A client with bipolar disorder taking lithium returns from a walk outside and reports feeling shaky and dizzy. The nurse suspects the client is experiencing a toxic reaction to the lithium and immediately notifies the:

Choice A reason: The nurse manager is responsible for administrative oversight, staffing, and unit operations. While they may be informed of serious events, they are not the immediate clinical authority to address suspected lithium toxicity. Lithium toxicity is a medical emergency requiring physician intervention, not administrative management. Choice B reason: The psychiatric nurse is skilled in monitoring mental health symptoms and providing therapeutic interventions. However, the psychiatric nurse does not have the authority to prescribe or adjust medications. While they can support the client and report findings, they cannot directly intervene in the pharmacological management of lithium toxicity. Choice C reason: The psychiatrist is the correct person to notify because they are the prescribing provider responsible for managing the client’s medication regimen. Lithium toxicity can cause neurological and systemic complications such as tremors, dizziness, confusion, and even seizures. Immediate medical evaluation and possible discontinuation or adjustment of lithium are required. The psychiatrist can order serum lithium levels, initiate treatment such as IV fluids to enhance excretion, and determine whether hospitalization is necessary. Choice D reason: The recreation therapist focuses on promoting psychosocial well-being through activities and leisure interventions. They do not have the medical expertise or authority to manage medication toxicity. Notifying them would not address the urgent clinical need of suspected lithium toxicity.