The nurse reviews a client's history before administering benztropine for medication-induced extrapyramidal symptoms. Which finding requires priority clarification?
1Seasonal allergic rhinitis controlled with environmental measures
2Essential hypertension controlled with one oral medication
3Narrow-angle glaucoma with a recent episode of severe eye pain✓ Correct answer
4A healed ankle fracture with full range of motion
Explanation
Benztropine has anticholinergic effects and should be avoided or used only with specific prescriber direction in a client with angle-closure glaucoma because it can increase intraocular pressure and precipitate an acute attack. Recent severe eye pain heightens the concern and requires clarification before administration. The other findings do not present the same immediate anticholinergic ocular risk.
Clinical reasoning Benztropine can relieve drug-induced extrapyramidal symptoms, but its anticholinergic effects can worsen angle-closure glaucoma.
Decision rule Clarify glaucoma history before administering a potent anticholinergic, especially when the client has recent eye pain, halos, blurred vision, or ocular redness.
Scenario 32-year-old male just received first haloperidol dose 6 hours ago; now has acute dystonia: neck twisted, upward eye deviation. Benztropine 2 mg IM ordered.
Benztropine — An anticholinergic medication used for parkinsonism and selected drug-induced extrapyramidal symptoms.
Angle-closure glaucoma — A condition in which anticholinergic pupil dilation can further obstruct aqueous drainage and precipitate an ocular emergency.
Oculogyric crisis — Upward involuntary deviation of the eyes — a form of acute dystonia.