MODULE 2 NCM 117 Part 2 (Schizophrenia Medications and HOTS)

Important teaching for clients receiving antipsychotic medication such as haloperidol (Haldol) includes which of the following instructions? Select all that apply. A. Use sunscreen because of photosensitivity. B. Take the antipsychotic medication with food. C. Have routine blood tests to determine levels of the medication. D. Abstain from eating aged cheese.

A & B Photosensitivity is an adverse effect of many drugs, characteristically producing skin lesions in the areas exposed to light, which includes the face, "V" area of the neck, extensor surfaces of forearms, and dorsa of hands with sparing of submental and retroauricular areas.

Hormonal effects of the antipsychotic medications include which of the following? A. Polydipsia and dysmenorrhea B. Dysmenorrhea and increased vaginal bleeding C. Retrograde ejaculation and gynecomastia D. Akinesia and dysphasia

C. Retrograde ejaculation and gynecomastia Decreased libido, retrograde ejaculation, and gynecomastia are all hormonal effects that can occur with antipsychotic medications. Reassure the client that the effects can be reversed or that changing medication may be possible.

The family of a schizophrenic client asks the nurse if there is a genetic cause of this disorder. To answer the family, which fact would the nurse cite? A. Conclusive evidence indicates a specific gene transmits the disorder. B. Incidence of this disorder is variable in all families. C. There is a little evidence that genes play a role in transmission. D. Genetic factors can increase the vulnerability for this disorder.

D. Genetic factors can increase the vulnerability for this disorder. Research shows that family history statistically increases the risk for the development of schizophrenia.

Jaime has a diagnosis of schizophrenia with negative symptoms. In planning care for the client, Nurse Brienne would anticipate a problem with: A. Auditory hallucinations B. Bizarre behaviors C. Ideas of reference D. Motivation for activities

D. Motivation for activities. In a client demonstrating negative symptoms of schizophrenia, avolition, or the lack of motivation for activities, is a common problem.

A client receiving fluphenazine decanoate (Prolixin Decanoate) therapy develops pseudoparkinsonism. The physician is likely to prescribe which drug to control this extrapyramidal effect? A. diphenhydramine (Benadryl) B. phenytoin (Dilantin) C. benztropine (Cogentin) D. amantadine (Symmetrel)

D. amantadine (Symmetrel) An antiparkinsonian agent, such as amantadine, may be used to control pseudoparkinsonism. Amantadine is now used mostly for Parkinson's disease.

A client with paranoid personality disorder is admitted to a psychiatric facility. Which remark by the nurse would best establish rapport and encourage the client to confide in the nurse? A. "I get upset once in a while, too." B. "I know just how you feel. I'd feel the same way in your situation." C. "I worry, too, when I think people are talking about me." D. "At times, it's normal not to trust anyone."

A. "I get upset once in a while, too." Sharing a benign, non-threatening, personal fact or feeling helps the nurse establish rapport and encourages the client to confide in the nurse. The nurse can't know how the client feels.

A client is admitted with a diagnosis of delusions of grandeur. This diagnosis reflects a belief that one is: A. Highly important or famous B. Being persecuted C. Connected to events unrelated to oneself D. Responsible for the evil in the world

A. Highly important or famous. A delusion of grandeur is a false belief that one is highly important or famous.

The nurse is assigned to a client with catatonic schizophrenia. Which intervention should the nurse include in the client's plan of care? A. Meeting all of the client's physical needs. B. Giving the client an opportunity to express concerns. C. Administering lithium carbonate (Lithonate) as prescribed. D. Providing a quiet environment where the client can be alone.

A. Meeting all of the client's physical needs Because a client with catatonic schizophrenia can't meet physical needs independently, the nurse must provide for all of these needs, including adequate food and fluid intake, exercise, and elimination.

Nurse Arya assesses for evidence of positive symptoms of schizophrenia in a newly admitted client. Which of the following symptoms are considered positive evidence? Select all that apply. A. Anhedonia B. Delusions C. Flat affect D. Hallucinations E. Loose associations F. Social withdrawal

B, D, E These are considered positive symptoms of schizophrenia. The typical positive symptoms of schizophrenia, such as hallucinatory experiences or fixed delusional beliefs, tend to be very upsetting and disruptive—not a positive experience at all for you or someone you care about who is experiencing them.

Every day for the past 2 weeks, a client with schizophrenia stands up during group therapy and screams, "Get out of here right now! The elevator bombs are going to explode in 3 minutes!" The next time this happens, how should the nurse respond? A. "Why do you think there is a bomb in the elevator?" B. "That is the same thing you said in yesterday's session." C. "I know you think there are bombs in the elevator, but there aren't." D. "If you have something to say, you must do it according to our group rules."

C. "I know you think there are bombs in the elevator, but there aren't." This is the most therapeutic response because it orients the client to reality. Identify feelings related to delusions. If a client believes someone is going to harm him/her, the client is experiencing fear. When people believe that they are understood, anxiety might lessen.

An agitated and incoherent client, age 29, comes to the emergency department with complaints of visual and auditory hallucinations. The history reveals that the client was hospitalized for paranoid schizophrenia from ages 20 to 21. The physician prescribes haloperidol (Haldol), 5 mg I.M. The nurse understands that this drug is used for this client to treat: A. Dyskinesia B. Dementia C. Psychosis D. Tardive dyskinesia

C. Psychosis By treating psychosis, haloperidol, an antipsychotic drug, decreases agitation. Haloperidol is a first-generation (typical) antipsychotic medication that is used widely around the world.

Important teaching for a client receiving risperidone (Risperdal) would include advising the client to: A. Double the dose if missed to maintain a therapeutic level. B. Be sure to take the drug with a meal because it's very irritating to the stomach. C. Discontinue the drug if the client reports weight gain. D. Notify the physician if the client notices an increase in bruising.

D. Notify the physician if the client notices an increase in bruising. Bruising may indicate blood dyscrasias, so notifying the physician about increased bruising is very important.

Which factor is associated with increased risk for schizophrenia? A. Alcoholism B. Adolescent pregnancy C. Overcrowded schools D. Poverty

D. Poverty Low socioeconomic status or poverty is an identified environmental factor associated with an increased incidence of schizophrenia.

How soon after chlorpromazine (Thorazine) administration should the nurse expect to see a client's delusional thoughts and hallucinations eliminated?A. Several minutes A. Several minutes B. Several hours C. Several days D. Several weeks

D. Several weeks Although most phenothiazines produce some effects within minutes to hours, their antipsychotic effects may take several weeks to appear. It can take a few days for chlorpromazine to take effect.

A client with a history of medication noncompliance is receiving outpatient treatment for chronic undifferentiated schizophrenia. The physician is most likely to prescribe which medication for this client? A. chlorpromazine (Thorazine) B. imipramine (Tofranil) C. lithium carbonate (Lithane) D. fluphenazine decanoate (Prolixin Decanoate)

D. fluphenazine decanoate (Prolixin Decanoate) Fluphenazine decanoate is a long-acting antipsychotic agent given by injection. Because it has a 4-week duration of action, it's commonly prescribed for outpatients with a history of medication noncompliance.

The nurse formulates a nursing diagnosis of Impaired verbal communication for a client with schizotypal personality disorder. Based on this nursing diagnosis, which nursing intervention is most appropriate? A. Helping the client to participate in social interactions. B. Establishing a one-on-one relationship with the client. C. Establishing alternative forms of communication. D. Allowing the client to decide when he wants to participate in verbal communication with the nurse.

B. Establishing a one-on-one relationship with the client By establishing a one-on-one relationship, the nurse helps the client learn how to interact with people in new situations.

Cersei is diagnosed as having disorganized schizophrenia. Which behaviors would Nurse Sansa most likely assess in the client? A. Absence of acute symptoms impaired role function. B. Extreme social withdrawal, odd mannerisms, and behavior. C. Psychomotor immobility; presence of waxy flexibility. D. Suspiciousness toward others increased hostility.

B. Extreme social withdrawal, odd mannerisms, and behavior Disorganized schizophrenia is characterized by regressive behavior with extreme social withdrawal and frequently odd mannerisms.

Which of the following client behaviors documented in Gio's chart would validate the nursing diagnosis of Risk for other-directed violence? A. Gio's description of being endowed with superpowers. B. Frequent angry outburst noted toward peers and staff. C. Refusal to eat cafeteria food. D. Refusal to join in group activities.

B. Frequent angry outburst noted toward peers and staff Anger is an important factor that indicates the potential for acting out. Because the client is angry with both peers and staff, any acting out would probably be directed toward others.

During a group therapy session in the psychiatric unit, a client constantly interrupts with impulsive behavior and exaggerated stories that cast her as a hero or princess. She also manipulates the group with attention-seeking behaviors, such as sexual comments and angry outbursts. The nurse realizes that these behaviors are typical of: A. Paranoid personality disorder B. Avoidant personality disorder C. Histrionic personality disorder D. Borderline personality disorder

C. Histrionic personality disorder This client's behaviors are typical of histrionic personality disorder, which is marked by excessive emotionality and attention seeking. The client constantly seeks and demands attention, approval, or praise; may be seductive in behavior, appearance, or conversation; and is uncomfortable except when she is the center of attention.

The etiology of schizophrenia is best described by: A. Genetics due to a faulty dopamine receptor. B. Environmental factors and poor parenting. C. Structural and neurobiological factors. D. A combination of biological, psychological, and environmental factors.

D. A combination of biological, psychological, and environmental factors. Communication and the family system have been studied as contributing factors in the development of schizophrenia. Therefore, a combination of biological, psychological, and environmental factors are thought to cause schizophrenia.

A client with persistent, severe schizophrenia has been treated with phenothiazines for the past 17 years. Now the client's speech is garbled as a result of drug-induced rhythmic tongue protrusion. What is another name for this extrapyramidal symptom? A. Dystonia B. Akathisia C. Pseudoparkinsonism D. Tardive dyskinesia

D. Tardive dyskinesia An adverse reaction to phenothiazines, tardive dyskinesia refers to choreiform tongue movements that commonly are irreversible and may interfere with speech.

A client tells the nurse that people from Mars are going to invade the earth. Which response by the nurse would be most therapeutic? A. "That must be frightening to you. Can you tell me how you feel about it?" B. "There are no people living on Mars." C. "What do you mean when you say they're going to invade the earth?" D. "I know you believe the earth is going to be invaded, but I don't believe that."

A. "That must be frightening to you. Can you tell me how you feel about it?" This response addresses the client's underlying fears without feeding the delusion. Attempt to understand the significance of these beliefs to the client at the time of their presentation.

A client with paranoid schizophrenia repeatedly uses profanity during an activity therapy session. Which response by the nurse would be most appropriate? A. "Your behavior won't be tolerated. Go to your room immediately." B. "You're just doing this to get back at me for making you come to therapy." C. "Your cursing is interrupting the activity. Take time out in your room for 10 minutes." D. "I'm disappointed in you. You can't control yourself even for a few minutes."

A. "Your behavior won't be tolerated. Go to your room immediately." The nurse should set limits on client behavior to ensure a comfortable environment for all clients. The nurse should accept hostile or quarrelsome client outbursts within limits without becoming personally offended. Maintain a consistent approach, employ consistent expectations, and provide a structured environment.

Which statement is correct about a 25-year-old client with newly diagnosed schizophrenia? A. Age of onset is typical for schizophrenia. B. Age of onset is later than usual for schizophrenia. C. Age of onset is earlier than usual for schizophrenia. D. Age of onset follows no predictable pattern in schizophrenia.

A. Age of onset is typical for schizophrenia. The primary age of onset for schizophrenia is late adolescence through young adulthood (ages 17 to 27).

Propranolol (Inderal) is used in the mental health setting to manage which of the following conditions? A. Antipsychotic-induced akathisia and anxiety. B. The manic phase of bipolar illness as a mood stabilizer. C. Delusions for clients suffering from schizophrenia. D. Obsessive-compulsive disorder (OCD) to reduce ritualistic behavior.

A. Antipsychotic-induced akathisia and anxiety Propranolol is a potent beta-adrenergic blocker and produces a sedating effect; therefore, it's used to treat antipsychotic-induced akathisia and anxiety.

A man with a 5-year history of multiple psychiatric admissions is brought to the emergency department by the police. He was found wandering the streets disheveled, shoeless, and confused. Based on his previous medical records and current behavior, he is diagnosed with chronic undifferentiated schizophrenia. The nurse should assign the highest priority to which nursing diagnosis? A. Anxiety B. Impaired verbal communication C. Disturbed thought processes D. Self-care deficit: Dressing/grooming

A. Anxiety For this client, the highest-priority nursing diagnosis is Anxiety (severe to panic-level), manifested by the client's extreme withdrawal and attempt to protect himself from the environment. The nurse must act immediately to reduce anxiety and protect the client and others from possible injury.

A client tells the nurse that psychotropic medicines are dangerous and refuses to take them. Which intervention should the nurse use first? A. Ask the client about any previous problems with psychotropic medications. B. Ask the client if an injection is preferable. C. Insist that the client takes medication as prescribed. D. Withhold the medication until the client is less suspicious.

A. Ask the client about any previous problems with psychotropic medications. The nurse needs to clarify the client's previous experience with psychotropic medication in order to understand the meaning of the client's statement.

A client with chronic schizophrenia receives 20 mg of fluphenazine decanoate (Prolixin Decanoate) by I.M. injection. Three days later, the client has muscle contractions that contort the neck. This client is exhibiting which extrapyramidal reaction? A. Dystonia B. Akinesia C. Akathisia D. Tardive dyskinesia

A. Dystonia Dystonia, a common extrapyramidal reaction to fluphenazine decanoate, manifests as muscle spasms in the tongue, face, neck, back, and sometimes the legs.

Ramsay is diagnosed with schizophrenia paranoid type and is admitted to the psychiatric unit of Nurseslabs Medical Center. Which of the following nursing interventions would be most appropriate? A. Establishing a non-demanding relationship. B. Encouraging involvement in group activities. C. Spending more time with Ramsay. D. Waiting until Ramsay initiates interaction.

A. Establishing a non-demanding relationship A non-threatening, non-demanding relationship helps decrease the mistrust that is common in a client with paranoid schizophrenia. Use a non-judgemental, respectful, and neutral approach with the client.

Nurse Dorothy is evaluating care of a client with schizophrenia; the nurse should keep which point in mind? A. Frequent reassessment is needed and is based on the client's response to treatment. B. The family does not need to be included in the care because the client is an adult. C. The client is too ill to learn about his illness. D. Relapse is not an issue for a client with schizophrenia.

A. Frequent reassessment is needed and is based on the client's response to treatment. Because the client responds to treatment in different ways, the nurse must constantly evaluate the client and his potential.

Positive symptoms of schizophrenia include which of the following?A. Hallucinations, delusions, and disorganized thinking A. Flat affect, avolition, and anhedonia B. Somatic delusions, echolalia, and a flat affect C. Waxy flexibility, alogia, and apathy D. Hallucinations, delusions, and disorganized thinking

A. Hallucinations, delusions, and disorganized thinking The positive symptoms of schizophrenia are distortions of normal functioning. Option A lists the positive symptoms of schizophrenia.

A client with schizophrenia is receiving antipsychotic medication. Which nursing diagnosis may be appropriate for this client? A. Ineffective protection related to blood dyscrasias B. Urinary frequency related to adverse effects of antipsychotic medication C. Risk for injury related to a severely decreased level of consciousness D. Risk for injury related to electrolyte disturbances

A. Ineffective protection related to blood dyscrasias Antipsychotic medications may cause neutropenia and granulocytopenia, life-threatening blood dyscrasias, that warrant a nursing diagnosis of Ineffective protection related to blood dyscrasias.

The nurse is caring for a client with schizophrenia. Which of the following outcomes is the least desirable? A. The client spends more time by himself. B. The client doesn't engage in delusional thinking. C. The client doesn't harm himself or others. D. The client demonstrates the ability to meet his own self-care needs.

A. The client spends more time by himself. The client with schizophrenia is commonly socially isolated and withdrawn; therefore, having the client spend more time by himself wouldn't be a desirable outcome.

A client with paranoid schizophrenia is admitted to the psychiatric unit of a hospital. Nursing assessment should include careful observation of the client's: A. Thinking, perceiving, and decision-making skills B. Verbal and nonverbal communication processes C. Affect and behavior D. Psychomotor activity

A. Thinking, perceiving, and decision-making skills Nursing assessment of a psychotic client should include careful inquiry about and observation of the client's thinking, perceiving, symbolizing, and decision-making skills and abilities.

A client is admitted to the psychiatric hospital with a diagnosis of catatonic 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. This client is exhibiting: A. Waxy flexibility B. Negativity C. Suggestibility D. Retardation

A. Waxy flexibility Waxy flexibility, the ability to assume and maintain awkward or uncomfortable positions for long periods, is characteristic of catatonic schizophrenia.

A client with schizophrenia who receives fluphenazine (Prolixin) develops pseudoparkinsonism and akinesia. What drug would the nurse administer to minimize extrapyramidal symptoms? A. benztropine (Cogentin) B. dantrolene (Dantrium) C. clonazepam (Klonopin) D. diazepam (Valium)

A. benztropine (Cogentin) Benztropine is an anticholinergic drug administered to reduce extrapyramidal adverse effects in the client taking antipsychotic drugs. It works by restoring the equilibrium between the neurotransmitters acetylcholine and dopamine in the central nervous system (CNS).

A client with schizophrenia is referred for psychosocial rehabilitation. Which of the following are typical of this type of program? Select all that apply. A. Analyzing family issues and past problems B. Developing social skills and supports C. Learning how to live independently in a community D. Learning job skills for employment E. Treating family members affected by the illness F. Participating in in-depth psychoanalytical counseling

B, C, D The goal of psychosocial rehabilitation as a treatment method is to help the client develop the skills and supports necessary for successful living, learning, and working in the community. Analysis of family issues and past problems and treatment of family members are not commonly part of this type of program.

Which of the following is one of the advantages of the newer antipsychotic medication risperidone (Risperdal)? A. The absence of anticholinergic effects. B. A lower incidence of extrapyramidal effects. C. Photosensitivity and sedation. D. No incidence of neuroleptic malignant syndrome.

B. A lower incidence of extrapyramidal effects Risperdal has a lower incidence of extrapyramidal effects than the typical antipsychotics. SGAs have loose binding to D2 receptors and can quickly dissociate from the receptor, potentially accounting for the lower likelihood of causing extrapyramidal symptoms (EPS).

A client with a diagnosis of paranoid schizophrenia comments to the nurse, "How do I know what is really in those pills?" Which of the following is the best response? A. Say, "You know it's your medicine." B. Allow him to open the individual wrappers of the medication. C. Say, "Don't worry about what is in the pills. It's what is ordered." D. Ignore the comment because it's probably a joke.

B. Allow him to open the individual wrappers of the medication. This is correct because allowing a paranoid client to open his medication can help reduce suspiciousness. Talk openly with the client about their beliefs and thoughts, showing empathy and support. Help build trust and rapport with clients.

Nurse Winona educates the family about symptom management for when the schizophrenic client becomes upset or anxious. Which of the following would Nurse Winona state be helpful? A. Call the therapist to request a medication change. B. Encourage the use of learned relaxation techniques. C. Request that the client be hospitalized until the crisis is over. D. Wait before the anxiety worsens before intervening.

B. Encourage the use of learned relaxation techniques. The client with schizophrenia can learn relaxation techniques, which help reduce anxiety. The family can be supportive and helpful by encouraging the client to use these techniques.

The nurse is caring for a client who experiences false sensory perceptions with no basis in reality. These perceptions are known as: A. Delusions B. Hallucinations C. Loose associations D. Neologisms

B. Hallucinations Hallucinations are visual, auditory, gustatory, tactile, or olfactory perceptions that have no basis in reality.

A client with schizophrenia tells the nurse he hears the voices of his dead parents. To help the client ignore the voices, the nurse should recommend that he: A. Sit in a quiet, dark room and concentrate on the voices. B. Listen to a personal stereo through headphones and sing along with the music. C. Call a friend and discuss the voices and his feelings about them. D. Engage in strenuous exercise.

B. Listen to a personal stereo through headphones and sing along with the music. Increasing the amount of auditory stimulation, such as by listening to music through headphones, may make it easier for the client to focus on external sounds and ignore internal sounds from auditory hallucinations.

The nurse is aware that antipsychotic medications may cause which of the following adverse effects? A. Increased production of insulin B. Lower seizure threshold C. Increased coagulation time D. Increased risk of heart failure

B. Lower seizure threshold Antipsychotic medications exert an effect on brain neurotransmitters that lowers the seizure threshold and can, therefore, increase the risk of seizure activity.

A client diagnosed with schizoaffective disorder is suffering from schizophrenia with elements of which of the following disorders? A. Personality disorder B. Mood disorder C. Thought disorder D. Amnestic disorder

B. Mood disorder According to the DSM5, schizoaffective disorder refers to clients suffering from schizophrenia with elements of a mood disorder, either mania or depression. The prognosis is generally better than for the other types of schizophrenia, but it's worse than the prognosis for a mood disorder alone.

A client's medication order reads, "Thioridazine (Mellaril) 200 mg P.O. q.i.d. and 100 mg P.O. p.r.n." The nurse should: A. Administer the medication as prescribed. B. Question the physician about the order. C. Administer the order for 200 mg P.O. q.i.d. but not for 100 mg P.O. p.r.n. D. Administer the medication as prescribed but observe the client closely for adverse effects.

B. Question the physician about the order. The nurse must question this order immediately. Thioridazine (Mellaril) has an absolute dosage ceiling of 800 mg/day. Any dosage above this level places the client at high risk for toxic pigmentary retinopathy, which can't be reversed.

Which information is most important for the nurse to include in a teaching plan for a schizophrenic client taking clozapine (Clozaril)? A. Monthly blood tests will be necessary. B. Report a sore throat or fever to the physician immediately. C. Blood pressure must be monitored for hypertension. D. Stop the medication when symptoms subside.

B. Report a sore throat or fever to the physician immediately. A sore throat and fever are indications of an infection caused by agranulocytosis, a potentially life-threatening complication of clozapine.

When teaching the family of a client with schizophrenia, the nurse should provide which information? A. Relapse can be prevented if the client takes the medication. B. Support is available to help family members meet their own needs. C. Improvement should occur if the client has a stimulating environment. D. Stressful family situations can precipitate a relapse in the client.

B. Support is available to help family members meet their own needs. Because family members of a client with schizophrenia face difficult situations and great stress, the nurse should inform them of support services that can help them cope with such problems.

Gio told his nurse that the FBI is monitoring and recording his every movement and that microphones have been placed in the unit walls. Which action would be the most therapeutic response? A. Confront the delusional material directly by telling Gio that this simply is not so. B. Tell Gio that this must seem frightening to him but that you believe he is safe here. C. Tell Gio to wait and talk about these beliefs in his one-on-one counseling sessions. D. Isolate Gio when he begins to talk about these beliefs.

B. Tell Gio that this must seem frightening to him but that you believe he is safe here. The nurse must realize that these perceptions are very real to the client. Acknowledging the client's feelings provides support; explaining how the nurse sees the situation in a different way provides reality orientation.

The nurse is teaching a psychiatric client about her prescribed drugs, chlorpromazine, and benztropine. Why is benztropine administered? A. To reduce psychotic symptoms. B. To reduce extrapyramidal symptoms. C. To control nausea and vomiting. D. To relieve anxiety.

B. To reduce extrapyramidal symptoms Benztropine is an anticholinergic medication, administered to reduce the extrapyramidal adverse effects of chlorpromazine and other antipsychotic medications.

A 26-year-old client is admitted to the psychiatric unit with acute onset of schizophrenia. His physician prescribes the phenothiazine chlorpromazine (Thorazine), 100 mg by mouth four times per day. Before administering the drug, the nurse reviews the client's medication history. Concomitant use of which drug is likely to increase the risk of extrapyramidal effects? A. guanethidine (Ismelin) B. droperidol (Inapsine) C. lithium carbonate (Lithonate) D. Alcohol

B. droperidol (Inapsine) When administered with any phenothiazine, droperidol may increase the risk of extrapyramidal effects. Despite being a low-potency drug, chlorpromazine can still cause extrapyramidal side effects (EPS) such as acute dystonia, akathisia, parkinsonism, and tardive dyskinesia (TD).

A client with borderline personality disorder becomes angry when he is told that today's psychotherapy session with the nurse will be delayed 30 minutes because of an emergency. When the session finally begins, the client expresses anger. Which response by the nurse would be most helpful in dealing with the client's anger? A. "If it had been your emergency, I would have made the other client wait." B. "I know it's frustrating to wait. I'm sorry this happened." C. "You had to wait. Can we talk about how this is making you feel right now?" D. "I really care about you and I'll never let this happen again."

C. "You had to wait. Can we talk about how this is making you feel right now?" This response may diffuse the client's anger by helping to maintain a therapeutic relationship and addressing the client's feelings.

A client is admitted to the psychiatric unit with a tentative diagnosis of psychosis. Her physician prescribes the phenothiazine thioridazine (Mellaril) 50 mg by mouth three times per day. Phenothiazines differ from central nervous system (CNS) depressants in their sedative effects by producing: A. Deeper sleep than CNS depressants. B. Greater sedation than CNS depressants. C. A calming effect from which the client is easily aroused. D. More prolonged sedative effects, making the client more difficult to arouse.

C. A calming effect from which the client is easily aroused. Shortly after phenothiazine administration, a quieting and calming effect occurs, but the client is easily aroused, alert, and responsive and has good motor coordination.

A client is about to be discharged with a prescription for the antipsychotic agent haloperidol (Haldol), 10 mg by mouth twice per day. During a discharge teaching session, the nurse should provide which instruction to the client? A. Take the medication 1 hour before a meal. B. Decrease the dosage if signs of illness decrease. C. Apply sunscreen before being exposed to the sun. D. Increase the dosage up to 50 mg twice per day if signs of illness don't decrease.

C. Apply a sunscreen before being exposed to the sun. Because haloperidol can cause photosensitivity and precipitate severe sunburn, the nurse should instruct the client to apply a sunscreen before exposure to the sun.

A client is unable to get out of bed and get dressed unless the nurse prompts every step. This is an example of which behavior? A. Word salad B. Tangential C. Avolition D. Perseveration

C. Avolition Avolition refers to impairment in the ability to initiate goal-directed activity. Avolition, a lack of motivation or reduced drive to complete goal-directed activities, is a concerning and common characteristic in people with schizophrenia.

A woman is admitted to the psychiatric emergency department. Her significant other reports that she has difficulty sleeping, has poor judgment, and is incoherent at times. The client's speech is rapid and loose. She reports being a special messenger from the Messiah. She has a history of depressed mood for which she has been taking an antidepressant. The nurse suspects which diagnosis? A. Schizophrenia B. Paranoid personality C. Bipolar illness D. Obsessive-compulsive disorder (OCD)

C. Bipolar illness Bipolar illness is characterized by mood swings from profound depression to elation and euphoria. Delusions of grandeur along with pressured speech are common symptoms of mania.

A client is admitted to the psychiatric unit with active psychosis. The physician diagnoses schizophrenia after ruling out several other conditions. Schizophrenia is characterized by: A. Loss of identity and self-esteem. B. Multiple personalities and decreased self-esteem. C. Disturbances in affect, perception, and thought content and form. D. Persistent memory impairment and confusion.

C. Disturbances in affect, perception, and thought content and form. DSM5 defines schizophrenia as a disturbance in multiple psychological processes that affect thought content and form, perception, affect, sense of self, volition, relationship to the external world, and psychomotor behavior.

Yesterday, a client with schizophrenia began treatment with haloperidol (Haldol). Today, the nurse notices that the client is holding his head to one side and complaining of neck and jaw spasms. What should the nurse do? A. Assume that the client is posturing. B. Tell the client to lie down and relax. C. Evaluate the client for adverse reactions to haloperidol. D. Put the client on the list for the physician to see tomorrow.

C. Evaluate the client for adverse reactions to haloperidol. An antipsychotic agent, such as haloperidol, can cause muscle spasms in the neck, face, tongue, back, and sometimes legs as well as torticollis (twisted neck position). The nurse should be aware of these adverse reactions and assess for related reactions promptly.

A client begins clozapine (Clozaril) therapy after several other antipsychotic agents fail to relieve her psychotic symptoms. The nurse instructs her to return for weekly white blood cell (WBC) counts to assess for which adverse reaction? A. Hepatitis B. Infection C. Granulocytopenia D. Systemic dermatitis

C. Granulocytopenia Clozapine can cause life-threatening neutropenia or granulocytopenia. To detect this adverse reaction, a WBC count should be performed weekly.

The nurse is providing care to a client with a catatonic type of schizophrenia who exhibits extreme negativism. To help the client meet his basic needs, the nurse should: A. Ask the client which activity he would prefer to do first. B. Negotiate a time when the client will perform activities. C. Tell the client specifically and concisely what needs to be done. D. Prepare the client ahead of time for the activity.

C. Tell the client specifically and concisely what needs to be done. The client needs to be informed of the activity and when it will be done. Use clear and simple language when communicating with a client. Minimize the opportunity for miscommunication and misconstruing the meaning of the message.

Which non-antipsychotic medication is used to treat some clients with schizoaffective disorder? A. phenelzine (Nardil) B. chlordiazepoxide (Librium) C. lithium carbonate (Lithane) D. imipramine (Tofranil)

C. lithium carbonate (Lithane) Lithium carbonate, an antimanic drug, is used to treat clients with cyclical schizoaffective disorder, a psychotic disorder once classified under schizophrenia that causes affective symptoms, including manic-like activity. Lithium helps control the affective component of this disorder.

Since admission 4 days ago, a client has refused to take a shower, stating, "There are poison crystals hidden in the showerhead. They'll kill me if I take a shower." Which nursing action is most appropriate? A. Dismantling the showerhead and showing the client that there is nothing in it. B. Explaining that other clients are complaining about the client's body odor. C. Asking a security officer to assist in giving the client a shower. D. Accepting these fears and allowing the client to take a sponge bath.

D. Accepting these fears and allowing the client to take a sponge bath By acknowledging the client's fears, the nurse can arrange to meet the client's hygiene needs in another way. Attempt to understand the significance of these beliefs to the client at the time of their presentation.

Drug therapy with thioridazine (Mellaril) shouldn't exceed a daily dose of 800 mg to prevent which adverse reaction? A. Hypertension B. Respiratory arrest C. Tourette syndrome D. Retinal pigmentation

D. Retinal pigmentation Retinal pigmentation may occur if the thioridazine dosage exceeds 800 mg per day. The development of pigmentary retinopathy is a unique adverse manifestation associated with thioridazine, and not with other antipsychotics.

Upon Sam's admission for acute psychiatric hospitalization, Nurse Jona documents the following: Client refuses to bathe or dress, remains in the room most of the day, speaks infrequently to peers or staff. Which nursing diagnosis would be the priority at this time? A. Anxiety B. Decisional conflict C. Self-care deficit D. Social isolation

D. Social isolation These behaviors indicate the client's withdrawal from others and possible fear or mistrust of relationships. If a client is found to be very paranoid, solitary or one-on-one activities that require concentration are appropriate.

Drogo, who has had auditory hallucinations for many years, tells Nurse Khally that the voices prevent his participation in a social skills training program at the community health center. Which intervention is most appropriate? A. Let Drogo analyze the content of the voices. B. Advise Drogo to participate in the program when the voices cease. C. Advise Drogo to take his medications as prescribed. D. Teach Drogo to use thought-stopping techniques.

D. Teach Drogo to use thought-stopping techniques. Clients with long-lasting auditory hallucinations can learn to use thought-stopping measures to accomplish tasks. In this technique, when the obsessive or racing thoughts begin, the client says, clearly and distinctly, "Stop!" This then allows the client to substitute a new, healthier thought.

A client, age 36, with paranoid schizophrenia believes the room is bugged by the Central Intelligence Agency and that his roommate is a foreign spy. The client has never had a romantic relationship, has no contact with family members, and hasn't been employed in the last 14 years. Based on Erikson's theories, the nurse should recognize that this client is in which stage of psychosocial development? A. Autonomy versus shame and doubt B. Generativity versus stagnation C. Integrity versus despair D. Trust versus mistrust

D. Trust versus mistrust This client's paranoid ideation indicates difficulty trusting others. Erikson believed that early patterns of trust help children build a strong base of trust that's crucial for their social and emotional development.