Comprehensive exams for Mental Health Q 174
Nurse Anne is caring for a client who has been treated long term with antipsychotic medication. During the assessment, Nurse Anne checks the client for tardive dyskinesia. If tardive dyskinesia is present, Nurse Anne would most likely observe:
A. Abnormal movements and involuntary movements of the mouth, tongue, and face.
B. Abnormal breathing through the nostrils accompanied by a “thrill.”
C. Severe headache, flushing, tremors, and ataxia.
D. Severe hypertension, migraine headache.
Correct Answer: A. Abnormal movements and involuntary movements of the mouth, tongue, and face.
Tardive dyskinesia is a severe reaction associated with long-term use of antipsychotic medication. The clinical manifestations include abnormal movements (dyskinesia) and involuntary movements of the mouth, tongue (flycatcher tongue), and face. Tardive dyskinesia (TD) is a syndrome which includes a group of iatrogenic movement disorders caused due to a blockade of dopamine receptors. The movement disorders include akathisia, dystonia, buccolingual stereotypy, myoclonus, chorea, tics, and other abnormal involuntary movements which are commonly caused by the long-term use of typical antipsychotics.
Option B: Tardive dyskinesia presents clinically as stereotypical involuntary movements of the tongue, neck and facial muscles, truncal musculature, and limbs. Buccolingual movements including masticatory muscles are characterized by lip-smacking, tongue protrusion, perioral movements, chewing movements, or puffing of cheeks.
Option C: However, tardive dyskinesia is seen in patients who have had chronic exposure to dopamine D2 receptor blockade and rarely seen in patients who have been exposed to antipsychotics for less than three to six months. Diagnosis of acute or chronic dyskinesias may be challenging without a careful history. A thorough history of movement disorders and medication history will aid in making an accurate diagnosis of tardive dyskinesia.
Option D: Tardive dyskinesia is caused due to long-term exposure to first and second-generation neuroleptics, certain antidepressants, lithium, and some antiemetic medications. Typically, the first-generation antipsychotics with increased dopamine D2 receptor affinity are affiliated with a higher risk of causing permanent abnormal involuntary movements.