A nurse is assessing a client who has schizophrenia which has been treated with fluphenazine for several years. Which of the following findings should the nurse document as manifestations of tardive dyskinesia (TD)?

Choice A reason: Twisting, protruding, or writhing tongue movements are classic signs of tardive dyskinesia, a late-onset movement disorder caused by long-term antipsychotic use. These movements result from chronic dopamine receptor hypersensitivity and involve involuntary, repetitive oral–facial movements. Choice B reason: Sudden high fever is associated with neuroleptic malignant syndrome, a rare but life-threatening reaction. This symptom is unrelated to tardive dyskinesia and suggests autonomic dysfunction rather than involuntary repetitive movements. Choice C reason: A shuffling gait is more consistent with drug-induced parkinsonism, another extrapyramidal side effect. It involves rigidity, slowed movement, and tremors rather than the involuntary choreiform movements of tardive dyskinesia. Choice D reason: Tapping of feet can indicate akathisia, an extrapyramidal symptom characterized by inner restlessness and an urge to move. It is not indicative of tardive dyskinesia, which specifically involves involuntary, repetitive, purposeless movements, especially of the mouth, tongue, and face.