A patient with schizophrenia on respridol and high-potency PRN antipsychotics develops fever, muscle rigidity, and confusion. What is the probable cause and the most appropriate initial nursing action?

• A. Continue the antipsychotic and monitor vitals
• B. Hold the antipsychotic and request CBC and CPK levels
• C. Administer antipyretic and restart the antipsychotic
• D. Start rapid cooling without stopping medications

Answer: (B)

When you see fever, severe muscle rigidity, and confusion in a patient taking antipsychotics, think neuroleptic malignant syndrome, a dangerous reaction to dopamine blockade. The likely cause is NMS from the antipsychotic medication, which can cause hyperthermia, rigid muscles, altered mental status, and potential organ injury from muscle breakdown.

The best initial nursing action is to hold the antipsychotic and request CBC and CPK levels. Stopping the offending drug is crucial to prevent further progression of NMS. CPK elevation reflects muscle breakdown (rhabdomyolysis), which can lead to kidney injury and helps confirm the diagnosis, while CBC can show leukocytosis that often accompanies NMS. These steps promptly address the cause and begin the diagnostic workup, after which supportive measures (hydration, cooling, monitoring) are started per protocol.

Continuing the medication would risk rapid deterioration. Restarting the antipsychotic at this moment would worsen the condition, and starting rapid cooling without stopping the drug ignores the underlying cause.