Mental Health Passpoint - Psychotic Disorders

A client with schizophrenia states, "I hear the voice of King Tut." Which response by the nurse is therapeutic?

"I don't hear the voice, but I know you hear what sounds like a voice."

A client who is incoherent and agitated comes to the emergency department. The client reports visual and auditory hallucinations. The healthcare provider orders haloperidol, 5 mg IM. When educating the client on this medication, which statement by the nurse is correct?

"This medication will help decrease your tension and agitation."

A client with schizophrenia and delusions tells a nurse, "There is a man wearing a red coat who's out to get me." The client exhibits increasing anxiety when focusing on the delusion. Which response by the nurse is appropriate?

"This subject seems to be troubling you. Let's walk to the activity room."

A client with schizophrenia repeatedly uses profanity during an activity therapy session. Which response by the nurse is appropriate?

"Your cursing is interrupting the activity. Take time out in your room for 10 minutes."

Which instructions should the nurse include when teaching a client about quetiapine therapy? Select all that apply.

1.) avoid becoming overheated or dehydrated during therapy. 2.) change positions slowly to prevent orthostatic hypotension 3.) contact the prescriber before taking over-the-counter preparations

A recently hospitalized client is diagnosed with manic-depressive disorder and started on lithium carbonate therapy. When teaching the client and the client's family about lithium carbonate, the nurse explains the importance of regular blood work to monitor lithium levels due to the risk of toxicity. When the client's family asks what signs or symptoms they may occur with toxicity, the nurse should include what? Select all that apply.

1.) confusion 2.) twitching

The nurse observes that a client on a psychiatric unit is looking around the room with eyes darting to a chair in the corner. The client grimaces and then states, "Bastard," under his breath. Which nursing action is most appropriate?

Approach the client to interrupt the hallucinations

A client whose symptoms of schizophrenia are under control with olanzapine, and who is functioning at home and in part-time employment, reports being very concerned about gaining 20 lb (9.1-kg) since starting the medication 6 months ago. What should the nurse do?

Discuss nutrition, daily diet, and exercise with the client.

A client's admitting diagnosis is schizophrenia with an episodic delusional disorder. The nurse applies what intervention strategy while working with the client in this pronounced delusional state?

Focus on the client's underlying feelings, and redirect inappropriate responses

The nurse is advising a client with schizophrenia about what to do when beginning to get agitated. The client has been compliant with taking medications and has worked with clinic staff on dealing with the illness and recognizing feelings of agitation. Indicate the order from first to last in which the nurse should suggest the actions be taken. All options must be used.

In order: 1.) go to a quiet place 2.) tell trusted people that you are becoming upset 3.) take your oral lorazepam 4.) take your oral haloperidol

What should the nurse do when the client with a diagnosis of schizophrenia walks into group naked?

Lead the client to his room and help him dress if he needs assistance.

A nurse is caring for a client with schizophrenia. Which outcome requires revising the client's care plan?

The client spends more time alone.

A client with chronic schizophrenia has received 10 mg of fluphenazine hydrochloride PO q.i.d. Now the client has a temperature of 102° F (38.9° C), a heart rate of 120 beats/minute, a respiratory rate of 20 breaths/minute, and a blood pressure of 210/140 mm Hg. Because the client is also confused and incontinent, the nurse suspects neuroleptic malignant syndrome. What steps should the nurse take?

Withhold the client's next dose of fluphenazine, call the physician, and monitor the client's vital signs.

A client who was prescribed clozapine 2 months ago arrives in the clinic and informs the nurse that the they have been feeling extremely fatigued and feverish and has a sore throat. The nurse observes that the client has two small ulcerations of the oropharynx. Which does the nurse suspect may be occurring with this client?

agranulocytosis

The nurse is facilitating a group of clients with schizophrenia when one client says, "I like to drive my car, bar, tar, far." This client is exhibiting:

clang association

A client has been admitted to the emergency department. The client's family tells the nurse that the client has suddenly become lethargic and is "not making sense." The client has not had anything to eat or drink for the last 8 hours. The nurse further assesses the client using the Confusion Assessment Method (CAM). The client's responses to questions are rambling, and the client is not able to focus clearly to answer the nurse's questions. Based on these findings, the nurse should report that the client has which problem?

delirium

A client with schizophrenia displays a lack of interest in activities, reduced affect, and poor ability to perform activities of daily living. What term would be used to describe this clustering of symptoms?

negative symptoms

A client who's taking antipsychotic medication develops a very high temperature, severe muscle rigidity, tachycardia, and rapid deterioration in mental status. What complication of antipsychotic therapy does the nurse suspect?

neuroleptic malignant syndrome

A client with a diagnosis of schizophrenia and paranoid personality disorder asks the nurse, "How do I know what's really in those pills?" Which response by the nurse is best?

"How would you feel if I allowed you to open the individual medication wrappers?"

At an outpatient visit 3 months after discharge from the hospital, a client says he has stopped his olanzapine even though it controls his symptoms of schizophrenia better than other medications. "I've gained 20 lb (9.1 kg) already. I can't stand it anymore." Which response by the nurse is most appropriate?

"I can help you with a diet and exercise plan to keep your weight down."

After the nurse has taught the client who is being discharged on lithium about the drug, which client statement would indicate that the teaching has been successful?

"I'll call my health care provider right away for any vomiting or muscle weakness."

The mother of a client with schizophrenia calls the visiting nurse in the outpatient clinic to report that her daughter has not answered the phone in 10 days. "She was doing so well for months. I don't know what's wrong. I'm worried." Which response by the nurse is most appropriate?

"She may have stopped taking her medications. I'll check on her."

A nurse is teaching a client about the prescribed drugs, chlorpromazine and benztropine. What evaluation would indicate a therapeutic response to these drugs?

The client is experiencing less psychosis and a decrease in extrapyramidal symptoms.

A client with schizophrenia hears a voice saying the client is evil and must die. The nurse understands that this client is experiencing:

a hallucination.

The client thinks he is being followed by foreign agents who are after secret papers in his briefcase. What thought process does this indicate?

delusion of persecution

When caring for a client receiving haloperidol, the nurse should assess for which problem?

extrapyramidal symptoms

The nurse should judge client education regarding valproic acid as effective if the client states which statement?

"I might need to take the valproic acid for a long time."

A client diagnosed with schizophrenia is being switched to risperidone long-acting injection. The client is told that he will remain on his oral dose of risperidone daily for approximately 1 month. The client says, "I didn't have to take pills when I was on fluphenazine shots in the past." What should the nurse tell the client?

"Risperidone long-acting injection initially takes a little longer to reach the ideal blood level."

A client tells a nurse that people from Mars are going to invade the Earth. Which response by the nurse would be therapeutic?

"That must be frightening to you. Can you tell me how you feel about it?"

A client is admitted to the psychiatric unit with delusional thinking. The client, who is overweight and has a history of eating when stressed, now shows a lack of interest in eating at meal times. The client states, "I am unworthy of eating. My children will die if I eat." Which response by the nurse is most appropriate?

"That sounds scary. Tell me more about how you are feeling."

A client is sitting in the corner of the dayroom cocking his head to one side as if he hears something, but no one is nearby. The nurse suspects he is having auditory hallucinations. Which question should the nurse ask first?

"What are you hearing right now?"

A delusional client says to a nurse "I am an alien from Mars," and insists that the nurse refer to them as such. The belief appears to be fixed and unchanging. Which nursing interventions would the nurse implement when working with this client? Select all that apply.

1.) consistently use the client's name in the interaction. 2.) redirect the client with structured activities.

The nurse is monitoring a client who appears to be hallucinating. The client displays paranoid speech content, seems agitated, and gestures at a figure on the television. Which nursing interventions are appropriate? Select all that apply.

1.) reinforce that the client is not in any danger 2.) acknowledge the presence of the hallucinations. 3.) use a calm voice and simple commands

A client is admitted to the psychiatric unit with acute onset of schizophrenia. The physician orders the phenothiazine chlorpromazine, 100 mg by mouth four times per day. Before administering the drug, a nurse reviews the client's medication history. Concomitant use of which drug is likely to increase the risk of extrapyramidal effects?

droperidol

A client begins clozapine therapy after several other antipsychotic agents fail to relieve psychotic symptoms. The nurse instructs the client to return for weekly white blood cell (WBC) counts to assess for which adverse reaction?

granulocytopenia

A nurse is reviewing the medication list of a client who presents with slow, involuntary muscle spasms of the arms and legs and twisting of the neck. The nurse reviews the client's prescriptions for which medication that could correlate with these symptoms?

haloperidol