NCLEX-RN practice › Psychosocial Integrity
NCLEX question: lithium toxicity after starting ibuprofen
Psychosocial Integrity · Multiple choice · Clinical judgment step: Prioritize hypotheses
Client record
Medication history
Lithium carbonate 300 mg three times daily for 2 years
Started ibuprofen 600 mg three times daily for knee pain 10 days ago
Laboratory results
| Test | Today | 3 months ago |
|---|---|---|
| Lithium (mEq/L) | 1.8 | 0.8 |
| Sodium (mEq/L) | 138 | 139 |
| Creatinine (mg/dL) | 1.3 | 1.0 |
Symptoms
Coarse hand tremor, diarrhea, slurred speech, unsteady gait
A client stable on lithium for bipolar disorder visits the clinic with new symptoms. Based on the client record, what is the most likely cause?
- A. The client took an extra dose by mistake
- B. Lithium-induced hypothyroidism
- C. Hyponatremia from low salt intake
- D. Ibuprofen reduced lithium excretion
Show the answer and rationales
Answer: D
NSAIDs, thiazides and ACE inhibitors reduce lithium clearance. A level above 1.5 mEq/L with coarse tremor, diarrhea and ataxia is toxicity; the drug is held and the provider notified.
- A. Incorrect. There is no history of a dosing error, and the timing matches starting ibuprofen.
- B. Incorrect. Hypothyroidism causes fatigue and weight gain, not a doubled lithium level with neurotoxicity.
- C. Incorrect. Low sodium raises lithium levels, but the sodium is normal.
- D. Correct. Correct. NSAIDs lower renal blood flow and lithium clearance, raising levels. Coarse tremor, GI symptoms, slurred speech and ataxia are signs of moderate toxicity.
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