A nurse is preparing a list of actions to take immediately following a tornado that damaged a local school, leaving multiple casualties. Which of the following actions should the nurse plan to take first as part of the disaster response?

A. Blurred vision: Blurred vision is a possible side effect of many antipsychotic medications, including ziprasidone, but it is not a contraindication. It should be monitored and reported if persistent, but it does not prevent the use of the medication.

B. History of cholelithiasis: A history of gallstones (cholelithiasis) is not a contraindication for ziprasidone. While metabolic changes and weight gain may be monitored with long-term antipsychotic use, prior cholelithiasis does not pose an acute risk that would prevent prescribing ziprasidone.

C. Fine hand tremors: Fine tremors may be associated with underlying neurological or metabolic conditions, or could be an early extrapyramidal symptom, but they are not an absolute contraindication for ziprasidone. The nurse should monitor for worsening movement disorders during therapy.

D. History of prolonged QT interval: Ziprasidone is contraindicated in clients with a history of prolonged QT interval because it can further prolong cardiac repolarization, increasing the risk of torsades de pointes and sudden cardiac death. Baseline and ongoing ECG monitoring is essential for safety, and use in this population should be avoided.

A. Avoid making eye contact when speaking to the client: Maintaining appropriate eye contact is important for building trust and therapeutic rapport. Avoiding eye contact may make the client feel ignored or increase anxiety, which can worsen hallucinations. Eye contact should be balanced and nonthreatening.

B. Encourage the client to rest quietly in their room until the voices subside: Isolating the client may exacerbate hallucinations or increase feelings of fear and paranoia. Active assessment and engagement are more effective than passive waiting for symptoms to resolve. The nurse should monitor the client and provide interventions to ensure safety.

C. Determine if the client is experiencing command hallucinations: Assessing for command hallucinations is a priority because they can instruct the client to harm themselves or others. Early identification allows the nurse to implement safety measures, provide appropriate interventions, and involve the healthcare team to reduce risk.

D. Gently touch the client on the arm when speaking: Physical touch can be misinterpreted by clients experiencing hallucinations or psychosis and may increase agitation or mistrust. Touch should only be used with caution and with explicit consent, and other noninvasive communication strategies are preferred.