A patient receiving risperidone (Risperdal) reports severe muscle stiffness midmorning

Question

During lunch he has difficulty swallowing food and speaking, and when vital signs are taken 30 minutes later, he is noted to be stuporous and diaphoretic, with a temperature of 38.8° C, pulse of 110 beats/min, and blood pressure of 150/90 mm Hg. The nurse should suspect _________ and should ______________. a. neuroleptic malignant syndrome…place him in a cooling blanket and transfer to ICU
b. anticholinergic toxicity…check vital signs and prepare to use a cooling blanket stat
c. relapse of his psychosis…administer PRN antipsychotic drugs and notify his physician
d. agranulocytosis…hold his antipsychotic and draw blood for a complete blood count

Answer 1

A
Neuroleptic malignant syndrome is a life-threatening reaction to antipsychotic medications that presents with increasing muscular stiffness (leading to rigidity), hyperpyrexia, autonomic nervous system instability, diminished level of consciousness, and other symptoms. Emergency cooling measures are indicated for hyperpyrexia, and because this is a dangerous medical emergency, care in a medical unit (preferably intensive care unit) is required stat. Anticholinergic toxicity includes hyperpyrexia and elevated and unstable vital signs but includes hot, dry skin and does not include motor rigidity. A simple relapse would not include the physical changes noted here. Agranulocytosis would present with symptoms suggesting infection, not the severe symptoms noted here.