# A client taking risperidone for 8 weeks reports new breast tenderness, galactorrhea, and amenorrhea. Which is the nurse's best interpretation?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391729&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A client taking risperidone for 8 weeks reports new breast tenderness, galactorrhea, and amenorrhea. Which is the nurse's best interpretation?

## Option

1. An early sign of pregnancy, which should be ruled out before considering medication side effects
2. A harmless side effect of risperidone that typically resolves without medical intervention
3. A symptom of hyperprolactinemia from D2 blockade that the provider should be notified about **✔ Correct answer**
4. A therapeutic indication that the dopamine blockade is effectively treating the client's condition

**Correct answer: 3**

## Explanation

Correct (2): Risperidone causes more hyperprolactinemia than other atypicals because of strong D2 receptor blockade in the tuberoinfundibular pathway. Symptoms include galactorrhea, gynecomastia, amenorrhea, decreased libido, and erectile dysfunction. Notify provider — options include dose reduction, switching to a prolactin-sparing atypical such as aripiprazole, or short-term dopamine agonist. (1) Not benign — chronic hyperprolactinemia accelerates bone density loss. (3) Pregnancy should still be ruled out but is not the primary explanation. (4) Not a therapeutic effect.

## In-depth explanation

Memory Tip Highest prolactin elevation: Risperidone + Paliperidone (active metabolite of risperidone). Lowest: Aripiprazole. Clinical Practice Guide Check baseline prolactin if the client has a prolactin-sensitive condition (breast cancer history, osteoporosis, or fertility concerns).

## Clinical scenario

Scenario A 24-year-old female on risperidone 4 mg PO daily for 8 weeks for schizoaffective disorder reports breast tenderness, milk-like nipple discharge, and two missed menstrual periods. She is not sexually active.

## Key concepts

- **Hyperprolactinemia** — Elevated serum prolactin; antipsychotic-induced when D2 blockade reduces dopamine's inhibitory effect on lactotrophs in the anterior pituitary.
- **Tuberoinfundibular pathway** — Dopamine pathway from the hypothalamus to the pituitary that suppresses prolactin secretion; blocked by typical antipsychotics and risperidone.
- **Prolactin-sparing antipsychotic** — Atypical antipsychotics with weak D2 binding or partial agonism (aripiprazole, quetiapine, clozapine) that do not elevate prolactin significantly.

## Related questions

- [A nurse is caring for an alert adult client with type 1 diabetes who reports tremors, swea…](https://mymerci.kr/pages/nclex_q.php?qn_id=360524&lang=en)
- [A 68-year-old client with COPD is admitted with shortness of breath and SpO2 86% on room a…](https://mymerci.kr/pages/nclex_q.php?qn_id=362940&lang=en)
- [A 58-year-old client arrives at the emergency department with crushing substernal chest pa…](https://mymerci.kr/pages/nclex_q.php?qn_id=362976&lang=en)
- [A 72-year-old client is brought to the emergency department by family who report that the …](https://mymerci.kr/pages/nclex_q.php?qn_id=363003&lang=en)
- [A 79-year-old client is admitted from a long-term care facility with diarrhea, decreased o…](https://mymerci.kr/pages/nclex_q.php?qn_id=363089&lang=en)
- [A 76-year-old female with chronic heart failure and atrial fibrillation receives digoxin 0…](https://mymerci.kr/pages/nclex_q.php?qn_id=374883&lang=en)
- [A 70-year-old client on long-term digoxin therapy reports new yellow-green halos around li…](https://mymerci.kr/pages/nclex_q.php?qn_id=374884&lang=en)
- [A 58-year-old client with type 2 diabetes mellitus and migraine prophylaxis is taking prop…](https://mymerci.kr/pages/nclex_q.php?qn_id=374893&lang=en)

## Read in another language

- [en](https://mymerci.kr/pages/nclex_q.php?qn_id=391729&lang=en)
- [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=391729&lang=ko)
- [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=391729&lang=ja)
- [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=391729&lang=zh-tw)
- [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=391729&lang=vi)

---

More free questions: [NCLEX-RN Practice](https://mymerci.kr/pages/nclex_bank.php?lang=en)

_For study reference only. Always follow current clinical guidelines and your institution’s protocols._