Chap. 16 Schizophrenia

The experienced psychiatric nurse shares with the novice nurse that effective nursing care for the delusional client depends on (Select all that apply.)

• Being relaxed during frequent client-nurse interactions • Expecting the client to adhere to all unit rules • Managing the milieu so as to minimize situations that will frustrate or anger the client

A nurse is assessing a client diagnosed with schizophrenia. When documenting the findings, which of the following would the nurse identify as a positive symptom? Select all that apply.

• Delusions • Hallucinations

A client is considered to have an ultrahigh risk for the development of schizophrenia when the assessment process identifies ...

A sibling who experiences visual hallucinations

The nurse is preparing to document information obtained from a client diagnosed with a delusional disorder who is experiencing somatic delusions. Which of the following would the nurse most likely document?

Body complaints

A client in an inpatient setting has a delusion that there are a multitude of noxious gases in circulation that have the potential to poison him and that these are undetectable. Which of the nurse's following responses is most therapeutic?

"I can assure you that you are actually very safe here."

A client diagnosed with schizophrenia tells the nurse, "I hear the voice of Elvis." Which of the following is the most therapeutic response by the nurse?

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

After teaching a client with schizoaffective disorder about the condition and treatment, the nurse determines that the education was successful when the client states which of the following?

"I need to eat properly so that I can control my weight."

In working with the individual and family, the most accurate statement that the nurse can teach the client and family about schizophrenia is what?

"Individuals with schizophrenia do have differences in brain structure and function that cause a variety of symptoms such as amotivation and hearing voices."

The nurse is teaching a client with schizoaffective disorders about his prescribed medication therapy. The nurse determines that additional education is needed when the client states which of the following?

"One day, I won't have to worry about taking any medication."

The nurse working with a client who is newly diagnosed with schizophrenia would include which of the following in the client's education?

"Schizophrenia is an illness that involves neurotransmitters, most particularly the dopamine system."

A client with schizophrenia is prescribed clozapine because other prescribed medications have been ineffective. After educating the client and family about the drug, the nurse determines that the education was successful when they state which of the following?

"We'll need to make sure that he has his blood count checked at least weekly."

A client is diagnosed with schizophreniform disorder. The nurse is reviewing the client's medical record and finds that his symptoms have been present for at least ...

1 month

When teaching a class of nursing students about brief psychotic disorder, the instructor explains that the episode lasts for at least one day but less than which time frame?

1 month

During an admission assessment with Ron, a psychiatric-mental health client, he states that he hears the voice of God in his head and the voice is telling him that he is worthless. What would the nurse document this symptom as?

A hallucination

Data from more than 45 family and twin studies spanning seven decades of research point to the following fact about the inheritability of schizophrenia:

A person whose twin has schizophrenia has a 40% chance of having the disease.

What is the difference between assertive community treatment (ACT) and intensive case management (ICM)?

ACT programs are more comprehensive than ICM programs and provide an individualized program of care delivered within the client's community by a team of professionals to clients who are identified as "high need."

A client diagnosed with schizophrenia has been prescribed clozapine (Clozaril). Which of the following is a potentially fatal side effect of this medication?

Agranulocytosis

Holding seemingly contradictory beliefs or feelings about the same person, event, or situation

Ambivalence

The nurse is caring for an older adult client who has been taking an antipsychotic medication for one week. The nurse notifies the physician when he observes that the client has muscle rigidity that resembles Parkinson's disease. Which agent would the nurse expect the physician to prescribe?

Anticholinergic

Which of the following data support a nursing diagnosis of impaired verbal communication?

As evidenced by the presence of neologism, echolalia, and clanging

When assuming the management of the care of a delusional client, the nurse's priority intervention is to

Assure the client that he or she is safe in this milieu

Absence of will, ambition,or drive to take action or accomplish

Avolition (Negative or soft symptoms)

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

Bathing Self-Care Deficit related to symptoms of schizophrenia

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

Benzotropine (Cogentin)

Which of the following groups of theories is believed currently to explain the etiology of schizophrenia?

Biologic

Client may be restless and unable to sit still, exhibit agitation and pacing or appear unmoving.

Catatonia

Which of the following speech patterns is exhibited by the client stating, "I will take a pill if I go up the hill but not if my name is Jill, I don't want to kill?"

Clang association

A nurse is developing a plan of care for a client diagnosed with delusional disorder. Which of the following would the nurse need to keep in mind?

Clients with delusional disorder typically have problems with medication compliance.

A client has been on Haldol for 5 years when she is admitted to the inpatient unit for a recent exacerbation of her schizophrenic symptoms. Upon assessment, she has akathisia, dystonia, a stiff gait, and rigid posture. When considering interventions for the client's symptoms, which of the following would be most appropriate?

Consult with the psychiatrist and suggest that she be placed on an anticholinergic drug.

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

Decreased dopamine

Fixed, false beliefs with no basis in reality. Schizophrenia usually experience this in psychotic phase of illness. Characteristic is direct, immediate, and total certainty.

Delusions

A hospitalized client with schizophrenia is receiving antipsychotic medications. While assessing the client, the nurse identifies signs and symptoms of a dystonic reaction. Which agent would the nurse expect to administer?

Diphenhydramine (Benadryl)

The nurse is developing a care plan for a client with delusional disorder, somatic type. Which of the following would be an appropriate nursing diagnosis for this client?

Disturbed thought process

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

Dopamine

Repetition or imitation of what someone else says. Speech may be slowed or accelerated in rate and volume.

Echolalia

The nurse is caring for a client in an inpatient mental health setting. The nurse notices that when the client is conversing with other clients, he repeats what they are saying word for word. The nurse interprets this finding and documents it as which of the following?

Echolalia

The client may imitate the movements and gestures of someone whom he/she is observing.

Echopraxia

Serious neurologic side effects. Acute dystonic reactions, akathisia, and parkinsonism.

Extrapyramidal symptoms (EPS)

A patient diagnosed with schizophrenia is telling everyone that he is the president of the United States. This patient is exhibiting which type of delusion?

Grandiose

During a client interview, a client states that "God has sent me a special message. I'm the only one who can carry out his plan." The nurse interprets this statement as suggesting which type of delusion?

Grandiose

A client with schizophrenia is hearing voices that tell him to kill himself. The nurse understands that this client is experiencing a ...

Hallucination

False sensory perceptions or perceptual experiences that do not exist in reality. Can affect all 5 senses.

Hallucinations

A client is telling the nurse that an actress is sending secret love notes to him. The nurse would be correct in suspecting that the client is experiencing a(n) ...

Ideas of reference

Misperceptions of actual environmental stimuli. For example, while walking through the woods, a person believes he sees a snake at the side of the path. On closer examination, however, he discovers it is only a curved stick. Reality or factual information corrected this.

Illusion

A client diagnosed with delusional disorder is experiencing persecutory delusions involving the belief that someone is putting poison in his food. When developing the client's plan of care, which nursing diagnosis would be most likely?

Imbalanced Nutrition, Less than Body Requirements

During a client interview, a client diagnosed with delusional disorder states, "I know my wife is being unfaithful to me with her colleague from work. I've found hotel room receipts. I've even followed her and her colleague." The nurse interprets the client's statements as suggesting which type of delusion?

Jealous

The nurse is caring for a client diagnosed with a delusional disorder. While assessing this client, which of the following would the nurse expect to find?

Living with one or more delusions for a period of time

Alogia; Anhedonia; Apathy; Asociality; Blunted affect; Catatonia; Flat affect; Avolition or lack of volition; Inattention

Negative symptoms

A client with schizophrenia is receiving antipsychotic therapy. The nurse understands that which of the following is a medical emergency should it develop in the client?

Neuroleptic malignant syndrome

Which of the following assessment findings in a client who is suspected of having a delusional disorder would be suggestive of a diagnosis of schizophrenia?

The client experiences frequent and sustained hallucinations.

The major difference between delusional disorder and schizophrenia is that clients with delusional disorder exhibit which of the following characteristics?

No sustained hallucinations

A client has been prescribed quetiapine (Seroquel) for delusional disorder. In teaching the client about this medication, the nurse must be certain to include which of the following information?

One of the common side effects is dry mouth.

A 44-year-old man with a successful corporate career has been going through a time of intense job stress. In recent weeks, he has confided in his wife that he believes his firm's financial oversight committee exists solely to monitor every aspect of his personal performance and that the committee's financial mandate is simply a deception and cover-up of its true purpose. A nurse would recognize that this man may be experiencing which subtype of delusional disorder?

Persecutory

A client with delusional disorder believes that the cook at the psychiatric hospital is trying to poison her. The nurse would record this type of delusion as which of the following?

Persecutory

A mental health client insists that her husband is trying to poison her. In this instance, the client is exhibiting which type of delusion?

Persecutory

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?

Persecutory

While assessing a client with schizophrenia, the client states, "Everywhere I turn, the government is watching me because I know too much. They are afraid that I might go public with the information about all those conspiracies." The nurse interprets this statement as indicating which type of delusion?

Persecutory

An appetite for substances largely non-nutritive, such as paper, clay, metal, chalk, soil, glass, or sand.

Pica

Ambivalence; Associative looseness; Delusions; Echopraxia; Flight of ideas; hallucinations; Ideas of reference; Preservation; Bizarre behavior.

Positive symptoms

One of the primary goals in caring for the client with schizophrenia is to establish clear, consistent, open communication. Which of the following nursing interventions would be most effective in accomplishing this goal?

Present reality in clear simple language, and demonstrate patience.

Condition is caused by mental disorders. Associated with a patient's increasing fluid intake due to the sensation of having a dry mouth.

Psychogenic polydipsia

Due to general medical condition or substance abuse/withdrawal. The diagnosis of schizophrenia usually is made when the person begins to display more actively positive symptoms of delusions, hallucinations, and disordered thinking.

Psychosis

After teaching a class on antipsychotic agents, the instructor determines that the education was successful when the class identifies which of the following as an example of a second-generation antipsychotic agent?

Quetiapine (Seroquel)

When the client is severely ill and has a mixture of psychotic and mood symptoms. The signs and symptoms include those of both schizophrenia and a mood disorder such as depression or bipolar disorder. The symptoms may occur simultaneously or may alternate between psychotic and mood disorder symptoms.

Schizo-affective disorder

A nurse is caring for a client diagnosed with schizophreniform disorder. The nurse demonstrates understanding of this disorder, identifying that the client is at risk for developing which of the following?

Schizophrenia

Causes distorted and bizarre thoughts, perceptions, emotions, movements, and behavior. It cannot be defined as a single illness. A syndrome or as disease process with many different varieties and symptoms, much like the varieties of cancer.

Schizophrenia

Viewed on a gradient of psychopathology from least to most severe

Schizophrenia Spectrum Disorder

The nurse's psychiatric assessment of a newly immigrated client being evaluated for possible religious oriented delusions is driven by the assumption that ...

Some cultures hold religious beliefs that might be confused with delusional thought

What are the signs and symptoms of schizophrenia according to the Diagnostic and Statistical Manual of Mental Disorders?

Schizophrenia lasts at least 6 months and includes at least 1 month of two or more active-phase symptoms.

Personality disorder involves odd, eccentric behaviors, including transient psychotic symptoms. Approximately 20% of persons with this personality disorder will eventually be diagnosed with schizophrenia.

Schizotypal

The nurse understands that certain factors are known to predispose an individual to a delusional disorder. These factors include what?

Severe stress

In order to promote recovery, which of the following would be most important for the nurse to keep in mind when establishing the nurse-client relationship with a client who has schizophrenia?

Short, time-limited interactions are best for the client experiencing psychosis.

A client diagnosed with delusional disorder comes to the clinic for an evaluation. During the interview, the client states that she feels insects crawling all over the skin on her arms and legs. The nurse interprets this as which type of delusion?

Somatic

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

Somatic

While interviewing a client diagnosed with a delusional disorder, the client states, "I have this really strange odor coming out of my mouth. I stop to brush my teeth almost every hour and then rinse with mouthwash every half hour to get rid of this smell. I've seen so many doctors, and they can't tell me what's wrong." The nurse interprets the client's statement as reflecting which type of delusion?

Somatic

A client diagnosed with schizophrenia states to the nurse, "My intestines are being eaten by snakes." This statement represents which type of delusion?

Somatic delusion

A client with schizoaffective disorder is prescribed an atypical antipsychotic agent. The nurse understands that this drug is effective in controlling the psychotic symptoms as well as helping with which of the following?

Stabilizing the client's mood symptoms

When a cognitively impaired client with a history of aggressive outbursts is observed pacing and grimacing while in the day room, the nurse initially ...

Suggests that they go into the client's room

The nurse is caring for a client who was diagnosed with schizoaffective disorder. Based on the nurse's understanding of this disorder, the nurse develops a plan of care to address which issue as the top priority?

Suicide

A 55-year-old man was admitted to the psychiatric unit after an incident in a department store in which he accused a sales clerk of following him around the store and stealing his keys. He was subdued by the police after destroying a window display because voices had told him that it was evil. As the nurse approached the client, he says, "You're all out to get me, and you're one of them. They're Rostoputians and grog babies here." This demonstrates what?

Suspiciousness and neologisms

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 ...

Tardive dyskinesia

The nurse is caring for a client who has been receiving treatment for schizophrenia with chlorpromazine for the past year. It would be essential for the nurse to monitor the client for which of the following?

Tardive dyskinesia

A client with a delusional disorder has been undergoing individual psychotherapy. The therapy would be deemed ultimately successful when the client meets which of the following outcomes?

The client will differentiate between reality and fantasy.

A client diagnosed with schizophrenia states, "I want to go home, go home, go home." This is an example of which of the following speech patterns?

Verbigeration

Clients receiving clozapine (Clozaril) must get white blood cell counts drawn every ...

Week for the first 6 months

Which of the following is a nonneurologic side effect of antipsychotic medications?

Weight gain

Jumbled words and phrases that are disconnected or incoherent and make no sense to the listener.

Word Salad

A client has been on Haldol for 5 years when she is admitted to the inpatient unit for a recent exacerbation of her schizophrenic symptoms. Upon assessment, she has akathisia, dystonia, a stiff gait, and rigid posture. The nurse realizes that these are symptoms of ...

extrapyramidal side effects of Haldol.

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

he client reports "hearing voices" for the last three months

Sarah states, "My boss keeps putting thoughts into my head. Yesterday she made me copy 25 reports and then told me I had wasted company time and money!" Sarah is experiencing

thought insertion.

The major difference between the typical and atypical antipsychotics is that

typical antipsychotics most often relieve positive symptoms but do not have a significant impact on negative symptoms.