PassPoint - Psychotic Disorders

A charge nurse is educating a new nurse on antipsychotic medications. The charge nurse knows teaching has been effective when the new nurse makes which statement?

"Antipsychotic medication depresses the central nervous system by blocking the postsynaptic transmission of dopamine, serotonin, and norepinephrine."

The nurse is caring for a client on the psychiatric unit. The client states, "The voices are bothering me. They are yelling and telling me stuff. They are really bad." Which responses by the nurse would be most appropriate?

"I do not hear any voices. What are you hearing?"

A client with schizophrenia is responding well to risperidone and is no longer psychotic. After the nurse teaches the client about managing the illness, which statement by the client reflects a need for further intervention?

"I just don't know if I can remember to keep taking medicines every day."

The client tells the nurse that they stopped taking olanzapine 2 weeks ago because they are better and want "to make it on my own without this darned medicine." What would be the nurse's most therapeutic response?

"I know you get tired of taking the medication, especially when you are doing well. Is there any special reason you decided to stop right now?"

The nurse should judge client education regarding valproic acid as effective if the client states which statement?

"I might need to take the valproic acid for a long time."

A client comes to the mental health clinic 2 days after being discharged from the hospital. The client was given a 1-week supply of clozapine. Which client statement indicates an accurate understanding of the nurse's teaching about this medication?

"I need to keep my appointment here at the clinic this week for a blood test."

The parent of a young adult client diagnosed with schizophrenia is asking questions about their child's antipsychotic medication, ziprasidone. Which statement by the parent reflects a need for further teaching?

"I should give them benztropine to help prevent constipation from the ziprasidone."

A nurse is providing education to a client recently diagnosed with schizoaffective disorder. Further teaching is necessary when the client makes which statement?

"I will need to get my blood drawn daily to check the levels of the antipsychotic medications."

A nurse is caring for a client receiving thioridazine 300 mg TID. It would be most important for the nurse to follow up with which client statement?

"My eye doctor said I have a new pigmented layer on my retina."

A client diagnosed with schizophrenia is being switched to risperidone long-acting injection. The client is told that they will remain on an oral dose of risperidone daily for approximately 1 month. The client says, "I didn't have to take pills when I was on fluphenazine shots in the past." What should the nurse tell the client?

"Risperidone initially takes a little longer to reach the ideal blood level."

The parents of a 20-year-old client admitted 4 days ago with a diagnosis of paranoid schizophrenia are attending a family psychoeducation group in the hospital. Which statement indicates that the parents understand their child's illness and management?

"Tasks as simple as getting out of bed and showering in the morning may be difficult."

A client is admitted to the psychiatric unit with delusional thinking. The client, who is overweight and has a history of eating when stressed, now shows a lack of interest in eating at meal times. The client states, "I am unworthy of eating. My children will die if I eat." Which response by the nurse is most appropriate?

"That sounds scary. Tell me more about how you are feeling."

A nurse is caring for a client with schizophrenia whose symptoms are managed with medications. The client reports feeling so well that the medications are no longer needed.. Which response indicates that the nurse understands the client's diagnosis?

"The medications are helping you. If you suddenly stop taking them, you could get sick again."

A new nurse is leading a family education group for those who have relatives with paranoid schizophrenia. Which statement by the new nurse indicates the need for further teaching about symptom management?

"The more we push the clients to spend time with friends, the more the voices that they're hearing decrease."

A client who is incoherent and agitated comes to the emergency department. The client reports visual and auditory hallucinations. The healthcare provider orders haloperidol, 5 mg IM. When educating the client on this medication, which statement by the nurse is correct?

"This medication will help decrease your tension and agitation."

A client with schizophrenia and delusions tells a nurse, "There is a man wearing a red coat who's out to get me." The client exhibits increasing anxiety when focusing on the delusion. Which response by the nurse is appropriate?

"This subject seems to be troubling you. Let's walk to the activity room."

During the initial interview, a client with schizophrenia suddenly turns to an empty chair and whispers, "Now just leave. I told you to stay home. There isn't enough work here for both of us!" What is the nurse's best initial response?

"When people are under stress, they may see things or hear things that others don't. Is that what just happened?"

A 20-year-old client with paranoid schizophrenia is on the fourth day of hospitalization. The client's parents visit and state to the nurse, "What did we do wrong? What caused this awful thing to happen?" Which explanation by the nurse is most accurate and therapeutic?

"You did not cause schizophrenia by doing something wrong. Schizophrenia is a brain disease."

Which concept is most important for a nurse to communicate to a client preparing to sign an informed consent for electroconvulsive therapy (ECT)?

"You may experience a time of confusion after the treatment."

A nurse is caring for an adolescent with paranoia who attempted to stab a family member. The client reports hearing voices but stabilizes after receiving haloperidol. The client's caregiver states, "There have been troubles in the past, but my child is a good person. Can I take my child home now?" Which response by the nurse is most appropriate?

"Your child is taking a very powerful medication and needs careful monitoring."

A client, diagnosed with Alzheimer's disease, is a new resident in a long-term care facility. The client has difficulty finding their room and is seen wandering into the room of others. When discussing the situation at a multidisciplinary conference, which client centered actions would the nurse suggest? Select all that apply.

-Ensure that the client has prescribed hearing aids and glasses on throughout the day. -Place a box with familiar personal items outside the client's door for visual recognition. -Assign the client to a room close to the nursing station for closer monitoring. -Provide verbal cueing as to where the client's room is located.

The nurse is admitting a 26-year-old male client into the inpatient mental health unit. The nurse is admitting a 26-year-old male client to the inpatient mental health unit after being assessed in the emergency department for suicidal ideation and alcohol intoxication. The client told police, "I want to die!" The client has a history of substance abuse and spent time in prison for criminal conduct. Client admits to having been abused as a child by a parent. Client further reports a positive history of animal abuse and domestic violence. Client is refusing to cooperate with the rest of admission process.

-Implement safety/suicide precautions -Assess client's substance abuse history -Antisocial personality disorder -Suicidal thoughts -Signs and symptoms of alcohol withdrawal

A 42-year-old female who comes to the clinic frequently for symptoms of neck pain is upset because there is no medical cause for the discomfort. Select the intervention(s) the nurse would take to help meet the client's needs.

Acknowledge the client's pain Ask what helps relieve the pain Review activities to use as a distraction Encourage participation in groups of interest

A client is admitted after the police found the client sleeping in a car for three nights. The client says, "My spouse kicked me out and is divorcing me. It wasn't my fault I was fired from work. My spouse and boss are plotting against me because I'm smarter than they are." The client then pounds the table and says, "I'm not staying here, and you can't stop me." What should be included in the client's immediate plan of care? Select all that apply.

Anxiety and anger management. Assault and escape precautions.

A nurse is caring for a client with schizophrenia who experiences auditory hallucinations. The client appears to be listening to someone who isn't visible. The client gestures, shouts angrily, and stops shouting in mid-sentence. Which nursing intervention is appropriate?

Ask the client to describe what the voices are saying while making it clear the nurse doesn't hear the voices.

An agitated client diagnosed with schizophrenia and the client's family arrive in the psychiatric unit for admission. Which action should the nurse perform first?

Assess the client's risk for suicide, homicide, or other violent behavior.

A client is sitting in the dining area and laughing out loud, shaking her head, and whispering behind her hand. Suddenly the client begins banging her head against the wall. Which intervention by the nurse is most appropriate?

Calmly walk over to the client and say, "Tell me what's going on."

A nurse is caring for a client receiving a dopamine receptor agonist for treatment of extrapyramidal symptoms caused by antipsychotic medications. What evaluation would indicate a therapeutic response to this drug?

Client experiences a decrease in dystonia.

Teaching for women of childbearing years who are receiving antipsychotic medications includes which statement?

Continue previous contraceptive use even if you're experiencing amenorrhea.

The client diagnosed with borderline personality disorder who is to be discharged soon threatens to "do something" to themself if discharged. What action should the nurse take first?

Discuss the meaning of the client's statement with them.

A client's admitting diagnosis is schizophrenia with an episodic delusional disorder. The nurse applies what intervention strategy while working with the client in this pronounced delusional state?

Focus on the client's underlying feelings, and redirect inappropriate responses.

What action should the nurse take when a client with a diagnosis of schizophrenia walks into group naked?

Lead the client to their room and help him dress if they need assistance.

The nurse is working in a community mental health clinic. A client who is diagnosed with schizophrenia is taking clozapine and reports of a sore throat. What is the most appropriate action for the nurse to take?

Obtain an order for the client to have a white blood cell count drawn.

A nurse is monitoring a client who appears to be hallucinating. The client is gesturing at a figure on the television and appears agitated with speech containing paranoid content. Which nursing interventions are appropriate at this time? Select all that apply.

Reassure the client that there is no danger. Acknowledge the presence of the hallucinations. Give simple commands in a calm voice.

The nurse is monitoring a client who appears to be hallucinating. The client displays paranoid speech content, seems agitated, and gestures at a figure on the television. Which nursing interventions are appropriate? Select all that apply.

Reinforce that the client is not in any danger. Acknowledge the presence of the hallucinations. Use a calm voice and simple commands.

Which information is important for a nurse to include in a teaching plan for a client with schizophrenia who is taking clozapine?

Report a sore throat or fever to the physician immediately.

After assessing the blood pressure of a client with a diagnosis of catatonia, the client's arm remains outstretched in an awkward position. Which of the following is the correct action by the nurse?

Reposition the client's arm.

A nurse is teaching a client about the prescribed drugs, chlorpromazine and benztropine. What evaluation would indicate a therapeutic response to these drugs?

The client is experiencing less psychosis and a decrease in extrapyramidal symptoms.

A client was admitted to the behavioral health unit with a diagnosis of severe depression. The client was started on bupropion. Forty-eight hours after initiating the drug therapy, the client has recovered from depression, is laughing, singing, and dancing in the hallway and in the sitting room. How should the nurse interpret this behavior?

The client is most likely bipolar rather than depressed, and the healthcare provider should be notified of the behavior.

A nurse is caring for a client with schizophrenia. Which outcome requires revising the client's care plan?

The client spends more time alone.

A client with a tentative diagnosis of psychosis is admitted to the psychiatric unit. A physician orders the phenothiazine thioridazine 50 mg by mouth three times per day. Phenothiazines differ from central nervous system (CNS) depressants in their sedative effects by producing:

a calming effect from which the client is easily aroused.

A client has refused to take a shower since being admitted 4 days earlier and tells a nurse, "There are poison crystals hidden in the showerhead. They'll kill me if I take a shower." Which nursing action is most appropriate?

accepting these fears and allowing the client to take a sponge bath

A client who was prescribed clozapine 2 months ago arrives in the clinic and informs the nurse that the they have been feeling extremely fatigued and feverish and has a sore throat. The nurse observes that the client has two small ulcerations of the oropharynx. Which does the nurse suspect may be occurring with this client?

agranulocytosis

A client with schizophrenia becomes angry and tells a nurse to leave. The nurse should:

agree to leave but explain the nurse will return soon.

A client diagnosed with schizophrenia is brought to the hospital from a group home where they became agitated, threw a chair at another client, and have been refusing medication for 8 weeks. The client exhibits a flat affect, is not caring for their hygiene, and has become increasingly withdrawn and asocial. The health care provider prescribes treatment with risperidone to improve the client's negative and positive symptoms of schizophrenia. When evaluating the drug's effectiveness on the client's negative symptoms, the nurse should expect improvement in which symptoms?

apathy, affect, social isolation

A client is unable to get out of bed and get dressed unless a nurse prompts every step. This is an example of which behavior?

avolition

During a home visit for a client diagnosed with paranoid schizophrenia and discharged 1 week ago, the client's parent tearfully states, "I can hardly sleep because I'm so worried about my child. I'm afraid to leave them alone in the house. What if something happens while I'm gone?" Which caregiver problem would be the most inclusive one for the nurse to incorporate into the client's plan of care?

caregiver role strain

A nurse working on a psychiatric unit is checking orders on a newly admitted client diagnosed with schizophrenia. An order reads, "thioridazine 200 mg PO qid and 100 mg PO prn." Before this drug is administered, which should be the nurse's priority action?

checking accuracy of the order

A client has been admitted to the emergency department. The client's family tells the nurse that the client has suddenly become lethargic and is "not making sense." The client has not had anything to eat or drink for the last 8 hours. The nurse further assesses the client using the Confusion Assessment Method (CAM). The client's responses to the questions are rambling, and the client is not able to focus clearly to answer the nurse's questions. Based on these findings, the nurse should report that the client has which problem?

delirium

When caring for a client receiving haloperidol, the nurse should assess for which problem?

extrapyramidal symptoms

The client with borderline personality disorder spends much time around the nurse's station, making numerous minor requests. The nurse interprets these behaviors as indicating which factor?

fears of abandonment and attention seeking

A client experiencing a schizophrenic episode is hospitalized. The client is attempting to hit and bite the staff. When the nurse phones the primary care provider for orders to help calm the client, the nurse anticipates what medication is likely to be ordered?

haloperidol

A nurse is caring for a client admitted with arching of the back, extension and rotation of the neck, and slow involuntary contractions of the arms and neck. After review of the client's medication list, the nurse would be correct in associating these symptoms with which medication?

haloperidol

A nurse is reviewing the medication list of a client who presents with slow, involuntary muscle spasms of the arms and legs and twisting of the neck. The nurse reviews the client's prescriptions for which medication that could correlate with these symptoms?

haloperidol

A nurse knows that a physician has ordered the liquid form of the drug chlorpromazine rather than the tablet form because the liquid:

has a more predictable onset of action.

During group therapy, a client constantly interrupts with impulsive behavior and exaggerated stories that cast the client as a hero. The client also manipulates the group with attention-seeking behaviors, such as sexual comments and angry outbursts. The nurse assesses that these behaviors are best correlated with which diagnosis?

histrionic personality disorder

The nurse cares for a client experiencing delirium. What intervention is essential to include in the plan of care?

identifying the underlying causative condition or illness

Which behavior indicates to the nurse that a client diagnosed with avoidant personality disorder is improving?

interacting with two other clients

Which clinical manifestation should alert the nurse to lithium toxicity?

lethargy and weakness with vomiting

A client with schizophrenia reports hearing the voices of the client's dead parents. To help the client ignore the voices, the nurse should recommend that the client:

listen to a personal stereo through headphones and sing along with the music.

A client diagnosed with paranoid personality disorder is hospitalized for physically threatening their spouse because they suspect the spouse is having an affair with a coworker. What approach should the nurse employ with this client?

matter-of-fact

A nurse is assigned to a client with catatonic schizophrenia. Which intervention should the nurse include in this client's care plan?

meeting all of the client's physical needs

A client who's taking antipsychotic medication develops a very high temperature, severe muscle rigidity, tachycardia, and rapid deterioration in mental status. What complication of antipsychotic therapy does the nurse suspect?

neuroleptic malignant syndrome

A client is admitted with a diagnosis of schizotypal personality disorder. Which signs would this client exhibit during social situations?

paranoid thoughts

A 20-year-old client diagnosed with paranoid schizophrenia is recovering from the first psychotic break. Before discharge from the hospital, the client becomes depressed and states, "I don't want this illness. I'm about to begin my junior year in college." Which issue would be most important for the nurse to address at this time?

potential for medication noncompliance

A client is brought to the hospital by the spouse, who states that the client has refused all meals for the past week and accused the spouse of trying to poison the client. During the initial interview, the client's speech, only partly comprehensible, reveals that the client's thoughts are controlled by delusions that the client is possessed by the devil. A health care provider diagnoses paranoid schizophrenia. Paranoid schizophrenia is best described as a disorder characterized by:

preoccupation with persecutory delusions, anxiety, anger, and potential for violence.

A client's medication order reads, "Thioridazine 200 mg P.O. q.i.d. and 100 mg P.O. PRN" A nurse should:

question the physician about the order.

A client has a history of schizophrenia. Because of a history of noncompliance with antipsychotic therapy, the client will receive fluphenazine decanoate injections every 4 weeks. Before discharge, what should the nurse include in the teaching plan?

sitting up for a few minutes before standing to minimize orthostatic hypotension

A client with schizophrenia tells the nurse, "My intestines are rotted from the worms chewing on them." This statement indicates a:

somatic delusion.

A nurse is preparing for the discharge of a client who has been hospitalized for schizophrenia. The client's spouse expresses concern over whether the client will continue to take daily ordered medication. The nurse should inform the spouse that:

the client can be given a long-acting medication that is administered every 1 to 4 weeks.

When discharging a client after treatment for a dystonic reaction, an emergency department nurse must ensure that the client understands:

the client must take benztropine as ordered to prevent a return of symptoms.