Mental Health Week 6: Online Quizzing

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

"Generally, it takes about 1 to 2 weeks to be effective in changing symptoms." *Generally, it takes about 1 to 2 weeks for antipsychotic drugs to effect a change in symptoms. During the stabilization period, the selected drug should be given an adequate trial, generally 6 to 12 weeks, before considering a change in the drug prescription. If treatment effects are not seen, another antipsychotic agent may be tried.

A client with schizophrenia is seen sitting alone and talking out loud. Suddenly, the client stops and turns as if listening to someone. The nurse approaches and sits down beside the client. Which is the best response by the nurse? "You must be pretty bored to be sitting here talking to an invisible person." "I don't hear or see anyone else; what are you hearing and seeing?" "I can tell you are hearing voices, but they are not real." "How long have you known the person you are talking to?"

"I don't hear or see anyone else; what are you hearing and seeing?" Intervening when the client experiences hallucinations requires the nurse to focus on what is real and to help shift the client's response toward reality. Initially, the nurse must determine what the client is experiencing—that is, what the voices are saying or what the client is seeing. As well, the nurse should state clearly that he or she does not share the hallucination. Referencing an "invisible person" is non-therapeutic because it is dismissive of the client's reality and is likely to cause the client to become defensive. It is ineffective and non-therapeutic to try to rationally explain that hallucinations are not real. "How long have you known the person you are talking to?" would reinforce the client's hallucination, which is not therapeutic.

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." "What's important to me is that it's real for you." "The conspiracy that you're explaining to me is actually a delusion." "What makes you think that I don't believe you?"

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

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 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 nurse monitoring client medication needs to recognize side effects quickly and intervene promptly for which reason? Determine adequate dosage is maintained to control symptoms Alleviate the side effects and help client maintain adherence Provide support to the client and let the client know this is normal Provide support to the client and encourage adherence as past side effects rarely reoccur

Alleviate the side effects and help client maintain adherence

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 An impending calamity Feeling of being watched An abnormal body function

An impending calamity *Delusions are erroneous fixed, false beliefs that cannot be changed by reasonable argument. Nihilistic delusions involve the belief that one is dead or a calamity is impending. 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. Somatic delusions involve beliefs about abnormalities in bodily functions or structures.

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

Benztropine *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.

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? Increasing the amount of serotonin and norepinephrine in the brain. Decreasing the amount of an enzyme that breaks down neurotransmitters. Normalizing the levels of serotonin, norepinephrine, and dopamine. Blocking dopamine receptors in the brain.

Blocking dopamine receptors in the brain. Olanzapine is an antypical antipsychotic. Like all antipychotics, its major action in the nervous system is to block receptors for the neurotransmitter dopamine. Selective serotonin reuptake inhibitors and tricyclic antidepressants act by blocking the reuptake of serotonin and norepinephrine. Monoamine oxidase inhibitors (MAOIs) prevent the breakdown of MAO, an enzyme that breaks down neurotransmitters. Lithium normalizes the reuptake of certain neurotransmitters such as serotonin, norepinephrine, acetylcholine, and dopamine.

A psychiatric-mental health nurse is conducting a review class for a group of colleagues about schizoaffective disorder. The nurse determines that the class was successful based on which description of the condition by the group? Delusions are present but hallucinations are absent. Clients are often misdiagnosed as having schizophrenia. The symptoms typically run a fairly constant course. Mood symptoms must occur consistently with positive symptoms.

Clients are often misdiagnosed as having schizophrenia.

Despite taking an atpyical antipsychotic medication for several years, a client with a diagnosis of schizophrenia has experienced a recent increase in the frequency and severity of command hallucinations that has resulted in a suicide attempt. The nurse should anticipate that this client may benefit from which of the following? An SSRI Lithium Naltrexone (ReVia) Clozapine (Clozaril)

Clozapine (Clozaril) *Clozapine (Clozaril) is considered to be a highly effective medication for suicidal clients with the diagnosis of schizophrenia. Lithium is typically used with clients with bipolar disorder, and naltrexone is given to suicidal clients who have developmental disorders. SSRIs are used primarily with clients who are diagnosed with depression.

Which increases the risk for neuroleptic malignant syndrome (NMS)? Overhydration Intake of vitamins Dehydration Vegetarian diet

Dehydration Dehydration, poor nutrition, and concurrent medical illness all increase the risk for NMS. Overhydration is opposite of dehydration and would therefore not increase the risk of NMS. Intake of vitamins would likely reduce the risk of NMS as it would improve nutritional status. Vegetarian diet would not relate to NMS.

The most defining characteristic of undifferentiated schizophrenia is which of the following? Displays both positive and negative symptomology Has a poor prognosis if symptomology has a sudden onset Does not experience psychotic thoughts Exhibits negative symptoms following an acute schizophrenic episode

Displays both positive and negative symptomology

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 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.

How often must clients receiving clozapine get white blood cell counts drawn? Every week for the first 6 months Every 3 months Every 6 months Every year

Every week for the first 6 months Clients taking clozapine must have weekly white blood cell counts for the first 6 months of clozapine therapy and every 2 weeks thereafter.

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? Psychosis Tardive dyskinesia Extrapyramidal side effects Progressed schizophrenia

Extrapyramidal side effects Extrapyramidal side effects include severe restlessness, muscle spasms, or contractions; chronic motor problems such as tardive dyskinesia; and the pseudoparkinsonian symptoms of rigidity, masklike faces, and stiff gait.

The parents of a young adult who has schizophrenia ask how they can recognize when their child is beginning to relapse. The nurse teaches the family to look for what? Select all that apply. Excessive sleeping Fatigue Irritability Increased inhibition Negativity

Fatigue Irritability Negativity Teaching the client and family members to prevent or manage relapse is an essential part of a comprehensive plan of care. This includes providing facts about schizophrenia, identifying the early signs of relapse, and teaching health practices to promote physical and psychological well-being. Early signs of relapse include impaired cause-and-effect reasoning, impaired information processing, poor nutrition, lack of sleep, lack of exercise, fatigue, poor social skills, social isolation, loneliness, interpersonal difficulties, lack of control, irritability, mood swings, ineffective medication management, low self-concept, looking and acting different, hopeless feelings, loss of motivation, anxiety and worry, disinhibition, increased negativity, neglecting appearance, and forgetfulness.

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 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.

Catatonia as seen in clients with schizophrenia is unique in the existence of which feature? Preoccupation with a delusion Presence of negative symptoms Immobility like being in a trance Disorganized speech patterns

Immobility like being in a trance Catatonia, as seen in clients with schizophrenia, is a psychologically induced immobility occasionally marked by periods of agitation or excitement; the client seems motionless as if in a trance.

A person suffering from schizophrenia has little emotional expression when interacting with others. The nurse would document the client's affect as what? Select all that apply. Flat Blunt Bright Inappropriate Pleasant

Inappropriate Flat Blunt Clients with schizophrenia are often described as having blunted affect (few observable facial expressions) or flat affect (no facial expression). The client may exhibit an inappropriate expression or emotions incongruent with the context of the situation. A bright affect would suggest a high level of expression and engagement, which is uncommon in clients with schizophrenia. Similarly, an affect that is described as "pleasant" would most likely denote happiness and high engagement, which are unlikely in clients who have schizophrenia.

Which of the following would be the most accurate nursing diagnosis within the social domain for a female client with a delusional disorder who is having martial conflict? Interrupted family processes related to delusional disorder Altered thought processes related to hallucinations Social isolation related to delusional disorder Ineffective coping related to hallucinations

Interrupted family processes related to delusional disorder

A nurse assessing a client with schizoaffective disorder should obtain a detailed history with a description of the full range and duration for which of the following reasons? Identifies which hypnotic to use Is important to predict outcomes Helps to determine the length of inpatient hospitalization required for the client Helps to determine coping skills of the family members

Is important to predict outcomes

A comprehensive nursing assessment for neuroleptic malignant syndrome (NMS) should include checking for which in a client taking an antipsychotic medication? Headache, muscle aches, and paresthesias Confusion, giddiness, and hyperalertness Muscular rigidity, tremors, and difficulty swallowing Dry mouth, flushing, and urinary retention

Muscular rigidity, tremors, and difficulty swallowing NMS is characterized by muscular rigidity, tremors, difficulty swallowing, fever, hypertension, and diaphoresis.

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? Referential Sexual Persucatory/paranoid Grandiose

Persucatory/paranoid The client's statements reflect persucatory/paranoid delusions that focus on the unfaithfulness or infidelity of a spouse or lover. Such delusions involve the belief that others are untrustworthy in some way. With referential delusions, the ideas of reference involve the client's belief that television broadcasts, music, or newspaper articles have special meaning for him or her. In the sexual delusion subtype, ideas involve the belief that the client's sexual behavior is known to others. With grandiose delusions, individuals believe that they have a great, unrecognized talent or have made an important discovery.

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. Which of the following side effects is occurring? Akathisia Dystonic movements Pseudoparkinsonism Neuroleptic malignant syndrome

Pseudoparkinsonism Pseudoparkinsonism is exhibited by a shuffling gait, drooling, and slowness of movement. Akathisia causes restlessness, anxiety, and jitteriness. Dystonia is characterized by cramps and rigidity of the tongue, face, neck, and back muscles. Neuroleptic malignant syndrome causes rigidity, fever, hypertension, and diaphoresis.

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? Cost savings Weight loss Reduction of hospitalizations and risk for suicide Combination with lithium for greater effect

Reduction of hospitalizations and risk for suicide

A client diagnosed with schizophrenia states to the nurse, "The TV knows what I'm thinking, they said it on the news." This statement represents which type of delusion? Persecutory delusion Grandiose delusion Referential delusion Somatic delusion

Referential delusion 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. Somatic delusions are generally vague and unrealistic beliefs about the client's health or bodily functions. Persecutory delusions involve the client's belief that "others" are planning to harm the client or are spying, following, or belittling the client in some way. Grandiose delusions are characterized by the client's claim to associate with famous people or celebrities or the client's belief that he or she is famous or capable of great feats.

Some research has suggested that schizophreniform disorder may be an early manifestation of which other mental health condition? Delusional disorder Schizophrenia Bipolar affective disorder Schizoaffective disorder

Schizophrenia *Some research has suggested that schizophreniform may be an early manifestation of schizophrenia. A client exhibiting an acute reactive psychosis for less than the 6 months necessary to meet the diagnostic criteria for schizophrenia is given the diagnosis of schizophreniform disorder. Symptoms lasting beyond the 6 months warrant a diagnosis of schizophrenia.

A 20-year-old son of a client who was diagnosed with schizophrenia at the age of 25 is concerned that he may also develop the disorder. Which statement regarding schizophrenia and genetics is true? Schizophrenia has not been shown to be genetic. Schizophrenia can only be passed from a father to his children. Schizophrenia has shown a strong genetic contribution. Schizophrenia can only be passed from a mother to her children.

Schizophrenia has shown a strong genetic contribution. Many studies strongly suggest a genetic contribution. Relatives of people with schizophrenia have a higher incidence of the disorder than found in the general population. First-degree relatives (i.e., parents, siblings, children) of clients with schizophrenia are at greater risk for the illness than are second-degree relatives (e.g., grandparents, grandchildren, aunts, uncles, half-siblings). Schizophrenia is 13% more likely to develop in children with one parent who has schizophrenia than in those with unaffected parents; when both parents have schizophrenia, a child has a 46% risk for the illness.

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. *According to the DSM-V, schizophrenia lasts at least 6 months and includes at least 1 month of two or more characteristic symptoms (e.g., delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior) and negative symptoms (e.g., diminished emotional expression, alogia, or avolition).

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 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.

When performing discharge planning for a client who has schizophrenia, the nurse anticipates barriers to adhering to the medication regimen. The nurse assesses which as improving the likelihood that the client will follow the prescribed medication regimen? Select all that apply. Short-term memory intact History of missing appointments Receives monthly disability checks Walking is primary mode of transportation States location of pharmacy nearest the client's residence

States location of pharmacy nearest the client's residence Receives monthly disability checks Short-term memory intact

Which of the following terms describes the use of words or phrases that are flowery, excessive, and pompous? Word salad Neologisms Stilted language Clang association

Stilted language Stilted language is the use of words or phrases that are flowery, excessive, and pompous. A word salad is a combination of jumbled words and phrases that are disconnected or incoherent and make no sense to the listener. Neologisms are words invented by the client. Clang associations are ideas that are related to one another based on sound or rhyming rather than meaning.

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

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 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 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.

A client with a delusional disorder has been undergoing individual psychotherapy. The therapy would be deemed ultimately successful when the client meets which outcome? The client will identify alternatives to present coping patterns. The client will describe problems relating to others. The client will identify situations that evoke anxiety. The client will differentiate between reality and fantasy.

The client will differentiate between reality and fantasy.

A client with schizophrenia is prescribed an antipsychotic medication. Which immediate side effects would the nurse include in the education plan for this medication? Risk for hypertension Risk for hypoprolactinemia The potential for weight loss The potential for sedation

The potential for sedation Sedation with antipsychotic medication will likely happen immediately after initiating the medication. The nurse should be sure to inform the client they he or she will experience this side effect readily. The other options are examples of side effects that are possible with longer term treatment using antipsychotic medications. Weight gain is commonly associated with many antipsychotic medications. The potential for weight loss with antipsychotic medication is not typically discussed with clients.

When assessing a client with a delusional disorder who is experiencing somatic delusions, which would the nurse expect as within normal parameters? Select all that apply. Thinking Orientation Self-care patterns Attention Sleep patterns

Thinking Orientation Attention *In clients with delusional disorders, mental status is not generally affected. Thinking, orientation, affect, attention, memory, perception, and personality are generally intact. Most clients who receive diagnoses of delusional disorder do not experience functional difficulties or impairments. Self-care patterns may be disrupted in clients with the somatic subtype by the elaborate processes used to treat perceived illness (e.g., bathing rituals, creams). Sleep may be disrupted because of the central and overpowering nature of the delusions.

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

Verbigeration 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.

Assessment of genetic predisposition supports asking a client who is exhibiting symptoms of a delusional disorder what? When the delusion first began If the client has complied with the treatment plan If any family member shows symptoms of depression Whether any family members have been diagnosed with schizophrenia

Whether any family members have been diagnosed with schizophrenia *Some studies have found that delusional disorders are more common among relatives of individuals with schizophrenia than would be expected by chance; thus, asking whether any family members have been diagnosed with schizophrenia could be helpful.

The nurse is caring for a client with schizoaffective disorder with depression. The nurse should instruct the client that the most effective medication therapy for this disorder is: mood-stabilizing medications. antipsychotic medications combined with lithium. antidepressant medications. atypical antipsychotic medications.

atypical antipsychotic medications. *Atypical antipsychotic medications may have mood stabilizing effects as well as antipsychotic effects; in many cases, symptoms of depression disappear when the psychotic symptoms decrease.

A nurse is working with a client that has been diagnosed with delusional thoughts. Which is an initial short-term outcome appropriate for this client? accept that the delusion is illogical distinguish external boundaries explain the basis for the delusions engage in reality oriented conversation

engage in reality oriented conversation *Delusions are not reality oriented; thus an appropriate outcome would be that the client will engage in reality-oriented conversation rather than discussing delusional beliefs. Delusions are fixed, false beliefs. Clients rarely accept anyone using logic to dispute them. Data are not present to suggest boundary disturbance. Explaining the delusion is not progress; it suggests the client still holds to the belief.

A week after beginning therapy with thiothixene, the client demonstrates muscle rigidity, a temperature of 103°F, an elevated serum creatinine phosphokinase level, stupor, and incontinence. The nurse should notify the physician because these symptoms are indicative of: acute dystonic reaction. extrapyramidal side effects. neuroleptic malignant syndrome. tardive dyskinesia.

neuroleptic malignant syndrome. The client demonstrates all the classic signs of neuroleptic malignant syndrome. Dystonia involves acute muscular rigidity and cramping, a stiff or thick tongue with difficulty swallowing, and, in severe cases, laryngospasm and respiratory difficulties. Extrapyramidal side effects are reversible movement disorders induced by antipsychotic or neuroleptic medication. Tardive dyskinesia is a late-onset, irreversible neurologic side effect of antipsychotic medications characterized by abnormal, involuntary movements, such as blinking, chewing, and grimacing.

A client with schizoaffective disorder is prescribed clozapine to treat his symptoms. The nurse should caution the client to notify the health care provider if he experiences ... dry mouth. urinary frequency. rapid weight gain. drowsiness.

rapid weight gain The client should be cautioned to notify the health care provider if there is rapid weight gain because this may be indicative of excessive fluid retention. Urinary frequency is not alarming but should be addressed if it has its' onset with initiation of Clozapine. Dry mouth and drowsiness are anticipated side effects of the drug and should be managed using appropriate nursing interventions.

A client is diagnosed with schizoaffective disorder. The nurse monitors the client closely based on the understanding that the client is at risk for suicide. Which would the nurse identify as increasing the client's risk? Select all that apply. accompanying depression alcohol use no previous suicide attempts substance use Hospitalization

substance use Hospitalization accompanying depression alcohol use