Mental health chapter 16
Which statement made by a client would indicate that the client has delusions of grandeur? "I can't eat this food. It's poisoned." "I hear messages from aliens that tell me to steal cars." "I let my baby die. I don't deserve to live." "I am a magician, and my magic powers are good when the moon is full."
"I am a magician, and my magic powers are good when the moon is full."
A client in an inpatient setting has a delusion that there are a multitude of undetectable noxious gases in circulation that have the potential to poison the client and others. Which of the nurse's responses is most therapeutic?
"I can assure you that you are actually very safe here."
A client tells the nurse, "I can see someone sticking out from underneath my bed, and he's telling me that he is going to kill me." Which is the most therapeutic response the nurse can provide? "Just tell the man to go away." "You are safe here, so don't worry about that." "I don't see or hear anything, but it sounds as though you are very frightened." "There is no man under your bed. Let's go to the dining room now."
"I don't see or hear anything, but it sounds as though you are very frightened."
The nurse is teaching a client with schizoaffective disorders (SAD) about the client's prescribed medication therapy. The nurse determines that additional education is needed when the client states what? "One day, I won't have to worry about taking any medication." "If I notice any strange muscle movements, I should call my provider." "I need to make sure that I drink enough fluids throughout the day." "I need to change my position slowly when getting up from lying down."
"One day, I won't have to worry about taking any medication."
A client in the psychiatric unit of the hospital has a diagnosis of schizophrenia. The client has approached the nurse in the hallway of the hospital and is elaborating in great detail about the client's delusions of persecution involving secret societies, the Vatican, and the mafia. How should the nurse respond to the client's expression of these delusions?
"That sounds very stressful for you. Would you like to join me and the others in the lounge?"
The parent of a client who has a delusional disorder spends a great deal of time and energy trying to convince the client that the client is not actually the focus of a nationwide, secret plot to track the client's activities. Which of the client's responses is most typical of an individual with a delusional disorder? "You're so naïve. You just don't understand what's really happening out there." "I'll consider what you think, but this is something I really, really need." "I know I've got delusions, but you would too if you had to live my life." "I've told you before that I can't just snap my fingers and change the way I think."
"You're so naïve. You just don't understand what's really happening out there."
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
Persecution
: feels singled out for harm by others such as being hunted down by the FBI
Which client exhibits the characteristics that are typical of the prodromal phase of schizophrenia? A 20-year-old is experiencing a gradual decrease in the ability to concentrate, be productive, and sleep restfully. A 30-year-old has experienced a relapse after deciding that the client's atypical antipsychotic is unnecessary. A 28-year-old has been displaying the behaviors characteristic of schizophrenia for many months and has just been diagnosed with the disease. A 25-year-old does not express any of the symptoms of schizophrenia
A 20-year-old is experiencing a gradual decrease in the ability to concentrate, be productive, and sleep restfully.
A nurse teaching a client about prescribed antipsychotic medication informs the client to contact a health care provider immediately if the client notices: A feeling of dizziness when the client stands up. A dramatic change in temperature. An increase in thirst. An increase in weight of 2 lbs in 1 month.
A dramatic change in temperature.
During an admission assessment with a psychiatric-mental health nurse, a client states that the client hears the voice of God in the client's head and the voice is telling the client that the client is worthless. How should the nurse document this symptom?
A hallucination
Negative symptoms
Absence of things normally present Affect: blunted or flat Alogia: poverty of thought or soeech(client may sit with visitor but only mumble) Anergia: lack of energy ANHE Sonia: lack of pleasure or joy Avolition: lack of motivation in activities and hygiene
A nurse monitoring client medication needs to recognize side effects quickly and intervene promptly for which reason? Provide support to the client and encourage adherence as past side effects rarely reoccur Determine adequate dosage is maintained to control symptoms Provide support to the client and let the client know this is normal Alleviate the side effects and help client maintain adherence
Alleviate the side effects and help client 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 Feeling of being watched, such as by the government Belief that communications intended for a broad audience have special meaning for the client
An impending calamity, such as death
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? a.Feeling of being watched, such as by the government b.Belief that communications intended for a broad audience have special meaning for the client c.Possession of exceptional powers, such as the ability to communicate with a powerful person d.An impending calamity, such as death
An impending calamity, such as death
third gen antipsychotics
Aripiprazole
Thought insertion
Believes others thoughts are being inserted into their mind
Being controlled
Believes that a force outside their body is controlling them
Magical thinking
Believes their actions or thought are able to control a situation or affect others, such as wearing a car than hat makes them invisible to others
Somatic delusions
Believes their body is changing in an unusual way such as growing a third arm
Jealousy
Believes their partner is sexually actively with another person with no factual basis
Thought with drawl
Believes their thoughts have been removed by an outside agency
Grandeur
Believes they are all powerful and important like GOD
Which would a nurse expect to administer to a client with schizophrenia who is experiencing a dystonic reaction? Trihexyphenidyl Aripiprazole Risperidone Benztropine
Benztropine
A nurse is preparing to document information obtained from a client diagnosed with a delusional disorder who is experiencing somatic delusions. Which would the nurse most likely document? Above average intelligence Body complaints Disorientation Reduced attention span
Body complaints
schizoaffective disorder
Both schizophrenia and depressive or bipolar disorder
Cognitive findings
Disordered thinking Inability to make decisions Poor problem solving Difficulty concentrating Short term memory deficits Impaired abstract thinking
Assessment of a client with schizophrenia reveals that the client is hearing voices that tell the client that people are staring at the client and that the client is seeing illusions. When developing the plan of care for this client, which nursing diagnosis would be most appropriate?
Disturbed sensory perception
The nurse is developing a care plan for a client with somatic delusions. Which would be an appropriate nursing diagnosis for this client? Risk for self-directed violence Chronic low self-esteem Disturbed thought process Disturbed sleep pattern
Disturbed thought process
What term is used to describe the speech pattern being used when the client imitates or repeats what the nurse is saying? Neologisms Clang associations Echolalia Word salad
Echolalia
How often must clients receiving clozapine get white blood cell counts drawn?
Every week for the first 6 months
Delusional
Experiences delusional thinking for at least 1 month Self or interpersonal functioning is not markedly impaired
A client has been taking haloperidol for 5 years when the client is admitted to the inpatient unit for relapse of symptoms of schizophrenia. Upon assessment, the client demonstrates akathisia, dystonia, a stiff gait, and rigid posture. The nurse correctly identifies these symptoms are indicative of what? Progressed schizophrenia Tardive dyskinesia Extrapyramidal side effects Psychosis
Extrapyramidal side effects
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 Folie à deux Psychotic disorder, not otherwise specified Delusional disorder, paranoid type
Folie à deux
A client with delusional disorder tells the nurse that the client has discovered how to jump to the moon. The nurse would document this belief as what? Jealous delusion Grandiose delusion Somatic delusion Erotomanic delusion
Grandiose delusion
A client with schizophrenia is hearing voices that tell the client to kill the self. What term is used to identify this type of false sensory perception?
Hallucination
first generation antipsychotics
Haloperidol Lo spine Chlorpromazine Fluphenazine
Affective findings
Hopeless Suicidal Unstable or rapidly changing moods
Clients diagnosed with schizophrenia may experience disordered water balance that may lead to water intoxication. Which may occur as a result of water intoxication? Weight loss Hypernatremia Hyponatremia Oliguria
Hyponatremia
Alterations in thought(delusions)
Ideas of reference: misconstrues trivial events and attaches personal significance
Schizotypal
Impaired personality Not as severe as schizophrenia
****Positive symptoms seen in schizophrenia are believed to be a result of which type of neurological dysfunction?
Increased amount of dopamine
Which is the central focus of persecutory delusions? A great, unrecognized talent Unfaithfulness Involving bodily functions or sensations Injustice that must be remedied by legal action
Injustice that must be remedied by legal action
positive symptoms of schizophrenia
Manifestation of things not normally present Hallucinations Delusions Alterations in speech Bizarre behavior
The nurse is assigned to a client with catatonic schizophrenia. Which intervention should the nurse include in the client's care plan?
Meeting all of the client's physical needs
Illusion
Misperceptions or misinterpreted of a real experience
A client is diagnosed with schizoaffective disorder (SAD). The nurse understands that in addition to psychosis, the client must also exhibit:
Mood disorder
A comprehensive nursing assessment for neuroleptic malignant syndrome (NMS) should include checking for which in a client taking an antipsychotic medication? Headache, muscle aches, and paresthesias Muscular rigidity, tremors, and difficulty swallowing Confusion, giddiness, and hyperalertness Dry mouth, flushing, and urinary retention
Muscular rigidity, tremors, and difficulty swallowing
The nurse must be aware that individuals from diverse ethnic groups might describe troubling experiences in terms of physical problems or specific culture-bound syndromes. The syndrome of ghost sickness is exhibited by which culture?
Native American
A client had been withdrawn in the client's room for 3 days, not eating or sleeping, prior to his admission to the inpatient unit. Upon interview, the client demonstrates difficulty answering questions, appears to have no facial expressions, and cannot follow simple instructions. This cluster of symptoms can be described as what? Delusions Thought disorder Negative symptoms Positive symptoms
Negative symptoms
Which has not been proposed as a potential mechanism for the etiology of thought disorders? Genetic predispositions Dysregulation of neurotransmitter systems Hemispheric brain dysfunction Neglect in childhood
Neglect in childhood
A client with schizophrenia is receiving antipsychotic therapy. The nurse understands that which is a medical emergency should it develop in the client? Neuroleptic malignant syndrome Parkinsonism Tardive dyskinesia Akathisia
Neuroleptic malignant syndrome
Chapter 16 schizophrenia PREP-U
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Depersonalization
Nonspecific feeling that the client lost their identify
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. Quetiapine can cause one to crave sugar. If dizziness is experienced, the client must call the doctor immediately. Quetiapine can cause breast milk production.
One of the common side effects is dry mouth.
Throat broadcasting
Openly expressing their need to have *something* in their throat
Antidepressants
Paroxetine
Derealization
Perception that the environment has changed
A 44-year-old client has been experiencing intense job stress. In recent weeks, the client has confided in the client's spouse that the client believes the client's firm monitors every aspect of the client's personal performance and that the firm is engaged in deception and cover-up of its "true purpose." A nurse would recognize that the primary theme of the client's delusional disorder is what? Persecutory Somatic Grandiose Conjugal
Persecutory
A client with schizophrenia believes that the cook at the psychiatric hospital is trying to poison the client. The nurse would record this type of delusion as what? a.Grandiose b.Conjugal c.Persecutory d. Erotomanic
Persecutory
Which type of delusion refers to a situation whereby a person or someone close to person is being malevolently treated in some way? Persecutory type Somatic type Unspecified type Grandiose type
Persecutory type
During a client interview, a client diagnosed with delusional disorder states, "I know my spouse is being unfaithful to me with a colleague from work."The nurse interprets the client's statements as suggesting which type of delusion? Sexual Referential Grandiose Persucatory/paranoid
Persucatory/paranoid
Schizophrenia
Psychotic behavior or thinking for at least 6 months Self care, school or work, interpersonal relationships impaired
Psychotic or catatonic disorder
Psychotic features(impaired relating testing) Bizarre behavior(psychotic) Significant change i motor activity behavior(catatonic)
After teaching a class on antipsychotic agents, the instructor determines that the education was successful when the class identifies which as an example of a second-generation antipsychotic agent?
Quetiapine
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?
Reduction of hospitalizations and risk for suicide
second generation antipsychotics
Risperidone Olanzapine Olanzapine Quetiapine Zip raid one Clozapine
A nurse is caring for a client diagnosed with schizophreniform disorder. The nurse demonstrates understanding of this disorder when identifying that the client is at risk for developing what?
Schizophrenia
When reviewing the diagnostic criteria for schizophrenia based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V), which would be most accurate? Schizophrenia lasts at least 1 month and must include the symptom of hallucinations. Schizophrenia can be diagnosed as soon as an individual states he or she is hallucinating and delusional. Schizophrenia lasts at least 6 months and includes at least 1 month of two or more characteristic symptoms. Schizophrenia can be diagnosed as soon as an individual states he or she is hearing voices.
Schizophrenia lasts at least 6 months and includes at least 1 month of two or more characteristic symptoms.
A client with schizophrenia is exhibiting positive and negative symptoms. The nurse anticipates that the client would be prescribed what?
Second generation antipsychotic
A client diagnosed with delusional disorder who uses excessive health care resources most likely has which type of delusions? Jealous Grandiose Somatic Nihilistic
Somatic
Which treatment would be inappropriate for a client with delusional disorder?
Somatic therapy
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 Delusions are often focused on the client's cultural religious beliefs Some cultures hold religious beliefs that might be confused with delusional thought 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
When developing the plan of care for a client with schizophrenia who is in the acute phase of illness, the nurse understands that the client is at high risk for what? Mania Water intoxication Suicide Depression
Suicide
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?
Support the client in returning to the client's room
A 55-year-old client was admitted to the psychiatric unit after an incident in a department store in which the client accused a sales clerk of following the client around the store and stealing the client's keys. The client was subdued by the police after destroying a window display because voices had told the client that it was evil. As the nurse approached the client, the client says, "You're all out to get me, and you're one of them. They're Rostoputians and grog babies here." This demonstrates what? Echolalia and echopraxia Illusions and loss of ego boundaries Loose associations and flight of ideas Suspiciousness and neologisms
Suspiciousness and neologisms
Which assessment findings in a client who is suspected of having a delusional disorder would be suggestive of a diagnosis of schizophrenia? The client responds to group psychotherapy. The client experiences frequent and sustained hallucinations. The client's beliefs are considered delusional but nonbizarre. The client does not have insight into his or her delusions.
The client experiences frequent and sustained hallucinations.
The client's diagnosis of schizoaffective disorder is supported when the nurse documents what? a.Diagnosis testing confirmed a right parietal brain lesion b.The client reports "hearing voices" for the last 3 months c.The client's spouse reported that the client "repeated everything I said" for 48 hours Td.he client's mother shares that "the client never missed work" even with the disorder
The client reports "hearing voices" for the last 3 months
A client with schizophrenia is prescribed an antipsychotic medication. Which immediate side effects would the nurse include in the education plan for this medication?
The potential for sedation
hich data support a nursing diagnosis of impaired verbal communication? The presence of neologism, echolalia, and clanging Rapid pacing and running Ambivalence, delusional thinking, and avolition The presence of neologism, delusions, and anergi
The presence of neologism, echolalia, and clanging
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.
A client is diagnosed with a delusional disorder. While providing care to the client, the nurse assesses the client's delusions. Which would be least appropriate for the nurse to do?
Try to change the client's delusional belief
A client is diagnosed with a delusional disorder. While providing care to the client, the nurse assesses the client's delusions. Which would be least appropriate for the nurse to do? Avoid dwelling on the delusion Determine the impact of the delusion on the client's safety Evaluate the significance to the client Try to change the client's delusional belief
Try to change the client's delusional belief
Which statements characterizes the major difference between the typical and atypical antipsychotic medications?
Typical antipsychotics most often relieve positive symptoms but do not have a significant impact on negative symptoms.
Mood stabilizers & benzo
Valproate Lamotrigine Lorazepam
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? Retardation Waxy flexibility Echopraxia Hypervigilance
Waxy flexibility
Which would be the benefit of including a client's family members in the long-term treatment of a client with schizophrenia? a. The onset of a possible relapse can be detected early and effective treatment can be initiated b.The client's compliance with treatment can be monitored and supported effectively c.It shows the client that he/she is loved and so it elevates the client's self-esteem d.The family can provide more effective care when it is based on an understanding of the disease
a. The onset of a possible relapse can be detected early and effective treatment can be initiated
A client with schizophrenia is exhibiting emotional withdrawal and poor eye contact and describing hallucinations. The mental health nurse knows that these symptoms are suggestive of which neurotransmitter imbalance? a.Increased serotonin and dopamine b.Decreased serotonin and dopamine c.Increased GABA d.Increased histamine
a.Increased serotonin and dopamine
Which is the central focus of persecutory delusions? a.Injustice that must be remedied by legal action b.Unfaithfulness c.Involving bodily functions or sensations d.A great, unrecognized talent
a.Injustice that must be remedied by legal action
A 24-year-old with schizophrenia and paranoid delusions is admitted to the hospital. The student nurse asks the charge nurse about what approach to take with the client, who has been exhibiting hostility and isolation. Which approach would be the most appropriate direction from the charge nurse? a. Greet the client by gently touching the client's arm and telling the client that the client can trust you. b. Respect the client's need for personal space and avoid physical contact. c.Tell the client that if the client does not comply with the rules, you will inform the doctor. d.Inform the client that the client must receive care and you will assist the client.
b. Respect the client's need for personal space and avoid physical contact.
A client states, "My boss keeps putting thoughts into my head. Yesterday my boss made me copy 25 reports and then told me I had wasted company time and money!" The nurse knows the client is experiencing which perceptual disturbance? a.Thought broadcasting b. Thought blocking c. Thought withdrawal d. Thought insertion
d. Thought insertion
A nurse is caring for a client in an inpatient mental health setting. The nurse notices that when the client is conversing with other clients, the client repeats what they are saying word for word. The nurse interprets this finding and documents it as: echolalia. tangentiality. echopraxia. neologisms.
echolalia.
When describing the difference between schizoaffective disorder (SAD) and schizophrenia, the nurse would address which as associated with SAD? decreased risk for suicide lower level of functioning delusions but no hallucinations increased mood responses
increased mood responses
A client with schizophrenia is exhibiting emotional withdrawal and poor eye contact and describing hallucinations. The mental health nurse knows that these symptoms are suggestive of which neurotransmitter imbalance? Increased GABA Increased histamine Decreased serotonin and dopamine Increased serotonin and dopamine
increased serotonin and dopamine
Religiosity
is obsessed with religious beliefs
A nurse is caring for a hospitalized client who has schizophrenia. The client has been taking antipsychotic medications for 1 week when the nurse observes that the client's eyes are fixed on the ceiling. The nurse interprets this finding as: retrocollis. tardive dyskinesia. akathisia. oculogyric crisis.
oculogyric crisis.
While being interviewed, a client diagnosed with a delusional disorder 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? jealous erotomanic somatic grandiose
somatic
While being interviewed, a client diagnosed with a delusional disorder 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 erotomanic jealous grandiose
somatic
A client has been prescribed clozapine for treatment of schizophrenia. The client must be taught to monitor which blood concentrations weekly while taking this drug? hemoglobin platelets hematocrit white blood cells
white blood cells
