A nurse is reviewing laboratory results for a client and notes a serum lithium level of 1.6 mEq/L. Which of the following manifestations should the nurse expect the client to report?

Choice A reason: Lip smacking and tongue thrusting are extrapyramidal symptoms (EPS), often associated with antipsychotic medications, not lithium toxicity. These are signs of tardive dyskinesia rather than lithium-related effects. Choice B reason: Fever and fluctuating blood pressure are characteristic of neuroleptic malignant syndrome, a rare but serious reaction to antipsychotics. They are not typical of lithium toxicity. Choice C reason: Blurred vision and jerking motor movements may occur with seizure activity or severe neurological impairment, but they are not early or expected manifestations of lithium toxicity at 1.6 mEq/L. Choice D reason: Gastrointestinal discomfort (nausea, vomiting, diarrhea) and poor coordination (ataxia) are hallmark signs of lithium toxicity. At 1.6 mEq/L, the client is above the therapeutic range, and these symptoms are expected. This makes D the correct answer.