Question

a nurse is assessing a client who has schizophrenia and is taking haloperidol. the nurse should report which of the following findings to the provider as a manifestation of neuroleptic malignant syndrome (nms)?

temperature of 39.7° c (103.5° f)
urinary retention
heart rate 56/min
muscle flaccidity

Explanation:

Identify the core condition and drug

The client has schizophrenia and is taking haloperidol, a high-potency typical antipsychotic. The question asks for a manifestation of neuroleptic malignant syndrome (NMS), a life-threatening adverse reaction associated with antipsychotic medications.

Analyze the pathophysiology of NMS

NMS is characterized by severe dopamine blockade in the hypothalamus and basal ganglia. This leads to hyperthermia (disrupted thermoregulation), severe muscle rigidity ("lead-pipe" rigidity), autonomic instability (tachycardia, labile blood pressure, diaphoresis), and altered mental status.

Evaluate the given options

• Temperature of \(39.7^\circ\text{ C}\) (\(103.5^\circ\text{ F}\)): High fever (hyperthermia) is a hallmark sign of NMS due to hypothalamic dysfunction.
• Urinary retention: This is an anticholinergic side effect of antipsychotics, not a specific diagnostic manifestation of NMS.
• Heart rate 56/min: NMS typically causes autonomic hyperactivity, leading to tachycardia (heart rate > 100/min), not bradycardia.
• Muscle flaccidity: NMS causes severe muscle rigidity ("lead-pipe" rigidity), not flaccidity.

Apply nursing assessment concepts

Using the Nursing Assessment knowledge point, the nurse must recognize that a high fever in a client taking haloperidol is a medical emergency indicating NMS. Immediate intervention includes stopping the medication, cooling the client, and notifying the provider.

Answer:

• (A) Temperature of 39.7° C (103.5° F) (Correct answer)
• (B) Urinary retention
• (C) Heart rate 56/min
• (D) Muscle flaccidity