A client with schizophrenia is prescribed risperidone. The nurse observes muscle stiffness and a shuffling gait. What is the most likely cause of these symptoms?

Serotonin syndrome

Neuroleptic malignant syndrome

Extrapyramidal symptoms

Tardive dyskinesia

Answer and Explanation

The Correct Answer is C

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.

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Correct Answer is B

Explanation

Choice A reason: Lorazepam, a benzodiazepine, reduces anxiety via GABA enhancement but is not specifically indicated for PTSD-related nightmares. It carries a risk of dependence and may worsen sleep architecture, making it less effective for this symptom compared to targeted medications.

Choice B reason: Prazosin, an alpha-1 adrenergic blocker, reduces norepinephrine-driven hyperarousal in PTSD, significantly decreasing nightmare frequency and intensity. It targets the sympathetic nervous system’s role in PTSD sleep disturbances, making it the most effective choice for this symptom.

Choice C reason: Fluoxetine, an SSRI, treats PTSD symptoms like depression and anxiety by increasing serotonin levels. While effective for overall PTSD management, it is less specific for nightmares compared to prazosin, which directly targets sleep-related hyperarousal.

Choice D reason: Lithium is used for bipolar disorder to stabilize mood via neurotransmitter modulation. It does not specifically address PTSD nightmares, which are driven by hyperarousal, making it an ineffective choice compared to prazosin’s targeted action on nightmares.

A. Calcium channel blocker B. Beta blocker C. Potassium-sparing diuretic D. Angiotensin receptor blocker (ARB)

Correct Answer is D

Explanation

Choice A reason: Calcium channel blockers reduce blood pressure by relaxing vascular smooth muscle but are not primary replacements for ACE inhibitors in heart failure. They do not address the renin-angiotensin system or the cough side effect mechanism, making them less suitable for this scenario.

Choice B reason: Beta blockers reduce heart rate and myocardial oxygen demand in heart failure but do not directly replace ACE inhibitor effects on the renin-angiotensin system. They are often used adjunctively, not as replacements, and do not address the cough side effect.

Choice C reason: Potassium-sparing diuretics manage fluid retention in heart failure but do not inhibit the renin-angiotensin system like ACE inhibitors. They are not a direct replacement and do not address the cough, which is specific to ACE inhibitor intolerance.

Choice D reason: ARBs block angiotensin II receptors, providing similar benefits to ACE inhibitors in heart failure by reducing vascular resistance and cardiac workload. They are less likely to cause cough, as they do not increase bradykinin levels, making them the expected replacement medication.

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A client with schizophrenia is prescribed risperidone. The nurse observes muscle stiffness and a shuffling gait. What is the most likely cause of these symptoms?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client with post-traumatic stress disorder (PTSD) who reports frequent nightmares. Which medication is most likely to be prescribed to address this symptom?

Correct Answer is B

Explanation

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?

Correct Answer is D

Explanation

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