Chapter 12 Schizophrenia and Schizophrenia Spectrum Disorders, Mental Health - Chapter 12 - Schizophrenia Spectrum Disorders, Psych Exam 2 - Ch. 12 (Schizophrenia Spectrum Disorders), Chapter 12: Schizophrenia Spectrum Disorders, Exam 2: Chapter 12,...

A patient's care plan includes monitoring for auditory hallucinations. Which assessment findings suggest the patient may be hallucinating? a. Detachment and overconfidence b. Darting eyes, tilted head, mumbling to self c. Euphoric mood, hyperactivity, distractibility d. Foot tapping and repeatedly writing the same phrase

ANS: B

Which hallucination necessitates the nurse to implement safety measures? The patient says, a. "I hear angels playing harps." b. "The voices say everyone is trying to kill me." c. "My dead father tells me I am a good person." d. "The voices talk only at night when I'm trying to sleep."

ANS: B

A young adult is hospitalized with schizophrenia. The parents are distraught and filled with guilt. What would be an appropriate nursing response?

"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 achievement of long-term treatment goals for a patient diagnosed with schizophrenia is reliant upon which factor? (SATA)

-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

What intervention is focused on supporting the overall goal of the acute phase of illness for a psychotic patient? (SATA)

-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

Which diagnostic finding associated with structural brain anomalies has been observed in patients diagnosed with schizophrenia? (SATA)

-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 with schizophrenia is prescribed clozapine. Which physiological conditions of the patient should the nurse monitor? (SATA)

-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

Which assessment finding supports the presence of extrapyramidal side effects (EPSs)? (SATA)

-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 nurse is caring for five patients on a unit who have schizophrenia. Which patients are presenting with alterations in perception? (SATA)

-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

What statement is true regarding schizophrenia? (SATA)

-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

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? (SATA)

-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 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? (SATA)

-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

The nurse is caring for a patient with schizophrenia who was given an injectable dose of dopamine (D2) antagonists for the limbic center. Which side effects does the nurse anticipate? Select all that apply. 1 Tremors 2 Difficulty walking 3 Increased energy 4 Loosening of reflexes 5 Pacing back and forth 6 Muscular contraction in the neck

1 Tremors 2 Difficulty walking 5 Pacing back and forth 6 Muscular contraction in the neck Dopamine antagonists are first-generation antipsychotics that are used less frequently because of their side effects. The medications block D2 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 diagnosed with schizophrenia is very disturbed and violent. After several doses of haloperidol, the patient is calm. Two hours later the nurse sees the patient's head rotated to one side in a stiff position, the lower jaw thrust forward, and drooling. Which problem is most likely? a. An acute dystonic reaction b. Tardive dyskinesia c. Waxy flexibility d. Akathisia

ANS: A

The parent of a child diagnosed with Tourette syndrome says to the nurse, "I think my child is faking the tics because they occur in different places at different times." Select the correct response by the nurse. 1 "Children diagnosed with Tourette syndrome often try to manipulate their caregivers by faking tics." 2 "The movements are real. Tics can occur anywhere in the body and can change in frequency and severity." 3 "Distract your child by planning activities with other children. That will help the tics stop permanently." 4 "This finding indicates a worsening of your child's disorder. Let's discuss this change with the health care provider."

2 "The movements are real. Tics can occur anywhere in the body and can change in frequency and severity." Motor tics usually involve the head but can involve the torso or limbs. They change in location, frequency, and severity over time. The nurse should provide accurate information to the parent. The child may be embarrassed if tics occur in the community.

During an assessment, the nurse finds that a patient says "wabbit" for "rabbit" and omits most of the sounds. Which neurodevelopmental disorder is the patient likely to have? 1 Learning disorder 2 Communication disorder 3 Intellectual development disorder 4 Attention-deficit/hyperactivity disorder

2 Communication disorder Patients having communication disorder often have problems with making sounds. They tend to distort, add, or omit some sounds. They often lack fluency while speaking and may repeat the words because of stammering. In intellectual development disorder, patients have problems in intellectual functioning and are unable to reason and judge in age-appropriate activities. In learning disorder, patients have reduced reading and writing skills. They have difficulty in doing mathematics and expressing their emotions. Patients suffering from attention-deficit/hyperactivity disorder have reduced attention and are often impulsive and hyperactive.

A patient diagnosed with schizophrenia says, "Cheese dog run fast." How should the nurse document this comment? 1 Neologism 2 Word salad 3 Circumstantiality 4 Magical thinking

2 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.

An acutely violent patient diagnosed with schizophrenia received several doses of haloperidol. Two hours later the nurse notices the patient's head rotated to one side in a stiffly fixed position, the lower jaw thrust forward, and drooling. Which intervention by the nurse is indicated? a. Administer diphenhydramine 50 mg IM from the prn medication administration record. b. Reassure the patient that the symptoms will subside. Practice relaxation exercises with the patient. c. Give trihexyphenidyl 5 mg orally at the next regularly scheduled medication administration time. d. Administer atropine sulfate 2 mg subcut from the prn medication administration record.

ANS: A

A patient diagnosed with schizophrenia is most likely to experience which type of hallucination? 1 Visual 2 Tactile 3 Auditory 4 Olfactory

3 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.

What electrolyte imbalance can be seen in patients who have schizophrenia who are experiencing polydipsia? 1 Hypokalemia 2 Hypocalcemia 3 Hyponatremia 4 Hypercalcemia

3 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.

The nurse believes a patient may have schizophrenia based on which signs and symptoms? Select all that apply. 1 Headaches 2 Depression 3 Incoherence 4 Hearing voices 5 Withdrawn behavior

3 Incoherence 4 Hearing voices 5 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.

Which of the following would indicate paranoia in a patient with schizophrenia? 1 Feelings of superiority to others 2 False perception of environment 3 Irrational fear of harm from others 4 Impaired ability to think abstractly

3 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.

Which factor can help explain why one child in a family might develop a mental disorder while another does not? 1 Culture 2 Genetics 3 Resilience 4 Environment

3 Resilience Resilience is considered to be an inborn trait that is shaped by both internal and external factors. Genetics would be an explanation of similarities in mental health history, not differences. Environment and culture would also affect both siblings in equal measure.

The family of a patient diagnosed with schizophrenia is unfamiliar with the illness and family's role in recovery. Which type of therapy should the nurse recommend? a. Psychoeducational b. Psychoanalytic c. Transactional d. Family

ANS: A

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? 1 "I will get you an as-needed medication for agitation." 2 "You are confused. I will take you to your room to rest awhile." 3 "You are having problems with your speech. You need to try harder to be clear." 4 "I'm sorry, I didn't understand that. Do you want to talk more about your mother as we did yesterday?"

4 "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.

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? 1 "Most people who take first-generation antipsychotics report fewer side effects." 2 "Second-generation antipsychotics are mostly used for treating negative symptoms of schizophrenia." 3 "First-generation antipsychotics are used more frequently than second-generation antipsychotics." 4 "Second-generation antipsychotics are usually better than first-generation antipsychotics because they have fewer side effects."

4 "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.

Which statement by a family member of a person diagnosed with schizophrenia demonstrates effective learning about the disease? 1 "The disease probably resulted from the mother's smoking during pregnancy. Nicotine is actually a neurotransmitter." 2 "If our family had more money, we could afford the promising psychoneuroimmunologic treatments available in other countries." 3 "The disease could be cured if our politicians and laws allowed for more stem cell research. Adult stem cells hold so much promise." 4 "The disease probably was caused by problems with several genes. These genes cause changes in how certain brain chemicals work."

4 "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.

The type of altered perception most commonly experienced by patients with schizophrenia is 1 Delusions 2 Illusions 3 Tactile hallucinations 4 Auditory hallucinations

4 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.

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? 1 Urinalysis 2 Liver panel 3 Serum lithium level 4 Complete blood cell count

4 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.

A nurse has to prepare a treatment plan for a patient with reduced nonverbal communication and reduced social relatedness. Which appropriate strategy should the nurse include in the treatment plan? 1 Change the patient's schedule frequently. 2 Avoid structured activities with the patient. 3 Avoid nonverbal communication with the patient. 4 Give a star to the patient when he or she learns a new skill.

4 Give a star to the patient when he or she learns a new skill. Autism spectrum disorder is characterized by reduced nonverbal communication and social relatedness. The treatment plan should aim for behavior management. The patient should be rewarded. A nurse can give a star or sticker to encourage when the patient learns a new activity. Consistency should be maintained in the daily routines of the patient. The patient's schedule should not be changed frequently as it can confuse the patient. The patient should be encouraged to improve nonverbal communication skills by providing speech therapy. The patient should also be involved in structured activities with the help of parents. These activities should have a definite process and not require frequent changes.

A child diagnosed with an autism spectrum disorder (ASD) will demonstrate impaired development in 1 Adhering to routines 2 Eye-hand coordination 3 Swallowing and chewing 4 Playing with other children

4 Playing with other children Autism affects the normal development of the brain in social interaction and communication skills. Symptoms associated with autism spectrum disorders include significant deficits in social relatedness, including communication, nonverbal behavior, and age-appropriate interaction.

Which assessment finding supports the belief that the patient is demonstrating a positive symptom of schizophrenia? 1 The patient states, "Nothing is fun anymore." 2 The patient unable to decide on what foods to select for dinner. 3 The patient finds it difficult to sit quietly, stating, "I have to fidget." 4 The patient refuses to sleep because "I'll be abducted by the aliens." 5 The patient is unable to remember his or her personal telephone number.

4 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.

A patient diagnosed with schizophrenia begins to talks about "macnabs" hiding in the warehouse at work. The term "macnabs" should be documented as a. a neologism. b. concrete thinking. c. thought insertion. d. an idea of reference.

A A neologism is a newly coined word having special meaning to the patient. "Macnabs" is not a known common word. Concrete thinking refers to the inability to think abstractly. Thought insertion refers to thoughts of others are implanted in one's mind. Ideas of reference are a type of delusion in which trivial events are given personal significance.

The family of a patient diagnosed with schizophrenia is unfamiliar with the illness and family's role in recovery. Which type of therapy should the nurse recommend? a. Psychoeducational b. Psychoanalytic c. Transactional d. Family

A A psychoeducational group explores the causes of schizophrenia, the role of medication, the importance of medication compliance, support for the ill member, and hints for living with a person with schizophrenia. Such a group can be of immeasurable practical assistance to the family. The other types of therapy do not focus on psychoeducation.

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

A 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.

The causation of schizophrenia currently is understood to be A. A combination of inherited and non-genetic factors B. Deficient amounts of the neurotransmitter dopamine C. Excessive amounts of the neurotransmitter serotonin D. Stress related and ineffective stress management skills

A Causation is a complicated matter. Schizophrenia most likely occurs as a result of a combination of inherited genetic factors and extreme non-genetic factors (e.g., viral infection, birth injuries, nutritional factors) that can affect the genes governing the brain or directly injure the brain.

A nurse asks a patient diagnosed with schizophrenia, "What is meant by the old saying 'You can't judge a book by looking at the cover.'?" Which response by the patient indicates concrete thinking? a. "The table of contents tells what a book is about." b. "You can't judge a book by looking at the cover." c. "Things are not always as they first appear." d. "Why are you asking me about books?"

A Concrete thinking refers to an impaired ability to think abstractly. Concreteness is often assessed through the patient's interpretation of proverbs. Concreteness reduces one's ability to understand and address abstract concepts such as love or the passage of time. The incorrect options illustrate echolalia, an unrelated question, and abstract thinking.

What assessment findings mark the prodromal stage of schizophrenia? a. Withdrawal, misinterpreting, poor concentration, and preoccupation with religion b. Auditory hallucinations, ideas of reference, thought insertion, and broadcasting c. Stereotyped behavior, echopraxia, echolalia, and waxy flexibility d. Loose associations, concrete thinking, and echolalia neologisms

ANS: A

The nurse is caring for four patients with schizophrenia. Which patient is exhibiting grandiose delusions?

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

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? Select all that apply. A. The nurse should advise them to keep in touch with support groups. B. The nurse should avoid mentioning the side effects of the drugs prescribed. C. The nurse should advise them to keep the patient in an isolated room. D. The nurse should advise them to adhere to the treatment plan. E. The nurse should advise them to immediately stop the medication if the patient's symptoms are relieved.

A, D 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 as it could cause relapse of the schizophrenic symptoms. Gradually decreasing the dosage of the drug would be useful to prevent a relapse.

A nurse works with a patient in the acute phase of schizophrenia. Which assessment findings increase the risk of aggression and violence? Select all that apply. A. Paranoia B. Flat affect C. Poor hygiene D. Delusional thinking E. Command hallucinations

A, D, E 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.

When a patient diagnosed with schizophrenia was discharged 6 months ago, haloperidol was prescribed. The patient now says, "I stopped taking those pills. They made me feel like a robot." What are common side effects the nurse should validate with the patient? a. Sedation and muscle stiffness b. Sweating, nausea, and diarrhea c. Mild fever, sore throat, and skin rash d. Headache, watery eyes, and runny nose

ANS: A

A newly hospitalized patient experiencing psychosis says, "Red chair out town board." Which term should the nurse use to document this finding? a. Word salad b. Neologism c. Anhedonia d. Echolalia

ANS: A

A nurse asks a patient diagnosed with schizophrenia, "What is meant by the old saying 'You can't judge a book by looking at the cover.'?" Which response by the patient indicates concrete thinking? a. "The table of contents tells what a book is about." b. "You can't judge a book by looking at the cover." c. "Things are not always as they first appear." d. "Why are you asking me about books?"

ANS: A

A patient diagnosed with schizophrenia begins to talks about "macnabs" hiding in the warehouse at work. The term "macnabs" should be documented as a. a neologism. b. concrete thinking. c. thought insertion. d. an idea of reference.

ANS: A

A patient has had difficulty keeping a job because of arguing with co-workers and accusing them of conspiracy. Today this patient shouts, "They're all plotting to destroy me. Isn't that true?" Select the nurse's most therapeutic response. a. "Everyone here is trying to help you. No one wants to harm you." b. "Feeling that people want to destroy you must be very frightening." c. "That is not true. People here are trying to help you if you will let them." d. "Staff members are health care professionals who are qualified to help you."

ANS: B

A client says, "Facebook has a new tracking capacity. If I use the Internet, Homeland Security will detain me as a terrorist." Select the nurse's best initial action. a. Tell the client, "Facebook is a safe website. You don't need to worry about Homeland Security." b. Tell the client, "You are in a safe place where you will be helped." c. Administer a prn dose of an antipsychotic medication. d. Tell the client, "You don't need to worry about that."

ANS: B

A newly admitted patient diagnosed with schizophrenia is hypervigilant and constantly scans the environment. The patient states, "I saw two doctors talking in the hall. They were plotting to kill me." The nurse may correctly assess this behavior as a. echolalia. b. an idea of reference. c. a delusion of infidelity. d. an auditory hallucination.

ANS: B

A nurse leads a psychoeducational group about first-generation antipsychotic medications with six adult men diagnosed with schizophrenia. The nurse will monitor for concerns regarding body image with respect to which potential side effect of these medications? a. Constipation b. Gynecomastia c. Visual changes d. Photosensitivity

ANS: B

A nurse observes a catatonic patient standing immobile, facing the wall with one arm extended in a salute. The patient remains immobile in this position for 15 minutes, moving only when the nurse gently lowers the arm. What is the name of this phenomenon? a. Echolalia b. Waxy flexibility c. Depersonalization d. Thought withdrawal

ANS: B

A patient diagnosed with schizophrenia demonstrates little spontaneous movement and has waxy flexibility. The patient's activities of daily living are severely compromised. An appropriate outcome would be that the patient will a. demonstrate increased interest in the environment by the end of week 1. b. perform self-care activities with coaching by the end of day 3. c. gradually take the initiative for self-care by the end of week 2. d. accept tube feeding without objection by day 2.

ANS: B

A patient diagnosed with schizophrenia has received fluphenazine decanoate twice a month for 3 years. The clinic nurse notes that the patient grimaces and constantly smacks both lips. The patient's neck and shoulders twist in a slow, snakelike motion. Which problem would the nurse suspect? a. Agranulocytosis b. Tardive dyskinesia c. Tourette's syndrome d. Anticholinergic effects

ANS: B

A patient diagnosed with schizophrenia has taken a conventional antipsychotic medication for a year. Hallucinations are less intrusive, but the patient continues to have apathy, poverty of thought, and social isolation. The nurse would expect a change to which medication? a. Haloperidol b. Olanzapine c. Chlorpromazine d. Diphenhydramine

ANS: B

A patient diagnosed with schizophrenia says, "My co-workers are out to get me. I also saw two doctors plotting to kill me." How does this patient perceive the environment? a. Disorganized b. Dangerous c. Supportive d. Bizarre

ANS: B

A patient insistently states, "I can decipher codes of DNA just by looking at someone." Which problem is evident? a. Visual hallucinations b. Magical thinking c. Idea of reference d. Thought insertion

ANS: B

A newly admitted patient diagnosed with schizophrenia says, "The voices are bothering me. They yell and tell me I am bad. I have got to get away from them." Select the nurse's most helpful reply. a. "Do you hear the voices often?" b. "Do you have a plan for getting away from the voices?" c. "I'll stay with you. Focus on what we are talking about, not the voices. " d. "Forget the voices and ask some other patients to play cards with you."

ANS: C

A nurse educates a patient about the antipsychotic medication regime. Afterward, which comment by the patient indicates the teaching was effective? a. "I will need higher and higher doses of my medication as time goes on." b. "I need to store my medication in a cool dark place, such as the refrigerator." c. "Taking this medication regularly will reduce the severity of my symptoms." d. "If I run out or stop taking my medication, I will experience withdrawal symptoms."

ANS: C

A patient diagnosed with schizophrenia begins a new prescription for ziprasidone. The patient is 5'6'' and currently weighs 204 lbs. The patient has dry flaky skin, headaches about twice a month, and a family history of colon cancer. Which intervention has the highest priority for the nurse to include in the patient's plan of care? a. Skin care techniques b. Scheduling a colonoscopy c. Weight management strategies d. Teaching to limit caffeine intake

ANS: C

A patient diagnosed with schizophrenia exhibits little spontaneous movement and demonstrates waxy flexibility. Which patient needs are of priority importance? a. Self-esteem b. Psychosocial c. Physiological d. Self-actualization

ANS: C

A patient diagnosed with schizophrenia has taken fluphenazine 5 mg po bid for 3 weeks. The nurse now observes a shuffling propulsive gait, a mask-like face, and drooling. Which term applies to these symptoms? a. Neuroleptic malignant syndrome b. Hepatocellular effects c. Pseudoparkinsonism d. Akathisia

ANS: C

The nurse assesses a patient diagnosed with schizophrenia. Which assessment finding would the nurse regard as a negative symptom of schizophrenia? a. Auditory hallucinations b. Delusions of grandeur c. Poor personal hygiene d. Psychomotor agitation

ANS: C

Which finding constitutes a negative symptom associated with schizophrenia? a. Hostility b. Bizarre behavior c. Poverty of thought d. Auditory hallucinations

ANS: C

A patient diagnosed with schizophrenia tells the nurse, "I eat skiller. Tend to end. Easter. It blows away. Get it?" Select the nurse's most therapeutic response. a. "Nothing you are saying is clear." b. "Your thoughts are very disconnected." c. "Try to organize your thoughts and then tell me again." d. "I am having difficulty understanding what you are saying."

ANS: D

A health care provider considers which antipsychotic medication to prescribe for a patient diagnosed with schizophrenia who has auditory hallucinations and poor social function. The patient is also overweight and hypertensive. Which drug should the nurse advocate? a. Clozapine b. Ziprasidone c. Olanzapine d. Aripiprazole

ANS: D

A nurse leads a psychoeducational group about problem solving with six adults diagnosed with schizophrenia. Which teaching strategy is likely to be most effective? a. Suggest analogies that might apply to a common daily problem. b. Assign each participant a problem to solve independently and present to the group. c. Ask each patient to read aloud a short segment from a book about problem solving. d. Invite participants to come up with solution to getting incorrect change for a purchase.

ANS: D

A nurse sits with a patient diagnosed with schizophrenia. The patient starts to laugh uncontrollably, although the nurse has not said anything funny. Select the nurse's most therapeutic response. a. "Why are you laughing?" b. "Please share the joke with me." c. "I don't think I said anything funny." d. "You're laughing. Tell me what's happening."

ANS: D

A patient diagnosed with schizophrenia anxiously says, "I can see the left side of my body merging with the wall, then my face appears and disappears in the mirror." While listening, the nurse should a. sit close to the patient. b. place an arm protectively around the patient's shoulders. c. place a hand on the patient's arm and exert light pressure. d. maintain a normal social interaction distance from the patient.

ANS: D

A patient diagnosed with schizophrenia anxiously tells the nurse, "The voice is telling me to do things." Select the nurse's priority assessment question. a. "How long has the voice been directing your behavior?" b. "Does what the voice tell you to do frighten you?" c. "Do you recognize the voice speaking to you?' d. "What is the voice telling you to do?"

ANS: D

A patient diagnosed with schizophrenia has been stable for a year, however, the family now reports the patient is tense, sleeps 3 to 4 hours per night, and has difficulty concentrating. The patient says, "My computer is sending out infected radiation beams." The nurse can correctly assess this information as an indication of a. the need for psychoeducation. b. medication nonadherence. c. chronic deterioration. d. relapse.

ANS: D

A patient diagnosed with schizophrenia says, "It's beat. Time to eat. No room for the cat." What type of verbalization is evident? a. Neologism b. Idea of reference c. Thought broadcasting d. Associative looseness

ANS: D

A patient receiving risperidone (Risperdal) reports severe muscle stiffness at 1030. By 1200, the patient has difficulty swallowing and is drooling. By 1600, vital signs are 102.8° F: pulse 110: respirations 26: 150/90. The patient is diaphoretic. Select the nurse's best analysis and action. a. Agranulocytosis: institute reverse isolation. b. Tardive dyskinesia: withhold the next dose of medication. c. Cholestatic jaundice: begin a high-protein, high-cholesterol diet. d. Neuroleptic malignant syndrome: notify health care provider stat.

ANS: D

The nurse is developing a plan for psychoeducational sessions for a small group of adults diagnosed with schizophrenia. Which goal is best for this group? Members will a. gain insight into unconscious factors that contribute to their illness. b. explore situations that trigger hostility and anger. c. learn to manage delusional thinking. d. demonstrate improved social skills.

ANS: D

Which symptom would NOT be assessed as a positive symptom of schizophrenia?

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

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

B 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.

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

B 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.

A patient diagnosed with schizophrenia has taken a conventional antipsychotic medication for a year. Hallucinations are less intrusive, but the patient continues to have apathy, poverty of thought, and social isolation. The nurse would expect a change to which medication? a. Haloperidol b. Olanzapine c. Chlorpromazine d. Diphenhydramine

B Olanzapine is a second-generation atypical antipsychotic that targets both positive and negative symptoms of schizophrenia. Haloperidol and chlorpromazine are conventional antipsychotics that target only positive symptoms. Diphenhydramine is an antihistamine. See relationship to audience response question.

A client says, "Facebook has a new tracking capacity. If I use the Internet, Homeland Security will detain me as a terrorist." Select the nurse's best initial action. a. Tell the client, "Facebook is a safe website. You don't need to worry about Homeland Security." b. Tell the client, "You are in a safe place where you will be helped." c. Administer a prn dose of an antipsychotic medication. d. Tell the client, "You don't need to worry about that."

B The patient is experiencing paranoia and delusional thinking, which leads to fear. Explaining that the patient is in a safe place will help relieve the fear. It is not therapeutic to disagree or give advice. Medication will not relieve the immediate concern.

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

B The patient with schizophrenia show 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.

Which finding constitutes a negative symptom associated with schizophrenia? a. Hostility b. Bizarre behavior c. Poverty of thought d. Auditory hallucinations

C Negative symptoms include apathy, anhedonia, poor social functioning, and poverty of thought. Poor personal hygiene is an example of poor social functioning. The distracters are positive symptoms of schizophrenia. See relationship to audience response question.

Which of the following symptoms would alert a health care provider to a possible diagnosis of schizophrenia in a young adult male? A. Excessive sleeping with disturbing dreams B. Hearing voices telling him to hurt his roommate C. Withdrawal from college because of failing grades D. Chaotic and dysfunctional relationships with his family and peers

C 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.

Which symptom seen in a schizophrenic patient can be categorized as a positive symptom? A. Loss of motivation B. Impaired judgment C. Delusions D. Dysphoria

C 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 to 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.

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? A. Anosognosia B. Affective blunting C. Positive symptoms D. Negative symptoms

C 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.

A patient diagnosed with disorganized schizophrenia would have greatest difficulty when the nurse A. Interacts with a neutral attitude B. Uses concrete language C. Gives multistep directions D. Provides nutritional supplements

C 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.

A patient diagnosed with schizophrenia begins a new prescription for ziprasidone. The patient is 5'6'' and currently weighs 204 lbs. The patient has dry flaky skin, headaches about twice a month, and a family history of colon cancer. Which intervention has the highest priority for the nurse to include in the patient's plan of care? a. Skin care techniques b. Scheduling a colonoscopy c. Weight management strategies d. Teaching to limit caffeine intake

C Ziprasidone is a second-generation antipsychotic medication. The incidence of weight gain, diabetes, and high cholesterol is high with second-generation antipsychotic medications. The patient is overweight now, so weight management will be especially important. The other interventions may occur in time, but do not have the priority of weight management.

The nurse is developing a plan for psychoeducational sessions for a small group of adults diagnosed with schizophrenia. Which goal is best for this group? Members will a. gain insight into unconscious factors that contribute to their illness. b. explore situations that trigger hostility and anger. c. learn to manage delusional thinking. d. demonstrate improved social skills.

D Improved social skills help patients maintain relationships with others. These relationships are important to management of the disorder. Most patients with schizophrenia think concretely, so insight development is unlikely. Not all patients with schizophrenia experience delusions.

A patient diagnosed with schizophrenia anxiously tells the nurse, "The voice is telling me to do things." Select the nurse's priority assessment question. a. "How long has the voice been directing your behavior?" b. "Does what the voice tell you to do frighten you?" c. "Do you recognize the voice speaking to you?' d. "What is the voice telling you to do?"

D Learning what a command hallucination is telling the patient to do is important because the command often places the patient or others at risk for harm. Command hallucinations can be terrifying and may pose a psychiatric emergency. The incorrect questions are of lesser importance than identifying the command.

A patient diagnosed with schizophrenia says, "It's beat. Time to eat. No room for the cat." What type of verbalization is evident? a. Neologism b. Idea of reference c. Thought broadcasting d. Associative looseness

D Looseness of association refers to jumbled thoughts incoherently expressed to the listener. Neologisms are newly coined words. Ideas of reference are a type of delusion. Thought broadcasting is the belief that others can hear one's thoughts.

A patient diagnosed with schizophrenia has been stable for a year; however, the family now reports the patient is tense, sleeps 3 to 4 hours per night, and has difficulty concentrating. The patient says, "My computer is sending out infected radiation beams." The nurse can correctly assess this information as an indication of a. the need for psychoeducation. b. medication nonadherence. c. chronic deterioration. d. relapse.

D Signs of potential relapse include feeling tense, difficulty concentrating, trouble sleeping, increased withdrawal, and increased bizarre or magical thinking. Medication nonadherence may not be implicated. Relapse can occur even when the patient is taking medication regularly. Psychoeducation is more effective when the patient's symptoms are stable. Chronic deterioration is not the best explanation.

Which side effect of antipsychotic medication is generally nonreversible? A. Anticholinergic effects B. Pseudoparkinsonism C. Dystonic reaction D. Tardive dyskinesia

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

A patient diagnosed with schizophrenia anxiously says, "I can see the left side of my body merging with the wall, then my face appears and disappears in the mirror." While listening, the nurse should a. sit close to the patient. b. place an arm protectively around the patient's shoulders. c. place a hand on the patient's arm and exert light pressure. d. maintain a normal social interaction distance from the patient.

D The patient is describing phenomena that indicate personal boundary difficulties and depersonalization. The nurse should maintain appropriate social distance and not touch the patient because the patient is anxious about the inability to maintain ego boundaries and merging or being swallowed by the environment. Physical closeness or touch could precipitate panic.

The nurse is confident that an individual prescribed antipsychotic medication has been experiencing medication efficacy and showing insight when the patient

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

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

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

The nurse is addressing a primary symptom of schizophrenia when

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

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

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?

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 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. 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 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 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 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 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

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