# Thirty minutes after prochlorperazine 10 mg IM for migraine-associated nausea, an adult client develops acute neck stiffness with upward eye deviation. Which is the most appropriate intervention?

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> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

Thirty minutes after prochlorperazine 10 mg IM for migraine-associated nausea, an adult client develops acute neck stiffness with upward eye deviation. Which is the most appropriate intervention?

## Option

1. Apply ice to the neck and observe
2. Administer diphenhydramine 25-50 mg IV or benztropine 1-2 mg IV/IM for acute dystonia **✔ Correct answer**
3. Administer additional prochlorperazine
4. Administer naloxone IV

**Correct answer: 2**

## Explanation

Correct (2): D2 antagonists (prochlorperazine, metoclopramide, antipsychotics) can cause acute dystonia. Treat with IV/IM diphenhydramine 25-50 mg or benztropine 1-2 mg; usually resolves within 15-30 min. (1) Naloxone is for opioid OD. (3) Worsens dystonia. (4) Insufficient — drug treatment needed.

## In-depth explanation

Memory Tip Acute dystonia from D2 blockade = first-line diphenhydramine or benztropine. Caution Differentiate from NMS (fever, rigidity, autonomic instability) and TD (chronic).

## Clinical scenario

Scenario 26-year-old male received prochlorperazine 10 mg IM in ED for migraine + nausea. 30 min later: torticollis, oculogyric crisis, no fever.

## Key concepts

- **Acute dystonia** — Sudden involuntary muscle contraction (torticollis, oculogyric crisis, opisthotonos).
- **Diphenhydramine/Benztropine** — First-line anticholinergic treatment for acute dystonia from antiemetic or antipsychotic.
- **Prochlorperazine** — Phenothiazine antiemetic; D2 antagonist with EPS risk similar to first-generation antipsychotics.

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