ch16: schizophrenia
After teaching a client with schizoaffective disorder about the condition and treatment, the nurse determines that the education was successful when the client states what? "I should go to sleep at night when I feel tired." "I need to eat properly so that I can control my weight." "I can stop my medication when I start to feel better." "I can vary my routines from day to day without problems."
"I need to eat properly so that I can control my weight." Client education should focus on nutrition and prevention of weight gain, which is a side effect of medication therapy. Establishing a regular sleep pattern by setting a routine can help to promote or reestablish normal patterns of rest. Establishing a daily routine can help address mood symptoms. Medication should not be stopped if the client feels better.
A client with schizophrenia tells a nurse, "I'm being watched constantly by the Federal Bureau of Investigation because of my job." Which response by the nurse would be most appropriate? "Tell me more about how you are being watched." "You are experiencing a delusion because of your illness." "It must be frightening to feel like you're always being watched." "You're not being watched; it's all in your mind."
"It must be frightening to feel like you're always being watched." When interacting with a client who is experiencing delusions, the nurse must remember that these experiences are real for the client. Based on the client's statement, the nurse should focus on the feelings that are generated by the delusion, such as acknowledging how frightening it must be to feel constantly watched. The nurse should not focus on the delusion itself (such as by asking the client to tell the nurse more about being watched). Telling the client that they are not being watched, that it is all in their mind, or that the client is experiencing a delusion would be inappropriate because these statements tell the person that their experiences are not real.
A client tells the nurse that the client has bugs in the client's brain and asks the nurse if the nurse can see them. Which response by the nurse is most therapeutic? "No, I don't see any bugs. You seriously can't have any bugs in your brain." "You have a thought disorder and only think you have bugs in your brain. There really aren't any. You don't have to worry because we would give you medicine for any medical problems." "No, I don't see any bugs. That sounds scary for you." "Your thinking is a little illogical. I wouldn't be able to see bugs if they were inside your brain. Would you like to talk more about this?
"No, I don't see any bugs. That sounds scary for you." The person who hallucinates is preoccupied and frightened by what he or she hears or sees. The hallucination is real to the client, and the nurse cannot argue away, dismiss, or ignore it. Although the hallucination is real to the client, nurses make it clear that they do not hear the voices or see the visual images. Nurses do, however, communicate concern that the client is bothered, upset, or frightened by the hallucination.
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 1 week 8 months 1 year
1 month 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.
A client diagnosed with schizophreniform disorder must have symptoms present for at least 1 month but with a duration of less than how long? 2 weeks 12 months 6 months 4 weeks
6 months 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.
A client diagnosed with schizophrenia has been prescribed clozapine. Which is a potentially fatal side effect of this medication? Tardive dyskinesia Dystonia Agranulocytosis Neuroleptic malignant syndrome
Agranulocytosis Agranulocytosis is manifested by a failure of the bone marrow to produce adequate white blood cells. Neuroleptic malignant syndrome is a life-threatening reaction to neuroleptic medication that requires immediate treatment. Tardive dyskinesia causes involuntary movements of the tongue, mouth, facial muscles, and arm and leg muscles. Dystonia is characterized by cramps and rigidity of the tongue, face, neck, and back muscles.
A nurse monitoring client medication needs to recognize side effects quickly and intervene promptly for which reason? Provide support to the client and let the client know this is normal Provide support to the client and encourage adherence as past side effects rarely reoccur Alleviate the side effects and help client maintain adherence Determine adequate dosage is maintained to control symptoms
Alleviate the side effects and help client maintain adherence Recognizing a medication's side effects quickly and intervening promptly to alleviate them will help maintain adherence.
A client was admitted to the psychiatric intensive care unit with schizophrenia. Among the client's signs and symptoms, the client was experiencing nihilistic delusions. The nurse understands that these delusions involve a belief about what? Possession of exceptional powers, such as the ability to communicate with a powerful person An impending calamity, such as death Belief that communications intended for a broad audience have special meaning for the client Feeling of being watched, such as by the government
An impending calamity, such as death Delusions are erroneous, fixed beliefs that cannot be changed by reasonable argument. Nihilistic delusions involve the belief that one is dead or a calamity is impending; when these delusions involve bodily illness, they take hypochondriacal concerns to the utmost extreme. Grandiose delusions involve the belief that one has exceptional powers, wealth, skill, influence, or destiny. Persecutory delusions involve the belief that one is being watched, ridiculed, harmed, or plotted against. Referential delusions, or ideas of reference, involve a belief that communications such as television broadcasts or website posts are directed toward the client or have special meaning for the client.
A client with schizoaffective disorder is having difficulty adhering to the medication regimen that requires the use of several agents. The client also is experiencing several side effects contributing to this nonadherence. The physician plans to change the client's medication. Which agent would the nurse anticipate that the physician would prescribe? Lithium Clozapine Aripiprazole Olanzapine
Aripiprazole The medication regimen for a client with schizoaffective disorder is complex and may include antipsychotics, mood stabilizers, antidepressants, and occasional antianxiety agents. The use of these agents can lead to multiple side effects and possible interactions. Aripiprazole exerts an antidepressant effect and may replace polypharmacy, thus reducing drug costs, the risk of drug interactions, and potential adverse drug effects and possibly enhancing adherence.
A client with schizophrenia walks up to the nurse with the client's arm outstretched and says, "My arm went away. Dog, dog, dog." How should the nurse respond? Tell the client that he or she can see the arm, and no dogs are around. Ask the client if the client is trying to say that something is wrong with the client's arm. Ignore the comments and redirect the client's attention. Ask the client if the client is having visual hallucinations.
Ask the client if the client is trying to say that something is wrong with the client's arm. The client's illogical, symbolic, and disorganized speech often holds a message that he or she cannot express clearly. The nurse listens for themes and reflects back to the client the meaning that the nurse has deciphered. The nurse does not dismiss the client's verbal and nonverbal behaviors as meaningless or nonsense. In effect, the nurse tries to decode the communication that the client offers and validate its meaning.
When assuming the management of the care of a delusional client, which should be the nurse's priority intervention? Encourage the client to talk about the reasoning behind his or her delusion Acknowledge that there may be some truth in the delusion Assure the client that he or she is safe in this milieu Identify what triggers the delusion
Assure the client that he or she is safe in this milieu Assuring the client that he or she is in a safe environment is the first step in the establishment of a therapeutic relationship that is vital to successful psychiatric treatment.
A client with schizoaffective disorder is prescribed long-term medication therapy. The nurse would most likely expect what to be prescribed as the mainstay of treatment? Mood stabilizer Typical antipsychotic Antidepressant Atypical antipsychotic
Atypical antipsychotic Pharmacologic intervention is needed to stabilize the symptoms, and it presents specific challenges. Long-term atypical antipsychotic agents, now the mainstay of pharmacologic treatment, are as effective as the traditional combination of a standard antipsychotic agent and an antidepressant drug. Mood stabilizers, such as lithium or valproic acid, may be used. A combination of antipsychotic and antidepressant agents is often used.
Which would a nurse expect to administer to a client with schizophrenia who is experiencing a dystonic reaction? Risperidone Trihexyphenidyl Benztropine Aripiprazole
Benztropine A client experiencing a dystonic reaction should receive immediate treatment with benztropine. Risperidone and aripiprazole are antipsychotics that may cause dystonic reactions. Trihexyphenidyl is used to treat parkinsonism due to antipsychotic drugs.
Which medication classification has been most effective in treating akathisia? Sedatives Antianxiety Beta-blockers Antimanics
Beta-blockers Beta-blockers, such as propranolol, have been most effective in treating akathisia.
Which group of theories is believed currently to explain the etiology of schizophrenia? Behavioral Biologic Family system Cognitive
Biologic Schizophrenia is thought to have multiple etiologies. The overwhelming body of scientific evidence suggests that schizophrenia is a brain disease. Computed tomography scanning and magnetic resonance imaging have shown frequent enlargement of the lateral cerebral ventricles in people with schizophrenia.
A nurse is preparing to document information obtained from a client diagnosed with a delusional disorder who is experiencing somatic delusions. Which characteristic would the nurse document? Reduced attention span Above average intelligence Body issues Disorientation
Body issues Clients usually live with delusions for years, rarely receiving psychiatric treatment unless their delusion relates to their health (somatic delusion). Clients with delusional disorder show few, if any, psychological deficits. These clients characteristically have average or marginally low intelligence. Mental status generally is not affected. Thinking, orientation, affect, attention, memory, perception, and personality are generally intact.
A client with schizoaffective disorder is engaging in an extremely long conversation about a current affairs in the world. The client goes on to provide the nurse with minute details. The nurse interprets this as suggesting what? Clang association Verbigeration Neologism Circumstantiality
Circumstantiality The client is demonstrating circumstantiality, which refers to extremely detailed and lengthy discourse about a topic.This can be commonly found in a client with euphoric or elevated mood due to the affective component of schizoaffective disorder. 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 nurse is interviewing a client diagnosed with schizophrenia when the client begins to say, "Kite, night, right, height, fright." What term would the nurse use to document this action? Verbigeration. Neologisms. Clang association. Stilted language.
Clang association. The client is manifesting clang association, which is the repetition of words or phrases that are similar in sound but are in no other way connected. Stilted language is the use of overly and inappropriate artificial formal language. Verbigeration is the purposeless repetition of words or phrases. Neologisms are words that are made up that have no common meaning and are not recognized.
The severity of a client's positive and negative symptoms of schizophrenia has not significantly improved since treatment began, despite the use of three different neuroleptic medications. The nurse should anticipate that this client may benefit from treatment with which medication? Olanzapine Haloperidol Risperidone Clozapine
Clozapine Clozapine may be used if the client has not responded favorably to the use of two different neuroleptics. It is not normally a drug of first resort, however, due to significant adverse effects.
A nurse is preparing a presentation about schizophrenia and outcomes focusing on recovery for families of clients with schizophrenia. Which main goal would the nurse include? Shorter inpatient stays Continuity of care Social engagement Immediate crisis stabilization
Continuity of care Outcome research has shown that schizophrenia can be successfully treated and managed. Continuity of care has been identified as a major goal of recovery for clients with schizophrenia because they are at risk for becoming lost to services if left alone after discharge. Although inpatient hospitalizations that are brief and focus on client stabilization, and crisis management is key to emergency care, and decreased social isolation through social engagement are all important, they are not considered major goals for recovery.
The relationships and associations among the words used to express thoughts are markedly disturbed in clients with schizophrenia. What is this disturbance characterized by? Disorganized speech Auditory hallucinations Paucity of speech Flight of ideas
Disorganized speech The lack of a logical relationship between thoughts and ideas may be manifested by speech that is vague, diffuse, unfocused (loose associations), or incoherent (using words that are totally unrelated, called "word salad") or by a client's inability to get to the point (tangentiality).
The nurse is developing a care plan for a client with somatic delusions. Which would be an appropriate nursing diagnosis for this client? Chronic low self-esteem Risk for self-directed violence Disturbed sleep pattern Disturbed thought process
Disturbed thought process The most appropriate nursing diagnosis for this client is disturbed thought process related to misperception of environmental stimuli. Disturbed sleep pattern, risk for self-directed violence, and chronic low self-esteem would not be the most appropriate nursing diagnosis for this client.
The nurse is performing the initial assessment of a client diagnosed with schizophrenia. What should be the nurse's approach while assessing this client? Select all that apply. Expect the client will have cognitive deficits Establish a therapeutic relationship Engage in a one-to-one interaction with the client Provide effective physical care Perform diagnostic testing
Establish a therapeutic relationship Engage in a one-to-one interaction with the client Caring for a client with mental illness requires appropriate communication skills and establishing a therapeutic relationship with the client. Physical-care skills and diagnostic tests are helpful for managing physically challenged clients. The nurse must not make assumptions about the client's abilities or limitations solely based on the medical diagnosis of schizophrenia. Expecting that the client will have cognitive deficits prior to assessing for this feature is an ineffective means to assess the client. The nurse should instead use active listening to identify themes or recurrent statements made by the client.
How often must clients receiving clozapine get white blood cell counts drawn? Every 3 months Every week for the first 6 months Every year Every 6 months
Every week for the first 6 months Clients taking clozapine must have weekly white blood cell counts for the first 6 months of clozapine therapy and every 2 weeks thereafter.
A married couple arrives at the outpatient clinic. Upon assessment, the nurse finds that the couple believes that the police have been following them and tapping their phones for 2 months. This couple most likely suffers from which disorder? Conjugal delusion Psychotic disorder, not otherwise specified Folie à deux Delusional disorder, paranoid type
Folie à deux Shared psychotic disorder, or folie à deux, involves two individuals who have a close relationship and share the same delusion. This occurrence is attributed to the strong influence of the more dominant person. It is seen more frequently in women who are isolated by language, culture, or geography. Such persons are often related by blood or marriage and have lived together for an extended period of time. Contributing factors include old age, low intelligence, sensory impairment, cerebrovascular disease, and alcohol abuse. This disorder has been diagnosed in twins and individuals, both of whom had a chronic psychotic disorder. This disorder also has occurred in a group of individuals or in families in which the parent is the primary case (inducer).
A client with delusions presents with strong defensiveness, even when watching the news or listening to the radio. The nurse would document this finding in the health history as what? Flight of ideas Echolalia Ambivalence Ideas of reference
Ideas of reference Ideas of reference occur when a client has self-centered thoughts and falsely believes ideas are centered on something the client is doing, thinking, or feeling. Looseness of association is the inability to think logically. Ambivalence refers to contradictory or opposing emotions, attitudes, ideas, or desires for the same person or things or toward the environment. Echolalia is a pathological parrot-like response of a word or phrase.
Catatonia as seen in clients with schizophrenia is unique in the existence of which feature? Preoccupation with a delusion Disorganized speech patterns Immobility like being in a trance Presence of negative symptoms
Immobility like being in a trance.. Catatonia, as seen in clients with schizophrenia, is a psychologically induced immobility occasionally marked by periods of agitation or excitement; the client seems motionless as if in a trance.
Positive symptoms seen in schizophrenia are believed to be a result of which type of neurological dysfunction? Cerebral atrophy An inadequate amount of dopamine Increased amount of dopamine Organic functional changes in the brain
Increased amount of dopamine 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 who is newly admitted to an inpatient unit is exhibiting acute delusional thoughts. The most therapeutic intervention for this client would include what? Insight-oriented therapy Problem-oriented therapy Group therapy Individual therapy
Individual therapy Individual psychotherapy is the treatment of choice because clients with delusional thoughts do not respond well to insight-oriented, problem-oriented, or group therapy in which delusions are confronted by peers or therapists. Establishing the therapeutic relationship with the client is the critical first step. Individual therapy would be the most therapeutic intervention for the client's current circumstance.
Which is the central focus of persecutory delusions? Involving bodily functions or sensations A great, unrecognized talent Unfaithfulness Injustice that must be remedied by legal action
Injustice that must be remedied by legal action 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 is providing teaching to a client diagnosed with schizoaffective disorder. The nurse should explain to the client that which is true about this disorder? It is a mix of psychotic and mood symptoms. It is most common with somatoform disorders. It is usually diagnosed in late adulthood. It is more common than schizophrenia.
It is a mix of psychotic and mood symptoms. Schizoaffective disorder is a mix of psychotic and mood symptoms and is typically diagnosed in early adulthood. It is not more common than schizophrenia and is not commonly adjunct to somatoform disorder although people diagnosed with schizoaffective disorder can present with somatic delusions.
The nurse is assigned to a client with catatonic schizophrenia. Which intervention should the nurse include in the client's care plan? Providing a quiet environment where the client can be alone Administering lithium carbonate as prescribed Meeting all of the client's physical needs Giving the client an opportunity to express concerns
Meeting all of the client's physical needs Meeting all of the client's physiologic needs is most important because clients with catatonic schizophrenia cannot meet their own needs by themselves. Clients with catatonic schizophrenia are unable to express their concerns. Lithium is used for the manic phase of bipolar disorder. The nurse needs to give support to the client and be present for him or her as reassurance.
A client with schizophrenia is receiving antipsychotic therapy. The nurse understands that which is a medical emergency should it develop in the client? Tardive dyskinesia Neuroleptic malignant syndrome Akathisia Parkinsonism
Neuroleptic malignant syndrome Although tardive dyskinesia, parkinsonism, and akathisia can occur with antipsychotic therapy, neuroleptic malignant syndrome is a life-threatening condition and medical emergency that requires immediate treatment.
Which should the nurse anticipate when providing therapy and evaluating outcomes for a client with delusional disorder? Maintained for a short period only Achieved when delusions completely disappear within 6 months' time Often not met completely Easily attained
Often not met completely In evaluating progress, the nurse must remember that outcomes are often not met completely.
A client has been prescribed quetiapine for delusional disorder. In teaching the client about this medication, the nurse must be certain to include which information? One of the common side effects is dry mouth. If dizziness is experienced, the client must call the doctor immediately. Quetiapine can cause one to crave sugar. Quetiapine can cause breast milk production.
One of the common side effects is dry mouth. Dry mouth is a common, sometimes bothersome, side effect. Quetiapine does not cause breast milk production. Dizziness may occur due to orthostatic hypotension but will decrease as the body becomes accustomed to the medication. It is not an emergency. Quetiapine can cause changes in blood sugar but will not induce sugar cravings.
Which are key diagnostic criteria of schizophrenia? Select all that apply. One or more major areas of social or occupational functioning markedly below previously achieved levels Major depression occurring concurrently with active symptoms A direct physiologic effect of a substance or medical condition Continuous signs for at least 6 months Delusions present for a significant portion of time during a 1-month period
One or more major areas of social or occupational functioning markedly below previously achieved levels Continuous signs for at least 6 months Delusions present for a significant portion of time during a 1-month period Key diagnostic criteria include continuous signs for at least 6 months, one or more major areas of social or occupational functioning markedly below previously achieved levels, and delusions present for a significant portion of time during a 1-month period. Other criteria include the absence, or insignificant duration, of major depressive, manic, or mixed episodes occurring concurrently with active symptoms and that the disease is not a direct physiologic effect of a substance or medical condition.
A client with a diagnosis of schizophrenia believes that the client is an undercover operative for the Central Intelligence Agency and that voices of various representatives of the organization give the client regular updates on the client's missions. The client is unwilling to participate in many interventions because the client is "too busy with things that are more important than you could possibly understand." The primary theme of the client's delusions is consistent with what? Catatonia Paranoia Undifferentiation Disorganization
Paranoia Clients with a diagnosis of schizophrenia who exhibit paranoid delusions tend to experience persecutory or grandiose delusions and auditory hallucinations.
After teaching a class of nursing students about the different types of delusions, the instructor determines that the education was successful when the class identifies which type as most common? Erotomanic Somatic Persecutory Grandiose
Persecutory Of the different types of delusions, persecutory delusions are the most common.
Which extrapyramidal side effect is noted by a client who has bradykinesia and a shuffling gait? Acute dystonia Pseudoparkinsonism Akathisia Tardive dyskinesia
Pseudoparkinsonism 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 has been prescribed clozapine for schizoaffective disorder (SCA) with depression. The nurse should explain to the client that one advantage of clozapine is that it can provide what? Combination with lithium for greater effect Cost savings Weight loss Reduction of hospitalizations and risk for suicide
Reduction of hospitalizations and risk for suicide Clozapine, reported effective for SCA by several authorities, can reduce hospitalizations and risk for suicide. A significant portion of clients whose symptoms have resisted other neuroleptic agents improve on clozapine.
The nurse documents that the client is exhibiting negative symptoms of schizophrenia when observing the client doing what? Select all that apply. Repeatedly turning down invitations to join in unit activities Inability to maintain to complete a goal-directed activity Walking in circles around the unit until exhausted Talking very quietly Threatening to "slap anyone that bothers my stuff."
Repeatedly turning down invitations to join in unit activities Inability to maintain to complete a goal-directed activity Negative symptoms reflect a lessening or 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 client who has a major depressive episode tells a nurse that, for the past 2 weeks, the client has been hearing voices and at times thinks that they are being followed. History reveals that the client had these alternating symptoms before. The client also has experienced time with neither of these symptoms and has been able to function adequately. The nurse interprets these findings as suggesting which condition? Schizoaffective disorder Undifferentiated schizophrenia Brief psychotic disorder Paranoid schizophrenia
Schizoaffective disorder Schizoaffective disorder is characterized by intervals of intense symptoms between quiescent periods. At times, there are symptoms of schizophrenia, and at other times, there seems to be a mood disorder. Because the symptoms alternate with quiet periods, schizophrenia, either paranoid or undifferentiated, would not apply. A brief psychotic episode involves symptoms of at least 1 day but less than 1 month, and the onset is sudden. The client generally experiences emotional turmoil or overwhelming confusion and rapid intense shifts of affect.
Some research has suggested that schizophreniform disorder may be an early manifestation of which other mental health condition? Bipolar affective disorder Schizoaffective disorder Schizophrenia Delusional disorder
Schizophrenia Some research has suggested that schizophreniform may be an early manifestation of schizophrenia. A client exhibiting an acute reactive psychosis for less than the 6 months necessary to meet the diagnostic criteria for schizophrenia is given the diagnosis of schizophreniform disorder. Symptoms lasting beyond the 6 months warrant a diagnosis of schizophrenia.
A client with schizophrenia is exhibiting positive and negative symptoms. The nurse anticipates that the client would be prescribed what? First generation antipsychotic Stimulant Antidepressant Second generation antipsychotic
Second generation antipsychotic The second-generation antipsychotics are effective in treating negative and positive symptoms. These newer drugs also affect several other neurotransmitter systems, including serotonin. This is believed to contribute to their antipsychotic effectiveness. None of the other agents would be appropriate.
The nurse should consider which during a psychiatric assessment of a newly immigrated client who is being evaluated for possible religious delusions? Most cultures contain well-accepted religious beliefs The nurse's cultural religious beliefs may differ from those of the client's Some cultures hold religious beliefs that might be confused with delusional thought Delusions are often focused on the client's cultural religious beliefs
Some cultures hold religious beliefs that might be confused with delusional thought Some cultures have widely held and culturally sanctioned beliefs that might be considered delusional in other cultures.
A client with command auditory hallucinations and a history of aggressive outbursts is observed pacing and grimacing while in the day room. Which should be the nurse's priority? Request that the other clients leave the dayroom Ask the client why the client appears to be agitated Turn off the dayroom's television Support the client in returning to the client's room
Support the client in returning to the client's room Removing the client from the milieu is the initial intervention that best addresses the safety of all the clients including the agitated client. The other provided options are not necessarily inappropriate, but none represents the best course of action.
A client has been taking neuroleptic medications for many years as a treatment for schizophrenia. The client is exhibiting tongue protrusion, facial grimacing, and excessive blinking. These manifestations are characteristic of which side effect? Tardive dyskinesia Akathisia Neuroleptic malignant syndrome Dystonia
Tardive dyskinesia Unusual movements of the tongue, neck, and arms suggest tardive dyskinesia, an adverse reaction to neuroleptic medication. Dystonia is characterized by cramps and rigidity of the tongue, face, neck, and back muscles. Neuroleptic malignant syndrome causes rigidity, fever, hypertension, and diaphoresis. Akathisia causes restlessness, anxiety, and jitteriness.
Which is an appropriate intervention for a client having auditory hallucinations? Discourage the client from discussing the content of the hallucinations with anyone else. Encourage the client to spend quiet time alone until hallucinations cease. Mildly admonish the client for the hallucinations. Tell the client to talk back to the voices and tell them to go away.
Tell the client to talk back to the voices and tell them to go away. Interventions for managing hallucinations include dismissal intervention (i.e., telling the voices to go away), various coping strategies (e.g., jogging, telephoning, playing games, seeking out others, employing relaxation techniques), or competing stimuli (e.g., listening to music or the voice of oneself or another to overcome auditory hallucinations and using visual stimuli to overcome visual hallucinations). Some clients desire to discuss their hallucinations with health care staff to gain understanding. In any event, the nurse may elicit a description of the hallucination to seek understanding of how to calm or reassure the client, protecting the client and others. While the nurse should never endorse a hallucination as real, the nurse should also not scold the client for having hallucinations. Isolation is not helpful for the client with hallucinations; the nurse should help maintain reality through frequent contact with client, and the client should be engaged in reality-based activities and reintegrated into the treatment milieu as soon as possible.
The nurse is evaluating the plan of care for a client with schizophrenia. Which observation best suggests that the plan has been effective? The client no longer believes that the client has special powers. The client reports that the client no longer has hallucinations. The client has been engaging in more conversation with the staff. The client has resumed employment and attends social functions.
The client has resumed employment and attends social functions. Major goals for the care of a client with schizophrenia are to experience improved thought processes and fewer psychotic symptoms, to not engage in violent behavior, to acquire improved social skills and engage in satisfying social interaction, and to gain knowledge about the disease process and treatment. Increased conversations with the staff is unrelated to the overall plan of care for the client with schizophrenia.
A client with schizophrenia is prescribed an antipsychotic medication. Which immediate side effects would the nurse include in the education plan for this medication? Risk for hypoprolactinemia The potential for sedation The potential for weight loss Risk for hypertension
The potential for sedation
Which data support a nursing diagnosis of impaired verbal communication? Ambivalence, delusional thinking, and avolition The presence of neologism, delusions, and anergia Rapid pacing and running The presence of neologism, echolalia, and clanging
The presence of neologism, echolalia, and clanging Although the client may be indecisive, have false beliefs, and lack motivation, these do not support a diagnosis of impaired verbal communication. Invented words, repetition of words heard, and rhyming do get in the way of the ability to use or understand language in the human interaction. Fixed false beliefs and an absence of energy do not support a diagnosis of impaired verbal communication, nor do pacing and running.
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. They are implausible within the person's ethnic background. They are variable in nature. They are easily changed with conflicting evidence.
They may include elements of a situation that could occur in real life. 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.
Which statements characterizes the major difference between the typical and atypical antipsychotic medications? Typical antipsychotics cause blood dyscrasias, whereas atypical ones do not. Atypical antipsychotics relieve only negative symptoms. Typical antipsychotics most often relieve positive symptoms but do not have a significant impact on negative symptoms. Atypical antipsychotics tend to cause many more extrapyramidal side effects than do the typical antipsychotics.
Typical antipsychotics most often relieve positive symptoms but do not have a significant impact on negative symptoms. Traditional antipsychotics treat the positive symptoms of schizophrenia (i.e., hallucinations and delusions). Atypical antipsychotics relieve both the positive and negative symptoms (e.g., apathy, avolition, social withdrawal) of schizophrenia and are less likely to cause distressing extrapyramidal side effects typically seen with traditional antipsychotics.
A client diagnosed with schizophrenia states, "I want to go home, go home, go home." This is an example of which speech pattern? Neologisms Verbigeration Word salad Clang association
Verbigeration A verbigeration is the stereotyped repetition of words or phrases that may or may not have meaning to the listener. Clang associations are ideas that are related to one another based on sound or rhyming rather than meaning. Neologisms are words invented by the client. A word salad is a combination of jumbled words and phrases that are disconnected or incoherent and make no sense to the listener.
A client is admitted to the psychiatric hospital with a diagnosis of schizophrenia. During the physical examination, the client's arm remains outstretched after the nurse obtains the pulse and blood pressure, and the nurse must reposition the arm. The nurse interprets this as what? Waxy flexibility Retardation Echopraxia Hypervigilance
Waxy flexibility Waxy flexibility, the ability to assume and maintain awkward or uncomfortable positions for long periods, is characteristic of catatonic schizophrenia. Clients commonly remain in these awkward positions until someone repositions them. Exchopraxia refers to the involuntary imitation of another person's movements and gestures. Hypervigilance refers to the sustained attention to external stimuli, as if expecting something important or frightening to occur. Retardation refers to slowed movements.
Assessment of genetic predisposition supports asking a client who is exhibiting symptoms of a delusional disorder what? If the client has complied with the treatment plan If any family member shows symptoms of depression When the delusion first began Whether any family members have been diagnosed with schizophrenia
Whether any family members have been diagnosed with schizophrenia Some studies have found that delusional disorders are more common among relatives of individuals with schizophrenia than would be expected by chance; thus, asking whether any family members have been diagnosed with schizophrenia could be helpful.
A client with schizophrenia is prescribed clozapine. The nurse would monitor the client closely for specific signs of: hypotension. weight loss. infection. nausea.
infection Agranulocytosis can develop with the use of all antipsychotic drugs, but it is most likely to develop with clozapine use. Therefore, the nurse needs to be alert for signs of infection, particularly bacterial infection. Hypotension may occur with any antipsychotic drug. Nausea is a common side effect of many drugs. Weight gain, not loss, can occur with olanzapine and clozapine.
