# A client taking aripiprazole reports new motor restlessness and an inability to sit still for the past week. Which is the nurse's best interpretation?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391731&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A client taking aripiprazole reports new motor restlessness and an inability to sit still for the past week. Which is the nurse's best interpretation?

## Option

1. Neuroleptic malignant syndrome, a life-threatening emergency requiring immediate medical intervention and drug discontinuation.
2. Tardive dyskinesia, a potentially irreversible movement disorder that requires prompt discontinuation of the offending agent.
3. Akathisia, a movement-related side effect that should be reported and may respond to dose reduction or a beta-blocker. **✔ Correct answer**
4. An indication of worsening anxiety from the underlying condition, requiring an increase in aripiprazole dosage.

**Correct answer: 3**

## Explanation

Correct (2): Akathisia — subjective inner restlessness with observable motor restlessness — is a common acute EPS of aripiprazole because of its partial D2 agonism. Treatment options: dose reduction, switching agents, or adding propranolol or a short-course benzodiazepine. (1) Relapse presents with positive psychotic symptoms (hallucinations, delusions), not motor restlessness. (3) Tardive dyskinesia develops after months to years and presents with repetitive involuntary movements (lip smacking, tongue thrusting). (4) NMS requires fever, rigidity, and autonomic instability — all absent here.

## In-depth explanation

Memory Tip Aripiprazole = partial D2 agonist; akathisia is its signature EPS despite overall lower EPS than haloperidol. Differentiate Akathisia (early, motor restlessness) ≠ Tardive dyskinesia (late, repetitive involuntary) ≠ NMS (fever + rigidity + autonomic).

## Clinical scenario

Scenario A 32-year-old male on aripiprazole 15 mg PO daily for 2 weeks for schizophrenia reports being unable to sit still, constantly pacing, and feeling "jittery from the inside." Vital signs are stable. There is no fever, rigidity, or repetitive involuntary movement.

## Key concepts

- **Akathisia** — Subjective inner restlessness with observable motor restlessness; a common acute EPS of antipsychotics, especially aripiprazole and high-potency typicals.
- **Partial D2 agonist** — Pharmacologic action of aripiprazole, brexpiprazole, and cariprazine — stabilizes dopamine signaling rather than fully blocking it; reduces EPS and metabolic risk.
- **Tardive dyskinesia** — Late-onset involuntary repetitive movements (face, tongue, limbs) after months to years of antipsychotic therapy; treatable with valbenazine or deutetrabenazine.

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