A nurse is caring for a client who has sleep dysregulation, poor memory, and poor concentration. When collecting data, which of the following neurotransmitters should the nurse identify as being responsible for the client's manifestations?

A. "Lip smacking and tongue thrusting." These symptoms are more characteristic of tardive dyskinesia, a side effect of long-term antipsychotic use, rather than lithium toxicity. Lithium toxicity primarily affects the gastrointestinal and neurological systems. While movement disorders can occur with severe toxicity, lip smacking and tongue thrusting are not typical early signs.
B. "GI discomfort and poor coordination." A lithium level of 1.6 mEq/L falls within the mild to moderate toxicity range. Early signs include nausea, vomiting, diarrhea, and fine hand tremors. Poor coordination, dizziness, and muscle weakness may also be present as lithium begins affecting the central nervous system. Prompt intervention, such as fluid management and dose adjustment, is necessary to prevent progression to severe toxicity.
C. "Blurred vision and jerking motor movements." Severe lithium toxicity (levels above 2.0 mEq/L) can cause neurological impairments, including tremors, muscle rigidity, and seizures. However, at a level of 1.6 mEq/L, symptoms are generally milder and include gastrointestinal distress and coordination issues. Blurred vision and significant motor dysfunction are more indicative of advanced toxicity.
D. "Fever and fluctuating blood pressure." Autonomic instability, including fever and blood pressure fluctuations, is not a common manifestation of lithium toxicity. These symptoms are more characteristic of conditions such as serotonin syndrome or neuroleptic malignant syndrome. Lithium toxicity primarily presents with gastrointestinal, neurological, and coordination-related symptoms.

A. "Provide reassurance and comfort ensuring the client is safe." Clients with schizophrenia experiencing confusion and thought distortions require reassurance and safety measures first. Confusion can increase the risk of self-harm or agitation, making safety a priority. Comforting the client and providing a structured environment can help reduce anxiety. Ensuring a calm and safe setting supports symptom management and overall well-being.
B. "Ensure the client goes to group activities as planned." While group activities can promote socialization, a client experiencing confusion and thought distortions may struggle to participate. Forcing group engagement without addressing immediate needs can increase distress. Individualized interventions should be prioritized before encouraging group involvement. Ensuring safety and reducing anxiety are more immediate concerns.
C. "Give PRN medications to treat increased hallucinations." PRN medications may help manage symptoms but are not the first priority. Assessing and ensuring safety takes precedence before administering medications. The nurse should first provide reassurance and evaluate the severity of symptoms. Medication is important, but nonpharmacological interventions should be attempted first when possible. Ensuring safety remains the immediate concern in managing schizophrenia-related confusion.
D. "Use distraction such as the television or music." While distraction techniques can be beneficial, they do not directly address confusion or distorted thinking. The client may require more structured interventions to reorient them and provide reassurance. Music or television might help in stable periods but may not be effective in acute distress. Ensuring the client’s safety and reducing distress are higher priorities in immediate care.