A nurse is caring for a client who has opioid toxicity and has a respiratory rate of 6/min. Which of the following medications should the nurse plan to administer?

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.

Choice A reason: Administering an analgesic may relieve pain but delays diagnosing serious conditions like meningitis, suggested by headache and stiff neck. Neurological assessment is urgent, making this incorrect as the first action.

Choice B reason: Evaluating neurological status is the first action, as headache and stiff neck suggest meningitis or other neurological issues. Assessing for signs like Brudzinski’s prioritizes diagnosis, making this the correct choice.

Choice C reason: Checking temperature is relevant for infection but secondary to neurological assessment. Meningitis requires immediate neurological evaluation to guide urgent treatment, making this incorrect as the first step.

Choice D reason: A complete blood count supports diagnosis but is not the first action. Neurological assessment identifies critical signs of meningitis, enabling faster intervention, making this incorrect compared to evaluation.