A client with heart failure is taking an angiotensin-converting enzyme inhibitor (ACE-I) and reports a nagging cough. Which replacement medication will the nurse expect to be prescribed for this client?

Choice A reason: Impotence is a potential side effect of SSRIs due to serotonin’s effect on sexual function but is not a symptom of serotonin syndrome, a life-threatening condition involving excessive serotonin causing hyperthermia, agitation, and muscle rigidity, making this incorrect.

Choice B reason: Hypotension is not a primary symptom of serotonin syndrome, which involves serotonin excess leading to hyperthermia, tremors, and autonomic instability. Hypotension may occur secondary to severe cases but is not a hallmark symptom included in teaching.

Choice C reason: Fever is a key symptom of serotonin syndrome, caused by excessive serotonin stimulation leading to hyperthermia, muscle rigidity, and autonomic dysfunction. It’s a critical teaching point, as it signals a medical emergency requiring immediate intervention to prevent organ damage.

Choice D reason: Constipation is a side effect of some SSRIs due to serotonin’s effect on gastrointestinal motility but is not associated with serotonin syndrome. This condition involves acute neurological and autonomic symptoms, not chronic gastrointestinal issues, making this incorrect.

Choice A reason: Serotonin syndrome involves fever, agitation, and hyperreflexia due to excessive serotonin, typically from SSRIs or MAOIs, not antipsychotics like risperidone. Muscle stiffness and shuffling gait are not characteristic, making this an incorrect cause of the symptoms.

Choice B reason: Neuroleptic malignant syndrome causes severe muscle rigidity, fever, and autonomic instability due to dopamine blockade by antipsychotics. While possible with risperidone, the client’s mild symptoms (stiffness, shuffling gait) are more consistent with extrapyramidal effects than this severe condition.

Choice C reason: Extrapyramidal symptoms, caused by risperidone’s dopamine D2 receptor blockade, include muscle stiffness and shuffling gait (parkinsonism). These occur due to disrupted basal ganglia function, mimicking Parkinson’s disease, and are common with antipsychotics, making this the most likely cause.

Choice D reason: Tardive dyskinesia involves involuntary movements like grimacing or lip smacking, typically after long-term antipsychotic use. Muscle stiffness and shuffling gait are not characteristic, as these are parkinsonian symptoms, making this less likely than extrapyramidal symptoms.