RUHS, Jaipur, PB B.Sc Nursing Entrance-2019
Mental Health Nursing
Medium
A 20 year male is brought to the Psychiatry Emergency OPD with severe stiffness over the neck and jaw after receiving Inj. Serenace for his behavioral disturbances. What side effect would be the focus of this consult?
Appeared in: RUHS, Jaipur, PB B.Sc Nursing Entrance-2019
Explanation
- Acute dystonia is an abrupt, painful muscle spasm that is a well-known extrapyramidal side effect of antipsychotic medications.
- It characteristically occurs within hours to a few days of initiating treatment with a high-potency agent like haloperidol (Serenace), matching the patient's timeline.
- The patient's symptoms of severe neck stiffness (torticollis) and jaw stiffness (trismus) are hallmark signs of acute dystonia.
- Young males are a high-risk demographic for developing this specific adverse reaction.
Why Other Options Were Wrong
- Option A: Neuroleptic Malignant Syndrome (NMS) is incorrect because it is a systemic illness characterized by high fever, severe 'lead-pipe' rigidity, autonomic instability (e.g., unstable blood pressure, tachycardia), and altered consciousness. The patient only presents with localized muscle stiffness.
- Option B: Tardive dyskinesia is incorrect because it is a late-onset disorder, developing after months or years of antipsychotic use. Its movements are typically involuntary, repetitive, and choreoathetoid (e.g., lip-smacking, tongue-darting), not acute, painful spasms.
- Option C: Rabbit syndrome is incorrect because it is also a late-onset side effect. It presents as a fine, rapid, rhythmic tremor of the perioral muscles (around the mouth), resembling a rabbit chewing, not a sustained, forceful spasm of the neck and jaw.
Related Visual
Clinical Relevance
- Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Extrapyramidal Side Effects (EPS) of Antipsychotic Medications as background academic context rather than a clinical decision trigger.
- Acute dystonia is a medical emergency because it can affect the laryngeal muscles (laryngospasm), leading to airway obstruction and respiratory arrest. Nurses must be able to recognize it immediately.
- The standard of care is prompt administration of an anticholinergic agent (e.g., benztropine, diphenhydramine) or a benzodiazepine, which provides rapid relief. The nurse should have these medications readily available when administering high-potency antipsychotics.
- Patient education is vital. Patients should be informed about this potential side effect and instructed to seek immediate medical help if they experience any muscle stiffness, especially in the neck or jaw.
How to Approach the Question
- First, identify the key elements in the clinical scenario: the patient (20-year-old male), the drug (Inj. Serenace/haloperidol), and the presenting symptoms (acute severe stiffness of neck and jaw).
- Recognize that Serenace (haloperidol) is a high-potency, first-generation antipsychotic, which has a high risk of causing extrapyramidal symptoms (EPS).
- Analyze the timeline. The symptoms appeared 'after receiving' the injection, indicating an acute or early-onset reaction.
- Evaluate each option based on its characteristic symptoms and timeline:
- NMS: Systemic illness with fever, not just muscle spasm.
- Tardive Dyskinesia: Late onset (months/years), different movement type.
Concept Tested & Keywords
- Concept Tested: Extrapyramidal Side Effects (EPS) of Antipsychotic Medications
- Stem keywords: 20 year male, stiffness over the neck and jaw, Inj. Serenace, behavioral disturbances
- Lead-in keywords: side effect, focus of this consult
- Clinical cues: The combination of a young male patient, a high-potency antipsychotic (Serenace/haloperidol), and acute onset of muscle spasms strongly points to a specific type of extrapyramidal side effect.
Question ID
QKWoDIW7OHX1iHOeqswnx4
Reference Book
E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) pp. 3903-3905, 10037-10039
E6 Kaplan Sadock's Synopsis of Psychiatry-2022 (pp 1-3768 of 3768) p. 1885-1887
Practise the full RUHS, Jaipur, PB B.Sc Nursing Entrance-2019
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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