Mental Health Chapter 16

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

A client in an inpatient setting has a delusion that there are a multitude of undetectable noxious gases in circulation that have the potential to poison the client and others. Which of the nurse's responses is most therapeutic?

"I can assure you that you are actually very safe here."

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. That sounds scary for you."

The nurse is teaching a client with schizoaffective disorders (SAD) about the client's prescribed medication therapy. The nurse determines that additional education is needed when the client states what?

"One day, I won't have to worry about taking any medication."

The nurse working with a client who is newly diagnosed with schizophrenia would include which in the client's education?

"Schizophrenia is an illness that involves neurotransmitters, more specifically dopamine."

A client diagnosed with schizophrenia is prescribed clozapine because other prescribed medications have been ineffective. After educating the client and family about the drug, the nurse determines that the education was successful when they agree with which statement?

"We'll need to make sure that the client has the client's blood count checked at least weekly."

A client who is delusional and paranoid refuses to take antipsychotic medication as prescribed. Which is the most therapeutic response by the nurse to this refusal?

"What is it about the medicine that you don't like?"

A client with a persecutory delusion has been explaining to the nurse the specifics of the conspiracy against the client. The client pauses and says, "I get the feeling that you don't actually believe that what I'm telling you is true." How should the nurse respond?

"What you're telling me is difficult for me to believe. This may be real for you, but not me."

A client is diagnosed with schizophreniform disorder. The nurse is reviewing the client's medical record and finds that the client's symptoms have been present for at least how long?

1 month

Which client exhibits the characteristics that are typical of the prodromal phase of schizophrenia?

A 20-year-old is experiencing a gradual decrease in the ability to concentrate, be productive, and sleep restfully.

During an admission assessment with a psychiatric-mental health nurse, a client states that the client hears the voice of God in the client's head and the voice is telling the client that the client is worthless. How should the nurse document this symptom?

A hallucination

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?

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?

A client diagnosed with schizophrenia has been prescribed clozapine. Which is a potentially fatal side effect of this medication?

Agranulocytosis

A nurse monitoring client medication needs to recognize side effects quickly and intervene promptly for which reason?

Alleviate the side effects and help client maintain adherence

After assessing a client with schizophrenia, the nurse notes that the client exhibits signs and symptoms related to being unable to experience pleasure. The nurse documents this finding as what?

Anhedonia

When assuming the management of the care of a delusional client, which should be the nurse's priority intervention?

Assure the client that he or she is safe in this milieu

A client with schizoaffective disorder is prescribed long-term medication therapy. The nurse would most likely expect what to be prescribed as the mainstay of treatment?

Atypical antipsychotic

Which medication is used to control the extrapyramidal effects associated with antipsychotic medications?

Benztropine

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

Benztropine

Which group of theories is believed currently to explain the etiology of schizophrenia?

Biologic

A client with schizophrenia is being treated with olanzapine 10 mg daily. The client asks the nurse how this medicine works. The nurse explains that the mechanism by which the olanzapine controls the client's psychotic symptoms is believed to be what?

Blocking dopamine receptors in the brain.

A nurse is preparing to document information obtained from a client diagnosed with a delusional disorder who is experiencing somatic delusions. Which characteristic would the nurse document?

Body issues

A nurse is interviewing a client diagnosed with schizophrenia when the client begins to say, "Kite, night, right, height, fright." What term would the nurse use to document this action?

Clang association.

In managing the milieu for clients with schizophrenia, the nurse considers which the priority?

Client safety

A nurse is preparing a presentation about schizophrenia and outcomes focusing on recovery for families of clients with schizophrenia. Which main goal would the nurse include?

Continuity of care

A client with schizophrenia states that the client is God's messenger and the client's mission is to become president. The nurse documents these comments as evidence of what?

Delusional thinking

The relationships and associations among the words used to express thoughts are markedly disturbed in clients with schizophrenia. What is this disturbance characterized by?

Disorganized speech

A client with schizophrenia is exhibiting hallucinations and delusions. The mental health nurse knows that these symptoms are associated with hyperactivity of which neurotransmitter?

Dopamine

A client diagnosed with schizophrenia is exhibiting disorganized behavior and imitating what the nurse is saying. What term is used to identify this behavior?

Echolalia

A client diagnosed with schizoaffective disorder and severe depression is being treated with antipsychotic medications. The client tells the nurse about difficulty with self-care activities. With which intervention should the nurse respond?

Establish a routine and set goals.

How often must clients receiving clozapine get white blood cell counts drawn?

Every week for the first 6 months

A client is diagnosed with schizoaffective disorder. Which would the nurse identify as supporting this diagnosis?

Evidence of hallucinations and delusions accompanied by major depression

A client has been taking haloperidol for 5 years when the client is admitted to the inpatient unit for relapse of symptoms of schizophrenia. Upon assessment, the client demonstrates akathisia, dystonia, a stiff gait, and rigid posture. The nurse correctly identifies these symptoms are indicative of what?

Extrapyramidal side effects

A client broke down in tears when speaking with the nurse, stating, "You have no idea what it's like to be responsible for finding terrorist leaders. Every day I have to stay one step ahead of the operatives that have been sent after me." In light of the client's statement, which nursing diagnosis should the nurse prioritize?

Fear related to persecutory delusions

Which type of antipsychotic medication is most likely to produce extrapyramidal effects?

First-generation antipsychotic drugs

A client with schizophrenia is hearing voices that tell the client to kill the self. What term is used to identify this type of false sensory perception?

Hallucination

Catatonia as seen in clients with schizophrenia is unique in the existence of which feature?

Immobility like being in a trance

Which assessment findings in a client who is suspected of having a delusional disorder would be suggestive of a diagnosis of schizophrenia?How often must clients receiving clozapine get white blood cell counts drawn?

The client experiences frequent and sustained hallucinations.

Positive symptoms seen in schizophrenia are believed to be a result of which type of neurological dysfunction?

Increased amount of dopamine

Which is the central focus of persecutory delusions?

Injustice that must be remedied by legal action

The nurse is providing teaching to a client diagnosed with schizoaffective disorder. The nurse should explain to the client that which is true about this disorder?

It is a mix of psychotic and mood symptoms.

A student nurse has been assigned to provide care for an inpatient psychiatric-mental health client who has a diagnosis of schizophrenia. The student nurse is apprehensive about interacting with the client. The client's detailed explanations of the client's delusions accompanied by unpredictable movements have prompted fear in the student. How should this nursing student interpret such feelings?

It is natural to feel fear when a client exhibits unpredictable behavior, and this can cause the student to be reasonably cautious.

The nurse is assigned to a client with catatonic schizophrenia. Which intervention should the nurse include in the client's care plan?

Meeting all of the client's physical needs

The nurse is developing a plan for group therapy sessions for several adult clients with schizophrenia. Which goal is best for this group?

Members will demonstrate adaptive social skills.

A nursing instructor is developing an education plan for a group of students about schizophrenia and schizoaffective disorders. The instructor identifies that in addition to psychosis, what other condition must be present at the same time for a diagnosis of schizoaffective disorder?

Mood disturbance

A comprehensive nursing assessment for neuroleptic malignant syndrome (NMS) should include checking for which in a client taking an antipsychotic medication?

Muscular rigidity, tremors, and difficulty swallowing

The nurse must be aware that individuals from diverse ethnic groups might describe troubling experiences in terms of physical problems or specific culture-bound syndromes. The syndrome of ghost sickness is exhibited by which culture?

Native American

A client had been withdrawn in the client's room for 3 days, not eating or sleeping, prior to his admission to the inpatient unit. Upon interview, the client demonstrates difficulty answering questions, appears to have no facial expressions, and cannot follow simple instructions. This cluster of symptoms can be described as what?

Negative symptoms

A client has been prescribed quetiapine for delusional disorder. In teaching the client about this medication, the nurse must be certain to include which information?

One of the common side effects is dry mouth.

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?

Persecutory

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

While assessing a client with schizophrenia, the client states, "Everywhere I turn, the government is watching me because I know too much. They are afraid that I might go public with the information about all those conspiracies." The nurse documents the client's statement as which type of delusion?

Persecutory

During a client interview, a client diagnosed with delusional disorder states, "I know my spouse is being unfaithful to me with a colleague from work."The nurse interprets the client's statements as suggesting which type of delusion?

Persucatory/paranoid

A client is being seen in the health clinic. The nurse observes a shuffling gait, drooling, and slowness of movement. The client is currently taking an antipsychotic for treatment of schizophrenia. The nurse knows that which side effect is occurring?

Pseudoparkinsonism

After educating a client on antipsychotic agents, a nurse determines that the education was successful when the client identifies which medication as an example of a second-generation antipsychotic agent?

Quetiapine

A 24-year-old with schizophrenia and paranoid delusions is admitted to the hospital. The student nurse asks the charge nurse about what approach to take with the client, who has been exhibiting hostility and isolation. Which approach would be the mostappropriate direction from the charge nurse?

Respect the client's need for personal space and avoid physical contact.

A client has been prescribed clozapine for schizoaffective disorder (SCA) with depression. The nurse should explain to the client that one advantage of clozapine is that it can provide what?

Reduction of hospitalizations and risk for suicide

While caring for a hospitalized client diagnosed with schizophrenia, a nurse observes that the client is listening to the radio. The client tells the nurse that the radio commentator is speaking directly to the client. The nurse interprets this finding as which type of thinking?

Referential

A client begins to exhibit hallucinations and delusions along with disorganized speech after forgetting to take antipsychotic medication. The nurse suspects that the client is at which point in the clinical course of the disorder?

Relapse

A client who has a major depressive episode tells a nurse that, for the past 2 weeks, the client has been hearing voices and at times thinks that they are being followed. History reveals that the client had these alternating symptoms before. The client also has experienced time with neither of these symptoms and has been able to function adequately. The nurse interprets these findings as suggesting which condition?

Schizoaffective disorder

A nurse is caring for a client diagnosed with schizophreniform disorder. The nurse demonstrates understanding of this disorder when identifying that the client is at risk for developing what?

Schizophrenia

What are the signs and symptoms of schizophrenia according to the Diagnostic and Statistical Manual of Mental Disorders?

Schizophrenia lasts at least 6 months and includes at least 1 month of 2 or more active-phase symptoms.

When obtaining a client's history, a nurse determines that the client has been experiencing delusions and hallucinations for the past 3 months, which has caused some problems with the ability to function at work. The client also is exhibiting catatonic excitement, echopraxia, loose associations, and pressured speech. Which condition does the nurse suspect?

Schizophreniform disorder

A client with a long history of schizophrenia has managed well on fluphenazine. The client reports smacking of the lips and sticking out the tongue. Based on this report, what does the nurse suspect is occurring with the client?

Signs of tardive dyskinesia (TD) associated with neuroleptic medication

While interviewing a client diagnosed with a delusional disorder, the client states, "I have this really strange odor coming out of my mouth. I stop to brush my teeth almost every hour and then rinse with mouthwash every half hour to get rid of this smell. I've seen so many doctors, and they can't tell me what's wrong." The nurse interprets the client's statement as reflecting which type of delusion?

Somatic

A client diagnosed with schizophrenia states to the nurse, "My intestines are being eaten by snakes." This statement represents which type of delusion?

Somatic delusion

The nurse should consider which during a psychiatric assessment of a newly immigrated client who is being evaluated for possible religious delusions?

Some cultures hold religious beliefs that might be confused with delusional thought

When developing the plan of care for a client with schizophrenia who is in the acute phase of illness, the nurse understands that the client is at high risk for what?

Suicide

Although a psychotic episode can be brief, the client impact can last a long time. For this reason, the nurse is aware of what?

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?

Suspiciousness and neologisms

The client's diagnosis of schizoaffective disorder is supported when the nurse documents what?

The client reports "hearing voices" for the last 3 months

A psychiatric-mental health nurse is teaching a class about schizophrenia. When describing delusions, which information would the nurse most likely include?

They may include elements of a situation that could occur in real life.

Clients with delusional disorder do not normally seek help independently because of their inability to establish what?

Trust

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

Which statements characterizes the major difference between the typical and atypical antipsychotic medications?

Typical antipsychotics most often relieve positive symptoms but do not have a significant impact on negative symptoms.

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

Assessment of genetic predisposition supports asking a client who is exhibiting symptoms of a delusional disorder what?

Whether any family members have been diagnosed with schizophrenia

A nurse is caring for a client in an inpatient mental health setting. The nurse notices that when conversing with other clients, the client repeats what they are saying word for word. The nurse interprets this finding and documents it as which condition(s)? Select all that apply.

echolalia disorganized thinking

A client is being released from the inpatient psychiatric unit with a diagnosis of schizophrenia and treatment with antipsychotic medications. After teaching the client and family about managing the disorder, a nurse determines that the education was effective when a family member states which symptom(s) should be reported immediately? Select all that apply.

elevated temperature muscle rigidity

When describing the difference between schizoaffective disorder (SAD) and schizophrenia, the nurse would address which as associated with SAD?

increased mood responses

A client with schizophrenia is prescribed clozapine. The nurse would monitor the client closely for specific signs of:

infection.

A nurse is caring for a hospitalized client who has schizophrenia. The client has been taking antipsychotic medications for 1 week when the nurse observes that the client has their head tilted back, staring at the ceiling, and appears in an uncomfortable position. Which dystonic reaction(s) will the nurse assess for? Select all that apply.

oculogyric crisis retrocollis torticollis

A client who has a major fear of people dressed in black tells the nurse that, for the past 2 weeks, the client has been hearing voices and at times thinks that they are being followed. The nurse interprets these findings as suggesting which condition?

paranoid type schizophrenia

A client diagnosed with delusional disorder who uses excessive health care resources most likely has which type of delusions?

somatic

A client has been prescribed clozapine for treatment of schizophrenia. The client must be taught to monitor which blood concentrations weekly while taking this drug?

white blood cells