# Two hours after receiving haloperidol 5 mg IM, a client is found rigid, diaphoretic, with temperature 39.8°C, BP 168/96, HR 124, and confused. Which is the priority nursing action?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391725&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

Two hours after receiving haloperidol 5 mg IM, a client is found rigid, diaphoretic, with temperature 39.8°C, BP 168/96, HR 124, and confused. Which is the priority nursing action?

## Option

1. Place the client in seclusion and reassess in 30 minutes.
2. Re-administer haloperidol 2.5 mg IM for continued agitation.
3. Administer benztropine 2 mg IM for extrapyramidal symptoms.
4. Stop the haloperidol, notify the provider immediately, and prepare for cooling and IV fluids. **✔ Correct answer**

**Correct answer: 4**

## Explanation

Correct (2): The constellation of muscle rigidity, hyperthermia, autonomic instability, and altered mental status after antipsychotic administration is classic neuroleptic malignant syndrome (NMS) — a medical emergency with up to 20% mortality if untreated. Priority actions: discontinue the offending agent, notify the provider immediately, and initiate supportive care (active cooling, IV crystalloid fluids, prepare for dantrolene and/or bromocriptine). (1) Incorrect — benztropine treats acute dystonia and drug-induced parkinsonism, not NMS. (3) Incorrect — additional haloperidol will worsen NMS and risk death. (4) Incorrect — seclusion delays recognition and treatment of a life-threatening condition.

## In-depth explanation

Memory Tip NMS = "FEVER" — Fever, Encephalopathy, Vitals unstable, Enzymes (CK ↑↑), Rigidity. Caution NMS ≠ EPS — EPS is movement-only and treatable with anticholinergics; NMS adds fever and autonomic instability and demands drug withdrawal.

## Clinical scenario

Scenario A 34-year-old male with schizophrenia received haloperidol 5 mg IM for acute agitation in the ED 2 hours ago. Current findings: muscle rigidity, fever 39.8°C, tachycardia 124, hypertension 168/96, diaphoresis, and altered mental status. CK and electrolytes are pending.

## Key concepts

- **Neuroleptic malignant syndrome (NMS)** — A rare but life-threatening reaction to antipsychotic medication marked by hyperthermia, lead-pipe muscle rigidity, autonomic instability, altered mental status, and elevated CK.
- **Dantrolene** — A direct skeletal muscle relaxant used to treat NMS and malignant hyperthermia; it reduces calcium release from the sarcoplasmic reticulum, relieving rigidity and hyperthermia.
- **Extrapyramidal symptoms (EPS)** — Movement-related side effects of antipsychotics — acute dystonia, akathisia, parkinsonism, tardive dyskinesia — treated with benztropine or diphenhydramine; distinct from NMS.

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