Prior to discharge, the nurse plans for client teaching related to side effects of phenothiazines to the client, family, or caregiver. Which of the following should be included?

Correct answer: 2
Haloperidol, a first-generation antipsychotic, can cause extrapyramidal symptoms (EPS), including acute dystonia, parkinsonism, akathisia, and tardive dyskinesia. Among these, acute dystonic reactions, such as neck spasms, are a high-priority finding because they can rapidly progress to laryngeal dystonia, compromising the airway. Prompt recognition and treatment are essential to prevent life-threatening complications.

Rationale for correct answer:

B. Neck spasms – Neck spasms may be a sign of acute dystonia, a severe EPS that can develop within hours or days of starting antipsychotic therapy. It may involve muscles of the neck, tongue, and larynx, leading to airway obstruction. This is an urgent condition requiring immediate treatment with an anticholinergic agent such as benztropine or diphenhydramine.

Rationale for incorrect answer:

A. Shuffling gait – This finding indicates parkinsonism, an EPS that can occur with haloperidol. While it requires intervention, it does not pose an immediate threat to life like acute dystonia does.

C. Drowsiness – Sedation is a common side effect of haloperidol but is not life-threatening. Monitoring and dose adjustments can address this over time.

D. Impotence – Sexual side effects are possible with haloperidol but are not urgent or dangerous. They can be addressed during routine follow-up.

Take-home points:

• Acute dystonia from haloperidol can be life-threatening if it affects respiratory muscles.
• Early signs include neck stiffness, facial grimacing, and abnormal tongue movements.
• Immediate treatment with parenteral anticholinergics is essential to prevent airway compromise.

Phenothiazines, a class of first-generation antipsychotics, can cause acute dystonia early in treatment. This is a type of extrapyramidal symptom (EPS) characterized by severe, involuntary muscle spasms that may affect the neck, face, tongue, or back, and require prompt medical attention.

Rationale for correct answer:

B. Severe muscle spasms may occur early in therapy.
Acute dystonic reactions are a known early adverse effect, often appearing within hours to days of starting phenothiazines. Education should stress reporting these symptoms immediately, as they can compromise breathing or swallowing.

Rationale for incorrect answer:

A. The client may experience withdrawal and slowed activity.
Phenothiazines more commonly cause sedation, not withdrawal-like symptoms, and this is not the most urgent teaching point before discharge.

C. Tardive dyskinesia is likely early in therapy.
Tardive dyskinesia usually develops after months to years of therapy, not in the early stages.

D. Medications should be taken as prescribed to prevent adverse effects.
While adherence is important, this statement does not address a specific high-priority side effect for early treatment.

Take-home points:

• Acute dystonia can occur within the first days of phenothiazine use.
• Early recognition and reporting of muscle spasms is critical to prevent complications.
• Tardive dyskinesia develops later, not at the start of therapy.