Psych Exam 5

A nurse in an acute care mental health facility is sitting with a client who has schizophrenia. The client whispers to the nurse, "I am being kept in this prison against my will. Please try to get me out." Which of the following responses should the nurse make?

"You feel that you don't belong here?"

A nurse is providing teaching to a client who has schizophrenia and is to begin taking haloperidol. Which of the following information should the nurse include in the teaching?

"You make experience dizziness upon standing while taking this medication."

A nurse is assisting a client who has schizophrenia prepare a relapse plan. Which of the following statements should the nurse make?

"You should keep your provider's and therapist's number with you."

Case managements role

-helps meet needs -used for crisis -aids in money and housing

Benefits of NAMI

offers support, education, resources, and access to other families that are going through similar situations

Paranoid hallucination

perceiving a sensory experience with no external stimuli

Tardive dyskinesia

persistent EPS, involuntary muscular contractions of the tongue, fingers, toes, neck, or pelvis

Positive symptoms

presence of something that is not normally present

Boundary difficulties

pt. stands too close to others pt drinks another beverage and believes it's his

Poverty of thoughts

reduction of quantity of thought where person returns to same idea

Ideas of reference

thinks people near them are talking about them

Looseness of association

thought disorder consisting of a sequence of unrelated ideas

A nurse is preparing to administer clozapine 300 mg PO daily to a client who has schizophrenia. The amount available is clozapine 200 mg tablets. How many tablets should the nurse administer?

1.5 tablets

Antipsychotics classifications

1st, 2nd, 3rd generation

A nurse is caring for a client who has schizophrenia. The client states, "The government is forcing thoughts into my brain through satellites." The nurse should document that the client is experiencing which of the following types of delusions?

Control

Nursing Diagnosis for SMI

Impaired verbal communication Chronic decreased self esteem Powerlessness

A nurse is providing teaching to a client who has schizophrenia and a new prescription for risperidone. Which of the following statements should the nurse include in the teaching?

Increase caloric intake to prevent weight loss

A nurse is assessing a client who has schizophrenia and has been on long term treatment with chlorpromazine. He notes the client is experiencing some involuntary movements of the tongue and the face. The nurse should suspect the client has developed which of the following adverse effects?

Tardive dyskinesia

A community mental health nurse is assessing a client who has schizophrenia. Which of the following findings indicates the client might be relapsing?

The client reports difficulties with sleeping and concentrating.

A nurse is assessing a client who has schizophrenia. Which of the following findings should the nurse identify as a negative manifestation of schizophrenia?

Thought blocking

A nurse is assessing a client who has schizophrenia and is taking risperidone. Which of the following findings should the nurse expect?

Weight gain

A nurse is reviewing the medical record of a client who has schizophrenia and is receiving olanzapine. Which of the following findings should the nurse identify as an adverse effect of olanzapine?

Weight gain of 3 lb in 2 weeks.

A nurse is caring for a client who has severe manifestations of schizophrenia and is medicated PRN for agitation with haloperidol. The nurse should assess the client for which of the following adverse effects?

dysrhythmias

EPS

dystonia, akathesia, parkinsonism, bradykinesia, tremor, tardive dyskinesia

Waxy flexibility

extended maintenance of posture, usually seen in catatonia ex. nurse holds up patient's arm and when nurse stops patient arm is still in the same position.

Delusions

false, fixed beliefs/thoughts

A nurse is caring for a client who has schizophrenia. Which of the following statements by the client indicates concrete thinking?

"I am aware that each problem has only one solution."

A nurse is caring for a client who has schizophrenia. Which of the following statements by the client indicates understanding of a relapse prevention plan?

"I know which of my hallucinations trigger a relapse."

A nurse is providing teaching to a client who has schizophrenia and is receiving chlorpromazine. Which of the following client statements indicates an understanding of the teaching?

"I will contact my provider if I have difficulty urinating."

A nurse is reading the medical record for a client who has schizophrenia which indicates that the client exhibits depersonalization. Which of the following statements by the client confirms that she is experiencing depersonalization?

"My hands and feet are much smaller than they used to be."

A nurse is providing teaching to a client who has schizophrenia about thioridazine. Which of the following instructions should the nurse include in the teaching?

"Report any sign of infection to the provider immediately." This is because thioridazine can cause agranulocytosis.

A nurse is providing teaching for a client who has schizophrenia and a new prescription for fluphenazine. Which of the following information should the nurse provide?

"Sleepiness should subside within a week."

A nurse is talking with a client who has schizophrenia. Suddenly the client states, "I'm frightened. Do you hear that? The voices are telling me to do terrible things." Which of the following responses by the nurse is appropriate?

"What are the voices telling you to do?"

A nurse is caring for a client who has schizophrenia and is experiencing auditory hallucinations. Which of the following responses should the nurse make first?

"What are the voices telling you?"

A nurse is caring for a client who has schizophrenia who consistently does the opposite of what the nurse asks of him. The nurse recognizes this as which of the following alterations in behavior?

Active Negativism

A nurse is performing an admission assessment for a client who has schizophrenia. Which of the following findings should the nurse identify as a negative symptom?

Affective flattening

A nurse in a mental health clinic is conducting a staff education session on schizophrenia. Which of the following manifestations should the nurse identify as negative symptoms?

Anhedonia Blunt Affect

Dangerous responses to antipsychotics

Anticholinergic Toxicity Neuroleptic Malignant Syndrome Agranulocytosis (specifically clozapine)

A nurse is caring for a client who has schizophrenia and is experiencing a hallucination. Which of the following actions should the nurse take?

Ask the client questions about the hallucinations.

A nurse is caring for a client who has schizophrenia and is experiencing a variety of hallucinations. Which of the following hallucinations is the priority for the nurse to address?

Command Hallucination

Interventions for a pt. that is homeless with a hx of nonadherence

Community tx Community services and programs Medications Crisis Hotline Groups (NAMI)

A nurse is planning care for a client who has paranoid schizophrenia. Which of the following interventions should be included in the plan of care?

Check the client's mouth after the client takes medication.

A nurse is preparing to administer the monthly injection of haloperidol decanoate to a client who has schizophrenia. Which of the following action should the nurse plan to take?

Have the client lie down for 30 min after the medication is injected.

A nurse is planning to administer olanzapine 10 mg IM to a client who has schizophrenia. Which of the following actions should the nurse take?

Monitor the client for at least 3 hr after the injection.

A nurse is developing a care plan for a client who has schizophrenia and is taking chloropromazine. Which of the following actions should the nurse include in the plan?

Monitor the client's respirations every 4 hours. (Chlorpromazine can cause resp. depression, dyspnea, and laryngospasm.)

A nurse is assessing a client who has schizophrenia and is taking aripiprazole. The nurse should notify the provider of which of the following findings?

Muscle stiffness

A nurse overhears a client who has schizophrenia talking to herself. The client keeps stating, "The flakalas are here. The flakalas are here." The nurse correctly recognizes the client's use of the word flakala as an example of which of the following alterations in speech?

Neologism

A nurse is caring for a client who has schizophrenia and is having difficulty with performing ADLs. The nurse should consult with which of the following members of the interdisciplinary team to assist the client?

Occupational Therapist

Basis of evaluation of patients progress

Pt is satisfied Health care team estimation of improvement

Possible effects of stigma

Social Problems -individuals expect and fear rejection -victims of crime, rape, and robbery

3rd generation antipsychotics

Stabilizes dopamine Ex. ariprazole

Depersonalization

a feeling body parts do not belong to them or that they are different or unreal

Negative symptoms

absence of something that should be present

Thought broadcasting

believes thoughts are heard by others

Magical Thinking

believing one event happens as a result of another with no link

Example of negative symptoms

blunted affect, poverty of thought, loss of motivation (ex. personal hygiene), loss of motivation, inability to experience pleasure or joy

Schizophrenia

brain d/o that affects thinking, language, emotions, and social behavior.

SMI (Serious Mental Illness)

can be chronic or recurrent pt. is at risk for multiple physical, social, and emotional problems.

Withdrawal as a defense mechanism

comes from negative symptoms

Example of positive symptoms

hallucinations, delusions, disorganized speech, bizarre behavior

Anosognosia

inability to recognize one's deficits due to illness

Life Expectancy for pts with SMIs

increased death potential by 25 years

Dystonia

involuntary muscle contractions that cause repetitive or twisting movements

Neologisms

make up words that have meaning only to the patient

2nd generation antipsychotics (atypical antipsychotics)

works on positive and negative symptoms less EPS and tardive dyskinesia can lead to metabolic syndrome Ex. End in -apine and -done

1st generation antipsychotics

works on postive symptoms ONLY leads to tardive dyskinesia and EPS dopamine antagonists Ex. Haldol and Thorazine