A nurse is reviewing the laboratory report of a client who has bipolar disorder prior to the administration of lithium carbonate. The client's lithium level is 2.6 mEq/L (0.8 to 1.2 mEq/L). Which of the following actions should the nurse take?

Lithium carbonate is a mood stabilizer primarily utilized for bipolar disorder to manage manic episodes. It has a very narrow therapeutic index, typically 0.6 to 1.2 mEq/L, and levels exceeding 2.5 mEq/L indicate severe toxicity. This state can lead to seizures, coma, cardiovascular collapse, and permanent neurological impairment. Rationale: A. A serum lithium level of 2.6 mEq/L represents severe lithium toxicity, which is a life-threatening medical emergency. Hemodialysis is the treatment of choice for levels above 2.5 mEq/L because it is the most effective method for rapidly clearing lithium from the blood. The nurse must prioritize this intervention to prevent irreversible organ damage and death from profound central nervous system depression. B. Placing the client on a low-sodium diet is contraindicated and dangerous in the context of lithium therapy and toxicity. The kidneys process lithium and sodium similarly; therefore, a reduction in sodium intake causes the renal tubules to reabsorb more lithium. This would further elevate the serum lithium level, exacerbating the toxic state rather than resolving the current clinical emergency. C. Obtaining a prescription for an NSAID is inappropriate because nonsteroidal anti-inflammatory drugs significantly increase lithium levels by reducing renal blood flow and lithium clearance. Administering an NSAID to a client already experiencing severe toxicity would be a critical pharmacological error. The nurse should instead ensure that all medications that interfere with renal excretion of lithium are strictly avoided. D. Implementing fluid restrictions is incorrect because dehydration and volume depletion are major triggers for lithium toxicity. Adequate hydration and sodium intake are necessary to facilitate the renal excretion of lithium ions. In cases of toxicity, aggressive intravenous fluid resuscitation is often required to maintain glomerular filtration, rather than restricting fluid intake which would worsen the condition.