Shortly after receiving prochlorperazine, a client develops painful neck twisting, jaw spasm, and difficulty speaking. Which action should the nurse take first?
1Encourage the client to walk in the hallway to reduce muscle stiffness.
2Place the client alone in a quiet room and reassess after the next dose.
3Apply wrist restraints and ask the client to suppress the movements.
4Protect the airway and give prescribed parenteral benztropine or diphenhydramine.✓ Correct answer
Explanation
Painful neck and jaw spasms after a dopamine-blocking medication indicate an acute dystonic reaction, which can threaten the airway if laryngeal muscles are involved. The nurse should protect the airway, stop further exposure as directed, notify the prescriber, and administer the prescribed parenteral treatment such as benztropine or diphenhydramine. Ambulation, isolation, or restraints do not treat the reaction and can delay emergency care.
Clinical reasoning Acute dystonia can appear soon after a dopamine-blocking antiemetic and produces sustained, painful muscle contractions. Jaw, neck, or laryngeal involvement makes airway assessment the priority.
Decision rule Protect the airway and give the prescribed rapid parenteral reversal medication; do not mislabel dystonia as voluntary behavior.
Scenario 26-year-old male received prochlorperazine 10 mg IM in ED for migraine + nausea. 30 min later: torticollis, oculogyric crisis, no fever.
Acute dystonia — A sudden extrapyramidal reaction with sustained painful muscle contractions that can involve the neck, jaw, eyes, or larynx.
Benztropine or diphenhydramine — Parenteral anticholinergic or antihistamine therapy can rapidly relieve medication-induced acute dystonia when prescribed.
Prochlorperazine — Phenothiazine antiemetic; D2 antagonist with EPS risk similar to first-generation antipsychotics.