Schizophrenia PrepU
Prodromal Signs of Schizophrenia
- isolation - odd behavior - self neglect - flat affect
A client tells the nurse, "I can see someone sticking out from underneath my bed, and he's telling me that he is going to kill me." Which is the most therapeutic response the nurse can provide? "Just tell the man to go away." "I don't see or hear anything, but it sounds as though you are very frightened." "There is no man under your bed. Let's go to the dining room now." "You are safe here, so don't worry about that."
Correct response: "I don't see or hear anything, but it sounds as though you are very frightened." Explanation: Nurses make it clear that they do not hear the voices or see the visual images but do communicate concern that the client is bothered, upset, or frightened by the hallucination.
In working with the individual and family, which is the most accurate statement the nurse can make in order to teach the client and family about schizophrenia? "Individuals with schizophrenia do have differences in brain structure and function that cause a variety of symptoms such as lack of motivation and hearing voices." "Schizophrenia is being found to be related more closely to family dysfunction than to physiology, which is why family therapy is the most effective treatment for this disorder." "Medications for schizophrenia have not changed much since the early 1950s, although there are some medications that may be helpful." "It is more effective to treat the individual on a one-to-one basis than to involve the family in treatment because it is a very complicated process."
Correct response: "Individuals with schizophrenia do have differences in brain structure and function that cause a variety of symptoms such as lack of motivation and hearing voices." Explanation: Excessive amount of the neurotransmitter dopamine allows nerve impulses to bombard the mesolimbic pathway, the part of the brain normally involved in arousal and motivation. Normal cell communications are disrupted, resulting in the development of hallucinations and delusions. Abnormalities in brain shape and brain circuitry are being researched
A client in the psychiatric unit of the hospital has a diagnosis of schizophrenia. The client has approached the nurse in the hallway of the hospital and is elaborating in great detail about the client's delusions of persecution involving secret societies, the Vatican, and the mafia. How should the nurse respond to the client's expression of these delusions? "Do you think that your delusions might be causing you to think this way?" "That sounds very stressful for you. Would you like to join me and the others in the lounge?" "What can I do to help you get away from these people who want to get you?" "Remember that none of this is real and that no one at all is trying to harm you."
Correct response: "That sounds very stressful for you. Would you like to join me and the others in the lounge?" Explanation: The most therapeutic response to a client's delusions is to empathically acknowledge the stress that these delusions may cause and to redirect the conversation in a respectful way. Accusing the person of delusional thinking, acknowledging the reality of the delusions, and trying to convince the person that the delusions are not real are interventions that may provoke rather than relieve symptoms.
A client is diagnosed with schizophreniform disorder. The nurse is reviewing the client's medical record and finds that the client's symptoms have been present for at least how long? 1 week 1 month 8 months 1 year
Correct response: 1 month Explanation: The essential features of schizophreniform disorder are identical to those of criteria A for schizophrenia, with the exception of the duration of the illness, which can be less than 6 months. Symptoms must be present for at least 1 month to be classified as a schizophreniform disorder.
A client diagnosed with schizophreniform disorder must have symptoms present for at least 1 month but with a duration of less than: 2 weeks. 4 weeks. 6 months. 12 months.
Correct response: 6 months. Explanation: The essential features of schizophreniform disorder are identical to those of criteria A for schizophrenia, with the exception of the duration of the illness, which can be less than 6 months. Symptoms must be present for at least 1 month to be classified as a schizophreniform disorder.
Which client exhibits the characteristics that are typical of the prodromal phase of schizophrenia? A 25-year-old does not express any of the symptoms of schizophrenia. A 20-year-old is experiencing a gradual decrease in the ability to concentrate, be productive, and sleep restfully. A 30-year-old has experienced a relapse after deciding that the client's atypical antipsychotic is unnecessary. A 28-year-old has been displaying the behaviors characteristic of schizophrenia for many months and has just been diagnosed with the disease.
Correct response: A 20-year-old is experiencing a gradual decrease in the ability to concentrate, be productive, and sleep restfully. Explanation: Gradual, subtle behavioral changes appear during the prodromal phase of schizophrenia, such as tension, the inability to concentrate, insomnia, withdrawal, or cognitive deficits. No symptoms are present in the premorbid phase, and relapses occur in the progressive and chronic phases. Diagnosis of the disease marks the beginning of the onset phase.
A client diagnosed with schizophrenia has been prescribed clozapine. Which is a potentially fatal side effect of this medication? Agranulocytosis Neuroleptic malignant syndrome Tardive dyskinesia Dystonia
Correct response: Agranulocytosis Explanation: Agranulocytosis is manifested by a failure of the bone marrow to produce adequate white blood cells. Neuroleptic malignant syndrome is a life-threatening reaction to neuroleptic medication that requires immediate treatment. Tardive dyskinesia causes involuntary movements of the tongue, mouth, facial muscles, and arm and leg muscles. Dystonia is characterized by cramps and rigidity of the tongue, face, neck, and back muscles
A nurse monitoring client medication needs to recognize side effects quickly and intervene promptly for which reason? Determine adequate dosage is maintained to control symptoms Alleviate the side effects and help client maintain adherence Provide support to the client and let the client know this is normal Provide support to the client and encourage adherence as past side effects rarely reoccur
Correct response: Alleviate the side effects and help client maintain adherence Explanation: Recognizing a medication's side effects quickly and intervening promptly to alleviate them will help maintain adherence.
Which constitutes a negative symptom associated with schizophrenia? Hostility Asociality Bizarre behavior Formal thought disorder
Correct response: Asociality Explanation: Asociality is characterized by social withdrawal, few or no relationships, and lack of closeness. These are recognized as negative symptoms of schizophrenia in accordance with the DSM-V. The other options listed are examples of positive symptoms of schizophrenia.
A nursing instructor is developing an education plan for a group of students about schizophrenia and schizoaffective disorders. The instructor identifies that in addition to psychosis, what other condition must be present at the same time for a diagnosis of schizoaffective disorder? Substance abuse Mood disturbance Delirium Anxiety
Correct response: Mood disturbance Explanation: When psychosis and mood disturbance occur at the same time, a diagnosis of schizoaffective disorder is made. Substance abuse, delirium, or anxiety are not involved with the diagnosis of schizoaffective disorder.
A client has been diagnosed with schizophrenia. Assessment reveals that the client lives alone. The client's clothing is disheveled, the client's hair is uncombed and matted, and the client's body has a strange odor. During an interview, the client's family members voice a desire for the client to live with them when the client is discharged. Based on the assessment findings, which nursing diagnosis would be the priority? Ineffective role performance related to symptoms of schizophrenia Social isolation related to auditory hallucinations Dysfunctional family processes related to psychosis Bathing self-care deficit related to symptoms of schizophrenia
Correct response: Bathing self-care deficit related to symptoms of schizophrenia Explanation: The negative symptom of avolition may be so profound that simple activities of daily living, such as dressing, bathing, or combing hair, may not get done. Therefore, a priority nursing diagnosis for the client is [bathing] self-care deficit related to the symptoms of schizophrenia. The family's desire to care for the client does not support a nursing diagnosis of dysfunctional family processes. There is no evidence of ineffective role performance or social isolation at this time.
Which medication is used to control the extrapyramidal effects associated with antipsychotic medications? Benztropine Chlorpromazine Haloperidol Thioridazine
Correct response: Benztropine Explanation: Benzotropine is an anticholinergic drug used to relieve drug-induced extrapyramidal adverse effects, such as muscle weakness, involuntary muscle movement, pseudoparkinsonism, and tardive dyskinesia.
A client with schizophrenia states that the client is God's messenger and the client's mission is to become president. The nurse documents these comments as evidence of what? Delusional thinking Hallucinatory experiences Bizarre behavior Formal thought disorder
Correct response: Delusional thinking Explanation: Delusions involve disturbances in thought content. They are firmly held false beliefs that reasoning cannot correct and for which there is no support in reality.
A nurse is assessing a client diagnosed with schizophrenia. When documenting the findings, which would the nurse identify as a positive symptom? Select all that apply. Delusions Hallucinations Alogia Anhedonia Avolition
Correct response: Delusions Hallucinations Explanation: Positive symptoms reflect an excess or distortion of normal functions, including delusions and hallucinations. Negative symptoms reflect a lessening (or complete loss) of normal functions, such as restriction or flattening in the range and intensity of emotion (diminished emotional expression); reduced fluency and productivity of thought and speech (alogia); withdrawal and inability to initiate and persist in goal-directed activity (avolition); and inability to experience pleasure (anhedonia).
A hospitalized client with schizophrenia is receiving antipsychotic medications. While assessing the client, a nurse identifies signs and symptoms of a dystonic reaction. Which agent would the nurse expect to administer? Diphenhydramine Propranolol Risperidone Aripiprazole
Correct response: Diphenhydramine Explanation: For dystonic reactions, the drug of choice is benztropine mesylate or diphenhydramine. Propranolol could be used to treat akathisia. Risperidone and aripiprazole are antipsychotic agents used to treat schizophrenia.
A 28-year-old woman has been diagnosed with schizophrenia. The health care provider has prescribed a typical antipsychotic, haloperidol. Which will the nurse include in the teaching related to the most common adverse effects? Neuroleptic malignant syndrome Agranulocytosis Extrapyramidal symptoms Gastrointestinal problems
Correct response: Extrapyramidal symptoms Explanation: Extrapyramidal symptoms (EPS) are the most common adverse effects of haloperidol. The cause of these symptoms is the relative lack of dopamine stimulation (i.e., excess dopamine blockade) and relative excess of cholinergic stimulation. Neuroleptic malignant syndrome and agranulocytosis are relatively rare, although potentially fatal adverse effects. Gastrointestinal problems are considered uncommon adverse effects of the drug
A client with schizophrenia is hearing voices that tell the client to kill the self. What term is used to identify this type of false sensory perception? Hallucination Delusion Flight of ideas Ideas of reference
Correct response: Hallucination Explanation: A hallucination is a sensory perception, such as hearing voices and seeing objects, that only the client experiences. A delusion is a false belief. Flight of ideas refers to a speech pattern in which the client skips from one unrelated subject to another. Ideas of reference refers to the mistaken belief that someone or something outside the client is controlling the client's ideas or behavior.
During an admission assessment, a client with schizoaffective disorder states that the client hears the voice of God in the client's head and the voice is telling the client that the client is worthless. What would the nurse document this symptom as? Hallucination Delusion Avolition Alogia
Correct response: Hallucination Explanation: Hallucinations are sensory perceptions with a compelling sense of reality but with no actual objective basis. During auditory hallucinations (the most common form), clients may hear the voice of God or close relatives, two or more voices with a running commentary about the client's behavior, or voices that command certain acts. Delusions are false, fixed beliefs. Avolition involves the withdrawal and inability to initiate and persist in goal-directed activity. Alogia refers to the reduced fluency and productivity of thought and speech.
Positive symptoms seen in schizophrenia are believed to be a result of which type of neurological dysfunction? Increased amount of dopamine An inadequate amount of dopamine Cerebral atrophy Organic functional changes in the brain
Correct response: Increased amount of dopamine Explanation: Positive (or productive) symptoms reflect an increased amount of dopamine affecting the cortical areas of the brain. Negative symptoms reflect an inadequate amount of dopamine, cerebral atrophy, and organic functional changes in the brain.
The nurse is assigned to a client with catatonic schizophrenia. Which intervention should the nurse include in the client's care plan? Meeting all of the client's physical needs Giving the client an opportunity to express concerns Administering lithium carbonate as prescribed Providing a quiet environment where the client can be alone
Correct response: Meeting all of the client's physical needs Explanation: Meeting all of the client's physiologic needs is most important because clients with catatonic schizophrenia cannot meet their own needs by themselves. Clients with catatonic schizophrenia are unable to express their concerns. Lithium is used for the manic phase of bipolar disorder. The nurse needs to give support to the client and be present for him or her as reassurance.
A comprehensive nursing assessment for neuroleptic malignant syndrome (NMS) should include checking for which in a client taking an antipsychotic medication? Headache, muscle aches, and paresthesias Confusion, giddiness, and hyperalertness Muscular rigidity, tremors, and difficulty swallowing Dry mouth, flushing, and urinary retention
Correct response: Muscular rigidity, tremors, and difficulty swallowing Explanation: NMS is characterized by muscular rigidity, tremors, difficulty swallowing, fever, hypertension, and diaphoresis.
A nurse is preparing an in-service program about schizophrenia for a group of psychiatric-mental health nurses. Which would the nurse include as a major reason for relapse? Lack of family support Accessibility to community resources Nonadherence to prescribed medications Stigmatization of mental illness
Correct response: Nonadherence to prescribed medications Explanation: Although a lack of family or social support, accessibility to community resources, and stigmatization are factors that can contribute to relapse, one of the major reasons for relapse is failure to follow the medication regimen.
A nurse provides care to a client with schizoaffective disorder during hospitalization for acute psychosis. Nursing interventions to help the client to establish trust with the health care team is bestaccomplished by what? Offering reassurance in a soft, nonthreatening voice Reminding the client that delusions are not real Encouraging the client to participate in group therapy daily Decrease stressful situations by controlling the client's symptoms
Correct response: Offering reassurance in a soft, nonthreatening voice Explanation: During periods of acute psychosis, offering reassurance in a soft, nonthreatening voice and avoiding confrontational stances will help the client begin to trust the staff and nursing care.
A client has been prescribed quetiapine for delusional disorder. In teaching the client about this medication, the nurse must be certain to include which information? Quetiapine can cause breast milk production. One of the common side effects is dry mouth. If dizziness is experienced, the client must call the doctor immediately. Quetiapine can cause one to crave sugar.
Correct response: One of the common side effects is dry mouth. Explanation: Dry mouth is a common, sometimes bothersome, side effect. Quetiapine does not cause breast milk production. Dizziness may occur due to orthostatic hypotension but will decrease as the body becomes accustomed to the medication. It is not an emergency. Quetiapine can cause changes in blood sugar but will not induce sugar cravings.
A mental health client insists that the client's spouse is trying to poison the client. In this instance, the client is exhibiting which type of delusion? Somatic Erotomanic Persecutory Grandiose
Correct response: Persecutory Explanation: Clients who exhibit persecutory delusions believe that they are being conspired against, spied on, poisoned, or drugged. Somatic delusions demonstrate a preoccupation with the body. A client exhibiting erotomanic delusions believes that a person of elevated social status loves him or her. Grandiose delusions are present when the client believes that he or she possesses unrecognized talent or insight or has made an important discovery.
Which extrapyramidal side effect is noted by a client who has bradykinesia and a shuffling gait? Pseudoparkinsonism Akathisia Acute dystonia Tardive dyskinesia
Correct response: Pseudoparkinsonism Explanation: Pseudoparkinsonism is noted by a resting tremor, rigidity, a masklike face, and a shuffling gait. Akathisia occurs when the client has motor restlessness evidenced by pacing, rocking, or shifting from foot to foot. Symptoms of acute dystonia are intermittent or fixed abnormal postures of the eyes, face, tongue, neck, trunk, and extremities
A client begins to exhibit hallucinations and delusions along with disorganized speech after forgetting to take antipsychotic medication. The nurse suspects that the client is at which point in the clinical course of the disorder? Prodromal phase Acute illness Stabilization Relapse
Correct response: Relapse Explanation: Relapse involves a return of the symptoms, most often due to the client's failure to follow the medication regimen. The prodromal phase is associated with small changes in overall function, such as difficulties at work or school, within relationships, or in daily activities accompanied by transient or weak symptoms of psychosis. ACute illness is the initial onset of changes in thought and bizarre or disruptive behavior. Stabilization occurs when symptoms become less acute, following the initial diagnosis and initiation of treatment.
Some research has suggested that schizophreniform disorder may be an early manifestation of which other mental health condition? Delusional disorder Schizophrenia Bipolar affective disorder Schizoaffective disorder
Correct response: Schizophrenia Explanation: Some research has suggested that schizophreniform may be an early manifestation of schizophrenia. A client exhibiting an acute reactive psychosis for less than the 6 months necessary to meet the diagnostic criteria for schizophrenia is given the diagnosis of schizophreniform disorder. Symptoms lasting beyond the 6 months warrant a diagnosis of schizophrenia.
The nurse should consider which during a psychiatric assessment of a newly immigrated client who is being evaluated for possible religious delusions? Some cultures hold religious beliefs that might be confused with delusional thought Most cultures contain well-accepted religious beliefs Delusions are often focused on the client's cultural religious beliefs The nurse's cultural religious beliefs may differ from those of the client's
Correct response: Some cultures hold religious beliefs that might be confused with delusional thought Explanation: Some cultures have widely held and culturally sanctioned beliefs that might be considered delusional in other cultures.
When developing the plan of care for a client with schizophrenia who is in the acute phase of illness, the nurse understands that the client is at high risk for what? Depression Mania Suicide Water intoxication
Correct response: Suicide Explanation: During the acute illness, individuals with schizophrenia are at high risk for suicide. Clients are hospitalized usually to protect themselves or others. Clients with schizophrenia who have an abnormality in the hippocampus may experience disordered water balance, whereupon individuals drink compulsively as a result of neuroendocrine dysfunction, placing them at risk for water intoxication. However, this is not the priority. Mania and depression are unrelated to schizophrenia during the acute illness.
Which is an appropriate intervention for a client having auditory hallucinations? Encourage the client to discuss the content of the hallucinations with staff as they occur. Ask the client to keep a journal about what the voices tell the client and to bring the journal to therapy sessions. Encourage the client to spend quiet time alone until hallucinations cease. Tell the client to talk back to the voices and tell them to go away.
Correct response: Tell the client to talk back to the voices and tell them to go away. Explanation: Interventions for managing hallucinations include dismissal intervention (i.e., telling the voices to go away), various coping strategies (e.g., jogging, telephoning, playing games, seeking out others, employing relaxation techniques), or competing stimuli (e.g., listening to music or the voice of oneself or another to overcome auditory hallucinations and using visual stimuli to overcome visual hallucinations)
A client with schizophrenia is prescribed an antipsychotic medication. Which immediate side effects would the nurse include in the education plan for this medication? Risk for hypertension Risk for hypoprolactinemia The potential for weight loss The potential for sedation
Correct response: The potential for sedation Explanation: Sedation with antipsychotic medication will likely happen immediately after initiating the medication. The nurse should be sure to inform the client they he or she will experience this side effect readily. The other options are examples of side effects that are possible with longer term treatment using antipsychotic medications. Weight gain is commonly associated with many antipsychotic medications. The potential for weight loss with antipsychotic medication is not typically discussed with clients.
Clients with delusional disorder do not normally seek help independently because of their inability to establish what? Rapport Stability Trust Residency
Correct response: Trust Explanation: Clients with delusional or shared psychotic disorders do not normally seek help independently because of their inability to establish trust.
Assessment of genetic predisposition supports asking a client who is exhibiting symptoms of a delusional disorder what? Whether any family members have been diagnosed with schizophrenia When the delusion first began If the client has complied with the treatment plan If any family member shows symptoms of depression
Correct response: Whether any family members have been diagnosed with schizophrenia Explanation: Some studies have found that delusional disorders are more common among relatives of individuals with schizophrenia than would be expected by chance; thus, asking whether any family members have been diagnosed with schizophrenia could be helpful.
A client with schizoaffective disorder is prescribed medication therapy. Which type of medications would be most likely be ordered? atypical antipsychotics typical antipsychotics antidepressants mood stabilizers
Correct response: atypical antipsychotics Explanation: Although numerous drugs may be prescribed, atypical antipsychotics are generally prescribed because of their efficacy for psychosis and for their thymoleptic (mood stabilizing) properties. Atypical antipsychotics have been used more often than typical antipsychotics. If depressive symptoms persist despite antipsychotic use, antidepressants may be prescribed. Mood stabilizers are an alternative adjunct for mood states associated with the bipolar type of the disorder.
A nurse is caring for a client in an inpatient mental health setting. The nurse notices that when the client is conversing with other clients, the client repeats what they are saying word for word. The nurse interprets this finding and documents it as: echopraxia. neologisms. tangentiality. echolalia.
Correct response: echolalia. Explanation: The nurse should document the client's speech pattern as echolalia, or parrot-like and inappropriate repetition of another's words. Echopraxia refers to an involuntary imitation of another person's movements or gestures. Neologisms are made-up words that have no common meaning and are not recognized. Tangentiality is a disorganized thinking pattern in which the topic of conversation changes to an entirely different topic; the change is a logical progression but causes a permanent detour from the original focus.
When assessing a person with delusional disorder, which finding would the nurse expect to assess? few, if any, psychological deficits changes in mental status altered personality high level of intelligence
Correct response: few, if any, psychological deficits Explanation: Clients with delusional disorder show few, if any, psychological deficits. In these clients, average or marginally low intelligence is characteristic. Mental status is not generally affected. Thinking, orientation, affect, attention, memory, perception, and personality are generally intact.
When describing the difference between schizoaffective disorder (SAD) and schizophrenia, the nurse would address which as associated with SAD? lower level of functioning increased mood responses decreased risk for suicide delusions but no hallucinations
Correct response: increased mood responses Explanation: Clients with SAD have many similar responses to their disorder as people with schizophrenia, with one exception. These clients have many more "mood" responses and are very susceptible to suicide. Persons with SAD usually have higher functioning than those with schizophrenia, with severe negative symptoms and early onset of illness. To be diagnosed with SAD, a client must have an uninterrupted period of illness when there is a major depressive, manic, or mixed episode along with two of the following symptoms of schizophrenia: delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, or negative symptoms.
A client with schizophrenia is experiencing delusions. The client states, "There's a huge apocalypse coming and the end of the world is near." The nurse interprets this statement as which type of delusion? grandiose nihilistic persecutory somatic
Correct response: nihilistic Explanation: A nihilistic delusion involves the belief that one is dead or a calamity is impending. A grandiose delusion involves the belief that one has exceptional powers, wealth, skill, influence, or destiny. A persecutory delusion involves the belief that one is being watched, ridiculed, harmed, or plotted against. A somatic delusion involves a belief about abnormalities in bodily structure or functions.
A nurse is caring for a client who has been receiving treatment for schizophrenia with chlorpromazine for the past year. It would be essential for the nurse to monitor the client for: weight loss. torticollis. hypoglycemia. tardive dyskinesia.
Correct response: tardive dyskinesia. Explanation: Tardive dyskinesia is late-appearing, abnormal involuntary movements. Therefore, it is essential that the nurse monitor the client for tardive dyskinesia at this time. Weight gain (not weight loss) and new onset of diabetes (hyperglycemia) are possible side effects of an antipsychotic. Torticollis, a dystonic reaction, would occur early in antipsychotic drug treatment.