# Stage 5 — Take action. After acute stabilization of neuroleptic malignant syndrome caused by haloperidol, the client's temperature and rigidity are improving, but auditory hallucinations persist. The psychiatry and medical teams meet with the client and family to plan future antipsychotic treatment. Which elements should the nurse support in the recurrence-prevention plan? Select all that apply. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=617238&lang=en > language: en > subject: Health Promotion/Disease Prevention > category: HPM ## Question Stage 5 — Take action. After acute stabilization of neuroleptic malignant syndrome caused by haloperidol, the client's temperature and rigidity are improving, but auditory hallucinations persist. The psychiatry and medical teams meet with the client and family to plan future antipsychotic treatment. Which elements should the nurse support in the recurrence-prevention plan? Select all that apply. 1 Use a long-acting injectable antipsychotic to secure adherence 2 Delay any antipsychotic until at least 2 weeks after symptoms resolve 3 Stay well hydrated; monitor temperature and vitals during any restart 4 Add lithium so that a lower antipsychotic dose controls the psychosis 5 Give benztropine with the first restart dose to prevent new rigidity 6 Choose a low dose of a lower-potency agent and increase it slowly ## Explanation When psychosis requires antipsychotic rechallenge after NMS, recurrence risk is lowered by waiting at least 2 weeks after resolution, starting a low dose of a lower-potency agent with slow titration, and maintaining hydration with close monitoring of temperature and vital signs. A long-acting injectable cannot be withdrawn if NMS recurs, adding lithium is itself a recognized NMS risk factor, and benztropine prophylaxis targets extrapyramidal symptoms, not NMS, while impairing heat loss. ## In-depth explanation Quick answer Support a delay of at least 2 weeks after resolution, a low-dose lower-potency agent titrated slowly, and hydration with temperature and vital-sign monitoring during any restart (2, 3, 6). Why this is correct Most clients who need antipsychotics after NMS can be rechallenged safely if risk factors are controlled. Recurrence risk is highest with early rechallenge, high-potency agents, rapid dose escalation, parenteral or depot routes, and dehydration, which are the exact factors present when this client's NMS began (repeated IM doses, rapid escalation, poor intake). Easy analogy or mental picture Think of re-entering cold water after a cramp: you wait until the muscle has fully recovered, go in slowly and shallowly, and have someone watching. Memory hook Rechallenge rule: Wait, go Weak (low potency), go Slow, stay Wet. NCLEX decision rule Plan antipsychotic rechallenge by reversing the risk factors that caused the original episode: timing, potency, rate of escalation, route, and hydration. Why the other choices are wrong A long-acting injectable is tempting because adherence matters in psychosis, but a depot cannot be withdrawn if NMS recurs, so oral agents are used for rechallenge. Adding lithium sounds like a dose-sparing strategy, but concurrent lithium is a recognized risk factor for NMS and does not make rechallenge safer. Benztropine with the first dose is tempting because anticholinergics prevent antipsychotic dystonia and EPS rigidity, but they do not prevent NMS and their anticholinergic effect reduces sweating and heat loss. References 1StatPearls: Neuroleptic Malignant Syndrome (NCBI Bookshelf)Rechallenge after NMS: wait at least 2 weeks, use low-potency or atypical agents at low dose with slow titration, avoid depot forms, maintain hydration, and monitor ## Clinical scenario Case update After acute stabilization, the client and family begin planning psychiatric treatment and medical follow-up. ## Key concepts - **Antipsychotic rechallenge** — Planned reintroduction of an antipsychotic after NMS under conditions that reduce the chance of recurrence. - **Antipsychotic potency** — The strength of dopamine D2 blockade; high-potency agents such as haloperidol carry greater NMS risk. - **Long-acting injectable** — A depot antipsychotic released over weeks that cannot be quickly removed if an adverse reaction develops. ## Related questions - [A 6-month-old infant is brought to the well-child clinic for routine vaccinations. 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