A client is treated for psychosis with fluphenazine. What drug will the nurse anticipate to given to prevent the development of acute dystonia?

Many antipsychotic medications, such as fluphenazine, have anticholinergic side effects due to their blockade of muscarinic receptors. These effects—dry mouth, blurred vision, constipation, and urinary retention—can significantly impact comfort and adherence. Nurses play a key role in teaching clients self-care strategies to reduce these symptoms and maintain compliance with therapy.

Rationale for correct answer:

B. Chew sugarless gum to moisten the mouth – Dry mouth is a common anticholinergic effect of fluphenazine. Chewing sugarless gum stimulates salivary flow, helping to moisten the oral mucosa and prevent dental problems. This is an effective, nonpharmacologic coping strategy.

Rationale for incorrect answer:

A. Take the medication in the morning to prevent insomnia – Fluphenazine is more likely to cause sedation than insomnia. Adjusting the time of administration does not address anticholinergic effects such as dry mouth.

C. Use cooling measures to decrease fever – While anticholinergic drugs can reduce sweating and theoretically contribute to heat intolerance, fever is not the most common issue. Cooling measures are not a primary intervention for typical anticholinergic effects in this context.

D. Take an antacid to relieve nausea – Antacids are not indicated for anticholinergic effects. In addition, they can interfere with the absorption of some oral medications, including certain antipsychotics.

Take-home points:

• Anticholinergic effects of fluphenazine include dry mouth, constipation, urinary retention, and blurred vision.
• Nonpharmacologic interventions, such as chewing sugarless gum or sipping water, can improve comfort and adherence.
• Client education should focus on practical, daily strategies to manage side effects without introducing unnecessary medications.

When a patient abruptly stops taking an antipsychotic medication, the therapeutic dopamine blockade is lost, often leading to a rapid recurrence of hallucinations, delusions, and disorganized thinking. The nurse’s priority is to address and prevent relapse of psychosis to ensure safety.

Rationale for correct answer:

D. Symptoms of psychosis are likely to return.
Stopping antipsychotics abruptly can cause rapid reemergence or worsening of psychotic symptoms, greatly increasing the risk of self-harm or harm to others. Immediate intervention is vital to maintain mental stability.

Rationale for incorrect answer:

A. A hypertensive crisis may occur with such abrupt withdrawal of the drug.
Hypertensive crisis is mainly linked to monoamine oxidase inhibitors (MAOIs), not antipsychotics, so it is not the primary concern.

B. Significant muscle twitching may occur, increasing fall risk.
Muscle twitching is not a common withdrawal effect of antipsychotics and is less urgent than psychosis relapse.

C. EPS symptoms such as pseudo-parkinsonism are likely to occur.
Extrapyramidal symptoms are usually a side effect during ongoing therapy, not after discontinuation.

Take-home points:

• Abrupt cessation of antipsychotics can trigger psychotic relapse.
• The nurse’s priority is patient safety and symptom management.
• Hypertensive crisis is not associated with antipsychotic withdrawal.