A nurse is monitoring a client who is receiving haloperidol. Which finding is the priority to report to the provider?

• A. Hypoactive bowel sounds in all four quadrants
• B. Client report of dry mouth
• C. Client report of photosensitivity
• D. Constant opening and closing of mouth

Answer: (D)

Haloperidol can cause extrapyramidal symptoms due to its strong dopamine blockade in the nigrostriatal pathway. A patient who is repeatedly opening and closing the mouth is showing an acute dystonic reaction ororofacial dyskinesia, a type of EPS that can progress and compromise the airway or feeding. This makes it the highest-priority finding because rapid treatment can prevent airway obstruction and other complications. The standard response is to administer an anticholinergic antidote (such as benztropine or diphenhydramine) as ordered, and to notify the provider promptly so the medication regimen can be adjusted and the patient monitored for improvement.

The other options reflect anticholinergic or nonspecific side effects (dry mouth, photosensitivity) or a gastrointestinal change (hypoactive bowel sounds). While these require attention and management, they do not pose the immediate risk to airway and safety that an acute dystonic reaction does.