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The focus for a nurse monitoring a client on lithium therapy is primarily on serum lithium levels. Lithium is a mood-stabilizing medication often used in the treatment of bipolar disorder, and it has a narrow therapeutic window. This means that maintaining serum lithium levels within a specific range is crucial to ensure efficacy while minimizing the risk of toxicity. Regular monitoring helps in adjusting dosages as needed and early detection of potential side effects.

While blood glucose levels, serum potassium levels, and urine output may be relevant in different clinical contexts or with other medications, they are not the primary concerns when it comes to lithium therapy. Blood glucose levels are more critical in patients with diabetes or when administering certain other medications. Serum potassium levels are more closely related to medications that affect the heart, like diuretics, and urine output becomes a concern primarily in the context of renal function or hydration status, rather than specifically with lithium. Thus, monitoring serum lithium levels is key to the safe management of a client on this medication.