Chapter 12 Schizophrenia and Schizophrenia Spectrum Disorders

Which statement by a person with paranoid schizophrenia most clearly indicates that the antipsychotic medication is effective? A. "I used to hear scary voices but now I don't hear them anymore." B. "My medicine is working fine. I'm not having any problems." C. "Sometimes it's hard for me to fall asleep, but I usually sleep all night." D. "I think some of the staff members don't like me. They're mean to me.

A Auditory hallucinations are a common manifestation of paranoid schizophrenia, so their absence is an indicator of medication effectiveness. "My medicine is working fine. I'm not having any problems" and "Sometimes it's hard for me to fall asleep, but I usually sleep all night" are too vague. "I think some of the staff members don't like me. They're mean to me" indicates paranoid thinking.

The causation of schizophrenia currently is understood to be A. A combination of inherited and non-genetic factors B. Deficient amounts of the neurotransmitter dopamine C. Excessive amounts of the neurotransmitter serotonin D. Stress related and ineffective stress management skills

A Causation is a complicated matter. Schizophrenia most likely occurs as a result of a combination of inherited genetic factors and extreme non-genetic factors (e.g., viral infection, birth injuries, nutritional factors) that can affect the genes governing the brain or directly injure the brain.

A nurse is educating a patient's family about schizophrenia. What is the most appropriate advice the nurse can give to the patient's family? Select all that apply. A. The nurse should advise them to keep in touch with support groups. B. The nurse should avoid mentioning the side effects of the drugs prescribed. C. The nurse should advise them to keep the patient in an isolated room. D. The nurse should advise them to adhere to the treatment plan. E. The nurse should advise them to immediately stop the medication if the patient's symptoms are relieved.

A, D The nurse should advise the family of the patient to join support groups such as National Alliance on Mental Illness and other local support groups. These groups would help to provide optimal patient care as well as support to the family. Adherence to the treatment plan would result in positive outcomes for the patient. The patient's family must be educated about the possible side effects of the prescribed drugs. This would help in effective monitoring and reducing panic in the patient and family members. The patient should be encouraged to interact with others. Keeping the patient isolated can make the patient either aggressive or withdrawn. The medications should not be stopped immediately after the symptoms are relieved as it could cause relapse of the schizophrenic symptoms. Gradually decreasing the dosage of the drug would be useful to prevent a relapse.

A nurse works with a patient in the acute phase of schizophrenia. Which assessment findings increase the risk of aggression and violence? Select all that apply. A. Paranoia B. Flat affect C. Poor hygiene D. Delusional thinking E. Command hallucinations

A, D, E A small percentage of patients with schizophrenia, especially during the acute phase, may exhibit a risk for physical violence, typically in response to hallucinations (especially command hallucinations), delusions, paranoia, and impaired judgment or impulse control. Poor hygiene and a flat affect are negative symptoms that usually are not associated with aggression or violence.

A nurse plans a series of psychoeducational groups for persons with schizophrenia. Which topic would take priority? A. How to complete an application for employment B. The importance of taking medication correctly C. Ways to dress and behave when attending community events D. How to give and receive compliments

B Although completing applications, dressing and behaving correctly, and giving and receiving compliments are important, correct self-management of pharmacotherapy takes priority. The patient cannot maintain remission without the appropriate medication.

A patient's dose of haloperidol (Haldol) was increased earlier today. The patient now is experiencing laryngeal dystonia. What is the nurse's priority action? A. Document the finding B. Maintain a patent airway C. Offer oral fluids to the patient D. Engage the patient in an alternative activity

B Laryngeal dystonia is associated with an acute dystonic reaction and may impair the integrity of the patient's airway. The nurse will document the events after they are managed. Oral fluids could be aspirated. Immediate nursing action is indicated; it would be inappropriate to try to engage the patient in an alternate activity.

In a clinical interview conducted at a community health care center, the nurses observe that a schizophrenic patient is very sensitive and feels extremely guilty about his or her previous actions. What is the appropriate diagnosis by a nurse about the patient? A. The patient has impaired verbal communication. B. The patient has risk for self-directed violence. C. The patient is showing positive symptoms of schizophrenia. D. The patient is a victim of child abuse.

B The patient with schizophrenia show negative symptoms such as self-blaming, guilt, and becoming sensitive. It indicates that the patient is at risk for self-directed violence and can do self-harm. Impaired verbal communication is characterized by dissociative ideas. Positive symptoms of schizophrenia include hallucination and associative looseness. Feeling guilty and being sensitive are negative symptoms of schizophrenia. Schizophrenia is not associated with a history of child abuse.

Which of the following symptoms would alert a health care provider to a possible diagnosis of schizophrenia in a young adult male? A. Excessive sleeping with disturbing dreams B. Hearing voices telling him to hurt his roommate C. Withdrawal from college because of failing grades D. Chaotic and dysfunctional relationships with his family and peers

C People diagnosed with schizophrenia all have at least one psychotic symptom, such as hallucinations, delusional thinking, or disorganized speech. Excessive sleeping, failing grades, and chaotic and dysfunctional relationships do not describe schizophrenia but could be caused by a number of problems.

Which symptom seen in a schizophrenic patient can be categorized as a positive symptom? A. Loss of motivation B. Impaired judgment C. Delusions D. Dysphoria

C The behavioral traits not normally found in healthy patients are called positive symptoms of schizophrenia. They include delusions, hallucinations, bizarre behavior, and paranoia. The behaviors that the patient lacks compared to healthy people are negative symptoms, such as loss of motivation and alogia (poverty of thought or inability to speak). Impaired judgment and illogical thinking are the cognitive symptoms associated with schizophrenia. Dysphoria and suicidal intentions are affective symptoms of schizophrenia. Affective symptoms involve emotions and their expression.

A nurse assesses a patient diagnosed with schizophrenia who states, "Aliens are trying to inject me with their DNA." The nurse documents the patient's comment and applies which term? A. Anosognosia B. Affective blunting C. Positive symptoms D. Negative symptoms

C The patient's comment indicates delusional thinking, which is a positive symptom of schizophrenia. Anosognosia refers to an inability to realize an illness exists. Affective blunting relates to the patient's outward expression of emotion. Negative symptoms include social isolation, anergia, lack of motivation, blunted affect, and inattention to personal hygiene.

A patient diagnosed with disorganized schizophrenia would have greatest difficulty when the nurse A. Interacts with a neutral attitude B. Uses concrete language C. Gives multistep directions D. Provides nutritional supplements

C The thought processes of the patient with disorganized schizophrenia are severely disordered, and severe perceptual problems are present, making it extremely difficult for the patient to understand what others are saying. All communication should be simple and concrete and may need to be repeated several times.

Which side effect of antipsychotic medication is generally nonreversible? A. Anticholinergic effects B. Pseudoparkinsonism C. Dystonic reaction D. Tardive dyskinesia

D Tardive dyskinesia is not always reversible with discontinuation of the medication and has no proven cure. The side effects in anticholinergic effects, pseudoparkinsonism, and dystonic reaction often appear early in therapy and can be minimized with treatment.