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?

Choice A reason: Lorazepam, a benzodiazepine, enhances GABA activity, often causing drowsiness as a common side effect. Reporting drowsiness is critical to monitor for excessive sedation, which can impair safety and daily functioning, ensuring the dose is adjusted appropriately to balance efficacy and side effects.

Choice B reason: Adjusting the dose or frequency of lorazepam without medical supervision is dangerous due to the risk of dependence and overdose. Benzodiazepines require strict adherence to prescribed regimens to prevent tolerance, withdrawal, or adverse effects, making this an incorrect and unsafe instruction.

Choice C reason: Alcohol enhances the sedative effects of lorazepam by further increasing GABA activity, risking severe central nervous system depression, respiratory failure, or coma. Avoiding alcohol is critical to ensure safety and prevent life-threatening interactions, making this a key teaching point for the client.

Choice D reason: A tyramine-free diet is relevant for MAOIs, not benzodiazepines like lorazepam. Tyramine interactions cause hypertensive crises with MAOIs, but lorazepam has no dietary restrictions related to tyramine, making this instruction irrelevant and incorrect for this medication.

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.