Schizo Spectrum Disorders & Psychosis

A client who has schizophrenia shares with their nurse that they are feeling lonely and isolated. Which of the following actions is the nurse's priority? Share information about support groups for people who have serious mental illness (SMI). Teach the client stress reduction techniques so they feel more in control of their social situation. Help the client focus on recovery so that their relationships can improve down the road. Suggest adding another type of treatment for the client.

Share information about support groups for people who have serious mental illness (SMI). Support groups can help clients who have SMIs reduce feelings of isolation and loneliness. Providing information about support groups that the client could join and benefit from is the priority nursing action.

A nurse is instructing a client who is experiencing hallucinations about medication use. Which of the following statements should the nurse make? "Over-the-counter medications generally do not cause hallucinations." "Both prescription and over-the-counter medications can sometimes cause hallucinations in some people." "Hallucinations from medication are extremely rare." "Hallucinations are only caused by acute toxicity from a medication."

"Both prescription and over-the-counter medications can sometimes cause hallucinations in some people." Both prescription and over-the-counter medications have been reported to cause hallucinations in some people.

A nurse is caring for a client who has been diagnosed with schizophrenia. The client is exhibiting delusional behavior stating that a new nurse is from the FBI and is stealing their thoughts and ideas. Which of the following statements should the nurse make? "Wow, since the FBI is involved now, you are safe. Tell me more about the FBI wanting to take your thoughts." "Don't worry, you are perfectly safe. The walls and ceiling are lined with lead and can't be penetrated." "You should stop these thoughts because they are making things worse for you. Take a deep breath." "I can see you are very concerned. The new nurse is not from the FBI and will not harm you."

"I can see you are very concerned. The new nurse is not from the FBI and will not harm you." Acknowledging the client's experience and making observations about the client's feelings, as well as stating who the new nurse is and reassuring the client that the nurse will not hurt them, provides a connection to what is real. This is the most appropriate response.

A nurse at a community treatment center asks a client about their use of prescription anti-psychotic meds. that should be taken daily. Which of the following client statements should suggest to the nurse that the client is not adhering to their medication treatment plan? "I sometimes go a few days without taking my medication." "I take my medication at a different time every day." "I sometimes forget to take my medication with food like it says to on the bottle." "I don't usually refill my medication until I'm down to the last dose or two."

"I sometimes go a few days without taking my medication." Treatment nonadherence involves not taking medication as prescribed. If a client is prescribed a medication for daily use and doesn't take the medication every day, this should indicate to the nurse that the client is experiencing non adherence.

A nurse is providing information about hallucinations to a client who has schizophrenia. Which of the following statements should the nurse make? "It is a belief that something is real when in reality it is not." "It is when behaviors that you typically display are abnormally absent." "It is when you see or hear things that others are not experiencing." "It is when you experience symptoms that affect your memory."

"It is when you see or hear things that others are not experiencing." Hallucinations are seeing or hearing things that others are not experiencing. The nurse should include this statement when providing information about hallucinations to a client who has schizophrenia.

A nurse is talking with a client about mental health care and services. The client asks, "What is the difference between psychosis and schizophrenia?" Which of the following responses should the nurse make? "Psychosis describes conditions where a person loses contact with what is real. Schizophrenia is a mental health illness where the person can show manifestations of psychosis." "Psychosis and schizophrenia are the same thing, and most providers use these terms interchangeably." "Psychosis is a mental health disorder which includes manifestations of schizophrenia, delirium, and hysteria." "Schizophrenia is a type of multiple personality disorder in which a person displays psychosis or illogical thoughts or beliefs."

"Psychosis describes conditions where a person loses contact with what is real. Schizophrenia is a mental health illness where the person can show manifestations of psychosis." Psychosis describes conditions where a person loses contact with what is real. Schizophrenia is a mental health illness where the person can show manifestations of psychosis.

A nurse is caring for a client who has schizophrenia. Which of the following questions should the nurse ask during the exploitation phase of the nurse-client relationship? "Which stress reduction techniques are you finding helpful alongside your medication?" "When would you like your first appointment to take place?" "Do you have any religious or cultural beliefs that should I be aware of to support you?" "Do you feel safe in your home environment?"

"Which stress reduction techniques are you finding helpful alongside your medication?" During the working phase, or the exploitation phase, the nurse and client should discuss interventions, such as stress reduction techniques and medications, that the client is using in their treatment.

A nurse is talking with the family of a 28-year-old client who has been diagnosed with schizophrenia. The client's patient asks, "Will my child ever be able to have a good quality of life?" Which of the following responses should the nurse make? "With treatment and support your child will be able to live a productive and rewarding life." "Your child will require care and treatment for the remainder of their life." "I see this is difficult for you. It really depends on if your child responds to treatment."

"With treatment and support your child will be able to live a productive and rewarding life." Although schizophrenia is a chronic mental health disorder, clients can live a productive life with treatment and support. Like other chronic health disorders, they may experience symptoms and require support or assistance.

A nurse is speaking with a client about the potential impact of living with a serious mental illness. Which of the following pieces of information should the nurse share? Having a job is positively associated with recovery from serious mental illness (SMI). The stigma over SMIs has improved dramatically in recent years in the United States. Males who have SMIs are more likely to be victimized than females who have SMIs. Once housing is secured, clients who have SMIs generally do not have issues with housing insecurity.

*Having a job is positively associated with recovery from serious mental illness (SMI).* While there are many factors that contribute to recovery and reduction of manifestations, employment is positively associated with recovery. Having a job can make it more likely for someone to be able to afford treatment, have insurance, and have stable housing, which all contribute toward better outcomes.

A nurse is caring for a client who has schizophrenia. Which of the following should the nurse identify as a social determinant of health for the client? Health history Ability to take oral medications Adherence to the medication regimen Access to healthy foods

Access to healthy foods Healthy foods are one social determinant of health that a nurse might identify. Having access to healthy foods can reduce stress. It can also reduce the chance that the client will develop comorbidities that could impact their care.

A nurse is caring for a client who has schizophrenia and is unaware of their own mental health. Which of the following is the client experiencing? Catatonia Anosognosia Tardive dyskinesia Seizure

Anosognosia - Anosognosia is when someone is either unaware or can't accurately perceive their own mental health. This client is experiencing anosognosia. A- A client who has schizophrenia can experience catatonia, or an abnormality of movement, but this doesn't affect the client's awareness of their own mental health. C- Tardive dyskinesia involves uncontrolled movements around the mouth. This does not affect the client's awareness of their own mental health. D- A seizure is a physical condition that can be an adverse effect of medication or related to something else. This client is not experiencing a seizure.

A nurse is caring for a young adult client who experienced a traumatic event and appears to be hallucinating. The client has no history of or evidence of risk factors for schizophrenia spectrum disorders and the client's toxicology screen is negative. Which of the following diagnoses provided the best explanation of this client's clinical manifestations? Brief psychotic disorder Delusional disorder Late-onset schizophrenia Shared psychotic disorder

Brief psychotic disorder - A brief psychotic event can be triggered by a very stressful or traumatic event. B- A delusional disorder occurs when a client experiences delusions, or events that are not really occurring. C- Late-onset schizophrenia occurs later in life, around age 40, and a client manifests psychosis symptoms. D- A shared psychotic disorder occurs when a client develops psychosis symptoms when closely interacting with a person who has a psychotic disorder.

A nurse is reviewing assessment findings for a 22-year-old client who was found wandering in the street. Which of the following manifestations suggests the client is experiencing positive symptoms of psychosis? Clanging speech Positive toxicology screen for opioids Flat affect Large bruise to right side of face

Clanging speech - Clanging speech reflects disorganized thought and speech patterns. This is a positive symptom of psychosis. B- A positive toxicology screening shows that a substance is affecting the client, but this is not considered a positive symptom of psychosis. C- Flat affect is a negative symptom of psychosis. This is an important finding for the client's overall mental health suggesting further evaluation is needed. D- A large bruise is an important finding suggesting injury and should be further investigated but is not a positive symptom of psychosis

A nurse is caring for a client who is being evaluated for schizophrenia spectrum disorder. Which of the following is used to determine a diagnosis for schizophrenia? Reality testing Laboratory testing Neurological imaging Clinical observation

Clinical observation There is no laboratory test that can provide a definitive diagnosis of schizophrenia, so observation and ruling out other medical conditions and substance exposure provides diagnosis. A- aware of their hallucinations or delusions B- used to rule out other medical conditions or substance exposure. C- evidence that supports schizophrenia spectrum disorders in the brain, this testing is not used to make a diagnosis.

A nurse is caring for a client who has been diagnosed with schizophrenia. Which of the following findings indicates that the client is in the residual phase of the disorder? No longer showing any noticeable negative symptoms Experiencing regular hallucinations and delusions Extended periods of disorganized thought and speech Decline in symptoms of psychosis

Decline in symptoms of psychosis - A nurse should expect a client who is in the residual phase of schizophrenia to exhibit less severe and regular psychotic symptoms. A- A nurse should expect a client to exhibit negative symptoms during the residual phase. Positive symptoms may occur but will be less severe. B- These symptoms are expected during the active phase. During the residual phase, less severe positive symptoms can be present and negative symptoms are common. C- A nurse should expect a client who is in the active phase to exhibit periods of disorganized thought and speech. These behaviors lessen during the residual phase.

A nurse is caring for a client who has schizophrenia. Which of the following describes the physiological changes caused by exposure to risk factors for this disorder? Increased volume in the hippocampus of the brain Decreased gray matter volume in the brain Structural changes in the part of the brain that regulates impulse control Increased volume of the frontal cortex

Decreased gray matter volume in the brain Decreased brain volume including gray matter are evident in persons with schizophrenia. These brain changes include the structural changes in connective tissue and reduction of brain volume in gray matter, prefrontal cortex, and temporal cortices.

A nurse is caring for a client who is experiencing psychosis and states that they are the president of the United States. The nurse should identify that the client is experiencing which of the following? Visual hallucinations Auditory hallucinations Disorganized speech Delusions

Delusions The nurse should identify that the client is experiencing delusions. Delusions are false beliefs that a client might have that cannot be influenced by logic.

A nurse working in a community health center is providing an in-service to a group of residents about schizophrenia. Which of the following should the nurse include as an environmental risk factor for this condition? Living in a rural community Experiencing poverty Smoking cigarettes Managing extreme weather conditions

Experiencing poverty Low socioeconomic status is an environmental risk factor associated with schizophrenia. As a result of living below the poverty line, clients lack adequate resources for medical and psychological issues, housing, and food. A- risk for developing schizophrenia C&D- Environmental factors for developing schizophrenia include living below the poverty line, where clients lack adequate resources for medical and psychological issues, housing, and food.

A nurse is caring for a client who has been diagnosed with schizophrenia. Which of the following should the nurse identify as a positive symptom? Alogia Hallucination Avolition Anhedonia

Hallucination The nurse should identify hearing things that are not real can be part of a hallucination. Hallucinations are a positive symptom of schizophrenia. Other positive symptoms can include paranoia, and distorted beliefs and perceptions. A- not speaking to anyone (-) C- lack of motivation (-) D- inability to find pleasure (-)

A nurse is caring for a client who has major depressive disorder. Which of the following findings should indicate to the nurse that client is experiencing psychosis? Depressed mood Anxiety symptoms Mania Hallucinations

Hallucinations - Hallucinations occur during a major depressive mood episode. A- Major depressive disorder is characterized by a depressed mood without psychosis. B- Clinical manifestations of anxiety can be present with major depressive disorder but do not indicate psychosis. Clinical manifestation of anxiety is not a positive nor a negative symptom of psychosis. C- Symptoms of mania only occur during major mood episodes of bipolar disorder.

A nurse is providing education to a group of staff members about risk factors for schizophrenia. Which of the following risk factors should the nurse include? Having a twin sibling who has the disorder History of seasonal allergies Living in a rural community Raised in a middle-class income family

Having a twin sibling who has the disorder A client who has a twin who has schizophrenia is at risk for developing schizophrenia. Studies have shown that twins have a heritability of schizophrenia of around 60% to 80%. The nurse should include this risk factor when educating staff members.

A nurse is caring for a client who is experiencing psychosis. Which of the following manifestations should the nurse identify as a positive symptom of schizophrenia? Flat affect Hearing voices Difficulty concentrating Withdrawn socially

Hearing voices The nurse should identify that hearing voices is considered a hallucination for a client experiencing psychosis. Hearing voices is a positive symptom of schizophrenia. Other positive symptoms include paranoia, distorted beliefs, and distorted perceptions. Negatives - Withdrawn socially, Difficulty concentrating, Flat affect, lack of motivation, lack of interest, lack of energy, withdrawal from others, absence of speech, difficulty processing information, the inability to make decisions, memory problems, diminished facial expressions & pleasure

A nurse is caring for a client who has an SMI and has been recently released from prison. Which of the following factors related to being released from prison increases the client's risk of relapsing? Experiencing medication adverse effects Inability to find housing Continued physical impairment Being the victim of a violent crime

Inability to find housing - Clients who have recently been released from prison can struggle to secure housing and employment. These risk factors can increase the client's chance of relapsing after release. A- While adverse effects from medications can increase the risk of nonadherence, which can then lead to relapses, this risk factor is not related to being recently released from prison. C- While physical impairments can lead to nonadherence which can increase the risk of relapse, this is not directly related to being recently released from prison. D- Clients with an SMI are more likely to be a victim of violent crime. However, this not a risk factor for relapse it is an example of disparity experienced by persons who have a serious mental illness.son.

A nurse is caring for a client in a VA facility. The nurse should first address the client's ____ due to _____. Personal Relationships Fear of Strangers Living situation Perception of self Access to meds - Esteem needs Safety needs Love & Belonging needs Self-actualization needs Physiological needs

Living situation - Psychological needs The greatest risk to the client is the lack of adequate shelter. According to Maslow's hierarchy, the most basic needs are physiological needs, such as food, water, air, and shelter. These needs must be met before the client can progress further up the hierarchy and improve self-functioning. The client's current living situation does not meet the physiological need of shelter as evidenced by the frostbite the client experienced.

A nurse is caring for a client who has schizophrenia. The client states, "My health care provider indicated that I likely got schizophrenia due to complications experienced in utero." Which of the following risk factors is this complication linked to? Genetics Physiological Biochemical Environmental

Physiological Physiological risk factors for the development of schizophrenia include complications experienced in utero. These risk factors include complications which occur during pregnancy such as hypoxia, prenatal stress, infection, inadequate nutrition, or gestational diabetes.

A nurse is evaluating a client for schizophrenia and asks the client about their work, social, and home life. For which of the following reasons should the nurse ask about these topics? To gather information that assists in billing To gather criteria to be included in the client's relapse prevention plan To gather insight into the client's background in order to guide care To gather standard information during the exploitation phase of the client-nurse relationship

To gather insight into the client's background in order to guide care Information provides insight into the full client history and is used to guide client-centered and compassionate holistic nursing care and to understand the client's experiences.

A nurse is caring for a client who has schizophrenia. Which of the following findings should the nurse identify as a cognitive symptom? Unable to express emotions Hearing voices Unable to concentrate Withdrawing from social situations

Unable to concentrate - The nurse should identify an inability to concentrate as a cognitive symptom of schizophrenia. Other cognitive symptoms can include the inability to remember and difficulty learning. A- Inability to express emotions is a negative symptom of schizophrenia. Other negative symptoms can include lack of motivation, lack of interest, and lack of energy. B- Hearing voices is part of a hallucination, which is a positive symptom of schizophrenia. Other positive symptoms can include delusions and changes in thoughts and behaviors. D- Withdrawing from a social situation or other people is a negative symptom of schizophrenia. Other negative symptoms can include lack of motivation, lack of interest, and lack of energy.

A nurse is caring for a client who is at risk for developing schizophrenia. Which of the following findings should the nurse identify as an environmental risk factor? Tobacco use Drinking alcohol Exposure to lead Using cannabis

Using cannabis Using cannabis is an environmental risk factor for individuals who are genetically or otherwise predisposed to developing schizophrenia.

A nurse is providing discharge instructions for a client who is prescribed clozapine. Which of the following information should the nurse include? The medication only treats negative symptoms. The medication takes full effect in one week. Weekly blood draws will need to be done while taking this medication. The medication requires the monitoring of red blood cells.

Weekly blood draws will need to be done while taking this medication. - It is critical that the nurse discuss the need for weekly blood draws. Clozapine can cause agranulocytosis and place the client at risk for infection. The client should report manifestations of infection to the provider immediately. A-Many of the medications for schizophrenia, including clozapine, treat both negative and positive symptoms. The nurse should provide information about both types of symptoms when discussing the medication. B- When discussing how long a medication takes to reach full effect, the nurse should inform the client that it could take up to six weeks for the medication to fully engage. D- Clozapine requires frequent monitoring of white blood cells. This is because clozapine can cause agranulocytosis, which creates changes in the number of white blood cells present, but not red blood cells.

The nurse is reviewing the client's medical record. Select the "3" findings that require immediate follow-up by the nurse. Temperature Stupor-like state Restlessness Muscle Rigidity Appetite

When analyzing cues, the nurse should identify that the *client's temperature, stupor-like state, and muscle rigidity* require immediate follow-up by the nurse. The client's temperature, which is outside the expected reference range, can be related to the client's level of catatonia due to infection or another related issue, which can lead to blood coagulation, pneumonia, or organ failure; therefore, this finding requires immediate follow-up by the nurse. The nurse should identify the client is experiencing stupor-like state by lying in bed unable to move with eyes open and staring; therefore, this finding requires immediate follow-up by the nurse. The nurse should identify the client is experiencing muscle rigidity by lying in bed unable to move with eyes open and staring in a catatonic state; therefore, this finding requires immediate follow-up by the nurse.