A patient receiving haloperidol for schizophrenia reports an inner feeling of motor restlessness, stating, "I can't stop moving my legs, I feel like I need to pace all the time." The nurse recognizes this extrapyramidal side effect as:

1. A

   Dystonia

2. B

   Akathisia

3. C

   Tardive dyskinesia

4. D

   Pseudoparkinsonism

Appeared in: NORCET 9 Prelims-2025

Explanation

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• The patient's symptoms of a subjective feeling of inner restlessness and a compulsion to move (pacing, moving legs) are the classic definition of akathisia.
• Akathisia is a well-known extrapyramidal side effect associated with first-generation antipsychotics like haloperidol.
• The term akathisia comes from the Greek for 'inability to sit still,' which perfectly describes the patient's condition.
• Unlike other EPS, the primary feature of akathisia is the subjective feeling of inner torment and restlessness, not just involuntary muscle movements.

Why Other Options Were Wrong

• Option A: Dystonia involves sudden, involuntary, and often painful muscle contractions or spasms (e.g., neck twisting, eye-rolling), not a generalized feeling of restlessness.
• Option C: Tardive dyskinesia involves involuntary, repetitive, choreoathetoid (jerky, writhing) movements, typically of the face, such as lip-smacking, tongue protrusion, and grimacing. It is a late-onset side effect, occurring after months or years of treatment.
• Option D: Pseudoparkinsonism presents with symptoms that mimic Parkinson's disease, such as a resting tremor, muscle rigidity (cogwheeling), and bradykinesia (slowness of movement). The patient's primary complaint is an urge to move, not slowness or tremor.

Related Visual

• Visual 1: Chart - A comparative table showing the key features, onset, and typical presentation of the four main extrapyramidal side effects (Akathisia, Dystonia, Pseudoparkinsonism, Tardive Dyskinesia).
• Visual 2: Illustration - A drawing depicting a person experiencing akathisia, showing them pacing and unable to sit still, contrasted with illustrations of dystonia (neck spasm) and tardive dyskinesia (lip smacking).

Clinical Relevance

• Nursing practice connection: Use the key finding related to Recognition of extrapyramidal side effects of antipsychotic medications to guide bedside assessment, documentation, and the next nursing action.
• Prompt recognition of akathisia is a critical nursing responsibility as it is highly distressing and a major reason for non-adherence to antipsychotic medication.
• Failure to identify and manage akathisia can lead to an exacerbation of psychosis (due to non-adherence) and increases the risk of agitation, aggression, and suicide.
• What if? - If a nurse mistakes akathisia for worsening psychotic agitation and the doctor increases the haloperidol dose, the akathisia will become even more severe, significantly increasing patient distress and risk.

How to Approach the Question

• First, identify the key information in the clinical scenario: the medication (haloperidol), the patient's diagnosis (schizophrenia), and the specific symptoms reported ('inner feeling of motor restlessness,' 'can't stop moving my legs,' 'need to pace').
• Next, recognize that haloperidol is a typical antipsychotic known for causing extrapyramidal side effects (EPS). The question asks you to identify the specific EPS.
• Systematically review the definitions of the options. Recall or look up the hallmark features of each EPS.
• Compare the patient's symptoms to the definitions. Dystonia is muscle spasms. Tardive dyskinesia is late-onset facial movements. Pseudoparkinsonism is slowness and tremor. Akathisia is inner restlessness and an urge to move.
• The patient's description directly matches the definition of akathisia. Select this as the correct answer.

Concept Tested & Keywords

• Concept Tested: Recognition of extrapyramidal side effects of antipsychotic medications.
• Stem keywords: haloperidol, schizophrenia, motor restlessness, extrapyramidal side effect
• Lead-in keywords: recognizes
• Clinical cues: Patient's subjective report: 'inner feeling of motor restlessness'
• Clinical cues: Patient's objective behavior: 'can't stop moving my legs, I feel like I need to pace'

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