MH Chapter 22

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 best accomplished by what?

Offering reassurance in a soft, nonthreatening voice

A client has been taking haloperidol for 5 years when the client is admitted to the inpatient unit for relapse of symptoms of schizophrenia. Upon assessment, the client demonstrates akathisia, dystonia, a stiff gait, and rigid posture. The nurse correctly identifies these symptoms are indicative of what?

Extrapyramidal side effects

A client with delusional disorder tells the nurse that the client has discovered how to jump to the moon. The nurse would document this belief as what?

Grandiose delusion

The nurse is caring for a client who was diagnosed with schizoaffective disorder two years ago. Which of the following assessments should the nurse prioritize?

Suicide

The client has been living in the community with schizophrenia. Which drug classification is the primary medication treatment for schizophrenia?

Antipsychotics

A client has been prescribed clozapine for treatment of schizophrenia. The client must be taught to monitor which blood concentrations weekly while taking this drug?

White blood cells

The client is diagnosed with schizophrenia and the nurse is observing for effects of medication during the teaching session. Which medication rarely causes extrapyramidal side effects (EPS)?

Ziprasidone

A week after beginning therapy with thiothixene, the client demonstrates muscle rigidity, a temperature of 103°F, an elevated serum creatinine phosphokinase level, stupor, and incontinence. The nurse should notify the physician because these symptoms are indicative of:

neuroleptic malignant syndrome.

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

A nurse is assessing a client who is reporting the sensation of "bugs crawling under the skin" and intense itching and burning. The client states, "I know bugs have invaded my body." There is no evidence to support the client's report. The nurse interprets this as which type of delusion?

Somatic

Which is the central focus of persecutory delusions?

Injustice that must be remedied by legal action

A nurse monitoring client medication needs to recognize side effects quickly and intervene promptly for which reason?

Alleviate the side effects and help client maintain adherence

Which is the most common subtype of delusion?

Persecutory

The nurse notices the client with a shuffling gait walking in the hall. Which would not be included as a symptom of drug-induced parkinsonism?

Tachycardia

A client diagnosed with schizophreniform disorder must have symptoms present for at least 1 month but with a duration of less than:

6 months

Which client best exhibits the characteristics that are typical of the prodromal period of schizophrenia?

A 20-year-old man who is exhibiting a gradual decrease in his ability to concentrate and function in daily activities

A nurse teaching a client about prescribed antipsychotic medication informs the client to contact a health care provider immediately if the client notices:

A dramatic change in temperature.

A client is considered to have an ultrahigh risk for the development of schizophrenia when the assessment process identifies ...

A sibling who experiences visual hallucinations

A client diagnosed with schizophrenia has been prescribed Clozapine (Clozaril). Which of the following is a potentially fatal side effect of this medication?

Agranulocytosis

Which of the following would the nurse identify as a negative symptom associated with schizophrenia?

Anhedonia

What is an anticholinergic side effect associated with some antipsychotic medications?

Photophobia

A client diagnosed with delusional disorder who uses excessive health care resources most likely has which type of delusions?

Somatic

Which increases the risk for neuroleptic malignant syndrome (NMS)?

Dehydration

A client with schizophrenia is prescribed clozapine. The nurse would monitor the client closely for specific signs of:

Infection

A client is admitted with the diagnosis of possible schizophrenia and to rule out (R/O) organic pathology. Based on this information, what treatment will the nurse expect for this client?

to be scheduled for a computerized tomography (CT) of the brain

Some research has suggested that schizophreniform disorder may be an early manifestation of which other mental health condition?

Schizophrenia

Encephalopathic syndrome has occurred in a few clients when haloperidol is taken with which medication?

Lithium carbonate (Lithium)

A nurse has been assigned a newly admitted client. The client's report notes that the client is demonstrating grandiosity. Which client statement is most consistent with this symptom?

"I'm the world's most astute financier."

One evening, a client with schizophrenia leaves the client's room and begins marching in the hall. When approached by the nurse, the client says, "God says I'm supposed to guard the area." Which response would be best?

"I understand you hear a voice. You and I are the only ones in the hall, and I don't hear a voice."

The nurse enters the room of a client with schizophrenia the day after the client has been admitted to an inpatient setting and says, "I would like to spend some time talking with you." The client stares straight ahead and remains silent. Which would be the best response by the nurse?

"You don't need to talk right now. I'll just sit here for a few minutes."

A diagnosis of delusional disorder is based on the presence of one or more nonbizarre delusions for at least what period of time?

1 month

A college freshman is admitted to the hospital with a diagnosis of schizophrenia. Friends reported that the client had been in the client's room for 2 days in a trance-like state, not eating nor speaking to anyone. Which is the priority for this client?

Assessing fluid intake and output

During the nursing assessment, a client describes constantly hearing voices mumbling in the background. The client denies that the voices are telling the client to do anything harmful. The nurse documents that the client is experiencing what?

Auditory hallucinations

A client with schizophrenia is being treated with olanzapine 10 mg daily. The client asks the nurse how this medicine works. The nurse explains that the mechanism by which the olanzapine controls the client's psychotic symptoms is believed to be what?

Blocking dopamine receptors in the brain.

A client with schizoaffective disorder is engaging in an extremely long conversation about a current affairs in the world. The client goes on to provide the nurse with minute details. The nurse interprets this as suggesting what?

Circumstantiality

A nurse is developing a plan of care for a client diagnosed with delusional disorder. Which of the following would the nurse need to keep in mind?

Clients with delusional disorder typically have problems with medication adherence.

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

A nurse is reviewing a journal article about the etiology of schizophrenia.The nurse would expect to find information about the dysfunction of which neurotransmitter? Select all that apply.

Dopamine Glutamine Serotonin Gamma-aminobutyric acid (GABA)

The nurse suspects that a client is experiencing a brief psychotic episode based on what? Select all that apply.

Evidence of hallucinations Intense changes in affect Recent life stressor

Which type of antipsychotic medication is most likely to produce extrapyramidal effects?

First-generation antipsychotic drugs

A psychiatric-mental health nurse is reviewing a journal article about schizophrenia and disorders related to it. The nurse demonstrates understanding of the article by identifying which information as a major factor associated with increasing a person's risk for schizophrenia?

Genetics

A client on the unit suddenly cries out in fear. The nurse notices that the client's head is twisted to one side, the client's back is arched, and the client's eyes have rolled back in the sockets. The client has recently begun drug therapy with haloperidol. Based on this assessment, which would be the first action of the nurse?

Give a PRN dose of benztropine IM

Clients diagnosed with schizophrenia may experience disordered water balance that may lead to water intoxication. Which may occur as a result of water intoxication?

Hyponatremia

A client diagnosed with delusional disorder is experiencing persecutory delusions involving the belief that someone is putting poison in his food. When developing the client's plan of care, which nursing diagnosis would be most likely?

Imbalanced Nutrition, Less than Body Requirements

When preparing a class presentation about schizophrenia, what would the nurse most likely include?

Improvement in symptoms can occur as a client with a history of schizophrenia reaches older adulthood.

Positive symptoms seen in schizophrenia are believed to be a result of which type of neurological dysfunction?

Increased amount of dopamine

A nurse is preparing a presentation for a group of mental health nurses on the staff. The nurse is planning to address the topic of the effect of psychoeducation on schizoaffective disorder. Which of the following would the nurse include as an effect? Select all that apply.

Increased medication compliance Decreased family tension Increased social function

Which of the following would be the most accurate nursing diagnosis within the social domain for a female client with a delusional disorder who is having martial conflict?

Interrupted family processes related to delusional disorder

A nurse assessing a client with schizoaffective disorder should obtain a detailed history with a description of the full range and duration for which of the following reasons?

Is important to predict outcomes

Throughout the assessment, the client displays disorganized thinking, jumping from one idea to another with no clear relationship between the thoughts. The nurse interprets the client's behavior as:

Loose associations

A nurse is reading a journal article about schizophrenia spectrum disorders and theories related to their etiology. Part of the article describes events occurring in utero in which genes involved with cell migration, cell proliferation, axonal outgrowth, and myelination may be affected by neurologic insults such as viral infections. The nurse identifies this as which hypothesis?

Neurodevelopmental

A client with schizophrenia is receiving antipsychotic therapy. The nurse understands that which is a medical emergency should it develop in the client?

Neuroleptic malignant syndrome

All are included in the plan of care for a client with schizophrenia. Which nursing intervention should the nurse perform first when caring for this client?

Observe for signs of fear or agitation.

Delusional disorders are primarily characterized by which of the following? Select all that apply.

Paranoia Jealousy Distrust

During a client interview, a client diagnosed with delusional disorder states, "I know my spouse is being unfaithful to me with a colleague from work."The nurse interprets the client's statements as suggesting which type of delusion?

Persucatory/paranoid

A client with schizophrenia reads the advice column in the newspaper daily. When asked why the client is so interested in the advice column, the client replies, "This person is my guide and tells me what I must do every day." The nurse would best describe this type of thinking as what?

Referential delusion

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?

Relapse

A nurse is caring for a client diagnosed with schizophreniform disorder. The nurse demonstrates understanding of this disorder when identifying that the client is at risk for developing what?

Schizophrenia

When reviewing the diagnostic criteria for schizophrenia based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V), which would be most accurate?

Schizophrenia lasts at least 6 months and includes at least 1 month of two or more characteristic symptoms.

When performing discharge planning for a client who has schizophrenia, the nurse anticipates barriers to adhering to the medication regimen. The nurse assesses which as improving the likelihood that the client will follow the prescribed medication regimen? Select all that apply.

Short-term memory intact Receives monthly disability checks States location of pharmacy nearest the client's residence

All are nursing diagnoses identified for a client with schizophrenia. The student nurse correctly anticipates that which diagnosis will resolve when the client's negative symptoms improve?

Social isolation

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

A client diagnosed with schizophrenia is laughing and talking while sitting alone. Which is the best response by the nurse?

State, "Tell me what's happening."

A client is diagnosed with schizoaffective disorder. The interdisciplinary plan of care includes key family members. The nurse understands that a major reason for doing so involves which of the following?

Strengthening the client's recovery

A client is diagnosed with a delusional disorder. While providing care to the client, the nurse assesses the client's delusions. Which would be least appropriate for the nurse to do?

Try to change the client's delusional belief

When describing the difference between schizoaffective disorder (SAD) and schizophrenia, the nurse would address which as associated with SAD?

increased mood responses

A client is admitted to the psychiatric hospital with a diagnosis of schizophrenia. During the physical examination, the client's arm remains outstretched after the nurse obtains the pulse and blood pressure, and the nurse must reposition the arm. The nurse interprets this as what?

Waxy flexibility

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

A client has a history of schizophrenia, controlled by haloperidol. During an assessment, the nurse notes sudden muscular tension with client's neck being pulled to the side. Which medication would nurse expect to be prescribed for this client?

benztropine mesylate

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?

suicide