A 38-year-old female client with a history of chronic schizophrenia, paranoid type, is currently an outpatient at the local mental health and mental retardation clinic. The client comes in once a week for medication evaluation and/or refills. She self-administers haloperidol 5 mg twice a day and benztropine 1 mg once a day. During a recent clinic visit, she says to the nurse, "I can't stay still at night. I toss and turn and can't fall asleep." The nurse suspects that she may be experiencing?

Appeared in: NORCET 5 mains

Explanation

The patient's complaint of being unable to stay still, tossing, and turning is the classic subjective report of akathisia.
Akathisia is defined as a state of motor restlessness and a subjective feeling of being compelled to move.
It is one of the most common extrapyramidal side effects (EPS) associated with first-generation antipsychotics like haloperidol.
The symptoms can be highly distressing and may interfere with sleep, as reported by the client.

Option B: Akinesia is characterized by a lack of movement or slowness in initiating movement (bradykinesia), which is the opposite of the patient's reported restlessness.
Option C: Dystonia involves involuntary, sustained muscle spasms that cause abnormal postures (e.g., neck twisting, eye deviation). The patient is describing a need to move, not an involuntary muscle contraction.
Option D: Opisthotonos is a specific, severe form of dystonia characterized by a dramatic arching of the back and neck. It is a medical emergency and does not fit the patient's description of restlessness.

Visual 1: Chart - A comparative chart showing the different physical manifestations of Akathisia (pacing, fidgeting), Dystonia (neck twisting), and Parkinsonism/Akinesia (shuffling gait, masked face) to help differentiate EPS.

Clinical Relevance

Nursing practice connection: Use the key finding related to Recognition of extrapyramidal side effects (EPS) of antipsychotic medication to guide bedside assessment, documentation, and the next nursing action.
Nurses must be able to differentiate akathisia from psychotic agitation. Mistaking akathisia for worsening psychosis and increasing the antipsychotic dose will worsen the akathisia and patient distress.
Benztropine is an anticholinergic used to manage EPS like dystonia and parkinsonism, but it is often less effective for akathisia. Management may require reducing the antipsychotic dose or adding a beta-blocker (like propranolol) or a benzodiazepine.
What if the patient was also shuffling their feet and had a tremor? If the patient also showed signs of bradykinesia, shuffling gait, and a pill-rolling tremor, the nurse would suspect drug-induced parkinsonism in addition to or instead of akathisia.

How to Approach the Question

First, identify the key information in the clinical scenario: the patient's diagnosis (schizophrenia), medications (haloperidol, an antipsychotic), and the specific complaint ('I can't stay still...toss and turn').
Recognize that haloperidol is a first-generation antipsychotic known for causing extrapyramidal side effects (EPS).
Analyze the patient's subjective complaint. The core of the issue is a feeling of restlessness and an inability to be still.
Evaluate each option based on its definition as a type of EPS.
Match the patient's symptoms to the correct definition. 'Can't stay still' directly translates to the definition of akathisia.
Eliminate the other options by confirming they describe different movement patterns (lack of movement, muscle spasms, or arching).

Concept Tested & Keywords

Concept Tested: Recognition of extrapyramidal side effects (EPS) of antipsychotic medication
Stem keywords: chronic schizophrenia, haloperidol, benztropine, can't stay still, toss and turn
Lead-in keywords: suspects that she may be experiencing
Clinical cues: Patient on haloperidol (a first-generation antipsychotic) presenting with motor restlessness.

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