Mental Health -- Schizophrenia/Bipolar

Neologisms

"His mannerologies are poor."

C

A 33-year-old female diagnosed with bipolar I disorder has been functioning well on lithium for 11 months. At her most recent checkup, the nurse states, "You are ready to enter the maintenance therapy stage, so at this time I am going to adjust your dosage by prescribing: a. a higher dosage b. once a week dosing c. a lower dosage d. a different drug

D

A female patient diagnosed with schizophrenia has been prescribed a first-generation antipsychotic medication. What information should the nurse provide to the patient regarding her signs and symptoms? a. Her memory problems will likely decrease b. Depressive episodes should be less severe c. She will probably enjoy social interactions more d. She should experience a reduction in hallucinations

D -- Aripiprazole is a third-generation atypical antipsychotic effective against both positive and negative symptoms of schizophrenia. It causes little or no weight gain and no increase in glucose, high- or low-density lipoprotein cholesterol, or triglycerides, making it a reasonable choice for a patient with obesity or heart disease. Clozapine may produce agranulocytosis, making it a poor choice as a first-line agent. Ziprasidone may prolong the QT interval, making it a poor choice for a patient with cardiac disease. Olanzapine fosters weight gain.

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

A -- Sodium depletion and dehydration increase the chance for development of lithium toxicity. The other options offer inappropriate information.

A health teaching plan for a patient taking lithium should include instructions to: a. maintain normal salt and fluids in the diet b. drink twice the usual daily amount of fluid c. double the lithium dose if diarrhea or vomiting occurs d. avoid eating aged cheese, processed meats, and red wine

B

A male patient calls to tell the nurse that his monthly lithium level is 1.7. Which nursing intervention will the nurse implement initially? a. reinforce that the level is considered therapeutic b. instruct the patient to hold the next dose of medication and contact the prescriber c. have the patient go to the hospital ER immediately d. alert the patient to the possibility of seizures and appropriate precautions

illusion

A man sees a coat on a shadowy coat rack and believes it is a bear.

B -- Ideas of reference are misinterpretations of the verbalizations or actions of others that give special personal meanings to these behaviors; for example, when seeing two people talking, the individual assumes they are talking about him or her. The other terms do not correspond with the scenario.

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

C -- Staying with a distraught patient who is hearing voices serves several purposes: ongoing observation, the opportunity to provide reality orientation, a means of helping dismiss the voices, the opportunity of forestalling an action that would result in self-injury, and general support to reduce anxiety. Asking if the patient hears voices is not particularly relevant at this point. Asking if the patient plans to "get away from the voices" is relevant for assessment purposes but is less helpful than offering to stay with the patient while encouraging a focus on their discussion. Suggesting playing cards with other patients shifts responsibility for intervention from the nurse to the patient and other patients.

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 will 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."

D -- The patient with heart failure will likely need diuretic drugs, which will complicate the maintenance of the fluid balance necessary to avoid lithium toxicity.

A newly diagnosed patient is prescribed lithium. Which information from the patient's history indicates that monitoring of serum concentrations of the drug will be challenging and critical? a. arthritis b. epilepsy c. psoriasis d. heart failure

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

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?"

C -- Diaphoresis, weakness, and nausea are early signs of lithium toxicity. Problems mentioned in the incorrect options are unrelated to lithium therapy.

A nurse assesses a patient who takes lithium. Which findings demonstrate evidence of complications? a. pharyngitis, mydriasis, and dystonia b. alopecia, purpura, and drowsiness c. diaphoresis, weakness, and nausea d. ascites, dyspnea, and edema

A, E Stabilization is maximized by adherence to the antipsychotic medication regimen. Because so many persons with schizophrenia smoke cigarettes, this topic relates directly to the patients' physiological well-being. The other topics are also important but are not priority topics.

A nurse at the mental health clinic plans a series of psychoeducational groups for persons newly diagnosed with schizophrenia. Which two topics take priority? (Select all that apply.) a. The importance of taking your medications correctly. b. How to complete an application for employment. c. How to dress when attending community events. d. How to give and receive compliments e. How to quit smoking

C -- Antipsychotic drugs provide symptom control and allow most patients diagnosed with schizophrenia to live and be treated in the community. Dosing is individually determined. Antipsychotics are not addictive; however, they should be discontinued gradually to minimize a discontinuation syndrome.

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."

B, C, E

A nurse is assessing a client who is currently taking perphenazine. Which of the following findings should the nurse identify as an EPS? Select all that apply. a. decreased LOC b. drooling c. involuntary arm movement d. urinary retention e. continual pacing

D

A nurse is caring for a client who has bipolar disorder. Which of the following is the priority nursing action? a. set consistent limits for expected client behavior b. administer prescribed medications as scheduled c. provide the client with step-by-step instructions during hygiene activities d. monitor the client for escalating behavior

A

A nurse is caring for a client who is experiencing extreme mania due to bipolar disorder. Prior to administration of lithium carbonate, the client's lithium blood level is 1.2. Which of the following actions should the nurse take? a. administer the next dose of lithium carbonate as scheduled b. prepare for administration of aminophylline c. notify the HCP for a possible increase in the dosage of lithium d. request a stat repeat of the client's lithium blood level

B

A nurse is caring for a client who is prescribed lithium therapy. The client tells of the plan to take ibuprofen for osteoarthritis pain relief. Which of the following statements should the nurse make? a. "That is a good choice. Ibuprofen does not interact with lithium." b. "Regular aspirin would be a better choice than ibuprofen." c. "Lithium decreases the effectiveness of ibuprofen." d. "The ibuprofen will make your lithium level fall too low."

B, D

A nurse is discussing early indications of toxicity with a client who has a new prescription for lithium carbonate for bipolar disorder. The nurse should include which of the following manifestations in the teaching? Select all that apply. a. constipation b. polyuria c. rash d. muscle weakness e. tinnitus

B, D, E

A nurse is discussing relapse prevention with a client who has bipolar disorder. Which of the following information should the nurse include in the teaching? Select all that apply. a. use caffeine in moderation to prevent relapse b. difficulty sleeping can indicate a relapse c. begin taking your medications as soon as relapse begins d. participating in psychotherapy can help prevent a relapse e. anhedonia is a clinical manifestation of a depressive relapse

A

A nurse is discussing routine follow-up needs with a client who has a new prescription for valproate. The nurse should inform the client of the need for routine monitoring of which of the following? a. AST/ALT and LDH b. creatinine and BUN c. WBC and granulocyte counts d. blood sodium and potassium

B, C, E

A nurse is planning care for a client who has bipolar disorder and is experiencing a manic episode. Which of the following interventions should the nurse include in the plan of care? Select all that apply. a. provide flexible client behavior expectations b. offer concise explanations c. establish consistent limits d. disregard client concerns e. use a firm approach with communication

C

A nurse is teaching a newly licensed nurse about the use of ECT for the treatment of bipolar disorder. Which of the following statements by the newly licensed nurse indicates understanding? a. "ECT is the recommended initial treatment for bipolar disorder." b. "ECT is contraindicated for clients who have suicidal ideation." c. "ECT is effective for clients who are experiencing severe mania." d. "ECT is prescribed to prevent relapse of bipolar disorder."

B -- FGAs (first-generation antipsychotic) stimulate release of prolactin, which can result in gynecomastia (enlargement of the breasts) as well as other changes in sexual function. Men may experience disturbances in body image as a result of gynecomastia. Other side effects of FGAs may be disturbing to other aspects of the patient's physical health but are not likely to bother body image.

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

D -- Concrete thinking, an impaired ability to think abstractly resulting in interpreting or perceiving things in a literal manner, is evident in many patients diagnosed with schizophrenia. People who think concretely benefit from concrete situations during education. Finding a solution in order to get incorrect change for a purchase is an example of a concrete situation. Analogies require abstract thinking and insight. Independently solving a problem and presenting it to the group may be intimidating. All participants may or may not be literate.

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

B -- Waxy flexibility is the ability to hold distorted postures for extended periods of time, as though the patient were molded in wax. Echolalia is a speech pattern. Depersonalization refers to a feeling state. Thought withdrawal refers to an alteration in thinking.

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

B, C

A nurse prepares the plan of care for a patient experiencing an acute manic episode. Which nursing diagnoses are most likely? (Select all that apply.) a. Imbalanced nutrition: more than body requirements b. impaired mood regulation c. sleep deprivation d. chronic confusion e. social isolation

B -- Manic symptoms are controlled by lithium only after a therapeutic serum level is attained. Because this takes several days to accomplish, a drug with rapid onset is necessary to reduce the hyperactivity initially. Antipsychotic drugs neither enhance lithium's antimanic activity nor minimize the side effects. Lithium will be used for long-term control.

A patient demonstrating characteristics of acute mania relapsed after discontinuing lithium. New orders are written to resume lithium twice daily and begin olanzapine. What is the rationale for the addition of olanzapine to the medication regimen? It will: a. minimize the side effects of lithium b. bring hyperactivity under rapid control c. enhance the antimanic actions of lithium d. be used for long-term control of hyperactivity

A -- The distractibility characteristic of manic episodes can assist the nurse to direct the patient toward more appropriate, constructive activities without entering into power struggles. Humor usually backfires by either encouraging the patient or inciting anger. Limit setting and honest feedback may seem heavy-handed and may incite anger.

A patient diagnosed with bipolar disorder commands other patients, "Get me a book. Take this stuff out of here," and other similar demands. The nurse wants to interrupt this behavior without entering into a power struggle. Which initial approach should the nurse select? a. Distraction: "Let's go to the dining room for a snack." b. Humor: "How much are you paying servants these days?" c. Limit setting: "You must stop ordered other patients around." d. Honest feedback: "Your controlling behavior is annoying others."

D -- Some patients diagnosed with bipolar disorder, especially those who have only short periods between episodes, have a favorable response to the anticonvulsants carbamazepine and valproate. Carbamazepine seems to work better in patients with rapid cycling and in severely paranoid, angry manic patients. Phenytoin is also an anticonvulsant but not used for mood stabilization. Risperidone is not an anticonvulsant.

A patient diagnosed with bipolar disorder has rapidly changing mood cycles. The health care provider prescribes an anticonvulsant medication. To prepare teaching materials, which drug should the nurse anticipate will be prescribed? a. phenytoin b. clonidine c. risperidone d. carbamazepine

A -- During the continuation phase of treatment for bipolar disorder, the physical needs of the patient are not as important an issue as they were during the acute episode. After hospital discharge, treatment focuses on maintaining medication compliance and preventing relapse, both of which are fostered by ongoing psychoeducation.

A patient diagnosed with bipolar disorder will be discharged tomorrow. The patient is taking a mood stabilizing medication. What is the priority nursing intervention for the patient as well as the patient's family during this phase of treatment? a. attending psychoeducation sessions b. decreasing physical activity c. increasing foods and fluids d. meeting self-care needs

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.

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

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.

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

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

B -- Outcomes related to self-care deficit nursing diagnoses should deal with increasing ability to perform self-care tasks independently, such as feeding, bathing, dressing, and toileting. Performing the tasks with coaching by nursing staff denotes improvement over the complete inability to perform the tasks. The incorrect options are not directly related to self-care activities, difficult to measure, and unrelated to maintenance of nutrition.

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

C -- Physiological needs must be met to preserve life. A patient with waxy flexibility must be fed by hand or tube, toileted, given range-of-motion exercises, and so forth to preserve physiological integrity. Waxy flexibility may also precipitate a risk for falls; therefore, safety is a concern. Higher level needs are of lesser concern.

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

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.

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 nonadherance c. chronic deterioration d. relapse

B -- Fluphenazine decanoate is a first-generation antipsychotic medication. Tardive dyskinesia is a condition involving the face, trunk, and limbs that occurs more frequently with first-generation antipsychotics than second or third generation. Involuntary movements, such as tongue thrusting; licking; blowing; irregular movements of the arms, neck, and shoulders; rocking; hip jerks; and pelvic thrusts, are seen. These symptoms are frequently not reversible even when the drug is discontinued. The scenario does not present evidence consistent with the other disorders mentioned. Agranulocytosis is a blood disorder. Tourette's syndrome is a condition in which tics are present. Anticholinergic effects include dry mouth, blurred vision, flushing, constipation, and dry eyes.

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

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.

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 occur with which medication? a. haloperidol b. olanzapine c. chlorpromazine d. diphenhydramine

C -- Pseudoparkinsonism induced by antipsychotic medication mimics the symptoms of Parkinson's disease. It frequently appears within the first month of treatment and is more common with first-generation antipsychotic drugs. Hepatocellular effects would produce abnormal liver test results. Neuroleptic malignant syndrome is characterized by autonomic instability. Akathisia produces motor restlessness.

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

A -- Acute dystonic reactions involve painful contractions of the tongue, face, neck, and back. Opisthotonos and oculogyric crisis may be observed. Dystonic reactions are considered emergencies requiring immediate intervention. Tardive dyskinesia involves involuntary spasmodic muscular contractions that involve the tongue, fingers, toes, neck, trunk, or pelvis. It appears after prolonged treatment. Waxy flexibility is a symptom seen in catatonic schizophrenia. Internal and external restlessness, pacing, and fidgeting are characteristics of akathisia.

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

D -- The patient's unrealistic fear of harm indicates paranoia. Neologisms are invented words. Concrete thinking involves literal interpretation. Poverty of content refers to an inadequate fund of information.

A patient diagnosed with schizophrenia says, "Contagious bacteria are everywhere. When they get in your body, you will be locked up with other infected people." Which problem is evident? a. poverty of content b. concrete thinking c. neologisms d. paranoia

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 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

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

D -- When a patient's speech is loosely associated, confused, and disorganized, pretending to understand is useless. The nurse should tell the patient that he or she is having difficulty understanding what the patient is saying. If a theme is discernible, ask the patient to talk about the theme. The incorrect options tend to place blame for the poor communication with the patient. The correct response places the difficulty with the nurse rather than being accusatory.

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.

B

A patient experiencing acute mania dances around the unit, seldom sits, monopolizes conversations, interrupts, and intrudes. Which nursing intervention will best assist the patient with energy conservation? a. monitor physiological functioning b. provide a subdued environment c. supervise personal hygiene d. observe for mood changes

B

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 would let them." d. "Staff members are health care professionals who are qualified to help you."

B -- Magical thinking is evident in the patient's appraisal of his own abilities. There is no evidence of the distracters.

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

D -- aking an antipsychotic medication coupled with the presence of extrapyramidal symptoms, such as severe muscle stiffness and difficulty swallowing, hyperpyrexia, and autonomic symptoms (pulse elevation), suggest neuroleptic malignant syndrome, a medical emergency. The symptoms given in the scenario are not consistent with the medical problems listed in the incorrect options.

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 HCP immediately

symbolic speech

A patient reports "demons are sticking needles in me" when he means that he is experiencing a sharp pain (symbolized by "needles")

D -- A patient who repeatedly disrobes despite verbal limit setting needs more structure. One-on-one supervision may provide the necessary structure. Directing the patient to wear clothes at all times has not proven successful, considering the behavior has continued. Asking if the patient is bothered by clothing serves no purpose. Telling the patient that others are embarrassed will not make a difference to the patient whose grasp of social behaviors is impaired by the illness.

A patient with acute mania has disrobed in the hall three times in 2 hours. The nurse should: a. direct the patient to wear clothes at all times b. ask if the patient finds clothes bothersome c. tell the patient that others feel embarrassed d. arrange for one-to-one supervision

D -- he patient continues to exhibit manic symptoms. Nonadherence to the medication regime is a common problem for patients diagnosed with bipolar disorder. The lithium level should be approaching a therapeutic range after 7 days but may be low from "cheeking" (not swallowing) the medication. The prescribed dose is high, so one would not expect a need for the dose to be increased. Monitoring the patient does not address the problem.

A patient with diagnosed bipolar disorder was hospitalized 7 days ago and has been taking lithium 600 mg tid. Staff observes increased agitation, pressured speech, poor personal hygiene, and hyperactivity. Which action demonstrates that the nurse understands the most likely cause of the patient's behavior? a. educate the patient about the proper ways to perform personal hygiene and coordinate clothing b. continue to monitor and document the patient's speech patterns and motor activity c. ask the HCP to prescribe an increased dose and frequency of lithium d. consider the need to check lithium level; the patient may not be swallowing the medication

B

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

C -- Hyperactivity (activity without sleep) and poor judgment (posting rhymes on government websites) are characteristic of manic episodes. The distracters do not specifically apply to mania.

A person was online continuously for over 24 hours, posting rhymes on official government websites and inviting politicians to join social networks. The person has not slept or eaten for 3 days. What features of mania are evident? a. increased muscle tension and anxiety b. vegetative signs and poor grooming c. poor judgement and hyperactivity d. cognitive deficits and paranoia

Erotomanic delusions

Although he barely knows her, Patty wishes that Eric would marry her if only his current wife would stop interfering.

A -- Diphenhydramine, trihexyphenidyl, benztropine, and other anticholinergic medications may be used to treat dystonias. Swallowing will be difficult or impossible; therefore, oral medication is not an option. Medication should be administered immediately, so the intramuscular route is best. In this case, the best option given is diphenhydramine.

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 MAR b. reassure the patient that the symptoms will subside; practice relaxation techniques with 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 MAR

A

An outpatient diagnosed with bipolar disorder takes lithium carbonate 300 mg three times daily. The patient reports nausea. To reduce the nausea most effectively, the nurse suggests that the lithium be taken with: a. meals b. an antacid c. an antiemetic d. a large glass of juice

referential delusion

Andrea believes songs on the radio are chosen to send her a message.

referential delusion

Barbara believes that the birds sing songs to cheer her up.

control delusions

Brian covered his apartment walls with aluminum foil to block aliens' effort to control his thoughts.

grandiose delusions

Brianna believes she is a famous playwright.

somatic delusions

Chris says his heart is dead and rotting away.

C -- The three drugs in the stem of the question are all anticonvulsants. Lamotrigine is also an anticonvulsant. Clonazepam is an anxiolytic; aripiprazole and risperidone are antipsychotic drugs.

Consider these three anticonvulsant medications: divalproex, carbamazepine, and gabapentin. Which medication also belongs to this classification? a. clonazepam b. risperidone c. lamotrigine d. aripiprazole

A -- Bipolar I is a mood disorder characterized by excessive activity and energy. Psychosis (hallucinations, delusions, and dramatically disturbed thoughts) may occur during manic episodes. A patient with bipolar I disorder is more unstable than a patient diagnosed with bipolar II, cyclothymic disorder, or dysthymic disorder.

Four new patients were admitted to the behavioral health unit in the past 12 hours. The nurse directs a psychiatric technician to monitor these patients for safety. Which patient will need the most watchful supervision? A patient diagnosed with: a. bipolar I disorder b. bipolar II disorder c. dysthymic disorder d. cyclothymic disorder

D

Gilbert, age 19, is described by his parents as a "moody child" with an onset of odd behavior about at age 14, which caused Gilbert to suffer academically and socially. Gilbert has lost the ability to complete household chores, is reluctant to leave the house, and is obsessed with the locks on the windows and doors. Due to Gilbert's early and slow onset of what is now recognized as schizophrenia, his prognosis is considered: a. favorable with medication b. in the relapse stage c. improvable with psychosocial interventions d. to have a less positive outcome

Persecutory delusion

John believes his co-workers plot to prevent his promotion.

A, B

Kyle, a patient with schizophrenia, began to take the first-generation antipsychotic haloperidol last week. One day you find him sitting very stiffly and not moving. He is diaphoretic, and when you ask if he is okay he seems unable to respond verbally. His vital signs are: BP 170/100, P 110, T 104.2. What is the priority nursing intervention? Select all that apply. a. hold his medication and contact his prescriber b. wipe him with a washcloth wet with cold water or alcohol c. administer a medication such as benztropine IM to correct this dystonic reaction d. reassure him that although there is not treatment for his tardive dykinesia, it will pass e. hold his medication for now and consult his prescriber when he comes to the unit later today

nihlistic delusion

Larry gives away all his belongings since they won't be of any use when the comet hits.

B -- The desired outcome is that the patient will be able to control the grandiose thinking associated with acute mania as evidenced by making realistic comments about self, abilities, and plans. Patients with acute mania are already unduly optimistic as a result of their use of denial, and they are overly interested in their environment. Sleep stability is a desired outcome but is not related to distorted thought processes.

Outcome identification for the treatment plan of a patient experiencing grandiose thinking associated with acute mania will focus on a. developing an optimistic outlook b. distorted thought self-control c. interest in the environment d. sleep pattern stabilization

Depersonalization

Patient sees his fingers as being smaller or not theirs

Persecutory Delusion

Shannon believes that her food is poisoned; therefore, she only eats prepackaged food.

B

Tatiana has been hospitalized for an acute manic episode. On admission, the nurse suspects lithium toxicity. What assessment findings would indicate the nurses's suspicions? a. SOB, GI distress, chronic cough b. ataxia, severe hypotension, large volume of dilute urine c. GI distress, thirst, nystagmus d. chest pain, dizziness

C

Ted, a former executive, is now unemployed due to manic episodes at work. He was diagnosed with bipolar I 8 years ago. Ted has a history of IV drug abuse, which resulted in Hep C. He is taking his lithium exactly as scheduled, a fact that both Ted's wife and his BP tests confirm. To reduce Ted's mania, the nurse recommends: a. clonazepam b. fluoxetine c. ECT d. Lurasidone

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.

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

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.

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

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.

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, E

The nurse is providing medication education to a patient who has been prescribed lithium to stabilize mood. Which early signs and symptoms of toxicity should the nurse stress to the patient? Select all that apply. a. increased attentiveness b. getting up at night to urinate c. improved vision d. an upset stomach for no apparent reason e. shaky hands that make holding a cup difficult

A -- Normal range for a blood sample taken 8 to 12 hours after the last dose of lithium is 0.6 to 1.2 mEq/L.

The nurse receives a laboratory report indicating a patient's serum level is 1 mEq/L. The patient's last dose of lithium was 8 hours ago. This result is: a. within therapeutic limits b. below therapeutic limits c. above therapeutic limits d. invalid because of the time lapse since the last dose

A, B, D, E

To provide effective care for the patient diagnosed with schizophrenia, the nurse should frequently assess for which associated condition? Select all that apply. a. alcohol use disorder b. major depressive disorder c. stomach cancer d. polydipsia e. metabolic syndrome

A -- Withdrawal, misinterpreting, poor concentration, and preoccupation with religion are prodromal symptoms, the symptoms that are present before the development of florid symptoms. The incorrect options each list the positive symptoms of schizophrenia that might be apparent during the acute stage of the illness.

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

B -- This intervention provides support through the nurse's presence and provides structure as necessary while the patient's control is tenuous. Acting out may lead to loss of behavioral control. The patient will probably be unable to focus on instructions and comply. Restraint is used only after other interventions have proved ineffective.

When a hyperactive patient diagnosed with acute mania is hospitalized, what is the initial nursing intervention? a. allow the patient to act out feelings b. set limits on patient behavior as necessary c. provide verbal instructions to the patient to remain calm d. restrain the patient to reduce hyperactivity and aggression

A -- Typical antipsychotic drugs often produce sedation and extrapyramidal side effects such as stiffness and gait disturbance, effects the patient might describe as making him or her feel like a "robot."

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

D

When patients diagnosed with schizophrenia suffer from anosognosia, they often refuse medication, believing that: a. medications provided are ineffective b. nurses are trying to control their mind c. the medications will make them sick d. they are not actually ill

waxy flexibility

When the nurse raises the arm, the patient continues to hold this position in a statue-like manner

A

Which characteristic in an adolescent female is sometimes associated with the prodromal phase of schizophrenia? a. always afraid another student will steal her belongings b. an unusual interest in numbers and specific topics c. demonstrates no interest in athletics or organized sports d. appears more comfortable among males

D

Which characteristic presents the greatest risk for injury to others by the patient diagnosed with schizophrenia? a. depersonalization b. pressured speech c. negative symptoms d. paranoia

C -- These foods provide adequate nutrition, but more importantly, they are finger foods that the hyperactive patient could eat while in motion. The foods in the incorrect options cannot be eaten without utensils.

Which dinner menu is best suited for a patient with acute mania? a. spaghetti and meatballs, salad, and a banana b. beef and vegetable stew, a roll, and chocolate pudding c. broiled chicken breast on a roll, an ear of corn, and an apple d. chicken casserole, green beans, and flavored gelatin with whipped cream

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. .

Which finding constitutes a negative symptom associated with schizophrenia? a. hostility b. bizarre behavior c. poverty of thought d. auditory hallucinations

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 am trying to sleep.

A, C, D, E

Which intervention should the nurse implement when caring for a patient demonstrating manic behavior? Select all that apply. a. Monitor the patient's vital signs frequently. b. Keep the patient distracted with group-oriented activities. c. Provide the patient with frequent milkshakes and protein drinks. d. Reduce the volume on the TV and dim bright lights in the environment e. Use a firm but calm voice to give specific concise directions to the patient

B -- Patients with mood disorders, both depression and mania, experience sleep pattern disturbances. Assessment data should be routinely gathered about this possible problem. Deficient diversional activity is more relevant for patients with depression. Defensive coping is more relevant for patients with mania. Fluid volume excess is less relevant for patients with mood disorders than is deficient fluid volume.

Which nursing diagnosis would most likely apply to a patient diagnosed with major depressive disorder as well as one experiencing acute mania? a. deficient diversional activity b. disturbed sleep pattern c. fluid volume excess d. defensive coping

A

Which nursing intervention is particularly well chosen for addressing a population at high risk for developing schizophrenia? a. screening a group of males between the ages 15-25 for early symptoms b. forming a support group for females ages 25-35 who are diagnosed with substance use issues c. providing a group for patients between the ages 45-55 with information on coping skills that have proven to be effective d. educating the parents of a group of developmentally delayed 5-6 year olds on the importance of early intervention

A, C, D, E

Which nursing response demonstrates accurate information that should be discussed with the female patient diagnosed with bipolar and her support system? Select all that apply. a. "Remember that alcohol and caffeine can trigger a relapse of your symptoms." b. "Due to the risk of manic episode, antidepressant therapy is never used with bipolar disorder." c. "It is critical to let your HCP know immediately if you are not sleeping well." d. "Is your family prepared to be actively involved in helping manage this disorder?" e. "The symptoms tend to come and go and so you need to be able to recognize the early signs."

A, B, E

Which statement made by the patient demonstrates an understanding of the effective use of newly prescribed lithium to manage bipolar mania? Select all that apply. a. "I have to keep reminding myself to consistently drink 6 12-oz glasses of fluid every day. b. "I discussed the diuretic my cardiologist prescribed with my psychiatric care provider." c. "Lithium may help me lose the few extra pounds I tend to carry around." d. "I take my lithium on an empty stomach to help with absorption." e. "I have already made arrangements for my monthly lab work."

A, B, D, E

Which suggestions are appropriate for the family of a patient diagnosed with bipolar disorder who is being treated as an outpatient during a hypomanic episode? (Select all that apply.) a. limit credit card access b. provide a structured environment c. encourage group social interaction d. supervise medication administration e. monitor the patient's sleep patterns

A - Although each of the nursing diagnoses listed is appropriate for a patient having a manic episode, the priority lies with the patient's physiological safety. Hyperactivity and poor judgment put the patient at risk for injury.

patient diagnosed with acute mania has distributed pamphlets about a new business venture on a street corner for 2 days. Which nursing diagnosis has priority? a. risk for injury b. ineffective coping c. impaired social interaction d. ineffective therapeutic regimen management