MH Prep U CH 16

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 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.

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. Explanation: Gradual, subtle behavioral changes appear during the prodromal phase of schizophrenia, such as tension, the inability to concentrate, insomnia, withdrawal, or cognitive deficits. No symptoms are present in the premorbid phase, and relapses occur in the progressive and chronic phases. Diagnosis of the disease marks the beginning of the onset phase.

A nurse teaching a client about prescribed antipsychotic medication informs the client to contact a health care provider immediately if the client notices:

A dramatic change in temperature. Explanation: Advise clients to contact their case coordinators or health care providers immediately if they experience dramatic changes in body temperature. The client may be at risk for neuroleptic malignant syndrome.

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 Explanation: Hallucinations are sensory perceptions with a compelling sense of reality but with no actual objective basis. During auditory hallucinations (the most common form), clients may hear the voice of God or close relatives, two or more voices with a running commentary about the client's behavior, or voices that command certain acts. Usually the voices are obscene, accusatory, or insulting. They may call clients names and make nasty remarks.

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

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

Which medication classification has been most effective in treating akathisia?

Beta-blockers Explanation: Beta-blockers, such as propranolol, have been most effective in treating akathisia.

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 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 Explanation: Positive symptoms reflect an excess or distortion of normal functions, including delusions and hallucinations. Negative symptoms reflect a lessening (or complete 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).

A group of nursing students is reviewing the various theories related to the etiology of schizophrenia. The students demonstrate understanding of the information when they identify which neurotransmitter as being responsible for hallucinations and delusions?

Dopamine Explanation: Although research is demonstrating that schizophrenia does not result from dysregulation of a single neurotransmitter or biogenic amine (such as serotonin, norepinephrine, or dopamine), positive symptoms of schizophrenia, specifically hallucinations and delusions, are thought to be caused by dopamine hyperactivity in the mesolimbic tract. Researchers are also hypothesizing a role for GABA but have yet to identify any specific information.

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 Explanation: 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.

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 Explanation: The client is expressing fear and anxiety resulting from a perceived threat. The client is confused about the client's role and/or identity. There is no evidence of labile affect, despite the client having grandiose delusions. The primary concern for the client is fear. Defensive coping is not in evidence, and impaired social interactions are secondary to the client's immediate fear.

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

Increased amount of dopamine Explanation: Positive (or productive) symptoms reflect an increased amount of dopamine affecting the cortical areas of the brain. Negative symptoms reflect an inadequate amount of dopamine, cerebral atrophy, and organic functional changes in the brain.

A client with schizophrenia is exhibiting emotional withdrawal and poor eye contact and describing hallucinations. The mental health nurse knows that these symptoms are suggestive of which neurotransmitter imbalance?

Increased serotonin and dopamine Explanation: Lack of volition and motivation, social withdrawal, and anhedonia (inability to feel pleasure) are negative signs of schizophrenia. Hallucinations are a positive sign of the disease. Second-generation antipsychotic medications, which are antagonists of dopamine and serotonin, lessen both positive and negative symptoms; this suggests that excess dopamine and serotonin are both involved in schizophrenia. The etiology of schizophrenia is still very much under investigation, but it is hypothesized that an excess of dopamine is a factor in psychosis and that, while a certain amount of serotonin can help modulate the effects of dopamine, an excess of serotonin contributes to schizophrenia. The involvement of brain anatomy, metabolism, and neurotransmitter and neuroconnectivity are also being investigated; the exact etiology of schizophrenia is complex.

Which is the central focus of persecutory delusions?

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.

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 Explanation: The culture-bound syndrome of ghost sickness is seen in the Native American tribal culture. This culture exhibits a preoccupation with death and the deceased. Bad dreams, weakness, feelings of danger, anxiety, and hallucinations may occur. The other options are not related to the culture-bound syndrome of ghost sickness.

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 Explanation: Common negative symptoms of schizophrenia include alogia, affective blunting, avolition, anhedonia, and attentional impairment.

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

Which extrapyramidal side effect is noted by a client who has bradykinesia and a shuffling gait?

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 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 Explanation: TD is a type of extrapyramidal side effect characterized by abnormal, involuntary, irregular, choreoathetoid (writhing) movements, which may include lip smacking, neck twisting, facial grimacing, and tongue and chewing movements. TD can occur after several months to years of therapy with traditional antipsychotics.

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

Somatic Explanation: Persons who have somatic delusions believe they have a physical ailment. Clients with somatic delusions use excessive health care resources. The central theme of the jealous subtype is the unfaithfulness or infidelity of a spouse or lover. Nihilistic delusions focus on death or calamity. Clients presenting with grandiose delusions are convinced they have a great, unrecognized talent or have made an important discovery; a less common presentation is the delusion of a special relationship with a prominent person or actually being a prominent person.

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?

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.

Which treatment would be inappropriate for a client with delusional disorder?

Somatic therapy Explanation: Somatic and alternative therapies generally are not used to treat delusional or shared psychotic disorders because the mark of successful treatment usually depends on a satisfactory social adjustment rather than a suppression of the client's delusions.

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 Explanation: Some cultures have widely held and culturally sanctioned beliefs that might be considered delusional in other cultures.

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 Explanation: During the acute illness, individuals with schizophrenia are at high risk for suicide. Clients are hospitalized usually to protect themselves or others. Clients with schizophrenia who have an abnormality in the hippocampus may experience disordered water balance, whereupon individuals drink compulsively as a result of neuroendocrine dysfunction, placing them at risk for water intoxication. However, this is not the priority. Mania and depression are unrelated to schizophrenia during the acute illness.

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 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

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

The client reports "hearing voices" for the last 3 months Explanation: The client's diagnosis of schizoaffective disorder is supported when the nurse documents that the client reports "hearing voices" for the last 3 months. The documentation is objective and includes a direct quote from the actual client. What is being documented is consistent with the criteria for schizoaffective disorde

Which would be the benefit of including a client's family members in the long-term treatment of a client with schizophrenia?

The onset of a possible relapse can be detected early and effective treatment can be initiated Explanation: Family education can help family members deal more effectively with a loved one who has schizohprenia, enabling them to contribute to a better outcome for the client, especially because they may be more able to recognize relapse.

A client has been diagnosed with schizophrenia. Assessment reveals that the client lives alone. The client's clothing is disheveled, the client's hair is uncombed and matted, and the client's body has a strange odor. During an interview, the client's family members voice a desire for the client to live with them when the client is discharged. Based on the assessment findings, which nursing diagnosis would be the priority?

The negative symptom of avolition may be so profound that simple activities of daily living, such as dressing, bathing, or combing hair, may not get done. Therefore, a priority nursing diagnosis for the client is [bathing] self-care deficit related to the symptoms of schizophrenia. The family's desire to care for the client does not support a nursing diagnosis of dysfunctional family processes. There is no evidence of ineffective role performance or social isolation at this time.

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. Explanation: Delusions are fixed, false beliefs that cannot be changed by conflicting evidence. They can be situations that could occur in real life and are plausible in the context of the person's ethnic and cultural background, or they may be clearly fantastical. They usually involve a misinterpretation of the client's experience.

A client with schizoaffective disorder is prescribed medication therapy. Which type of medications would be most likely be ordered?

atypical antipsychotics Explanation: Although numerous drugs may be prescribed, atypical antipsychotics are generally prescribed because of their efficacy for psychosis and for their thymoleptic (mood stabilizing) properties. Atypical antipsychotics have been used more often than typical antipsychotics. If depressive symptoms persist despite antipsychotic use, antidepressants may be prescribed. Mood stabilizers are an alternative adjunct for mood states associated with the bipolar type of the disorder.

When investigating biologic theories related to schizophrenia, which neuroanatomic findings would be consistent with this mental health disorder?

enlarged lateral ventricle Explanation: The lateral and third ventricles are somewhat larger and total brain volume is somewhat smaller in persons with schizophrenia compared with those without schizophrenia. The thalamus and the medial temporal lobe structures, including the hippocampus, superior temporal, and prefrontal cortices, also tend to be smaller.

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

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 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's eyes are fixed on the ceiling. The nurse interprets this finding as:

oculogyric crisis. Explanation: The nurse should contact the client's physician because the client is exhibiting a dystonic reaction termed oculogyric crisis in which the muscles that control eye movements tense and pull the eyeball so that the client is looking toward the ceiling. Akathisia is manifested by restlessness, with clients often reporting that they feel driven to keep moving. Retrocollis involves the neck muscle, causing the head to be pulled back. Tardive dyskinesia involves abnormal, involuntary movements that are constant.