A client who has been taking haloperidol for several weeks presents with restlessness, constant pacing, and inability to sit still. What is the most likely extrapyramidal symptom the client is experiencing?

Tardive dyskinesia

Dystonia

Akathisia

Pseudoparkinsonism

Answer and Explanation

The Correct Answer is C

Choice A reason: Tardive dyskinesia, an extrapyramidal symptom from long-term antipsychotic use like haloperidol, involves involuntary, repetitive movements such as grimacing, lip smacking, or tongue protrusion. These are caused by dopamine receptor hypersensitivity in the nigrostriatal pathway. The client’s restlessness and pacing do not match these motor tics, making tardive dyskinesia an unlikely explanation for the symptoms.

Choice B reason: Dystonia, another extrapyramidal symptom, involves sustained muscle contractions causing abnormal postures, such as neck twisting (torticollis) or ocular deviation. It results from dopamine receptor blockade in the basal ganglia. The client’s symptoms of pacing and inability to sit still do not align with dystonia’s characteristic spasms, making it an incorrect choice for this presentation.

Choice C reason: Akathisia is an extrapyramidal symptom characterized by subjective restlessness, constant movement, and inability to remain still, often described as an inner urge to move. Caused by dopamine receptor blockade in the nigrostriatal pathway from antipsychotics like haloperidol, it precisely matches the client’s pacing and restlessness, making it the most likely diagnosis requiring management.

Choice D reason: Pseudoparkinsonism, induced by antipsychotics, mimics Parkinson’s disease with symptoms like tremor, rigidity, and bradykinesia, resulting from dopamine depletion in the basal ganglia. The client’s hyperactive pacing and restlessness contrast with the slowed movements of pseudoparkinsonism, making this an unlikely extrapyramidal symptom in this case, as the presentation is more dynamic.

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Correct Answer is C

Explanation

Choice A reason: Wearing an eye patch at all times for diplopia in multiple sclerosis is inappropriate, as it may not address the underlying demyelination causing visual disturbances. Alternating eye patches or consulting a neurologist is preferred, as constant patching could strain vision or mask worsening symptoms, reducing quality of life.

Choice B reason: Relaxing in a hot tub daily is not advisable for multiple sclerosis, as heat can exacerbate symptoms (Uhthoff’s phenomenon) by slowing nerve conduction in demyelinated areas. This could worsen fatigue, sensory changes, or motor symptoms, making it an unsafe recommendation for managing MS symptoms.

Choice C reason: Implementing a rest schedule is appropriate for multiple sclerosis, as fatigue is a common symptom due to immune-mediated demyelination and central nervous system dysfunction. Rest periods help conserve energy, reduce symptom exacerbation, and improve daily functioning, making this a critical strategy for managing MS effectively.

Choice D reason: A vigorous exercise program is inappropriate for MS clients with active symptoms like diplopia and sensory changes, as overexertion can worsen fatigue and neurological symptoms. Gentle, tailored exercise may be beneficial, but vigorous activity risks exacerbating demyelination-related impairments, making this an unsuitable recommendation.

A. Ask the client if she has a plan to commit suicide. B. Notify the client’s family and request a visitor to stay with the client until thoughts of suicide are gone. C. Assist the client to her room and allow her to rest before resuming activity. D. Recognize the attempt at manipulation and escort the client back to her activity.

Correct Answer is A

Explanation

Choice A reason: Asking if the client has a suicide plan is the priority, as it assesses the immediacy and specificity of suicidal intent, critical in depression due to serotonin and norepinephrine dysregulation. A specific plan indicates high risk, necessitating immediate safety measures to prevent self-harm driven by impaired emotional regulation.

Choice B reason: Notifying family and requesting a visitor may provide support but does not immediately assess the client’s suicide risk. Depression-related suicidal ideation, linked to prefrontal cortex dysfunction, requires direct evaluation of intent and plan to ensure safety, making this a secondary action after risk assessment.

Choice C reason: Assisting the client to rest in her room dismisses the suicidal statement, risking neglect of a serious threat. Depression’s neurochemical imbalances can amplify hopelessness, and ignoring suicidal ideation may escalate risk, as it fails to address the immediate need for safety and intervention.

Choice D reason: Recognizing the statement as manipulation is inappropriate, as it dismisses genuine suicidal ideation in depression, driven by profound neurochemical despair. This risks underestimating the client’s intent, potentially leading to harm, as suicidal thoughts require serious assessment rather than being attributed to behavioral manipulation.

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A client who has been taking haloperidol for several weeks presents with restlessness, constant pacing, and inability to sit still. What is the most likely extrapyramidal symptom the client is experiencing?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is presenting discharge instructions to a client who has multiple sclerosis (MS). The client reports symptoms of diplopia and sensory change. Which of the following nursing statements are appropriate?

Correct Answer is C

Explanation

A nurse is caring for a client 3 days after admission for treatment of depression. The client leaves her current activity, approaches the nurse, and states, “There’s no reason to go on living. I just want to end it all.” Which of the following actions should the nurse take?

Correct Answer is A

Explanation

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