A nurse is reinforcing education to a client who is prescribed clozapine. Which of the following findings should the nurse identify as consistent with agranulocytosis and instruct the client to monitor?

A. Engaging in extracurricular activities. Participating in extracurricular activities is generally associated with social support and positive mental health. Individuals involved in structured activities often have a sense of purpose and connection, which can be protective against suicide rather than a risk factor.
B. Loss of a job. Job loss is a significant risk factor for suicide due to its impact on financial stability, self-esteem, and emotional well-being. Unemployment can lead to feelings of hopelessness, social isolation, and increased stress, all of which contribute to a higher suicide risk.
C. Financial stability. Financial stability generally reduces stress and provides security, lowering the likelihood of suicidal ideation. While financial difficulties can be a risk factor, having stable finances is not associated with increased suicide risk.
D. Exercising caution in behavior. Practicing caution in behavior reflects awareness of potential dangers and a tendency to avoid reckless or impulsive actions. Individuals who take precautions in their daily lives are less likely to engage in high-risk behaviors that could lead to suicide.

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.