Schizophrenia Spectrum Disorders

A patient with schizophrenia is prescribed clozapine. Which physiological conditions of the patient should the nurse monitor? SELECT ALL THE APPLY Liver function Kidney function Total red blood cell count Total white blood cell count Total water intake and output

Liver function Total white blood cell count Agranulocytosis is the most common symptom of clozapine. It is characterized by a reduced white blood cell count (less than 3000/mm 3) and liver impairment. Hence, the nurse should frequently monitor the liver function and total white blood cell count. Clozapine does not have an effect on the kidneys; therefore the total water intake and output and kidney function do not need to be monitored. Clozapine reduces white blood cell count but does not affect red blood cell count; therefore, it is not required to monitor red blood cell count. pp. 214, 216, Table 12.6

A nursing intervention designed to help a patient with schizophrenia manage relapse is to Schedule the patient to attend group therapy that includes those who have relapsed Teach the patient and family about behaviors associated with relapse Remind the patient of the need to return for periodic blood draws to minimize the risk for relapse Help the patient and family adapt to the stigma of chronic mental illness and periodic relapses

Teach the patient and family about behaviors associated with relapse By knowing what behaviors signal impending relapse, interventions can be invoked quickly when the behaviors occur. The earlier the intervention, the greater the likelihood that a recurrence can be averted. p. 202, Box 12.2

Which drug would a nurse anticipate being given with chlorpromazine to reduce extrapyramidal side effects? Lamivudine Valacyclovir Montelukast Trihexyphenidyl

Trihexyphenidyl Chlorpromazine is a first-generation antipsychotic drug. It can cause extrapyramidal side effects, like akathisia, tremor, impaired gait, and so on, as a result of the blockage of dopamine receptors. These side effects can be treated by administering antiparkinson drugs like trihexyphenidyl. Trihexyphenidyl is an antimuscarinic class of drug. Montelukast is a leukotriene receptor antagonist used to treat asthma. Lamivudine is a nucleoside reverse transcriptase used to treat HIV/AIDS; it cannot be used to reduce the extrapyramidal side effects of chlorpromazine. Valacyclovir is an antiviral drug used to treat viral infections. p. 211

The nurse is caring for a patient with schizophrenia who was given an injectable dose of dopamine (D 2) antagonists for the limbic center. Which side effects does the nurse anticipate? Tremors Difficulty walking Increased energy Loosening of reflexes Pacing back and forth Muscular contraction in the neck

Tremors Difficulty walking Pacing back and forth Muscular contraction in the neck Dopamine antagonists are first-generation antipsychotics that are used less frequently because of their side effects. The medications block D 2 receptors, causing extrapyramidal side effects that include pacing and general restlessness (akathisia); muscular contractions (acute dystonia); gait impairment; and tremors (pseudoparkinsonism). These agents do not loosen reflexes or increase energy, though akathisia can sometimes be confused with increased energy.

A patient's dose of haloperidol was increased earlier today. The patient now is experiencing laryngeal dystonia. What is the nurse's priority action? Document the finding. Maintain a patent airway. Offer oral fluids to the patient. Engage the patient in an alternative activity.

Maintain a patent airway. Laryngeal dystonia is associated with an acute dystonic reaction and may impair the integrity of the patient's airway. The nurse will document the events after they are managed. Oral fluids could be aspirated. Immediate nursing action is indicated; it would be inappropriate to try to engage the patient in an alternate activity. p. 215, Table 12.6

A patient diagnosed with schizophrenia was experiencing paranoid thinking. Which statement by this patient most clearly indicates the antipsychotic medication was effective? "I think the staff wants to help me." "I finished my project in arts and crafts group." "A nurse on the night shift gave me too much medicine." "I don't need to take medicine anymore. I do not have any problems."

"I think the staff wants to help me." Recognizing that the staff desires to be helpful suggests the paranoia is gone or has subsided. Finishing an art project, thinking the nurse is giving too much medicine, and believing that one no longer has a problem show a statement of accomplishment, paranoia, and anosognosia. pp. 203-205, Case Study and Nursing Care Plan

When a patient diagnosed with paranoid schizophrenia tells the nurse, "I have to get away. The volmers are coming to execute me," an appropriate response for the nurse would be "You are safe here. This is a locked unit, and no one can get in." "It must be frightening to think something is going to harm you." "Why do you think someone or something is going to harm you?" "I do not believe I understand the word volmers. Tell me more about them."

"It must be frightening to think something is going to harm you." The correct response focuses on the patient's feelings and neither directly supports the delusion nor denies the patient's experience. Assuring the patient that he or she is safe gives global reassurance. Asking for more details encourages elaboration about the delusion. Asking why is asking for information that the patient will likely be unable to provide. p. 209, Box 12.4

Which symptom would NOT be assessed as a positive symptom of schizophrenia? Idea of reference Affective flattening Auditory hallucinations Delusion of persecution

Affective flattening Positive symptoms are those symptoms that should not be present, but are. They include hallucinations, delusions, bizarre behavior, and paranoia and are referred to as florid symptoms. Affective flattening is one of the negative symptoms that contribute to rendering the person inert and unmotivated. pp. 197-199, 201, Table 12.2

A patient who has been receiving antipsychotic medication for 6 weeks tells the nurse that the hallucinations are nearly gone and that concentration has improved. When the patient reports flulike symptoms, including a fever and a very sore throat, the nurse should Consider recommending a change of antipsychotic medication Arrange for the patient to have blood drawn for a white blood cell count Suggest that the patient take something for his or her fever and get extra rest Advise the health care provider that the patient should be admitted to the hospital

Arrange for the patient to have blood drawn for a white blood cell count Antipsychotic medications may cause agranulocytosis, the first manifestation of which may be a sore throat and flulike symptoms. Agranulocytosis with infection could be life threatening, so recommending rest does not address the underlying problem. The patient may not need to be admitted to the hospital but should have blood drawn to guide the next step. A nurse would not recommend a change of medication. The medication has been effective and might not need to be changed. p. 216, Table 12.6

A nurse understands that antipsychotic drugs may sometimes have toxic effects. The nurse suggests to the patient's guardians to give the patient foods rich in carbohydrates and protein and to ensure that the patient undergoes a liver function test every 6 months. Which of these toxic effects was the nurse thinking about when making such a suggestion? Weight gain Hyperpyrexia Agranulocytosis Cholestatic jaundice

Cholestatic jaundice Antipsychotics may cause cholestatic jaundice because of impaired liver function. Hence, a liver function test should be performed every 6 months. The patients must be given foods rich in carbohydrates and protein in order to enhance liver function. Hyperpyrexia is an extreme elevation of the body temperature and is a medical emergency. Weight gain is a common side effect with some antipsychotics and the drug may need to be changed. Agranulocytosis is caused by a reduction in white blood cell count. p. 216, Table 12.6

Which of the following would indicate paranoia in a patient with schizophrenia? Feelings of superiority to others False perception of environment Irrational fear of harm from others Impaired ability to think abstractly

Irrational fear of harm from others Patients with paranoia experience an irrational fear of harm from others that ranges from mild to severe. The patients suspect that others want to harm them, and they react defensively toward caregivers and other patients. Feelings of superiority are seen in patients with delusions. Patients with derealization have false perceptions of the environment and may misinterpret the stimuli in the environment. An impaired ability to think abstractly is seen in patients with disorders of concrete thinking. p. 198

Which assessment finding supports the presence of extrapyramidal side effects (EPSs)? Nausea and vomiting Eyes sensitive to light Near constant pacing Hand tremors observable bilaterally Sustained contraction of the neck muscle

Near constant pacing Hand tremors observable bilaterally Sustained contraction of the neck muscle First-generation antipsychotics are dopamine D2 antagonists in both the limbic and motor centers. This blockage of D2 dopamine receptors in the motor areas causes EPSs. Three of the more common EPSs are acute dystonia (acute sustained contraction of muscles, usually of the head and neck), akathisia (psychomotor restlessness evident as pacing or fidgeting, sometimes pronounced and very distressing to patients), and pseudoparkinsonism (a medication-induced, temporary constellation of symptoms associated with Parkinson's disease: tremor, reduced accessory movements, impaired gait, and stiffening of muscles). Nausea and photosensitivity are not considered EPSs. p. 211

The most common course of schizophrenia is an initial episode followed by Complete recovery Continuous deterioration Recurrent acute exacerbations Recurrent acute exacerbations and deterioration

Recurrent acute exacerbations and deterioration Schizophrenia is usually a disorder marked by an initial episode followed by recurrent acute exacerbations. With each relapse of psychosis, an increase in residual dysfunction and deterioration occurs. p. 196

A distinguishing factor of psychosis is that it Is caused by moderate to severe anxiety Incorporates delusions into an individual's reality Results in a significant misrepresentation of what is real Is dependent on an individual's baseline cognitive function

Results in a significant misrepresentation of what is real Psychosis is disintegrative and involves a significant distortion of reality. Psychosis emerges with the panic level of anxiety. Delusional thinking may not be demonstrated by all psychotic individuals. Cognitive function is not a predisposing factor for the development of psychosis. p. 192

Tara and Aaron are twins who are both diagnosed with schizophrenia. Aaron was diagnosed at 23 years and Tara at 31 years. Based on knowledge of early- and late-onset schizophrenia, which statement is true? Aaron will be more likely to hold a job and live a productive life. Tara has a better chance for positive outcomes because of later onset. Tara and Aaron have the same expectation of a poor long-term prognosis. Tara will experience more positive signs of schizophrenia, such as hallucinations.

Tara has a better chance for positive outcomes because of later onset. Female patients diagnosed with schizophrenia between the ages of 25 and 35 have better outcomes than do their male counterparts diagnosed earlier. These two patients do not have the same expectation of a poor prognosis. There is no evidence suggesting that she will have more positive signs of schizophrenia. It is actually more unlikely that he will be able to live a productive life because of his earlier onset, which has a poorer prognosis. p. 193

The purpose of the Abnormal Involuntary Movement Scale (AIMS) assessment on a persistently mentally ill patient who has been diagnosed with schizophrenia is early detection of Acute dystonia Tardive dyskinesia Cholestatic jaundice Pseudoparkinsonism

Tardive dyskinesia An AIMS assessment should be performed periodically on patients who are being treated with antipsychotic medication known to cause tardive dyskinesia. p. 213, Figure 12.2

A patient diagnosed with schizophrenia says, "Cheese dog run fast." How should the nurse document this comment? Neologism Word salad Circumstantiality Magical thinking

Word salad A word salad is a jumble of words that is meaningless to the listener and results from an extreme level of disorganization. A neologism is an invented word. Circumstantiality refers to verbal expression with excessive detail. Magical thinking means believing that one's thoughts or actions can affect others. p. 198

The nurse demonstrates an understanding of the most common comorbid condition observed in a patient with schizophrenia when asking, "Would you describe yourself as being depressed?" "How often do you drink enough alcohol to get drunk?" "How old were you when you became sexually active?" "Have you ever been diagnosed with an eating disorder?"

"How often do you drink enough alcohol to get drunk?" About 50% of patients with schizophrenia have a co-occurring substance abuse disorder, most commonly alcohol or cannabis. Assessing alcohol consumption patterns will help identify this comorbid condition. Eating disorders generally are not observed in patients with schizophrenia. Sexual habits are not generally viewed as being abnormal in the patient with schizophrenia. Although depression may occur, it is not a primary comorbid condition. p. 193

The causation of schizophrenia currently is understood to be A combination of inherited and nongenetic factors Deficient amounts of the neurotransmitter dopamine Excessive amounts of the neurotransmitter serotonin Stress related and ineffective stress management skills

A combination of inherited and nongenetic factors Causation is a complicated matter. Schizophrenia most likely occurs as a result of a combination of inherited genetic factors and extreme nongenetic factors (e.g., viral infection, birth injuries, and nutritional factors) that can affect the genes governing the brain or directly injure the brain. Changes in dopamine and serotonin are signs of schizophrenia but not thought to be the cause. Stress and ineffective stress management are risk factors but not thought to cause schizophrenia. pp. 194-196

A patient diagnosed with paranoid schizophrenia tells the nurse, "I have to get away. The volmers are coming to execute me." The term "volmers" can be assessed as Blocking A delusion A neologism Clang association

A neologism A neologism is a newly coined word that has meaning only for the patient. Clang association is choosing a word with similar sound like "click, clack, clutch." Blocking is related to thoughts and a stop or reduction in thoughts often related to interruptions caused by hallucinations. Delusions are false beliefs. p. 198

A patient diagnosed with schizophrenia is most likely to experience which type of hallucination? Visual Tactile Auditory Olfactory

Auditory Patients diagnosed with schizophrenia may experience hallucinations arising out of any of the senses; however, auditory hallucinations are experienced by 60% of people with schizophrenia at some time during their lives. Visual hallucinations more commonly are associated with substance abuse and withdrawal. Tactile and olfactory hallucinations are rare. p. 198

A patient with schizophrenia was changed to clozapine 3 weeks ago. The patient calls the clinic nurse complaining of sore throat, fever, and malaise. Which laboratory test would be most helpful in determining the cause of these findings? Urinalysis Liver panel Serum lithium level Complete blood cell count

Complete blood cell count Agranulocytosis is the reduction of white blood cells (WBCs) and is a possible adverse effect of antipsychotic drugs, particularly clozapine. Chief complaints are flulike symptoms. A complete blood cell count would show the reduction in WBCs. Serum lithium level, liver panel, and urinalysis are not necessary. p. 217

Which assessment findings in a 19-year-old patient support the existence of prepsychotic-phase symptomology associated with schizophrenia? Depression Social awkwardness Narcissist tendencies Poor academic performance Demonstration of phobic fears

Depression Social awkwardness Poor academic performance Demonstration of phobic fears The onset of prepsychotic (prodromal) symptoms may appear a month to more than a year before the first psychotic break or full-blown manifestation of the illness. Often, before the illness, a person with schizophrenia is socially awkward, lonely, and perhaps depressed. In this prodromal phase, anxiety, phobias, obsessions, dissociation, and compulsions may be noted. Concentration, memory, and completion of school- or job-related work deteriorate. Narcissistic (self-absorbed, self-centered) tendencies are not classic prodromal characteristics. p. 196

Which diagnostic finding associated with structural brain anomalies has been observed in patients diagnosed with schizophrenia? Increased cortical thickness Increased frontal lobe volume Enlargement of the lateral cerebral ventricles Reduced connectivity in various brain regions Increased size of the sulci (fissures) on the brain's surface

Enlargement of the lateral cerebral ventricles Reduced connectivity in various brain regions Increased size of the sulci (fissures) on the brain's surface Brain imaging techniques provide substantial evidence that some people with schizophrenia have structural brain abnormalities that include the following: enlargement of the lateral cerebral ventricles, reduced frontal lobe volume, increased size of the sulci (fissures) on the surface of the brain, reduced cortical thickness, and reduced connectivity in various brain regions. p. 194

A patient diagnosed with schizophrenia reports voices stating the patient is a horrible human being. The nurse can correctly assume that the hallucination May signal seizure onset Is a retained memory fragment Derives from neuronal impulse misfiring Is a projection of the patient's own feelings

Is a projection of the patient's own feelings One theory about derogatory hallucinations is that the content is a projection of the individual's feelings about him- or herself. The derogatory hallucinations are an extension of the strong feelings of rejection and lack of self-respect experienced by the individual during the prodromal period. pp. 198-199

What statement is true regarding schizophrenia? Schizophrenia is a potentially devastating brain disorder. Social behavior and emotions are affected by schizophrenia. This disorder moderately affects the individual's quality of life. The disorder often affects an individual's language and thinking skills. The disorder disturbs a person's ability to determine what is or is not real.

Schizophrenia is a potentially devastating brain disorder. Social behavior and emotions are affected by schizophrenia. The disorder often affects an individual's language and thinking skills. The disorder disturbs a person's ability to determine what is or is not real. Schizophrenia spectrum and other psychotic disorders disturb the fundamental inability to determine what is or is not real. Schizophrenia is a potentially devastating brain disorder that affects a person's thinking, language, emotions, social behavior, and ability to perceive reality accurately. It affects more than 3.5 million people in the United States and is among the most disruptive and disabling of mental disorders. p. 192

Which intervention is directed toward the management of a classic comorbid condition associated with schizophrenia? Screening for possible cocaine abuse Providing nicotine patch therapy as prescribed Monitoring for possible elevated blood glucose levels Scheduling art therapy sessions to facilitate regular attendance Explaining the role contracting for safety has on managing suicidal impulses

Screening for possible cocaine abuse Providing nicotine patch therapy as prescribed Monitoring for possible elevated blood glucose levels Explaining the role contracting for safety has on managing suicidal impulses Comorbid conditions associated with schizophrenia include substance abuse, nicotine dependence, anxiety, depression, and suicide, as well as physical health illnesses, such as diabetes. Although scheduling therapy sessions to facilitate attendance is appropriate, it is not relevant to comorbid conditions associated with schizophrenia. pp. 193-194

Which nursing diagnosis is most applicable to a patient experiencing an acute exacerbation of schizophrenia with predominantly negative symptoms? Disturbed sensory perception related to auditory hallucinations Impaired verbal communication related to associative looseness Risk for other-directed violence related to inability to control hostile impulses Social isolation related to withdrawal and reduced communication with others

Social isolation related to withdrawal and reduced communication with others Negative symptoms include social isolation, anergia, lack of motivation, blunted affect, and inattention to personal hygiene. Associative looseness, auditory hallucinations, and hostile impulses represent positive symptoms. p. 201, Table 12.2

A patient with schizophrenia reports to the nurse, "At night my business rival came to the hospital to kill me for my property." What is the most appropriate response of the nurse while handling such a patient? "Next time when you see him, call me." "Oh, really! Let's file a police complaint." "No one can come to the hospital in the night." "Because of your illness you are having hallucinations. No one can hurt you."

"Because of your illness you are having hallucinations. No one can hurt you." A patient with schizophrenia often has hallucinations. The nurse should try to persuade the patient to focus on reality by convincing him that these visions are part of the illness. This assurance makes the patient confident and does not support the illness. A nurse also should not neglect the patient's hallucinations because this can make the patient feel rejected and be at risk for withdrawing. It is advisable that the nurse does not encourage the patient's hallucination by saying that the patient should call her the next time he sees the business rival. This can worsen the patient's condition. p. 209, Box 12.3

The nurse is performing an assessment of geriatric patients in a community health care center. The nurse reports that one of the patients has schizophrenia. Which statement made by the patient while interacting with the nurse supports the nurse's assessment? "Every morning I enjoy the humming of birds; it relaxes me." "Every day my friends wait for me in front of my gate for our morning walk." "Every day birds sing songs for me and spread flowers on the path where I walk." "Everyone feels as if I am a burden to them; I would like to put an end to their problem."

"Every day birds sing songs for me and spread flowers on the path where I walk." Patients with schizophrenia have delusions of self-importance and state false events related to them, like birds singing songs for them and spreading flowers on their path. The statement that every morning the patient enjoys the humming of birds indicates that the patient has no impaired perception and is able to connect with reality. The statement that every morning the patient's friends wait for him or her is normal. The statement that everyone feels the patient is a burden indicates that the patient feels worthless and has suicidal intentions. It does not indicate schizophrenic symptoms. p. 198, Table 12.1

A patient diagnosed with paranoid schizophrenia refuses food, stating the voices are saying the food is contaminated and deadly. A therapeutic response for the nurse would be "The voices are wrong about the hospital food. It is not contaminated." "You are safe here in the hospital; nothing bad will happen to you." "I understand that the voices are very real to you, but I do not hear them." "Other people are eating the food, and nothing is happening to them."

"I understand that the voices are very real to you, but I do not hear them." This reply acknowledges the patient's reality but offers the nurse's perception that he or she is not experiencing the same thing. p. 209, Box 12.4

Which statement by a person with paranoid schizophrenia most clearly indicates that the antipsychotic medication is effective? "My medicine is working fine. I'm not having any problems." "I used to hear scary voices but now I don't hear them anymore." "Sometimes it's hard for me to fall asleep, but I usually sleep all night." "I think some of the staff members don't like me. They're mean to me."

"I used to hear scary voices but now I don't hear them anymore." Auditory hallucinations are a common manifestation of paranoid schizophrenia, so their absence is an indicator of medication effectiveness. "My medicine is working fine. I'm not having any problems" and "Sometimes it's hard for me to fall asleep, but I usually sleep all night" are too vague. "I think some of the staff members don't like me. They're mean to me" indicates paranoid thinking. p. 209, Box 12.3

A patient diagnosed with schizophrenia states, "My, oh my. My mother is brother. Anytime now it can happen to my mother." How will the nurse respond to the patient's statement? "I will get you an as-needed medication for agitation." "You are confused. I will take you to your room to rest awhile." "You are having problems with your speech. You need to try harder to be clear." "I'm sorry, I didn't understand that. Do you want to talk more about your mother as we did yesterday?"

"I'm sorry, I didn't understand that. Do you want to talk more about your mother as we did yesterday?" The guidelines that are useful in communicating with a patient with disorganized or bizarre speech are to place the difficulty in understanding on the nurse, not the patient, and look for themes that may be helpful in interpreting what the patient wants to say. Telling the patient to try harder to be clearer is unrealistic because the patient would be unable do this. Taking the patient to his or her room or getting the patient medication are not useful options in communicating with this patient and attempting to find common themes. p. 208

The nurse is teaching a patient and the patient's family about first- and second-generation antipsychotics for schizophrenia. What will the nurse include in the teaching? "Most people who take first-generation antipsychotics report fewer side effects." "Second-generation antipsychotics are mostly used for treating negative symptoms of schizophrenia." "First-generation antipsychotics are used more frequently than second-generation antipsychotics." "Second-generation antipsychotics are usually better than first-generation antipsychotics because they have fewer side effects."

"Second-generation antipsychotics are usually better than first-generation antipsychotics because they have fewer side effects." Both first- and second-generation antipsychotics are used to treat schizophrenia. Second-generation antipsychotics are used more frequently than and are starting to replace first-generation antipsychotics, because they are more effective with fewer side effects. Second-generation antipsychotics are used to treat positive symptoms of schizophrenia, not negative symptoms. First-generation antipsychotics are used less frequently than second-generation drugs, not more frequently. First-generation antipsychotics cause more negative side effects, not fewer side effects. Test-Taking Tip: Avoid looking for an answer pattern or code. There may be times when four or five consecutive questions have the same letter or number for the correct answer. p. 201

A nurse manager plans to follow up with a nurse after hearing which comment while talking to a patient who is reporting someone is trying to poison him or her? "Let's discuss the stressors you have in your life right now." "Tell me more about how someone keeps trying to poison your food." "Have other members of your family ever experienced this kind of thing?" "How has this affected your ability to keep a job or care for yourself?"

"Tell me more about how someone keeps trying to poison your food." It is nontherapeutic to reinforce the delusion by encouraging the individual to focus on the details, as suggested by asking the patient how his or her food is being poisoned. The statements "Have other members of your family ever experienced this kind of thing?", "How has this affected your ability to keep a job or care for yourself?", and "Let's discuss the stressors you have in your life right now" do not reinforce the delusion. Rather, they help gain knowledge about the history of the disorder in the family, the extent of the dysfunction the fear is causing, and the triggers that may have resulted in this behavior. p. 209, Box 12.4

Which statement by a family member of a person diagnosed with schizophrenia demonstrates effective learning about the disease? "The disease probably resulted from the mother's smoking during pregnancy. Nicotine is actually a neurotransmitter." "If our family had more money, we could afford the promising psychoneuroimmunologic treatments available in other countries." "The disease could be cured if our politicians and laws allowed for more stem cell research. Adult stem cells hold so much promise." "The disease probably was caused by problems with several genes. These genes cause changes in how certain brain chemicals work."

"The disease probably was caused by problems with several genes. These genes cause changes in how certain brain chemicals work." The outcome statement indicates that the person understands the basic information about causative factors of schizophrenia. Rationalizing the use of stem cell research, blaming the problem on the mother's smoking behavior, and having funds to afford alternative treatments do not indicate an understanding about the mental disorder. p. 194

A young adult is hospitalized with schizophrenia. The parents are distraught and filled with guilt. What would be an appropriate nursing response? "I'll recommend some excellent websites to learn about schizophrenia and other mental illnesses." "Look on the bright side. With the right medications and treatment, this disease can be cured." "There are many theories about the cause of schizophrenia, but this illness is not your fault." "Does anyone in your family have mental illness? Schizophrenia is a genetically transmitted disease."

"There are many theories about the cause of schizophrenia, but this illness is not your fault." It is important for the nurse to give accurate information without adding to the parent's emotional burden. There are many theories about the etiology of schizophrenia; asking whether anyone in the family has schizophrenia is not a therapeutic statement and may induce guilt. Telling the family to look on the bright side is not realistic and does not respond to their feelings. Recommending websites for research is an incorrect response because the parents are not ready to learn details about mental illness. pp. 194-196

The nurse teaches the parents of an adolescent who was diagnosed with schizophrenia about comorbidity. What does the nurse include in the teaching? "Watch your child for signs of substance abuse." "Make sure your child does not become dehydrated." "With schizophrenia, your child will not experience any depression." "Contact the healthcare provider immediately if your child has anxiety."

"Watch your child for signs of substance abuse." Substance use disorders involving alcohol, marijuana, and nicotine occur in nearly half of the people who are diagnosed with schizophrenia. Substance use is linked to higher rates of treatment nonadherence. Schizophrenia may cause polydipsia, which is a compulsive drinking of excess fluids, not dehydration. Depression frequently co-occurs in individuals with schizophrenia. Anxiety co-occurs with schizophrenia, but it is not necessary to contact the healthcare provider immediately if these symptoms present. p. 193

A patient with schizophrenia tells the nurse he or she has discontinued the pharmacological treatment plan because the symptoms are cured. Which is the best response by the nurse? "It's fine to stop your medication since you are in control of your own treatment." "It is normal to want to stop taking medication, but think about how much better it is making you." "You are experiencing something called anosognosia, which means it is difficult to realize you need to continue with treatment." "If you stop taking your medication, then you must promise to come to weekly appointments so that you can continue to be monitored."

"You are experiencing something called anosognosia, which means it is difficult to realize you need to continue with treatment." People with schizophrenia are often unable to realize they are ill, a condition known as anosognosia. This can result in the patient stopping treatment or being resistant to continue with treatment. It is important to reassure patients of why they feel as though they no longer need treatment by explaining anosognosia. Telling the patient the medication is making him or her better is ineffective for a patient with disordered thinking, even if it is true. A patient is unlikely to come to weekly appointments if the schizophrenia is not appropriately managed. Although the nurse cannot force adherence, the nurse should explain why the medication is important. p. 200

The nurse is caring for four patients with schizophrenia. Which patient is exhibiting grandiose delusions? A patient who believes that his or her brain is rotting A patient who believes he or she is the President of the United States A patient who believes his or her food in the hospital is being poisoned A patient who believes the healthcare provider has romantic feelings for the patient

A patient who believes he or she is the President of the United States Grandiose delusions involve believing that one is a powerful or important person, such as the President of the United States. Believing that food is being poisoned is an example of persecutory delusions. Believing that the brain is rotting away is an example of somatic delusions. Believing that the healthcare provider has romantic feelings for the patient is an example of erotomanic delusions. p. 198

The nurse understands that which patients have risk factors for schizophrenia? A patient who was raised in an affluent environment A patient who was a victim of childhood sexual abuse A patient who had a concussion from a sports accident A patient whose mother had an infection during the pregnancy A patient who was exposed to tetrachloroethylene in drinking water

A patient who was a victim of childhood sexual abuse A patient whose mother had an infection during the pregnancy A patient who was exposed to tetrachloroethylene in drinking water A maternal infection is a prenatal risk factor for schizophrenia. Exposure to tetrachloroethylene in drinking water is an environmental risk factor for schizophrenia. Childhood sexual abuse is a psychological risk factor for schizophrenia. Concussions do not predispose people to schizophrenia. Being raised in poverty, not affluence, is a risk factor for schizophrenia. p. 194

The achievement of long-term treatment goals for a patient diagnosed with schizophrenia is reliant upon which factor? A trusting nurse-patient relationship Patient adherence to treatment plan Patient achievement of accepted cognitive and social skills Medication therapy that is reviewed regularly for effectiveness Patient interaction with community-based therapeutic services

A trusting nurse-patient relationship Patient adherence to treatment plan Medication therapy that is reviewed regularly for effectiveness Patient interaction with community-based therapeutic services Effective long-term care of persons with schizophrenia relies on a three-pronged approach: medication administration/adherence, relationships with trusted care providers, and community-based therapeutic services. Cognitive and social skills are not relevant. p. 203

A desired outcome for a patient diagnosed with schizophrenia who is experiencing auditory hallucinations would be that the patient will Ask for validation of reality Describe content of hallucinations Demonstrate a cool, aloof demeanor Identify prodromal symptoms of disorder

Ask for validation of reality Beginning to question his or her own altered perceptions by seeking input from staff is highly desirable. pp. 203-205, Case Study and Nursing Care Plan

What intervention is focused on supporting the overall goal of the acute phase of illness for a psychotic patient? Evaluating the patient's understanding of the diagnosis of schizophrenia. Assessment of patient regarding the existence of command hallucinations. Administration of medication therapy prescribed for negative symptoms of schizophrenia. Encouraging the patient to be independent regarding self-care needs. Providing a low-stimulation environment to minimize aggressive behavior.

Assessment of patient regarding the existence of command hallucinations. Providing a low-stimulation environment to minimize aggressive behavior. For the acute phase, the overall goal is patient safety and stabilization. Phase II focuses on helping the patient understand the illness and treatment, becoming stabilized on medications, and controlling or coping with symptoms. Outcome criteria for phase III focuses on maintaining achievement, adhering to treatment, preventing relapse, and achieving independence and a satisfactory quality of life. p. 201

The type of altered perception most commonly experienced by patients with schizophrenia is Delusions Illusions Tactile hallucinations Auditory hallucinations

Auditory hallucinations Hallucinations, especially auditory hallucinations, are the major example of alterations of perception in schizophrenia. They are experienced by as many as 90% of individuals with schizophrenia. pp. 198-199

Which strategy will the nurse implement when caring for a patient who is experiencing auditory hallucinations? Call the patient by name. Remove the patient to a seclusion room. Assess for suicidal or homicidal commands. Work to maintain eye contact with the patient. Speak loud enough to attract the patient's attention.

Call the patient by name. Assess for suicidal or homicidal commands. Work to maintain eye contact with the patient. Speak loud enough to attract the patient's attention. When a patient is hallucinating, the nurse focuses on understanding the patient's experiences and responses. Suicidal or homicidal themes or commands necessitate appropriate safety measures. Call the patient by name, speak simply and loudly enough to be understood amid the hallucinations, present in a nonthreatening and supportive manner, maintain eye contact, and redirect the patient's focus to the conversation as needed. Removing the patient to seclusion is not always necessary and is implemented only when there are reasons to believe the patient poses harm to him- or herself or to others. p. 209, Box 12.3

Which symptom seen in a patient with schizophrenia can be categorized as a positive symptom? Delusions Dysphoria Loss of motivation Impaired judgment

DELUSIONS The behavioral traits not normally found in healthy patients are called positive symptoms of schizophrenia. They include delusions, hallucinations, bizarre behavior, and paranoia. The behaviors that the patient lacks compared with healthy people are negative symptoms, such as loss of motivation and alogia (poverty of thought or inability to speak). Impaired judgment and illogical thinking are the cognitive symptoms associated with schizophrenia. Dysphoria and suicidal intentions are affective symptoms of schizophrenia. Affective symptoms involve emotions and their expression. pp. 197, 201, Table 12.2

What question would the nurse consider when determining the ability of a patient diagnosed with schizophrenia to ensure his or her own personal safety? Is the patient able to read and write? Does the patient appear fed and hydrated? Is the patient attending to personal hygiene? Is the patient appropriately dressed for the weather? Does the patient appear to have mobility problems?

Does the patient appear fed and hydrated? Is the patient attending to personal hygiene? Is the patient appropriately dressed for the weather? Does the patient appear to have mobility problems? The nurse would assess the patient's ability to ensure personal safety by asking questions concerning adequate food and fluid intake, hygiene and self-care, ability to move about safely (e.g., falls, walking into traffic), impulse control and judgment, and safe dress for weather conditions. Ability to read and write is not relevant. p. 201

The nurse is caring for a patient who was diagnosed with schizophrenia 16 months ago. It has been nearly 10 months since the last psychotic episode. How does the nurse specify this disease progression? First episode, currently in full remission First episode, currently in acute episode First episode, currently in partial remission Multiple episodes, currently in acute episode

First episode, currently in full remission The patient who does not present with any signs or symptoms of schizophrenia for a period of time after a previous episode is considered to be first episode, currently in full remission. An acute episode is a time in which the symptoms criteria are fulfilled. Partial remission means that there is an improvement after a previous episode, and the criteria of the disorder are only partially fulfilled. This patient is not displaying multiple episodes, which indicates two episodes. p. 193

Gynecomastia, amenorrhea, and galactorrhea are side effects most often associated with which medications? Anticholinergic medications Third-generation antipsychotics Second-generation (atypical) antipsychotics First-generation (conventional) antipsychotics

First-generation (conventional) antipsychotics First-generation antipsychotic medications commonly have side effects that relate to sexual dysfunction. These side effects include gynecomastia (enlarged breast tissue), amenorrhea (absence of menstruation), and galactorrhea (discharge from nipples). The incidence of these side effects is much less in second- and third-generation antipsychotic medications. Anticholinergic medications have side effects of constipation and blurred vision.

A patient with schizophrenia who is experiencing symptoms of disorganized thinking would have the greatest difficulty when the nurse Uses concrete language Gives multistep directions Interacts with a neutral attitude Provides nutritional supplements

Gives multistep directions The thought processes of the patient with disorganized schizophrenia are severely disordered, and severe perceptual problems are present, making it extremely difficult for the patient to understand what others are saying. All communication should be simple and concrete and may need to be repeated several times. p. 205, Table 12.3

The nurse documents that a patient is demonstrating a negative symptom of schizophrenia when observing the patient doing what? Refusing to eat anything that is not tasted by the staff first Having difficulty focusing on any task for more than a few minutes Communicating using a pattern of speech identified as "word salad" Reporting hearing voices telling the patient that the world will end soon

Having difficulty focusing on any task for more than a few minutes Attention impairment is considered a negative symptom because it represents a diminution or loss of normal brain function. Paranoia, hallucinations, and distorted speech are considered positive symptoms because they are an exaggeration or distortion of normal brain function. p. 201, Table 12.2

A patient has had schizophrenia for the past 15 years and is treated with first-generation antipsychotics and bromocriptine. The nurse suspects that the patient is not following the schedule for taking bromocriptine regularly. What complications does the nurse evaluate in the patient during assessment? Neutropenia Hyperpyrexia Muscular rigidity Sexual dysfunction Deep vein thrombosis

Hyperpyrexia Muscular rigidity Deep vein thrombosis Neuroleptic malignant syndrome is caused by excessive reduction in dopamine functions as a result of receptor blockage. Patients with schizophrenia who take first- and second-generation antipsychotic drugs for 15 to 20 years may develop neuroleptic malignant syndrome. Patients are prescribed bromocriptine to treat neuroleptic malignant syndrome. The nurse should evaluate muscular rigidity in patients because neuroleptic malignant syndrome is characterized by muscular rigidity, hyperpyrexia, and deep vein thrombosis. Neutropenia is caused by agranulocytosis and is seen in patients who are treated with clozapine, a second-generation antipsychotic drug. Sexual dysfunction is not a characteristic of neuroleptic malignant syndrome. It is a common side effect of antipsychotic drugs. pp. 216, 217, Table 12.6

What electrolyte imbalance can be seen in patients who have schizophrenia who are experiencing polydipsia? Hypokalemia Hypocalcemia Hyponatremia Hypercalcemia

Hyponatremia In patients with schizophrenia, polydipsia is seen as a result of dry mouth. Patients experience excessive thirst because of antipsychotic drugs and drink a lot of water. Polydipsia is characterized by hyponatremia, confusion, and severe symptoms of schizophrenia. It is caused by the inability of the kidneys to filter excess fluids. Hypokalemia is a condition that produces reduced levels of potassium, which can be caused by antibiotics. Hypocalcemia refers to increased levels of calcium as a result of a deficiency of vitamin D or defective absorption. It can also happen because of impaired metabolism of vitamin D in the body. Hypercalcemia is an increase in levels of calcium seen during hyperparathyroidism. pp. 198-199

The nurse believes a patient may have schizophrenia based on which signs and symptoms? Headaches Depression Incoherence Hearing voices Withdrawn behavior

Incoherence Hearing voices Withdrawn behavior Hearing voices is an auditory hallucination, which is a symptom of psychosis that could be present with schizophrenia. Incoherence is a type of disorganized speech, which is also a symptom of schizophrenia. Withdrawn behavior is a sign of psychosis and schizophrenia. Headaches are general symptoms that could indicate many types of diseases or disorders, not specific to schizophrenia. Depression is not an initial symptom of schizophrenia or psychosis, but may co-occur with schizophrenia. p. 192

The nurse is confident that an individual prescribed antipsychotic medication has been experiencing medication efficacy and showing insight when the patient Can restate the importance of medication compliance Has been attending regularly prescribed therapy sessions No longer experiences hallucinations or delusional thinking Is able to assess effectively the reality of his or her thinking processes

Is able to assess effectively the reality of his or her thinking processes Attaining insight is demonstrated by the ability to make reliable reality checks. This takes 6 to 18 months and depends on medication efficacy and ongoing support. Although attending therapy sessions and restating the importance of medication compliance are positive behaviors, they do not show insight because there is no critical thinking involved. The lack of hallucinations or delusional thinking reflects positive outcomes but not necessarily insight because there is no critical thinking involved. p. 197

Which intervention will improve outcomes for a patient diagnosed with schizophrenia? SELECT ALL Managing the titrating of the patient's medication. Assessing the patient for suicidal ideations regularly. Screening the patient for involuntary motor movement. Encouraging patient involvement in self-help support groups. Minimizing patient stress by limiting involvement in the goal-setting process.

Managing the titrating of the patient's medication. Assessing the patient for suicidal ideations regularly. Screening the patient for involuntary motor movement. Encouraging patient involvement in self-help support groups. Patient care and outcomes can be improved by including the use of evidence-based performance measures regarding assessment, treatment, and evaluating care, including the use of effective, affordable medications titrated to effective dosages, such as second-generation antipsychotics for persons with prominent negative symptoms, assessment for risk of suicide, screening for involuntary movement and metabolic syndrome, and promoting involvement in self-help and support groups. Patients always should be involved in the treatment plan to the extent of their abilities. p. 218

What area of instruction should the nurse include in the education of a family with a member who has been diagnosed with schizophrenia? SELECT ALL THE APPLY Medication side effects Stress as a psychotic trigger Relapse prevention strategies Need for family to take over the management of care Family's role in achieving positive treatment outcomes

Medication side effects Stress as a psychotic trigger Relapse prevention strategies Family's role in achieving positive treatment outcomes Education is essential and includes teaching the patient and family about the illness: causes, medications, and side effects, coping strategies, what to expect, and relapse prevention. This knowledge and skill help the patient and family to appreciate the impact of stress and the importance of treatment to a good outcome. The patient who returns to a warm, concerned, and supportive environment is less likely to experience relapse. The patient should always be involved in the management of his or her care to the extent of his or her abilities. p. 210, Box 12.5

A patient diagnosed with residual schizophrenia is uninterested in community activities, lacks initiative, demonstrates both poverty of content and poverty of speech, and seems unable to follow the schedule for taking prescribed antipsychotic medication. The case manager continues to direct care with the knowledge that this behavior most likely is prompted by Personality conflict Neural dysfunction Dependency needs Chronic uncooperativeness

Neural dysfunction Schizophrenia is considered a neurobiological disorder. The course of schizophrenia involves recurrences. With each relapse further deterioration is noted. Residual schizophrenia refers to the disorder when active phase symptoms are no longer present and the individual is left with two or more of the following symptoms: lack of initiative, social withdrawal, impaired role function, marked speech deficits, and odd beliefs. p. 194

A patient with schizophrenia is treated with antipsychotics for 3 months. The nurse reports that the patient has reduced confusion and hallucinations. The health care provider wants to improve the social functioning and withdrawing nature of the patient along with the confusion and hallucination. Which drug would be prescribed to the patient in this phase? Loxapine Olanzapine Fluphenazine Chlorpromazine

Olanzapine Confusion and hallucination are positive symptoms of schizophrenia. Reduced social functioning and withdrawal are the negative symptoms of schizophrenia. Olanzapine is a second-generation antipsychotic. It can treat both positive and negative symptoms of schizophrenia. Chlorpromazine is a first-generation low-potency antipsychotic. Fluphenazine is a first-generation high-potency antipsychotic. Loxapine is a first-generation medium-potency antipsychotic. First-generation antipsychotics treat only positive symptoms of schizophrenia. p. 212, Table 12.5

Which drug can be used to treat alogia, avolition, and anhedonia in schizophrenic patients? Molindone Olanzapine Thiothixene Thioridazine

Olanzapine Olanzapine is a second-generation antipsychotic. It is prescribed to treat both positive symptoms, like hallucination and delusion, and negative symptoms, like alogia, avolition, and anhedonia. Thiothixene is a high-potency first-generation antipsychotic. It is prescribed to treat positive symptoms like hallucination and delusion. Molindone is a medium-potency first-generation antipsychotic. It does not treat alogia, avolition, or anhedonia. Thioridazine is a low-potency first-generation antipsychotic used to treat positive symptoms of schizophrenia. p. 212, Table 12.5

A nurse works with a patient in the acute phase of schizophrenia. Which assessment findings increase the risk of aggression and violence? Paranoia Flat affect Poor hygiene Delusional thinking Command hallucinations

Paranoia Delusional thinking Command hallucinations A small percentage of patients with schizophrenia, especially during the acute phase, may exhibit a risk for physical violence, typically in response to hallucinations (especially command hallucinations), delusions, paranoia, and impaired judgment or impulse control. Poor hygiene and a flat affect are negative symptoms that usually are not associated with aggression or violence. p. 203

An adult with a 6-year history of schizophrenia begins a community rehabilitation program. Select the most appropriate initial outcome for this patient. The patient will Lead the morning exercise group Participate actively in scheduled programming Apply for employment in a local sheltered workshop Report that no auditory hallucinations have occurred

Participate actively in scheduled programming Participation in scheduled activities of the program should occur first. After the patient is accustomed to the program, he or she might lead a group or apply for employment. Hallucinations commonly continue to occur in patients diagnosed with schizophrenia. pp. 203, 210, Box 12.5

The nurse is caring for five patients on a unit who have schizophrenia. Which patients are presenting with alterations in perception? Patient who reports feeling depressed Patient who reports seeing the his or her dead relative Patient who reports hearing babies crying in a quiet room Patient who reports feeling disoriented in the hospital room Patient who reports feeling like ants are crawling on his or her skin

Patient who reports seeing the his or her dead relative Patient who reports hearing babies crying in a quiet room Patient who reports feeling like ants are crawling on his or her skin Hallucinations are alterations in perception and include auditory (hearing the sounds of babies crying), visual (seeing people or things that are not there), and tactile (feeling ants crawling on the skin). Patients who feel disoriented or depressed are experiencing affective signs, not alterations in perception. p. 198

Which statement is true regarding schizophrenia, treatment, and outcomes? If treated quickly following diagnosis, schizophrenia can be cured. Schizophrenia can be managed by receiving treatment only at the time of acute exacerbations. If patients with schizophrenia stay on their drug regimen, they usually lead fully productive lives with no further symptoms. Patients with schizophrenia often do not fully respond to treatment and have residual symptoms and varying degrees of disability.

Patients with schizophrenia often do not fully respond to treatment and have residual symptoms and varying degrees of disability. Unfortunately, in most cases, schizophrenia does not respond fully to available treatments; it leaves residual symptoms and causes varying degrees of dysfunction or disability. Untrue statements about schizophrenia are that it can be cured if treated quickly, it can be managed by receiving treatment only at the time of acute exacerbations, and if patients with schizophrenia stay on their drug regimen, they usually lead fully productive lives with no further symptoms. p. 196

A nurse assesses a patient diagnosed with schizophrenia who states, "Aliens are trying to inject me with their DNA." The nurse documents the patient's comment and applies which term? Anosognosia Affective blunting Positive symptoms Negative symptoms

Positive symptoms The patient's comment indicates delusional thinking, which is a positive symptom of schizophrenia. Anosognosia refers to an inability to realize an illness exists. Affective blunting relates to the patient's outward expression of emotion. Negative symptoms include social isolation, anergia, lack of motivation, blunted affect, and inattention to personal hygiene. pp. 197-199, 201, Table 12.2

The nurse is caring for a patient who presents with disorganized thoughts and reports hearing voices that tell him or her to stay home. As a result, the patient has not shown up for work in several weeks and is at risk of losing employment. How does the nurse document this in the patient's chart? Positive symptoms of schizophrenia Negative symptoms of schizophrenia Cognitive symptoms of schizophrenia Affective symptoms of schizophrenia

Positive symptoms of schizophrenia The patient is presenting with positive symptoms of schizophrenia. This includes the presence of something that should not be present, such as hallucinations, delusions, paranoia, disorganized thoughts, and bizarre behaviors. Negative symptoms are the absence of something that should be present. Examples include the inability to enjoy activities or being uncomfortable in social situations. Cognitive symptoms can include subtle or obvious impairment in memory, thinking, and attention. Affective symptoms involve motions and their expressions.

Which statement is accurate regarding the relationship between depression and schizophrenia? Suicide attempts usually occur early in the course of schizophrenia. Antipsychotic medications alleviate symptoms of depression for patients diagnosed with schizophrenia. Regular assessments should occur for both depression and suicide risk in patients diagnosed with schizophrenia. Nicotine use in patients diagnosed with schizophrenia stimulates neurotransmitters, resulting in a decreased incidence of depression and suicide.

Regular assessments should occur for both depression and suicide risk in patients diagnosed with schizophrenia. Almost half of people with schizophrenia will attempt suicide; therefore, assessments for depression and suicide should occur throughout the patient's life. Both depression and suicide attempts can occur at any point in the illness. Antipsychotic medications do not alleviate symptoms of depression for patients diagnosed with schizophrenia. Nicotine use is higher in patients diagnosed with schizophrenia; nicotine stimulates some neurotransmitters, but this does not result in a decreased incidence of depression. p. 193

The nurse is addressing a primary symptom of schizophrenia when Arranging for the patient to attend stress management classes Reinforcing the patient's ability to interrupt intrusive paranoid thoughts Working with the patient to arrive at a budget that allows him or her to live independently Supporting the patient in his or her attempts to stop using alcohol to cope with hallucinations

Reinforcing the patient's ability to interrupt intrusive paranoid thoughts Primary symptoms are ones that are directly caused by the mental illness, such as paranoid thoughts. Stress is a secondary symptom of schizophrenia resulting from stressors related to coping with the illness. A need for assistance while living independently is a secondary symptom of schizophrenia resulting from stressors created by the illness. Alcohol abuse is a secondary symptom of schizophrenia resulting from the use of alcohol to manage the stress of the hallucinations (a primary symptom). p. 193

A patient has reached the stable plateau phase of schizophrenia. An appropriate clinical focus for planning would be Acute symptom stabilization Safety and crisis intervention Stress and vulnerability assessment Social, vocational, and self-care skills

Social, vocational, and self-care skills During the stable plateau phase of schizophrenia, planning is geared toward the patient and family education and skills training that will help maintain the optimal functioning of schizophrenic individuals in the community. p. 196

The nurse is caring for a patient with schizophrenia who reports diminishing symptoms and the ability to "remember things clearly again." The healthcare provider determines the patient is ready for outpatient mental health services. The nurse identifies that the patient is in which phase of schizophrenia? Acute Prodromal Stabilization Maintenance

Stabilization The patient with diminishing or stabilizing symptoms with movement toward a previous level of functioning is in the stabilization phase of schizophrenia. The prodromal phase is the first phase in which the patient presents with mild changes in thinking and mood but symptoms are insufficient to meet the diagnostic criteria for schizophrenia. The acute phase is when symptoms vary from mild to severe and become disabling. During this phase, the patient experiences delusions, hallucinations, withdrawn behaviors, and other functional impairment. The maintenance (or residual) phase is when the condition has stabilized and a new baseline is established. p. 196

Which side effect of antipsychotic medication is generally nonreversible? Dystonic reaction Tardive dyskinesia Pseudoparkinsonism Anticholinergic effects

Tardive dyskinesia Tardive dyskinesia is not always reversible with discontinuation of the medication and has no proven cure. The side effects of anticholinergic effects, pseudoparkinsonism, and dystonic reaction often appear early in therapy and can be minimized with treatment. pp. 211, 213, 215, Table 12.6

A patient with schizophrenia says, "I could hear the dog barking. It is trying to bite me." The nurse has taught hallucination-coping techniques to the patient's family to facilitate the patient's rehabilitation at home. What would be the most appropriate action by the patient's family in this case? SELECT ALL APPLY The family members should ask the patient to read loudly. The family members would ask the patient to clean the house. The family members should ask the patient not to go anywhere. The family members should ask the patient to cover his or her ears. The family members should ask the patient to close his or her eyes.

The family members should ask the patient to read loudly. The family members would ask the patient to clean the house. It is helpful if family members are included in the treatment of a patient with schizophrenia. They form a support group for the patient and thus are taught different coping techniques for hallucinations and delusions. It is useful to use other auditory stimuli to overcome auditory hallucination in patients with schizophrenia. The patient should be asked to read loudly or listen to music in such cases. The patient may also be engaged in an activity like cleaning the house. Asking the patient to cover the ears will not help the patient to overcome auditory hallucinations. The patient should be taken to a favorite place so he or she can relax. Asking the patient to close his or her eyes will not help the patient to overcome hallucinations. pp. 208-210

A nurse plans a series of psychoeducational groups for persons with schizophrenia. Which topic would take priority? How to give and receive compliments The importance of taking medication correctly How to complete an application for employment Ways to dress and behave when attending community events

The importance of taking medication correctly Although completing applications, dressing and behaving correctly, and giving and receiving compliments are important, correct self-management of pharmacotherapy takes priority. The patient cannot maintain remission without the appropriate medication. p. 202, Box 12.2

A patient is prescribed intramuscular fluphenazine. On the 15th day, the nurse finds the patient is stiff, dripping saliva, and has a masklike face. What is the most appropriate action by a nurse to help the patient? The nurse should administer the drug orally. The nurse should administer chlorpromazine. The nurse should administer trihexyphenidyl. The nurse should consult the health care provider. The nurse should provide the patient with a handkerchief.

The nurse should administer trihexyphenidyl. The nurse should consult the health care provider. The nurse should provide the patient with a handkerchief. Fluphenazine is a high-potency antipsychotic drug. It may cause pseudo-Parkinsonism between 5 and 30 hours after administering. The nurse should consult the primary health care provider to report the adverse effects and to change the drug. The nurse should administer the anticholinergic drug trihexyphenidyl to reduce the symptoms. The nurse should provide a handkerchief to wipe the saliva. A nurse cannot change the drug and administer chlorpromazine without the consent of the primary health care provider. The nurse should not change the dosage because it may cause adverse effects. p. 215, Table 12.6

A nurse is educating a patient's family about schizophrenia. What is the most appropriate advice the nurse can give to the patient's family? The nurse should advise them to adhere to the treatment plan. The nurse should advise them to keep in touch with support groups. The nurse should advise them to keep the patient in an isolated room. The nurse should avoid mentioning the side effects of the drugs prescribed. The nurse should advise them to immediately stop the medication if the patient's symptoms are relieved.

The nurse should advise them to adhere to the treatment plan. The nurse should advise them to keep in touch with support groups. The nurse should advise the family of the patient to join support groups such as National Alliance on Mental Illness and other local support groups. These groups would help to provide optimal patient care as well as support to the family. Adherence to the treatment plan would result in positive outcomes for the patient. The patient's family must be educated about the possible side effects of the prescribed drugs. This would help in effective monitoring and reducing panic in the patient and family members. The patient should be encouraged to interact with others. Keeping the patient isolated can make the patient either aggressive or withdrawn. The medications should not be stopped immediately after the symptoms are relieved because it could cause relapse of the schizophrenic symptoms. Gradually decreasing the dosage of the drug would be useful to prevent a relapse. p. 210, Box 12.5

A patient with schizophrenia prescribed with trihexyphenidyl complains of constipation. What is the most appropriate action by a nurse to help the patient? The nurse should give prune juice. The nurse should prescribe benztropine. The nurse should discontinue administration of the drug. The nurse should report to the primary health care provider.

The nurse should give prune juice. Constipation is a side effect usually caused by anticholinergic drugs like trihexyphenidyl. A nurse can help by advising the patient to take fluids like prune juice and water, as well as eat fiber-rich foods. A nurse should not discontinue administration of the medication because patients with schizophrenia develop extrapyramidal side effects (EPSs) as a result of conventional antipsychotics. Trihexyphenidyl is a centrally acting anticholinergic that reduces EPS. A nurse should report to the primary health care provider, but it is not the primary action to be taken. Benztropine is an anticholinergic drug. It has the same side effects as that of trihexyphenidyl. p. 215, Table 12.6

A patient with schizophrenia often becomes aggressive and bangs his head on the wall. What is the most appropriate action toward the patient by the nurse? The nurse should seclude the patient. The nurse should leave the patient alone. The nurse should make frequent visits to the patient. The nurse should shout when the patient is aggressive. The nurse should find out the reason for the patient's aggressiveness.

The nurse should seclude the patient. The nurse should make frequent visits to the patient. The nurse should find out the reason for the patient's aggressiveness. Patients with schizophrenia become aggressive during the acute phase and may try to harm themselves as a result of hallucinations. A nurse should seclude such patients to avoid the risk of patients harming themselves or others. A nurse should also try to determine the cause of the aggressive impulse and minimize or avoid it. Such patients must always be kept under continuous supervision. Therefore, it is also appropriate that the nurse frequently visits the patient. Shouting at the patient may cause the patient to withdraw or may make the patient more aggressive. Leaving the patient unattended can cause potential harm to the patient. p. 207, Table 12.3

A nurse observes multiple patients with schizophrenia in a ward. The patients do not like to interact with others and believe that the others would cause harm. What is the most appropriate action a nurse should take for such patients? The nurse should take the patients to the garden. The nurse should not give any task to the patients. The nurse should ask the patients about their family. The nurse should keep the patients away from peers.

The nurse should take the patients to the garden. The patients should be engaged in recreational activities and should be taken out to the garden. This helps to increase social comfort and leisure skills. Patients with schizophrenia should not be asked about the family frequently, because it may cause withdrawal. The patients should also be encouraged to mingle with peers and to interact with them. This promotes interaction skills in the patient. Patients should also be encouraged to participate in group activities. Patients should be involved in a task and encouraged to complete it. This enhances their self-esteem. p. 208

A patient with schizophrenia was prescribed antipsychotics. After daily observation, the nurse finds the patient's blood pressure has decreased. What is the most appropriate action by a nurse before administering the prescribed drug to the patient? The nurse should tell the patient to rise slowly. The nurse should tell the patient to avoid taking fluids. The nurse should avoid administering the drug for the day. The nurse should give an adrenergic agonist to raise the blood pressure.

The nurse should tell the patient to rise slowly. Antipsychotics block the α 2-receptor, which may cause hypotension. The nurse can give advice to the patient to rise slowly from the bed because the patient may feel dizzy as a result of reduced blood pressure. The nurse cannot administer the adrenergic agonist but can report to the health care provider if the patient's diastolic pressure falls below 80 mm Hg. The nurse should not stop administering the drug because that may worsen the schizophrenic symptoms. The nurse should not advise the patient to avoid fluid intake, because the patient may feel dehydrated and the total pressure exerted on the blood vessels maybe reduced. pp. 215-216, Table 12-6

A nurse is caring for a patient with schizophrenia. The nurse observes that the patient does opposite of any given instruction unintentionally and the patient often runs in the corridor. What is the probable diagnosis by the nurse from such behavior? The patient is restless. The patient has negativism. The patient has hearing problems. The patient does not like the nurse.

The patient has negativism. Schizophrenia is characterized by the symptoms of negativism, in which patients tend toward resistance and to do the opposite of what they are told. These patients also have motor agitation, in which they run or pace rapidly in response to stimuli and show unintended excessive movements. The patient's behavior is unlikely to be due to hearing problem, restlessness, or dislike toward the nurse.

A patient is on conventional antipsychotics. On clinical observation, the nurse finds that the patient has hyponatremia, increased confusion, and delirium. Which is the most likely cause of the patient's condition? The patient is dehydrated. The patient has stopped taking medication. The patient is not responding to the medication. The patient has potentially fatal water intoxication.

The patient has potentially fatal water intoxication. Antipsychotics are usually prescribed in combination with anticholinergics because they cause dry mouth. The patient feels excessive thirst and drinks lots of water. This results in water intoxication, which is indicated by hyponatremia, confusion, and worsening of the psychotic symptoms. If the patient has stopped taking medication or is not responding to them, it would lead the psychotic conditions to worsen as well. It would not produce hyponatremia. In addition, mental stress would not cause hyponatremia. Fatal water intoxication occurs as a result of excessive water intake. The signs do not indicate that the patient is dehydrated. p. 194

In a clinical interview conducted at a community health care center, the nurses observe that a patient with schizophrenia is very sensitive and feels extremely guilty about previous actions. What is the appropriate nursing diagnosis? The patient is a victim of child abuse. The patient has risk for self-directed violence. The patient has impaired verbal communication. The patient is showing positive symptoms of schizophrenia.

The patient has risk for self-directed violence. The patient with schizophrenia shows negative symptoms such as self-blaming, guilt, and becoming sensitive. It indicates that the patient is at risk for self-directed violence and can do self-harm. Impaired verbal communication is characterized by dissociative ideas. Positive symptoms of schizophrenia include hallucination and associative looseness. Feeling guilty and being sensitive are negative symptoms of schizophrenia. Schizophrenia is not associated with a history of child abuse. pp. 201, 207, Table 12.2, Table 12.3

A patient with schizophrenia was prescribed perphenazine. During the follow-up visit after 12 weeks on the medication, the nurse suggests that the patient go on bed rest and follow a diet rich in proteins and carbohydrates. Which is the most appropriate reason for the nurse to give this suggestion? The patient has the symptoms of agranulocytosis. The patient has the symptoms of cholestatic jaundice. The patient has the symptoms of postural hypotension. The patient has the symptoms of autonomic dysfunction.

The patient has the symptoms of cholestatic jaundice. Schizophrenic patients taking perphenazine, a first-generation antipsychotic drug, may have toxic effects as a result of long-term therapy. The nurse should identify the signs and symptoms of the toxic effects, like cholestatic jaundice, which is due to collection of bile juice in the gallbladder. The patient should be instructed to go on bed rest and consume a diet rich in proteins and carbohydrates. Postural hypotension is characterized by a drop in blood pressure with a change in position. It cannot be managed by a protein-rich diet. Agranulocytosis is characterized by dangerously low levels of white blood cells; this condition is not related to bed rest and diet changes. Autonomic nervous system controls involuntary actions of the body. An autonomic dysfunction is not treated by bed rest and diet changes. p. 212, Table 12.5

A nurse is caring for a patient with schizophrenia. Upon the nurse's report, the primary health care provider prescribed 25 mg of diphenhydramine hydrochloride to the patient. What had the nurse reported to the primary health care provider about the patient? The patient has a peptic ulcer and asthma. The patient has mydriasis and photosensitivity. The patient has tremors and tardive dyskinesia. The patient has excessively dry mucous membranes.

The patient has tremors and tardive dyskinesia. Patients with schizophrenia are generally prescribed antipsychotic drugs. These drugs cause extrapyramidal side effects, like tremors, and abnormal involuntary movements, like tardive dyskinesia. Diphenhydramine hydrochloride 25 mg by the intramuscular or intravenous route is prescribed to such patients to treat extrapyramidal side effects. Diphenhydramine hydrochloride is contraindicated in patients with peptic ulcer and asthma because it causes stomach distress like nausea, vomiting, and diarrhea. Physostigmine and benzodiazepines are administered to control these symptoms. Photosensitivity and mydriasis are symptoms of anticholinergic toxicity. Dry mucous membranes can be a symptom of anticholinergic toxicity but are not a major concern with the administration of diphenhydramine hydrochloride. p. 211

A nurse is devising a treatment plan for a patient who is in the first phase of schizophrenia. Which of these actions by the patient supports the assumption that the patient is in the first phase of schizophrenia? The patient takes the medication properly. The patient has good interactions with others. The patient hears the voice of a late grandfather. The patient repeats the words uttered by the nurse. The patient reports that the primary health care provider tried to kill him.

The patient hears the voice of a late grandfather. The patient repeats the words uttered by the nurse. The patient reports that the primary health care provider tried to kill him. Schizophrenia is characterized by three phases. The first phase is the acute phase. In this phase, the patient has positive schizophrenia symptoms such as hallucinations, echolalia, and paranoia. The patient may hear unusual voices and repeat what others have said. The patient also may have irrational fears and may believe that the primary health care provider had tried to kill him. In the second phase of schizophrenia, the patient starts taking medication and shows improvement. In this phase, the patient also develops an ability to interact with others. pp. 201-204

Which assessment finding supports the belief that the patient is demonstrating a positive symptom of schizophrenia? The patient states, "Nothing is fun anymore." The patient unable to decide on what foods to select for dinner. The patient finds it difficult to sit quietly, stating, "I have to fidget." The patient refuses to sleep because "I'll be abducted by the aliens." The patient is unable to remember his or her personal telephone number.

The patient refuses to sleep because "I'll be abducted by the aliens." The four main symptom groups of schizophrenia are (1) positive symptoms: the presence of something that is not normally present (e.g., hallucinations, delusions, bizarre behavior, paranoia, abnormal movements, gross errors in thinking); (2) negative symptoms: the absence of something that should be present (e.g., interest in hygiene, motivation, ability to experience pleasure); (3) cognitive symptoms: often subtle changes in memory, attention, or thinking (e.g., impaired executive functioning [the ability to set priorities or make decisions]); (4) and affective symptoms: symptoms involving emotions and their expression. pp. 197, 201, Table 12.2

A patient diagnosed with schizophrenia receives an injection of fluphenazine monthly. Which assessment findings indicate that this patient is experiencing extrapyramidal symptoms? Tremor Drooling Dry eyes Constipation Shuffling gait

Tremor Drooling Shuffling gait Fluphenazine is a first-generation antipsychotic medication. These medications commonly cause extrapyramidal symptoms, which include masklike faces, stiff and stooped posture, shuffling gait, drooling, tremor, "pill-rolling" movements, and akathisia. Constipation and dry eyes are anticholinergic side effects. pp. 211, 212, Table 12.4, Table 12-5

A patient diagnosed with schizophrenia and experiencing command hallucinations had a brief stay on an inpatient unit. Afterward, the patient was transferred to a partial hospitalization program. Which outcome is most appropriate to achieve by the end of the first week of partial hospitalization? The patient will Express self clearly and in organized sentences Clearly describe the content and source of the hallucinations Ask the nurse for medication when experiencing hallucinations Verbalize an understanding that hallucinations are a sign of the illness

Verbalize an understanding that hallucinations are a sign of the illness Anosognosia refers to an inability to realize an illness exists. This problem occurs in many persons diagnosed with schizophrenia. If the patient recognizes that hallucinations are an aspect of the illness, he or she has made initial progress in management of the illness. It will take longer than 1 week for the patient to communicate clearly and in organized sentences. The patient does not know the source of hallucinations and it is not productive to explore their content in detail. The patient should take medication daily, not just when experiencing hallucinations. pp. 200, 206, Table 12.3

A patient diagnosed with schizophrenia has been drinking frequently from the water fountain and taking drinks from peers' meal trays. The staff has observed an increase in auditory hallucinations and episodes of acute confusion. Which nursing actions are appropriate? SELECT ALL THE APPLY Weigh the patient daily. Restrict the patient's access to fluids. Assess the patient for water intoxication. Administer an as needed dose of the patient's antipsychotic medication. Monitor the patient daily to identify any changes in mental status.

Weigh the patient daily. Restrict the patient's access to fluids. Assess the patient for water intoxication. Polydipsia can lead to fatal water intoxication (indicated by hyponatremia, confusion, worsening psychotic symptoms, and, ultimately, coma). Polydipsia occurs in upwards of 20% of persons with schizophrenia and a seemingly insatiable thirst can cause hyponatremia in 2% to 5%. Contributing factors include antipsychotic medication (causes dry mouth), compulsive behavior, and neuroendocrine abnormalities. Additional medication is not indicated at this time; physiological needs have a higher priority. This patient needs very frequent observation for changes in status; every 15 minutes or continuous observation will better provide for the patient's safety. p. 194

A patient with undifferentiated schizophrenia lives in a community care home and takes olanzapine daily with supervision. During the patient's monthly outpatient visits with a psychiatric nurse, which assessment parameter takes priority? Height Weight Pupillary response to light Integrity of mucous membranes

Weight An important part of the nurse's role in the community is monitoring the patient's response to medications, compliance, and potential side or adverse effects. Key side effects of sexual dysfunction and weight gain are particularly important to monitor for persons taking antipsychotic medications. Olanzapine is an atypical antipsychotic drug that can cause significant weight gain, which results in diabetes for many patients. Neither height, mucous membrane integrity, nor pupil response takes priority over weight. p. 202, Box 12.2

A community mental health nurse cares for a patient diagnosed with schizophrenia who takes olanzapine. In addition to monitoring the patient's mental status, the nurse regularly should assess what of the patient? Height Weight Blood glucose Blood pressure Peripheral pulses

Weight Blood glucose Blood pressure Peripheral pulses Olanzapine is a second-generation antipsychotic medication. These medications have a high risk of causing metabolic syndrome. It is important to monitor blood glucose, weight, and serum lipids, as well as indicators of diabetes, atherosclerotic heart disease, and hypertension. Height is not relevant. p. 212, Table 12-5,p. 211, Table 12.4

Which of the following symptoms would alert a health care provider to a possible diagnosis of schizophrenia in a young adult patient? Excessive sleeping with disturbing dreams Command hallucinations to hurt roommate Withdrawal from college because of failing grades Chaotic and dysfunctional relationships with family and peers

Withdrawal from college because of failing grades People diagnosed with schizophrenia all have at least one psychotic symptom, such as hallucinations, delusional thinking, or disorganized speech. Excessive sleeping, failing grades, and chaotic and dysfunctional relationships do not describe schizophrenia but could be caused by a number of problems. p. 192