Psychotic Disorders

Which characteristics would the nurse expect to see in the client with schizophrenia? 1. Loose associations, grandiose delusions, and auditory hallucinations 2. Periods of hyperactivity and irritability alternating with depression 3. Delusions of jealousy and persecution, paranoia, and mistrust 4. Sadness, apathy, feelings of worthlessness, anorexia, and weight loss

1. Loose associations, grandiose delusions, and auditory hallucinations RATIONALES: Loose associations, grandiose delusions, and auditory hallucinations are all characteristic of the classic schizophrenic client. These clients aren't able to care for their physical appearance. They frequently hear voices telling them to do something either to themselves or to others. Additionally, they verbally ramble from one topic to the next. Periods of hyperactivity and irritability alternating with depression are characteristic of bipolar disorder. Delusions of jealousy and persecution, paranoia, and mistrust are characteristics of paranoid disorders. Sadness, apathy, feelings of worthlessness, anorexia, and weight loss are characteristics of depression.

Teaching for clients receiving an antipsychotic medication such as haloperidol (Haldol) include which instruction? 1. Use sunscreen because of photosensitivity. 2. Avoid sucking hard candy. 3. Have routine blood tests to determine levels of the medication. 4. Abstain from eating aged cheese.

1. Use sunscreen because of photosensitivity. RATIONALES: Antipsychotics such as haloperidol increase photosensitivity; therefore, clients taking these medications should be warned about the possibility of sunburns. Routine blood work isn't necessary. Food restrictions are necessary with monoamine oxidase inhibitors, not antipsychotics such as haloperidol. Chewing sugarless gum and sucking hard candy are recommended to relieve dry mouth.

A client with a diagnosis of delusions of grandeur is admitted to the facility. The client's diagnosis reflects a belief that one is: 1. highly important or famous. 2. being persecuted. 3. connected to events unrelated to oneself. 4. responsible for the evil in the world.

1. highly important or famous. RATIONALE: A delusion of grandeur is a false belief that one is highly important or famous. A delusion of persecution is a false belief that one is being persecuted. A delusion of reference is a false belief that one is connected to events unrelated to oneself or a belief that one is responsible for the evil in the world.

A client is admitted with a diagnosis of delusions of grandeur. This diagnosis reflects a belief that he is: 1. highly important or famous. 2. being persecuted. 3. connected to events unrelated to himself. 4. responsible for the evil in the world.

1. highly important or famous. RATIONALES: A client with delusions of grandeur has a false belief that he is highly important or famous. A delusion of persecution is a false belief that one is being persecuted. A delusion of reference is a false belief that one is connected to events unrelated to oneself or a belief that one is responsible for the evil in the world.

Which information is important for the nurse to include in a teaching plan for a schizophrenic client taking clozapine (Clozaril)? 1. Monthly blood tests will be necessary. 2. Report a sore throat or fever to the physician immediately. 3. Blood pressure must be monitored for hypertension. 4. Stop the medication when symptoms subside.

2. Report a sore throat or fever to the physician immediately. RATIONALES: A sore throat and fever are indications of an infection caused by agranulocytosis, a potentially life-threatening complication of clozapine. Because of the risk of agranulocytosis, white blood cell (WBC) counts are necessary weekly, not monthly. If the WBC count drops below 3,000/μl, the medication must be stopped. Hypotension may occur in clients taking this medication. Warn the client to stand up slowly to avoid dizziness from orthostatic hypotension. The medication should be continued, even when symptoms have been controlled. If the medication must be stopped, it should be slowly tapered over 1 to 2 weeks and only under the supervision of a physician.

For several years, a client with chronic schizophrenia has received 10 mg of fluphenazine hydrochloride (Prolixin) by mouth four times per day. Now the client has a temperature of 102° F (38.9° C), a heart rate of 120 beats/minute, a respiratory rate of 20 breaths/minute, and a blood pressure of 210/140 mm Hg. Because the client also is confused and incontinent, the nurse suspects malignant neuroleptic syndrome. What steps should the nurse take? 1. Give the next dose of fluphenazine, call the physician, and monitor vital signs. 2. Withhold the next dose of fluphenazine, call the physician, and monitor vital signs. 3. Give the next dose of fluphenazine and restrict the client to his room to decrease stimulation. 4. Withhold the next dose of fluphenazine, administer an antipyretic agent, and increase the client's fluid intake.

2. Withhold the next dose of fluphenazine, call the physician, and monitor vital signs. RATIONALES: Malignant neuroleptic syndrome is a dangerous adverse effect of neuroleptic drugs such as fluphenazine. The nurse should withhold the next dose, notify the physician, and continue to monitor vital signs. Although an antipyretic agent may be used to reduce fever, increased fluid intake is contraindicated because it may increase the client's fluid volume further, raising his blood pressure even higher.

A client with schizophrenia hears a voice telling him he is evil and must die. The nurse understands that the client is experiencing: 1. a delusion. 2. flight of ideas. 3. ideas of reference. 4. a hallucination.

4. a hallucination. RATIONALES: 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.