A client with schizophrenia is started on Zyprexa (Olanzapine). Three weeks later, the client develops severe muscle rigidity and elevated temperature. The nurse should give priority to?

Appeared in: DHS Staff Nurse - 2018 (Shift-2nd)

Explanation

The client is exhibiting classic signs of Neuroleptic Malignant Syndrome (NMS): severe muscle rigidity and hyperthermia, which is a life-threatening reaction to antipsychotic medication.
NMS is a medical emergency requiring intensive supportive care and monitoring that can only be provided in a medical unit or ICU, not a psychiatric ward.
The priority is to ensure patient safety and provide immediate life-sustaining treatment, which necessitates a transfer to a facility equipped to manage this critical condition.
Treatment for NMS includes stopping the antipsychotic, aggressive hydration, cooling, and specific medications like dantrolene or bromocriptine, all of which are managed in a medical setting.

Why Other Options Were Wrong

Option A: While stopping the antipsychotic is a necessary action, simply withholding the next dose is a passive and insufficient response to a rapidly progressing medical emergency. The patient requires immediate, active intervention.
Option B: Ordering labs like CBC and CPK is important for diagnosis and monitoring (CPK will be very high in NMS), but this action is diagnostic, not therapeutic. It does not address the immediate life-threat and takes time to yield results.
Option C: Anti-parkinsonian medications are used to treat Extrapyramidal Symptoms (EPS). The client's high fever is the key sign that distinguishes NMS from EPS. These medications are ineffective for NMS and can sometimes worsen the condition.

Related Visual

Clinical Relevance

Nursing practice connection: Knowing Recognition and immediate management of Neuroleptic Malignant Syndrome (NMS) helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Nurses must be able to rapidly differentiate between NMS and EPS. Mistaking NMS for EPS and administering only an anticholinergic can have fatal consequences.
The mortality rate for NMS can be as high as 10-20%; rapid recognition and escalation of care are the most critical nursing functions to improve patient outcomes.
What if? If the client had muscle rigidity but was afebrile (no fever), the priority would shift. The condition would likely be diagnosed as an Extrapyramidal Symptom (EPS), and the priority action would be to administer a prescribed PRN anti-parkinsonian agent like benztropine.

How to Approach the Question

First, analyze the patient's clinical presentation. Note the key symptoms: a new antipsychotic medication, severe muscle rigidity, and an elevated temperature.
Recognize this triad as the classic presentation of Neuroleptic Malignant Syndrome (NMS).
Understand that NMS is a life-threatening medical emergency, not just a medication side effect.
Evaluate the options based on the urgency and needs of a patient with NMS. The priority must be an action that addresses the immediate threat to life.
Eliminate options that are passive (withholding meds), diagnostic but not therapeutic (ordering labs), or incorrect for the diagnosis (giving anti-parkinsonian meds for NMS).
Select the option that moves the patient to the appropriate level of care for stabilization and treatment, which is transferring to a medical unit.

Concept Tested & Keywords

Concept Tested: Recognition and immediate management of Neuroleptic Malignant Syndrome (NMS).
Stem keywords: schizophrenia, Zyprexa, Olanzapine, severe muscle rigidity, elevated temperature
Lead-in keywords: priority
Clinical cues: The combination of antipsychotic use, muscle rigidity, and fever is a classic presentation for NMS.

Question ID

Qpi_9hmjqaqrQXnoIdHIGe

Reference Book

E6 Kaplan Sadock's Synopsis of Psychiatry-2022 (pp 1-3768 of 3768) p. 1885-1887

E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) pp. 9901-9903, 10041-10043

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