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. To keep the client's environment calm and with minimal daily stimuli: While a calm environment can help manage acute psychotic symptoms, it is a short-term intervention rather than a long-term goal. Long-term management focuses on adherence to treatment and relapse prevention.
B. To be reoriented to their current environment as needed: Reorientation is beneficial for clients experiencing disorientation due to acute psychosis, but it is a short-term intervention. A long-term goal should focus on maintaining stability and preventing future relapse.
C. To ensure the client participates in a walk with staff on a daily basis: Regular physical activity can improve mental health, but it does not directly address medication adherence or long-term relapse prevention. The goal should focus on strategies to maintain treatment compliance.
D. To develop and acknowledge understanding of a relapse plan prior to discharge: A relapse plan helps the client recognize early warning signs, understand medication importance, and seek support when needed, which is essential for long-term symptom management and prevention of future hospitalizations.