The nurse should immediately report the development of which of the following symptoms in a client taking antipsychotic medication?

Fever, tachycardia, confusion, incontinence

Pacing, squirming, or difficulty with gait such as bradykinesia

Severe spasms of the muscles of the tongue, face, neck, or back

Sexual dysfunction or gynecomastia

Answer and Explanation

The Correct Answer is A

Clients on antipsychotic medications are at risk for both common and life-threatening adverse effects. While many side effects are uncomfortable but manageable, the sudden onset of certain symptoms may indicate a medical emergency such as neuroleptic malignant syndrome (NMS), which requires immediate intervention to prevent serious complications or death.

Rationale for correct answer:

A. Fever, tachycardia, confusion, incontinence – These symptoms suggest neuroleptic malignant syndrome, a rare but potentially fatal reaction to antipsychotics. NMS is characterized by hyperthermia, autonomic instability, altered mental status, and severe muscle rigidity. Immediate discontinuation of the drug, rapid medical management, and supportive care are critical.

Rationale for incorrect answer:

B. Pacing, squirming, or difficulty with gait such as bradykinesia – These are signs of akathisia or drug-induced parkinsonism, which are types of extrapyramidal symptoms (EPS). While uncomfortable and requiring prompt treatment, they are not typically life-threatening emergencies.

C. Severe spasms of the muscles of the tongue, face, neck, or back – This describes acute dystonia, an early-onset EPS that can be distressing and potentially dangerous if airway muscles are involved, but it is generally managed quickly with anticholinergic medications like benztropine or diphenhydramine.

D. Sexual dysfunction or gynecomastia – These are related to endocrine side effects from increased prolactin levels. They are bothersome and may affect adherence but are not medical emergencies.

Take-home points:

NMS is a life-threatening complication of antipsychotic therapy and must be recognized early.
Key warning signs include hyperthermia, autonomic instability, altered mental status, and muscle rigidity.
Immediate drug discontinuation and emergency medical care are essential for survival.

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Correct Answer is A

Explanation

When clients are treated for psychosis with first-generation antipsychotics like fluphenazine, there is an increased risk of developing extrapyramidal symptoms (EPS), particularly acute dystonia in the early stages of therapy. Nurses must anticipate prophylactic measures, including the use of specific medications to prevent or manage these symptoms, to ensure patient safety and comfort during antipsychotic treatment.

Rationale for correct answer:

A. Benztropine (Cogentin) – Anticholinergic medications like benztropine are frequently prescribed to prevent or treat EPS, including acute dystonia caused by dopamine blockade in the nigrostriatal pathway. By restoring the dopamine-acetylcholine balance in the CNS, benztropine helps reduce muscle rigidity, spasms, and abnormal postures that can occur shortly after initiating antipsychotic therapy.

Rationale for incorrect answer:

B. Diazepam (Valium) – This benzodiazepine is primarily used for anxiety, muscle relaxation, and seizure control, not for preventing EPS. While it may reduce anxiety related to symptoms, it does not address the underlying neurotransmitter imbalance that causes acute dystonia.

C. Haloperidol (Haldol) – Another first-generation antipsychotic, haloperidol can actually increase the risk of EPS, making it inappropriate for prevention. Administering it alongside fluphenazine could worsen movement-related side effects.

D. Lorazepam (Ativan) – This benzodiazepine can help relieve agitation or anxiety in psychotic patients, but it does not prevent acute dystonia because it does not correct the dopamine-acetylcholine imbalance in the basal ganglia.

Take-home points:

Benztropine is the drug of choice for preventing acute dystonia caused by high-potency first-generation antipsychotics.
Acute dystonia is an early-onset EPS that can occur within hours to days of starting antipsychotic therapy.
Prevention is important because untreated acute dystonia can cause airway compromise or severe discomfort.

A. Shuffling gait B. Neck spasms C. Drowsiness D. Impotence

Correct Answer is B

Explanation

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.

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The nurse should immediately report the development of which of the following symptoms in a client taking antipsychotic medication?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client is treated for psychosis with fluphenazine. What drug will the nurse anticipate to given to prevent the development of acute dystonia?

Correct Answer is A

Explanation

A nurse is assessing a male client who recently began taking haloperidol (Haldol). Which of the following findings is the highest priority to report to the provider?

Correct Answer is B

Explanation

An antipsychotic agent, fluphenazine (Prolixin), is ordered for a patient with psychosis. The nurse understands that this agent can lead to extrapyramidal symptoms that may be treated with which medication?

The client states that he has not taken his antipsychotic drug for the past 2 weeks because it was causing sexual dysfunction. What is the nurse’s primary concern at this time?

A 20-year-old man is admitted to the psychiatric unit for treatment of acute schizophrenia and is started on risperidone (Risperdal). Which client effects should the nurse assess for to determine whether the drug is having therapeutic effects?

A patient asks the nurse to explain how antipsychotic drugs work to make him feel better. The nurse understands that antipsychotics act in which way?

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?

The nurse suspects that a patient who is experiencing facial grimacing, involuntary upward eye movement, and muscle spasms of the tongue and face may have which condition?

A nurse is providing discharge teaching for a client who has a new prescription for clozapine (Clozaril). Which of the following statements is appropriate for the nurse to include in the teaching?

A nurse is teaching a client who has schizophrenia strategies to cope with anticholinergic effects of fluphenazine. Which of the following should the nurse suggest to the client to minimize anticholinergic effects?