Practice Question
A client receiving first-generation antipsychotics develops a fever of 40.5°C, severe muscle rigidity, tachycardia, labile blood pressure, and confusion. After recognizing these signs as neuroleptic malignant syndrome (NMS), which nursing intervention should be prioritized to prevent complications?
Answer Choices:
Correct Answer:
Administer cooling measures and notify the healthcare provider immediately.
Rationale:
🔥 This client on first-generation antipsychotics has very high fever (40.5°C), severe muscle rigidity, tachycardia, labile BP, and confusion, which are hallmark signs of neuroleptic malignant syndrome (NMS).
🔥 NMS is a life-threatening emergency characterized by hyperthermia, “lead-pipe” rigidity, autonomic instability, and altered mental status.
🔥 Priority management includes stopping the antipsychotic, initiating aggressive cooling measures, and urgently notifying the provider to start treatments like dantrolene (muscle relaxant) or bromocriptine (dopamine agonist).
🔥 Early, aggressive intervention is essential to prevent complications such as rhabdomyolysis, acute kidney injury, dysrhythmias, and cardiovascular collapse.
🔥 Therefore, the nurse must focus on rapid cooling and immediate provider notification rather than routine comfort or mobility measures.
Encourage early ambulation to prevent complications of immobility and muscle atrophy.
🔥 With severe muscle rigidity and hyperthermia, ambulation is unsafe and does not address the life-threatening pathophysiology of NMS.
🔥 This could increase risk of falls, arrhythmias, or further physiologic stress.
Administer antipyretics like acetaminophen to reduce fever and prevent seizures.
🔥 While antipyretics may help slightly, they do not address the underlying dopamine blockade and muscle rigidity causing hyperthermia in NMS.
🔥 Relying solely on acetaminophen delays definitive treatment and cooling, increasing risk of complications.
Increase oral fluid intake to prevent dehydration and monitor intake and output.
🔥 The client is acutely ill, likely unstable, and may not be able to safely take oral fluids due to confusion or risk of aspiration.
🔥 Fluid management in NMS is important but must occur alongside aggressive cooling and pharmacologic treatment, not as the primary action.
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This question is from Custom RN Pharmacology-Fall 2025 Exam 4 which contains 60 questions.
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Question Details
- Category: RN Nursing Exam(s)
- Subcategory: ATI Exam(s)
- Domain: RN ATI Pharmacology
- Answer Choices: 4