Chapter 23: schizophrenia

In working with the individual and family, which is the most accurate statement the nurse can make in order to teach the client and family about schizophrenia? "Individuals with schizophrenia do have differences in brain structure and function that cause a variety of symptoms such as lack of motivation and hearing voices." "Schizophrenia is being found to be related more closely to family dysfunction than to physiology, which is why family therapy is the most effective treatment for this disorder." "Medications for schizophrenia have not changed much since the early 1950s, although there are some medications that may be helpful." "It is more effective to treat the individual on a one-to-one basis than to involve the family in treatment because it is a very complicated process."

"Individuals with schizophrenia do have differences in brain structure and function that cause a variety of symptoms such as lack of motivation and hearing voices." Explanation: Excessive amount of the neurotransmitter dopamine allows nerve impulses to bombard the mesolimbic pathway, the part of the brain normally involved in arousal and motivation. Normal cell communications are disrupted, resulting in the development of hallucinations and delusions. Abnormalities in brain shape and brain circuitry are being researched.

A diagnosis of delusional disorder is based on the presence of one or more nonbizarre delusions for at least what period of time? 1 month 2 months 3 months 4 months

1 month

Which is the central focus of persecutory delusions? Injustice that must be remedied by legal action Involving bodily functions or sensations Unfaithfulness A great, unrecognized talent

Injustice that must be remedied by legal action Explanation: The focus of persecutory delusions is often on some injustice that must be remedied by legal action. Clients often see satisfaction by repeatedly appealing to courts and other government agencies. The central theme of somatic delusions involves bodily functioning or sensations. The central theme of the jealous subtype is the unfaithfulness or infidelity of a spouse or lover. Clients representing with grandiose delusions are convinced they have a great, unrecognized talent or have made an important discovery.

After teaching a class of nursing students about the different types of delusions, the instructor determines that the education was successful when the class identifies which type as most common? Persecutory Somatic Grandiose Erotomanic

Persecutory

A client is diagnosed with a delusional disorder. While providing care to the client, the nurse assesses the client's delusions. Which would be least appropriate for the nurse to do? Try to change the client's delusional belief Evaluate the significance to the client Determine the impact of the delusion on the client's safety Avoid dwelling on the delusion

Try to change the client's delusional belief

A client diagnosed with schizophrenia is having delusions that the client is being plotted against by the government. This would be documented as which type of delusion? persecutory grandiose nihilistic somatic

persecutory

A client with schizophrenia is prescribed a second-generation antipsychotic. The client's parent asks, "About how long will it take until we see any changes in the symptoms?" Which response by the nurse would be most appropriate? "You should see improvement in 36 to 48 hours." "It will take about 6 to 12 weeks for the drug to become effective." "Generally, it takes about 1 to 2 weeks to be effective in changing symptoms." "The symptoms should subside almost immediately."

"Generally, it takes about 1 to 2 weeks to be effective in changing symptoms."

After teaching a client with schizoaffective disorder about the condition and treatment, the nurse determines that the education was successful when the client states what? "I need to eat properly so that I can control my weight." "I should go to sleep at night when I feel tired." "I can vary my routines from day to day without problems." "I can stop my medication when I start to feel better."

"I need to eat properly so that I can control my weight." Explanation: Client education should focus on nutrition and prevention of weight gain, which is a side effect of medication therapy. Establishing a regular sleep pattern by setting a routine can help to promote or reestablish normal patterns of rest. Establishing a daily routine can help address mood symptoms. Medication should not be stopped if the client feels better.

A client tells the nurse that the client has bugs in the client's brain and asks the nurse if the nurse can see them. Which response by the nurse is most therapeutic? "No, I don't see any bugs. You seriously can't have any bugs in your brain." "No, I don't see any bugs. That sounds scary for you." "Your thinking is a little illogical. I wouldn't be able to see bugs if they were inside your brain. Would you like to talk more about this?" "You have a thought disorder and only think you have bugs in your brain. There really aren't any. You don't have to worry because we would give you medicine for any medical problems."

"No, I don't see any bugs. That sounds scary for you."

A client states, "I am dead. I have come back from the dead." What is the most appropriate response by the nurse? "What is it like to feel dead?" "No you didn't. People don't come back from the dead." "Show me what you did in art therapy this morning." "I'll get your medicine and you'll feel better."

"Show me what you did in art therapy this morning." Explanation: The client experiencing delusions utterly believes them and cannot be convinced they are false or untrue. It is the nurse's responsibility to present and maintain reality by making simple statements. The nurse must avoid openly confronting the delusion or arguing with the client about it. The nurse also must avoid reinforcing the delusional belief by "playing along"with what the client says.

A client diagnosed with schizophreniform disorder must have symptoms present for at least 1 month but with a duration of less than how long? 2 weeks 4 weeks 6 months 12 months

6 months Explanation: The essential features of schizophreniform disorder are identical to those of criteria A for schizophrenia, with the exception of the duration of the illness, which can be less than 6 months. Symptoms must be present for at least 1 month to be classified as a schizophreniform disorder.

A mental health client has been prescribed clozapine for the treatment of schizophrenia. The nurse should be alert to which potentially life-threatening adverse effects of this medication? Weight loss Agranulocytosis Palpitations Hemorrhage

Agranulocytosis Explanation: Agranulocytosis is a life-threatening adverse effect of clozapine. White blood cell counts should be monitored frequently due to extremely low levels of white blood cells. Weight gain occurs with certain antipsychotics. Palpitations and hemorrhage are not generally associated with antipsychotics.

A client was admitted to the psychiatric intensive care unit with schizophrenia. Among the client's signs and symptoms, the client was experiencing nihilistic delusions. The nurse understands that these delusions involve a belief about what? Possession of exceptional powers, such as the ability to communicate with a powerful person An impending calamity, such as death Feeling of being watched, such as by the government Belief that communications intended for a broad audience have special meaning for the client

An impending calamity, such as death Explanation: Delusions are erroneous, fixed beliefs that cannot be changed by reasonable argument. Nihilistic delusions involve the belief that one is dead or a calamity is impending; when these delusions involve bodily illness, they take hypochondriacal concerns to the utmost extreme. Grandiose delusions involve the belief that one has exceptional powers, wealth, skill, influence, or destiny. Persecutory delusions involve the belief that one is being watched, ridiculed, harmed, or plotted against. Referential delusions, or ideas of reference, involve a belief that communications such as television broadcasts or website posts are directed toward the client or have special meaning for the client.

Which of the following would the nurse identify as a negative symptom associated with schizophrenia? Hallucinations Anhedonia Bizarre behavior Loose associations

Anhedonia Explanation: Positive symptoms reflect an excess or distortion of normal functions, including delusions and hallucinations. Negative symptoms reflect a lessening or loss of normal functions, such as restriction or flattening in the range and intensity of emotion (diminished emotional expression), reduced fluency and productivity of thought and speech (alogia), withdrawal and inability to initiate and persist in goal-directed activity (avolition), and inability to experience pleasure (anhedonia). Loose associations reflect disorganized thinking, a neurocognitive impairment.

Which statement is true about delusional disorder? The disease onset is usually gradual. Psychosocial functioning is often markedly impaired. Behavior is relatively normal except when focused on the delusion. The individual's personality changes dramatically.

Behavior is relatively normal except when focused on the delusion. Explanation: The course of delusional disorder is variable. The onset can be acute, or the disorder can occur gradually and become chronic. Clients usually live with delusions for years, rarely receiving psychiatric treatment unless their delusion relates to their health (somatic delusion) or they act on the basis of their delusion and violate laws or social rules. Apart from the direct impact of the delusion, psychosocial functioning is not markedly impaired. Behavior is remarkably normal except when the client focuses on the delusion. At that time, the client's thinking, attitudes, and mood may change abruptly. Personality does not usually change, but the client is gradually, progressively involved with the delusional concern.

Which would a nurse expect to administer to a client with schizophrenia who is experiencing a dystonic reaction? Risperidone Aripiprazole Benztropine Trihexyphenidyl

Benztropine Explanation: A client experiencing a dystonic reaction should receive immediate treatment with benztropine. Risperidone and aripiprazole are antipsychotics that may cause dystonic reactions. Trihexyphenidyl is used to treat parkinsonism due to antipsychotic drugs.

Which medication is used to control the extrapyramidal effects associated with antipsychotic medications? Benztropine Chlorpromazine Haloperidol Thioridazine

Benztropine Explanation: Benzotropine is an anticholinergic drug used to relieve drug-induced extrapyramidal adverse effects, such as muscle weakness, involuntary muscle movement, pseudoparkinsonism, and tardive dyskinesia.

A client with schizoaffective disorder is engaging in an extremely long conversation about a current affairs in the world. The client goes on to provide the nurse with minute details. The nurse interprets this as suggesting what? Circumstantiality Neologism Verbigeration Clang association

Circumstantiality Explanation: The client is demonstrating circumstantiality, which refers to extremely detailed and lengthy discourse about a topic.This can be commonly found in a client with euphoric or elevated mood due to the affective component of schizoaffective disorder. Clang associations are ideas that are related to one another based on sound or rhyming rather than meaning. Neologisms are words invented by the client. A verbigeration is the stereotyped repetition of words or phrases that may or may not have meaning to the listener.

Which speech pattern is exhibited by the client stating, "I will take a pill if I go up the hill but not if my name is Jill, I don't want to kill?" Clang association Neologism Verbigeration Word salad

Clang association Explanation: Clang associations are ideas that are related to one another based on sound or rhyming rather than meaning. Neologisms are words invented by the client. A verbigeration is the stereotyped repetition of words or phrases that may or may not have meaning to the listener. A word salad is a combination of jumbled words and phrases that are disconnected or incoherent and make no sense to the listener.

A nurse is assessing a client diagnosed with schizophrenia. When documenting the findings, which would the nurse identify as a positive symptom? Select all that apply. Delusions Hallucinations Alogia Anhedonia Avolition

Delusions and Hallucinations

A physician has diagnosed a client with schizophrenia. The nurse knows that schizophrenia is characterized by which of the following? Loss of identity Disturbances in affect Multiple personalities Confusion

Disturbances in affect

After teaching a group of nursing students about neurotransmitters associated with schizophrenia, the nursing instructor determines that the education was successful when the students identify what as playing a role in the positive symptoms of schizophrenia? Dopamine Serotonin Glutamate Gamma-aminobutyric acid (GABA)

Dopamine Explanation: Positive symptoms of schizophrenia, specifically hallucinations and delusions, are thought to be related to dopamine hyperactivity. Studies are revealing that schizophrenia does not result from the dysregulation of a single neurotransmitter or biogenic amine, such as norepinephrine or serotonin. Hypothesis suggests a role for glutamate and GABA. However, dopamine dysfunction is also thought to be involved in psychosis with other disorders.

A client is repeating every word that the nurse says. This would be correctly documented as which of the following? Word salad Clang association Neologisms Echolalia

Echolalia Explanation: Echolalia is the client's imitation or repetition of what the nurse says. A word salad is a combination of jumbled words and phrases that are disconnected or incoherent and make no sense to the listener. Clang associations are ideas that are related to one another based on sound or rhyming rather than meaning. Neologisms are words invented by the client.

The nurse suspects that a client is experiencing a brief psychotic episode based on what? Select all that apply. Gradual onset of symptoms Evidence of hallucinations Intense changes in affect Mild confusion Recent life stressor

Evidence of hallucinations Intense changes in affect Recent life stressor Explanation: In brief psychotic disorder, the length of the episode is at least 1 day but less than 1 month. The onset is sudden and includes at least one of the positive symptoms of criteria A for schizophrenia (delusions or hallucinations). The person generally experiences overwhelming confusion and rapid, intense shifts of affect. Brief psychotic disorder can often occur in the context of a recent life stressor such as giving birth.

Which type of antipsychotic medication is most likely to produce extrapyramidal effects? Atypical antipsychotic drugs First-generation antipsychotic drugs Third-generation antipsychotic drugs Dopamine system stabilizers

First-generation antipsychotic drugs Explanation: The conventional, or first-generation, antipsychotic drugs are potent antagonists of dopamine receptors D2, D3, and D4. This makes them effective in treating target symptoms but also produces many extrapyramidal side effects because of the blocking of the D2 receptors. Newer, atypical or second-generation antipsychotic drugs are relatively weak blockers of D2, which may account for the lower incidence of extrapyramidal side effects. The third generation of antipsychotics, called dopamine system stabilizers, is being developed. These drugs are thought to stabilize dopamine output that results in control of symptoms without some of the side effects of other antipsychotic medications.

A client on the unit suddenly cries out in fear. The nurse notices that the client's head is twisted to one side, the client's back is arched, and the client's eyes have rolled back in the sockets. The client has recently begun drug therapy with haloperidol. Based on this assessment, which would be the first action of the nurse? Get a stat order for a serum drug level Hold the client's medication until the symptoms subside Place an urgent call to the client's physician Give a PRN dose of benztropine IM

Give a PRN dose of benztropine IM Explanation: The client is having an acute dystonic reaction; the treatment is anticholinergic medication. Dystonia is most likely to occur in the first week of treatment, in clients younger than 40 years, in males, and in those receiving high-potency drugs such as haloperidol. Immediate treatment with anticholinergic drugs usually brings rapid relief.

Which of the following life-threatening reactions, related to neuroleptic medication, is exhibited by rigidity, fever, hypertension, and diaphoresis? Neuroleptic malignant syndrome Dystonia Tardive dyskinesia Akathisia

Neuroleptic malignant syndrome Explanation: The client's signs and symptoms suggest neuroleptic malignant syndrome, a life-threatening reaction to neuroleptic medication that requires immediate treatment. Dystonia is characterized by cramps and rigidity of the tongue, face, neck, and back muscles. Tardive dyskinesia causes involuntary movements of the tongue, mouth, facial muscles, and arm and leg muscles. Akathisia causes restlessness, anxiety, and jitteriness.

The client was conversing with the nurse when noticeable changes occurred with the client. Which is a term used to describe the occurrence of the eye rolling back in a locked position, which occurs with acute dystonia? Opisthotonus Oculogyric crisis Torticollis Pseudoparkinsonism

Oculogyric crisis Explanation: Oculogyric crisis is the occurrence of the eye rolling back in a locked position, which occurs with acute dystonia. Opisthotonus is tightness in the entire body with the head back and an arched neck. Torticollis is twisted head and neck. Oculogyric crisis, opisthotonus, and torticollis are manifestations of acute dystonia. Pseudoparkinsonism is drug-induced parkinsonism and is often referred to by the generic label of extrapyramidal side effects.

A mental health client insists that the client's spouse is trying to poison the client. In this instance, the client is exhibiting which type of delusion? Somatic Erotomanic Persecutory Grandiose

Persecutory Explanation: Clients who exhibit persecutory delusions believe that they are being conspired against, spied on, poisoned, or drugged. Somatic delusions demonstrate a preoccupation with the body. A client exhibiting erotomanic delusions believes that a person of elevated social status loves him or her. Grandiose delusions are present when the client believes that he or she possesses unrecognized talent or insight or has made an important discovery.

A client with delusional disorder believes that the cook at the psychiatric hospital is trying to poison the client. The nurse would record this type of delusion as what? Erotomanic Persecutory Grandiose Somatic

Persecutory Explanation: The central theme of persecutory delusions is the client's belief that he or she is being conspired against, cheated on, spied on, followed, poisoned, drugged, maliciously maligned, harassed, or obstructed in pursuit of long-term goals. Erotomanic delusions are characterized by the delusional belief that the client is loved intensely by the loved object who is usually married, of a higher economic status, or otherwise unattainable. Grandiose delusions involve the belief that the person has a great, unrecognized talent or has made an important discovery or has a special relationship with a prominent person (or of actually being a prominent person). Somatic delusions involve bodily functions or sensations, with the client believing that he or she has physical ailments.

Which type of delusion refers to a situation whereby a person or someone close to person is being malevolently treated in some way? Grandiose type Persecutory type Somatic type Unspecified typ

Persecutory type Explanation: Persecutory type delusion refers to a situation whereby a person or someone close to person is being malevolently treated in some way.

What is an anticholinergic side effect associated with some antipsychotic medications? Photophobia Salivation Increased tearing Diarrhea

Photophobia Explanation: Photophobia, dry mouth, decreased lacrimation, and constipation are anticholinergic side effects associated with some antipsychotic medications.

Which extrapyramidal side effect is noted by a client who has bradykinesia and a shuffling gait? Pseudoparkinsonism Akathisia Acute dystonia Tardive dyskinesia

Pseudoparkinsonism Explanation: Pseudoparkinsonism is noted by a resting tremor, rigidity, a masklike face, and a shuffling gait. Akathisia occurs when the client has motor restlessness evidenced by pacing, rocking, or shifting from foot to foot. Symptoms of acute dystonia are intermittent or fixed abnormal postures of the eyes, face, tongue, neck, trunk, and extremities.

A client with schizophrenia reads the advice column in the newspaper daily. When asked why the client is so interested in the advice column, the client replies, "This person is my guide and tells me what I must do every day." The nurse would best describe this type of thinking as what? Referential delusion Grandiose delusion Thought insertion Personalization

Referential delusion Explanation: Referential delusions or ideas of reference involve the client's belief that television broadcasts, music, or newspaper articles have special meaning for him or her. Grandiose delusions are characterized by the client's claim to association with famous people or celebrities or the client's belief that he or she is famous or capable of great feats. Thought insertion is the belief that others are placing thoughts in their mind against their will. Personalization is not a psychotic characteristic of schizophrenia.

When reviewing the diagnostic criteria for schizophrenia based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V), which would be most accurate? Schizophrenia can be diagnosed as soon as an individual states he or she is hearing voices. Schizophrenia lasts at least 6 months and includes at least 1 month of two or more characteristic symptoms. Schizophrenia lasts at least 1 month and must include the symptom of hallucinations. Schizophrenia can be diagnosed as soon as an individual states he or she is hallucinating and delusional.

Schizophrenia lasts at least 6 months and includes at least 1 month of two or more characteristic symptoms.

A client with schizophrenia is exhibiting positive and negative symptoms. The nurse anticipates that the client would be prescribed what? Stimulant Antidepressant Second generation antipsychotic First generation antipsychotic

Second generation antipsychotic Explanation: The second-generation antipsychotics are effective in treating negative and positive symptoms. These newer drugs also affect several other neurotransmitter systems, including serotonin. This is believed to contribute to their antipsychotic effectiveness. None of the other agents would be appropriate

A nurse is assessing a client who is reporting the sensation of "bugs crawling under the skin" and intense itching and burning. The client states, "I know bugs have invaded my body." There is no evidence to support the client's report. The nurse interprets this as which type of delusion? Nihilistic Grandiose Somatic Persecutory

Somatic Explanation: Somatic delusions involve bodily functions or sensations, such as insects having infested the skin. The client vividly describes crawling, itching, burning, swarming, and jumping on the skin surface or below the skin. The client maintains the conviction that he or she is infested with parasites in the absence of objective evidence to the contrary. Nihilistic delusions focus on impending death or disaster. Clients presenting with grandiose delusions are convinced they have a great, unrecognized talent or have made an important discovery. The central theme of persecutory delusions is the client's belief that he or she is being conspired against, cheated, spied on, followed, poisoned, drugged, maliciously maligned, harassed, or obstructed in pursuit of long-term goals.

For a client taking clozapine, which symptom should the nurse report to the health care provider immediately, as it may indicate a potentially fatal side effect? Inability to stand still for 1 minute Mild rash Photosensitivity reaction Sore throat and malaise

Sore throat and malaise Explanation: Clozapine produces fewer traditional side effects than do most antipsychotic drugs, but it has the potentially fatal side effect of agranulocytosis. This develops suddenly and is characterized by fever, malaise, ulcerative sore throat, and leukopenia. This side effect may not be manifested immediately and can occur up to 24 weeks after the initiation of therapy. Any symptoms of infection must be investigated immediately. Agranulocytosis is characterized by fever, malaise, ulcerative sore throat, and leukopenia. Mild rash and photosensitivity reaction are not serious side effects.

A client diagnosed with schizophrenia is laughing and talking while sitting alone. Which is the best response by the nurse? State, "Can you share your joke with me?" To sit with the client quietly until the client is ready to talk. State, "Tell me what's happening." State, "You look lonely here. Let's join the others in the day room."

State, "Tell me what's happening."

A client is diagnosed with schizoaffective disorder. The interdisciplinary plan of care includes key family members. The nurse understands that a major reason for doing so involves which of the following? Strengthening the client's recovery Keeping the client's behavior on track Preventing a relapse Maintaining the client's boundaries

Strengthening the client's recovery Explanation: By collaborating with family members, the client's willingness to follow treatment, monitor symptoms, and continue with rehabilitation and recovery can be strengthened. Although family members can monitor the client's behavior and assist with boundaries, they cannot keep the behavior from occurring, preventing a relapse or maintain the client's boundaries.

Although a psychotic episode can be brief, the client impact can last a long time. For this reason, the nurse is aware of what? The best outcomes are achieved on an outpatient basis Family supports are required Supervision may be required to protect the person Cognitive therapy is indicated

Supervision may be required to protect the person

A 55-year-old client was admitted to the psychiatric unit after an incident in a department store in which the client accused a sales clerk of following the client around the store and stealing the client's keys. The client was subdued by the police after destroying a window display because voices had told the client that it was evil. As the nurse approached the client, the client says, "You're all out to get me, and you're one of them. They're Rostoputians and grog babies here." This demonstrates what? Loose associations and flight of ideas Suspiciousness and neologisms Illusions and loss of ego boundaries Echolalia and echopraxia

Suspiciousness and neologisms Explanation: The client is demonstrating suspiciousness ("you're all out to get me") and neologisms (use of the words "Rostoputians and grog babies"). Loose associations and flight of ideas occur when the client talks about many topics in rapid sequence, but they are not connected with each other. Illusions are when the client sees something that is not there; echolalia is the repetition of words (or words that sound similar) said by someone else.

A client with severe and persistent mental illness has been taking antipsychotic medication for 20 years. The nurse observes during a therapy session that the client's behavior includes repetitive movements of the mouth and tongue, facial grimacing, and rocking back and forth. The nurse recognizes these behaviors as indicative of what? Extrapyramidal side effects Loss of voluntary muscle control Posturing Tardive dyskinesia

Tardive dyskinesia Explanation: The client's behaviors are classic signs of tardive dyskinesia. Tardive dyskinesia, a syndrome of permanent involuntary movements, is most commonly caused by the long-term use of conventional antipsychotic drugs. Extrapyramidal side effects are reversible movement disorders induced by antipsychotic or neuroleptic medication. The client's behavior is not a loss of voluntary control or posturing.

The student nurse correctly recognizes that which finding is best supported by genetic studies in the etiology of schizophrenia? That if a person has schizophrenia, distant relatives are also at risk. That there is no relationship at all between schizophrenia and genetics. That there is a weak correlation between genetics and schizophrenia. That schizophrenia is at least partially inherited.

That schizophrenia is at least partially inherited.

Research related to the development of schizophrenia has shown what? The likelihood of developing schizophrenia for a sibling of a person with the disorder is less than that of individuals in the general population. The disorder is thought to arise from the interaction of a biological predisposition and environmental stressors. Behavioral family pathology, not genetics, is the primary risk factor for the development of schizophrenia. If an identical twin develops schizophrenia, the other twin will also develop the disorder.

The disorder is thought to arise from the interaction of a biological predisposition and environmental stressors. Explanation: The likelihood of first-degree relatives (including siblings and children) developing schizophrenia has long been recognized as 10 times more likely than individuals in the general population. While this likelihood clearly suggests a strong genetic factor, the concordance for schizophrenia among monozygotic (identical) twins is 50%, suggesting that there are also environmental factors. Schizophrenia is believed to be caused by the interaction of a biologic predisposition or vulnerability and environmental stressors.

A client is diagnosed with a delusional disorder. While providing care to the client, the nurse assesses the client's delusions. Which would be least appropriate for the nurse to do? Try to change the client's delusional belief Evaluate the significance to the client Determine the impact of the delusion on the client's safety Avoid dwelling on the delusion

Try to change the client's delusional belief Explanation: By definition, delusions are fixed, false beliefs that cannot be changed by reasonable arguments. The nurse should assess the client's delusion to evaluate its significance to the client, to the client's safety, and to the safety of others. The nurse should not dwell on the delusion or try to change it.

A client diagnosed with schizophrenia states, "I want to go home, go home, go home." This is an example of which speech pattern? Verbigeration Clang association Neologisms Word salad

Verbigeration Explanation: A verbigeration is the stereotyped repetition of words or phrases that may or may not have meaning to the listener. Clang associations are ideas that are related to one another based on sound or rhyming rather than meaning. Neologisms are words invented by the client. A word salad is a combination of jumbled words and phrases that are disconnected or incoherent and make no sense to the listener.

A client is admitted to the psychiatric hospital with a diagnosis of schizophrenia. During the physical examination, the client's arm remains outstretched after the nurse obtains the pulse and blood pressure, and the nurse must reposition the arm. The nurse interprets this as what? Waxy flexibility Hypervigilance Retardation Echopraxia

Waxy flexibility Explanation: Waxy flexibility, the ability to assume and maintain awkward or uncomfortable positions for long periods, is characteristic of catatonic schizophrenia. Clients commonly remain in these awkward positions until someone repositions them. Exchopraxia refers to the involuntary imitation of another person's movements and gestures. Hypervigilance refers to the sustained attention to external stimuli, as if expecting something important or frightening to occur. Retardation refers to slowed movements.

When describing the difference between schizoaffective disorder (SAD) and schizophrenia, the nurse would address which as associated with SAD? lower level of functioning increased mood responses decreased risk for suicide delusions but no hallucinations

increased mood responses Explanation: Clients with SAD have many similar responses to their disorder as people with schizophrenia, with one exception. These clients have many more "mood" responses and are very susceptible to suicide. Persons with SAD usually have higher functioning than those with schizophrenia, with severe negative symptoms and early onset of illness. To be diagnosed with SAD, a client must have an uninterrupted period of illness when there is a major depressive, manic, or mixed episode along with two of the following symptoms of schizophrenia: delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, or negative symptoms.

A client with schizophrenia is prescribed clozapine. The nurse would monitor the client closely for specific signs of: hypotension. nausea. weight loss. infection.

infection. Explanation: Agranulocytosis can develop with the use of all antipsychotic drugs, but it is most likely to develop with clozapine use. Therefore, the nurse needs to be alert for signs of infection, particularly bacterial infection. Hypotension may occur with any antipsychotic drug. Nausea is a common side effect of many drugs. Weight gain, not loss, can occur with olanzapine and clozapine.