SCHIZOPHRENIA
A client is experiencing extrapyramidal symptoms secondary to neuroleptic drug therapy. The physician ordered biperiden (Akineton), 2mg tid IV. If a 5mg/mL vial is used, what is the total amount, in mL per day, that the nurse will administer?
1.2
The family of a patient who has been prescribed antipsychotic medication tells the nurse they understand there are potentially fatal side effects with these medications. They ask the nurse for information about what they should look for that could signal potentially dangerous or fatal side effects. Which of the following responses by the nurse are accurate with regard to the family's question? (Select all that apply) A. "If the patient has acute muscle spasms or the patient's eyes appear to be rolling back, emergency intervention should be sought." B. "if the patient has an unusually high fever and complains of muscle rigidity, any further antipsychotic medication should be discontinued and immediate emergency intervention should be sought." C. "If the patient complains of sore throat, fever, and malaise, the doctor should be contacted to evaluate for a possible dangerous side effect of the mediation." D. "if the male patient begins to show signs of breast enlargement or the female patient experiences amenorrhea, take the patient immediately to the ER." E. "If the patient's psychotic symptoms appear to be absent, call the doctor immediately."
A. "If the patient has acute muscle spasms or the patient's eyes appear to be rolling back, emergency intervention should be sought." B. "if the patient has an unusually high fever and complains of muscle rigidity, any further antipsychotic medication should be discontinued and immediate emergency intervention should be sought." C. "If the patient complains of sore throat, fever, and malaise, the doctor should be contacted to evaluate for a possible dangerous side effect of the mediation." Feedback 1: These symptoms are indicative of an acute dystonia, which can progress to laryngospasm if not treated. Emergency intervention with an anticholinergic such as Cogentin is needed to reverse this side effect. Feedback 2: These symptoms are indicative of neuroleptic malignant syndrome, which can progress rapidly and be fatal. Immediate discontinuation of antipsychotic medication and emergency intervention are critical needs. Feedback 3: These symptoms may be indicative of agranulocytosis, which can be fatal is not treated. Further bloodwork is needed.
A client diagnosed with schizophrenia states, "My roommate is plotting to have others kill me." Which is the appropriate nursing response? A. "i know you believe that to be true, but i find that hard to believe." B. "What would make you think such a thing?" C. "I know your roommate. He would do no such thing." D. "I can see why you feel that way."
A. "i know you believe that to be true, but i find that hard to believe." This client is experiencing a persecutory delusion. this nursing response is an example o voicing doubt, which expresses uncertainty as to the reality of the client's perceptions. this is an appropriate therapeutic communication technique in dealing with clients experiencing delusional thinking.
Clint, a client on the psychiatric unit, has been diagnosed with schizophrenia. He begins to tell the nurse about how the CIA is looking for him and will kill him if they find him. Clint's belief is an example of a: A. Delusion of persecution B. Delusion of reference C. Delusion of control or influence D. Delusion of grandeur
A. Delusion of persecution
A client diagnosed with schizophrenia experiences identity confusion and communicates with the nurse using echolalia. What is the client attempting to do by using this form of speech? A. Identify with the person speaking B. Imitate the nurse's movements C. Alleviate alogia D. Alleviate avolition
A. Identify with the person speaking Echolalia is a parrot-like repetition of overheard words or fragments of speech. It is an attempt by the client to identify with the person who is speaking.
A client who is experiencing command hallucinations is hospitalized after jumping from a bridge. The client's parents insist that their son feel rather than jumped. Which of the following likely explain the parents' response? (Select all that apply) A. The parents are in denial about the reality of their son's mental illness B. The parents are grieving over the loss of their expectations for their child C. The parents do not understand the extent or seriousness of mental illness D. The parents reject the idea of their son having a mental illness E. The parents are showing support for their son.
A. The parents are in denial about the reality of their son's mental illness B. The parents are grieving over the loss of their expectations for their child C. The parents do not understand the extent or seriousness of mental illness D. The parents reject the idea of their son having a mental illness Feedback 1: by stating the jump was a fall, the parents are expressing denial and minimizing the problem Feedback 2: The child's attempted suicide could generate a loss of hope that their child will meet parental expectations. This can occur any time a child is physically or mentally different. Feedback 3: The parents may have a knowledge deficit and truly may not understand the implications of their child's mental illness Feedback 4: By claiming that their son feel rather than jumped from the bridge, the parents are embracing an accidental cause and rejecting the possibility of mental illness.
The family of a client diagnosed with schizophrenia tells the nurse that they were at a NAMI meeting and heard that the recovery model for intervention with people with schizophrenia is gaining recognition as a desirable approach. They ask the nurse to describe this model. Which of these responses by the nurse are accurate statements about the recovery model? (Select all that apply) A. This model supports that recovery is an obtainable objective for people with schizophrenia B. This approach engages the client in an Alcoholics Anonymous (AA) - like 12-step program for recovery C. the recovery model actively engages the client in determining the goals for the treatment plan. D. The recovery model should not be confused with providing a "cure" for schizophrenia E. The recovery model is controversial because it stigmatizes the person with schizophrenia
A. This model supports that recovery is an obtainable objective for people with schizophrenia C. the recovery model actively engages the client in determining the goals for the treatment plan. D. The recovery model should not be confused with providing a "cure" for schizophrenia Feedback 1: Conventional models for treatment in schizophrenia have been criticized for potentially inhibiting a client's ability to recognize his or her potential because they focus too heavily on the disease as one in which recovery is not obtainable. The recovery model shifts the focus toward recovery as an attainable goal. Feedback 3: Central to the recovery model in intervention with people with schizophrenia is a patient-centered approach in which the clinician and the client work together to develop a treatment plan that is in alignment with goals set forth by the client Feedback 4: It is important in educating clients and families that the recovery model is not to be confused with promising a remission or a cure for this illness. Instead, it focuses on potential to function more autonomously rather than a primary focus on managing an intractable illness.
A patient admitted to the psychiatric unit and diagnosed with schizophrenia reports to the nurse that there are people playing drums in his chest. Which of these would be appropriate interventions by the nurse? (Select all that apply) A. check the patient's vital signs B. tell the patient that these are tactile hallucinations and that he need not be concerned C. Ask the patient to describe more completely what he is feeling D. Give the patient PRN Cogentin as ordered E. Encourage the patient to discuss this with the music therapist.
A. check the patient's vital signs C. Ask the patient to describe more completely what he is feeling Feedback 1: This intervention is a priority to ensure that the patient's symptoms are not secondary to a medical emergency such as heart attack. Feedback 3: This is an appropriate intervention since further assessment is needed to ensure that the patient's physiological needs are being met.
A client diagnosed with schizophrenia experiences identify confusion and communicates with the nurse using echolalia. What is the client attempting to do by using this form of speech? A. identify with the person speaking B. imitate the nurse's movements C. alleviate alogia D. alleviate avolition
A. identify with the person speaking Echolalia is a parrot-like repetition of overheard words or fragments of speech. it is an attempt by the client to identify with the person who is speaking.
A withdrawn client, newly diagnosed with schizophrenia, is experiencing delusional thinking. Which nursing intervention is most appropriate? A. present objective reality B. use self-disclosure C. use physical touch for reassurance D. provide an in-depth explanation of unit rules and regulations
A. present objective reality When communicating with a client diagnosed with schizophrenia, the nurse should reinforce and focus on reality by talking about real events and real people. Discussions that focus on false ideas reinforce the client's delusions.
Some patients with schizophrenia express lack of insight or awareness that there is anything wrong or that any disorder is present. This symptom is referred to as _____________.
Anosognosia This symptom is often apparent when a client is asked what prompted admission to the hospital. A response such as "for some reason, the police just came over and told me I had to go to the hospital," is evidence of anosognosia. It is considered a symptom of the illness rather than a defense mechanism. A comparable symptom occurs following brain damage.
The family of a patient with schizophrenia requests information about Assertive Community Treatment (ACT). Which of the following responses by the nurse are consistent with this treatment model? (Select all that apply) A. "this model of treatment is based in the hospital and provides group education about how to assert oneself in the community." B. "this is a program of case management that takes a team approach in providing comprehensive community-based psychiatric services." C. This model is designed to meet the needs of people with conditions ranging from mild depression to severe and persistent illnesses such as schizophrenia." D. "One of the primary goals of ACT is to lessen the family's burden of providing care."
B. "this is a program of case management that takes a team approach in providing comprehensive community-based psychiatric services." D. "One of the primary goals of ACT is to lessen the family's burden of providing care." Feedback 1: This response demonstrates a lack of understanding of ACT. ACT is a community-based treatment model that focuses on comprehensive management of needs for patients with severe and persistent mental illnesses like schizophrenia. Feedback 4: NAMI (2012) identifies primary goals for ACT, one of which is to lessen the family's burden for providing care. ACT recognizes that patients with severe, persistent mental illness require many services beyond what one resource or the family can provide exclusively
The nurse is interviewing a client on the psychiatric unit. The client tilts his head to the side, stops talking in midsentence, and listens intently. the nurse recognizes these behaviors as a symptom of the client's illness. The most appropriate nursing intervention for this symptom is to: A. Ask the client to describe his physical symptoms B. Ask the client to describe what he is hearing C. Administer a dose of benzotropine D. Call the physician for additional orders
B. Ask the client to describe what he is hearing
The primary goal in working with an actively psychotic, suspicious client would be to: A. Promote interaction with others B. Decrease his anxiety and increase trust C. Improve this relationship with his parents D. Encourage participation in therapy activities
B. Decrease his anxiety and increase trust
A client diagnosed with schizophrenia manifests the symptom of mutism. Which nursing intervention would assist the client in communicating with others? A. Providing assistance with self-care needs B. Using clear, concrete statements C. Conveying acceptance of the client's need for false beliefs D. attempting to decode incomprehensible communication patterns.
B. Using clear, concrete statements The use of clear, concrete statement shows the client what is expected. Because clients diagnosed with schizophrenia experience concrete thinking, explanations must be provided at the client's concrete level of comprehension
The nurse is interviewing a client on the psychiatric unit. The client tilts is head to the side, stops talking in midsentence, and listens intently. The nurse recognizes from these signs that the client is likely experiencing: A. somatic delusions B. catatonic stupor C. auditory hallucinations D. pseudoparkinsonism
C. auditory hallucinations
A client diagnosed with schizophrenia hears another patient say, "You'll be tied up for another hour." and becomes agitated because he interprets that to mean he will literally be tied up. Which cognitive symptom of schizophrenia is this client manifesting? A. nihilistic delusions B. concrete thinking C. circumstantiality D. perseveration
B. concrete thinking Concrete thinking is manifested by literal interpretation of abstract or figurative ideas. This symptom may be present in schizophrenia and is believed to represent regression to an earlier level of cognitive development
Several types of delusions may occur in an individual with schizophrenia. Which of the following types of delusion places the patient at greatest risk for agitation or aggression? A. delusions of grandeur B. delusions of persecution C. delusions of reference D. nihilistic delusions
B. delusions of persecution In delusions of persecution an individual falsely believes he or she is being threatened or persecuted in some way. This carries a high risk for increasing the individual's agitation and possibly aggression in protective efforts.
In planning care to reinforce reality for a client diagnosed with schizophrenia, the nurse should include which interventions? A. explore the client's expressions of distorted thinking B. discuss perceptions and thinking that are in touch with reality C. Encourage the client to share delusional thinking in group discussions. D. ask the client why distorted thinking and bizarre behavior have occurred.
B. discuss perceptions and thinking that are in touch with reality Discussing reality=based perceptions and thinking will assist the client to maintain orientation and will promote organized thinking.
Tony, age 21, has been diagnosed with schizophrenia. He has been socially isolated and hearing voices telling him to kill his parents. He has been admitted to the psychiatric unit from the emergency department. The initial nursing intervention for Tony is to: A. give him an injection of Thorazine B. ensure a safe environment for him and others C. Place him in restraints. D. Order him a nutritious diet
B. ensure a safe environment for him and others
A nursing home resident who has been taking antipsychotic medications for several months complains to the nurse of a stiff neck and difficulty swallowing. These symptoms are indicative of which condition? A. dysphonia B. tardive dyskinesia C. akathisia D. echolalia
B. tardive dyskinesia Tardive dyskinesia is a syndrome characterized by abnormal, involuntary movements, including bizarre facial and tongue movements, a stiff neck, and/or difficulty swallowing. This condition may occur as an adverse effect of long-term therapy with antipsychotic medications
A client is admitted with a diagnosis of schizoaffective disorder. Which symptoms are characteristic of this diagnosis? A. strong ego boundaries and abstract thinking B. acute dystonias and tardive dyskinesia C. Altered mood and thought disturbances D. substance abuse and cachexia
C. Altered mood and thought disturbances The characteristic symptoms of schizoaffective disorder are a combination of alterations in mood (mania or depression) and thought
A client who has been taking chlorpromazine (Thorazine) for several months presents in the ED with extrapyramidal symptoms (EPS) of restlessness, drooling and tremors. What medication will the nurse expect the physician to order? A. Paroxetine (Paxil) B. Carbamazepine (Tegretol) C. Benztropine (Cogentin) D. Lorazepam (Ativan)
C. Benztropine (Cogentin) Benztropine is an anticholinergic medication that blocks cholinergic activity in the CNS, which is responsible for EPS. Anticholinergics are the drugs of choice to treat extrapyramidal symptoms associated with antipsychotic mediations
A client who has been taking chlorpromazine (Thorazine) for several months presents in the ED with extrapyramidal symptoms of restlessness, drooling, and tremors. What medication will the nurse expect the physician to order? A. Paroxetine (Paxil) B. Carbamazepine (Tegretol) C. Benztropine (Cogentin) D. Lorazepam (Ativan)
C. Benztropine (Cogentin) Cogentin is an anticholinergic medication that blocks cholinergic activity in the central nervous system, which is responsible for extrapyramidal symptoms. This is the drug of choice to treat extrapyramidal symptoms associated with antipsychotic medications.
When a client suddenly becomes aggressive and violent on the unit, which of the following approaches would be best for the nurse to use first? A. Provide large motor activities to relieve the client's pent-up tension. B. Administer a dose of PRN chlorpromazine to keep the client calm. C. Call for sufficient help to control the situation safely. D. Convey to the client that his behavior is unacceptable and will not be permitted.
C. Call for sufficient help to control the situation safely.
A client is admitted with a diagnosis of brief psychotic disorder with catatonic features. Which symptoms are associated with the catatonic specifier? A. Strong ego boundaries and abstract thinking B. Ataxia and akinesia C. Stupor, muscle rigidity, and negativism D. substance abuse and cachexia
C. Stupor, muscle rigidity, and negativism Symptoms associated with the catatonic specifier include stupor and muscle rigidity or excessive, purposeless motor activity. Waxy flexibility, negativism, echolalia, and echopraxia are also common behaviors
The nurse is caring for a client with schizophrenia. Orders from the physician include 100 mg chlorpromazine IM STAT and then 50 mg PO bid; 2 mg benztropine PO bid PRN. Why is chlorpromazine ordered? A. To reduce extrapyramidal symptoms B. To prevent neuroleptic malignant syndrome C. To decrease psychotic symptoms D. To induce sleep
C. To decrease psychotic symptoms
A client is experiencing paranoia and states, "the FBI and phone company are plotting against me." Which charting entry best describes this client's symptom? A. experiencing delusions of grandeur B. experiencing erotomanic delusions C. experiencing delusions of persecution D. experiencing somatic delusions
C. experiencing delusions of persecution Individuals experiencing delusions of persecution feel that they are being threatened and believe that others have harmful intentions. The client in the question believes that the FBI and the phone company are plotting harm.
The client hears the word "match". the client replies, "A match. I like matches. They are the light of the world. God will light the world. Let your light so shine." Which communication pattern does the nurse identify? A. word salad B. clang association C. Loose association D. ideas of reference
C. loose association Loose association is characterized by communication in which ideas shift from one unrelated topic to another. The situation in the question represents this communication pattern.
The client hears the word "match". The client says, "A match. Tomorrow is the end of the world. Nothing is better than hot coffee." Which communication pattern does the nurse identify? A. word salad B. clang association C. loose association D. ideas of reference
C. loose association Loose association is characterized by communication in which ideas shit from one unrelated topic to another. The situation in the question clearly represents this communication pattern
The nurse is providing care for an emaciated client experiencing an acute phase of catatonic stupor. Which nursing intervention would take priority when meeting this client's needs? A. minimize attempts to communicate with the client B. assist the client to ambulate C. provide nutrient-dense foods and beverages D. place the patient is seclusion for safety
C. provide nutrient-dense foods and beverages Nutrition is an essential consideration for a client with catatonic stupor. The emaciated client in the question is suffering from malnutrition. The nurse must prioritize this basic physical need.
A client has been admitted to the inpatient psychiatric unit and is manifesting mutism. His diagnosis is schizophrenia with catotonia. What would the nurse expect to observe? A. frenzied and purposeless movements B. exaggerated suspiciousness C. stuporous withdrawal D. sexual preoccupation
C. stuporous withdrawal The client's mutism indicates catatonic stupor. This client would be noted to have extreme psychomotor retardation, and efforts to move the individual may be met with bodily resistence
A client diagnosed with schizophrenia is experiencing disorganized thinking. Which technique should the nurse use to promote communication? A. giving broad openings B. probing C. verbalizing the implied D. using open-ended questions
C. verbalizing the implied When working with clients who have greatly impaired communication ability, the nurse can use the technique of verbalizing the implied. By putting into words what the client may be experiencing, the nurse helps the client to organize his or her thinking.
A client is being discharged on haloperidol (Haldol). Which teaching should the nurse include about the medication? A. "If you forget to take your morning dose of Haldol, double the dose at bedtime." B. "Limit your alcohol intake to no more than 3 ounces per day. " C. "When you go home, sit outside and enjoy the sunshine." D. "Do not stop taking Haldol abruptly."
D. "Do not stop taking Haldol abruptly." The client should be taught not to stop taking Haldol abruptly after long-term use. To do so might produce withdrawal symptoms, such as N/V, dizziness, gastritis, headache, tachycardia, insomnia and/or tremulousness
Clint, a client on the psychiatric unit, has been diagnosed with schizophrenia. He begins to tell the nurse about how the CIA is looking for him and will kill him if they find him. The most appropriate response by the nurse is: A. "That's ridiculous, Clint. No one is going to hurt you." B. "The CIA isn't interested in people like you, Clint." C. "Why do you think the CIA wants to kill you?" D. "I know you believe that, Clint, but it's really hard for me to believe."
D. "I know you believe that, Clint, but it's really hard for me to believe."
Which medication does the nurse determine will give the client the most immediate relief from neuroleptic-induced extrapyramidal side effects? A. lorazepam (Ativan), 1 mg PO B. Diazepam (Valium), 5 mg PO C. Haloperidol (Haldol), 2 mg IM D. Benztropine (Cogentin), 2 mg PO
D. Benztropine (Cogentin), 2 mg PO The symptoms of neuroleptic-induced extrapyramidal side effects include tremors, chorea, dystonia, akinesia, and akahesia. Congentin, 1-4 mg given once or twice daily, is the drug of choice to treat these symptoms.
The nurse is caring for a client with schizophrenia. Orders from the physician include 100 mg chlorpromazine IM STAT, and then 50 mg PO bid; 2 mg benztropine PO bid PRN. Because benztropine was ordered on a PRN basis, which of the following assessments by the nurse would convey a need for this medication? A. The client's level of agitation increases B. The client complains of a sore throat C. The client's skin has a yellowish cast. D. The client develops tremors and a shuffling gait.
D. The client develops tremors and a shuffling gait.
The primary focus of family therapy for clients with schizophrenia and their families is: A. to discuss concrete problem solving and adaptive behaviors for coping with stress B. To introduce the family to others with the same problem C. To keep the client and family in touch with the health care system D. To promote family interaction and increase understanding of the illness
D. To promote family interaction and increase understanding of the illness
To deal with a client's hallucinations therapeutically, which nursing intervention should be implemented? A. Reinforce the perceptual distortions until the client develops new defenses B. Provide an unstructured environment C. Avoid making connections between anxiety-producing situations and hallucinations D. distract the client's attention
D. distract the client's attention The nurse should first empathize with the client by focusing on feelings generated by the hallucination, present objective reality, and then distract or redirect the client to reality-based activities.
To deal with a client's hallucinations therapeutically, which nursing intervention should be implemented? A. reinforce the perceptual distortions until the client develops new defenses. B. Provide an unstructured environment C. avoid making connections between anxiety-producing situations and hallucinations D. use empathic listening and redirect the client's attention to reality-based interaction
D. use empathic listening and redirect the client's attention to reality-based interaction The nurse should first empathize with the client by focusing on feelings generarted by the hallucination, present objective reality, and then redirect the client to reality-based activites
A patient on antipsychotic medication reports to the nurse that her muscles feel very stiff, and she appears diaphoretic. Her temperature is 105 degrees. Her symptoms are indicative of the potentially fatal adverse reaction to antipsychotic medication known as ________________________
Neuroleptic Malignant Syndrome Although neuroleptic malignant syndrome is rare, its rapid progression and potential to cause death make it a priority to assess for regularly and to intervene aggressively when symptoms are apparent. Antipsychotic medication should be immediately discontinued
