The nurse is caring for a client who is being discharged after insertion of a permanent pacemaker. The client, an avid tennis player, is scheduled to play in a tournament in one week. What teaching should the nurse provide to the client related to this activity?

Choice A reason: Benzodiazepines enhance GABA activity, leading to rapid anxiety relief but with a high risk of tolerance and dependence. Teaching about this risk is critical to ensure the client understands the need for medical supervision, potential withdrawal symptoms, and strategies to prevent misuse or long-term dependency.

Choice B reason: Taking benzodiazepines with food may reduce gastrointestinal upset, but the timing is not critical for efficacy. This instruction is less urgent than addressing dependence, as benzodiazepines are effective regardless of meal timing, and the primary concern is their addictive potential.

Choice C reason: Discontinuing benzodiazepines abruptly can cause severe withdrawal symptoms, including seizures, due to their effect on GABA receptors. This is dangerous advice, as gradual tapering under medical supervision is required, making this choice incorrect and less critical than teaching about dependence risks.

Choice D reason: Increased caffeine consumption can counteract benzodiazepine effects by stimulating the central nervous system, potentially worsening anxiety. This is incorrect advice, as it could reduce the medication’s efficacy and exacerbate symptoms, making it less relevant than educating about dependence and tolerance risks.

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.