transport in nerve and muscle cells, slowing the speed of impulse transmission, so
look for hypotonic reflexes and muscle weakness. Lithium has no known effect on body temperature nor on
the transmission of pain impulses. The drug doesn’t cause lethargy. Oliguria and other signs of renal failure
occur late in sever lithium toxicity.
17. A client came to the psychiatric unit 2 days ago. She has a history of bipolar disorder, is in the manic phase,
and stopped taking lithium (Eskalith) 2 weeks ago. Which finding would the nurse be least likely to see?
A. Flight of ideas
B. Delusions of grandeur
C. Increased appetite
The manic client is usually unwilling or unable to slow down enough to eat. Flight of ideas, delusions of
grandeur and restlessness are associated with the manic phase.
18. Which discharge instructions is most important for a client taking lithium (Eskalith)?
A. Limit fluid to 1,500 ml daily
B. Maintain a high fluid intake
C. Take advantage of the warm weather by exercising outside whenever possible
D. When feeling a cold coming, it’s okay to take over-the-counter (OTC) remedies
Client taking lithium need to maintain a high fluid intake. Exercising outside may not be safe; photosensitivity
occurs with lithium use, and activity in warm weather could increase sodium loss, predisposing the client to
lithium toxicity. The client shouldn’t take OTC drugs without the physician’s approval.
19. The client taking lithium carbonate (Eskalith) is having difficulty time walking, is confused, agitated and is
complaining of blurred vision. The nurse checks the lithium level drawn earlier in the day, expecting the level
to be within which of the following ranges?
A. 0.5 to .8 mEq/L
B. 1.2 to 1.5 mEq/L
C. 1.5 to 1.8 mEq/L
D. 2.0 to 3.0 mEq/L
The symptoms listed are those of lithium toxicity, and are seen when the serum level is 2 to 3 mEq/L.
20. A man is prescribed with lithium to manage bipolar disorder. The nurse is most concerned about lithium
toxicity when he notices which of these assessment findings?
A. Manic episodes a week ago
B. Having diarrhea every day
C. Client has rashy pruritis on his arms and legs
D. The client presents as severely depressed
Persistent diarrhea can lead to dehydration, which can increase the risk of lithium toxicity. Rashy pruritis is
not a symptoms of lithium toxicity. Having a depressive or manic episodes is not an indication of lithium
toxicity—these findings indicates that the lithium is not effective or is not at a therapeutic level.
21. In giving discharge teaching to a client with a home med lithium carbonate. Which of the following should be
A. Advising the client to watch the diet carefully
B. Suggesting that the client take the pills with milk
C. Reminding the client that a CBC must be done once a month
D. Encouraging the client to have blood levels checked as ordered
Blood levels must be checked monthly or bimonthly when the client is on maintenance therapy because
there is only a small range between therapeutic and toxic levels.
22. A female client with manic episodes is taking lithium. Which electrolyte level should the nurse check before
administering the medication?
Lithium is chemically similar to sodium. If sodium levels are reduced, such as from sweating or diuresis,
lithium will be reabsorbed by the kidneys, increasing the risk of toxicity. Clients taking lithium shouldn’t
restrict their intake of sodium and should drink adequate amounts of fluid each day. The other electrolytes
are important for normal body functions but sodium is most important to the absorption of lithium.
23. A client on lithium has suffered from diarrhea and vomiting. Which of the following is the priority nursing
intervention of the nurse in-charge?
A. Reassure the client that these are common side effects of lithium therapy
B. Recognized this as a drug interaction
C. Give the client Cogentin
D. Hold the next dose and obtain an order for a stat serum lithium level
Diarrhea and vomiting are manifestations of lithium toxicity. The next dose of lithium should be withheld and
test is done to validate the observation. These manifestations are not due to drug interaction. Cogentin is
used to manage extrapyramidal symptom side effects of antipsychotics. The common side effects of lithium
are fine hand tremors, nausea, polyuria and polydipsia.
24. A physician prescribes lithium for a client diagnosed with bipolar disorder. The nurse needs to provide
appropriate education for the client on this drug. Which topic should the nurse cover? Select all that apply.
A. The potential for addiction
B. Signs and symptoms of drug toxicity
C. The potential for tardive dyskinesia
D. A low-tyramine diet
E. The need for consistently monitor blood levels
F. Changes in his mood that may take 7 to 21 days
Answer: B, E, F
Client education should cover the signs and symptoms of drug toxicity as well as the need to report them to
the physician. The client should be instructed to monitor his lithium levels on regular basis to avoid toxicity.
The nurse should explain that 7 to 21 days may pass before the client notes a change in his mood. Lithium
does not have addictive properties. Tyramine is a potential concern to clients taking monoamine-oxidase
25. A client with bipolar disorder was prescribed with lithium (Eskalith). Upon giving teaching, the nurse
instructed the client to report severe signs of toxicity? Select all that apply.
B. Blurred vision
C. Slurred speech
Answer: A, B, D, E
Slurred speech can be seen as early signs of toxicity.