Schizophrenia Prep U
In working with the individual and family, which is the most accurate statement the nurse can make in order to teach the client and family about schizophrenia? "Individuals with schizophrenia do have differences in brain structure and function that cause a variety of symptoms such as lack of motivation and hearing voices." "Schizophrenia is being found to be related more closely to family dysfunction than to physiology, which is why family therapy is the most effective treatment for this disorder." "Medications for schizophrenia have not changed much since the early 1950s, although there are some medications that may be helpful." "It is more effective to treat the individual on a one-to-one basis than to involve the family in treatment because it is a very complicated process."
"Individuals with schizophrenia do have differences in brain structure and function that cause a variety of symptoms such as lack of motivation and hearing voices." Excessive amount of the neurotransmitter dopamine allows nerve impulses to bombard the mesolimbic pathway, the part of the brain normally involved in arousal and motivation.
When assuming the management of the care of a delusional client, which should be the nurse's priority intervention? Assure the client that he or she is safe in this milieu Acknowledge that there may be some truth in the delusion Encourage the client to talk about the reasoning behind his or her delusion Identify what triggers the delusion
Assure the client that he or she is safe in this milieu
A client diagnosed with delusional disorder who uses excessive health care resources most likely has which type of delusions? somatic jealous erotomanic grandiose
somatic
A nurse teaching a client about prescribed antipsychotic medication informs the client to contact a health care provider immediately if the client notices: An increase in weight of 2 lbs in 1 month. A feeling of dizziness when the client stands up. An increase in thirst. A dramatic change in temperature.
A dramatic change in temperature.
Which client exhibits the characteristics that are typical of the prodromal phase of schizophrenia? A 25-year-old does not express any of the symptoms of schizophrenia. A 20-year-old is experiencing a gradual decrease in the ability to concentrate, be productive, and sleep restfully. A 30-year-old has experienced a relapse after deciding that the client's atypical antipsychotic is unnecessary. A 28-year-old has been displaying the behaviors characteristic of schizophrenia for many months and has just been diagnosed with the disease.
A 20-year-old is experiencing a gradual decrease in the ability to concentrate, be productive, and sleep restfully.
The experienced psychiatric nurse shares with the novice nurse that effective nursing care for the delusional client depends on what? Select all that apply. Being relaxed during frequent client-nurse interactions Expecting the client to adhere to all unit rules Managing the milieu so as to minimize situations that will frustrate or anger the client Remaining in confrontation with the client until the delusions are neutralized Supporting the delusion only when the client is extremely agitated
Being relaxed during frequent client-nurse interactions Expecting the client to adhere to all unit rules Managing the milieu so as to minimize situations that will frustrate or anger the client
Which medication is used to control the extrapyramidal effects associated with antipsychotic medications? Benztropine Chlorpromazine Haloperidol Thioridazine
Benztropine Benzotropine is an anticholinergic drug used to relieve drug-induced extrapyramidal adverse effects, such as muscle weakness, involuntary muscle movement, pseudoparkinsonism, and tardive dyskinesia.
Which medication is used to control the extrapyramidal effects associated with antipsychotic medications? Benztropine Chlorpromazine Haloperidol Thioridazine
Benztropine Haloperidol is a typical antipsychotic. Ziprasidone, clozapine, and paliperidone are atypical antipsychotics.
A nurse is preparing to document information obtained from a client diagnosed with a delusional disorder who is experiencing somatic delusions. Which would the nurse most likely document? Disorientation Reduced attention span Above average intelligence Body complaints
Body complaints
A client with a persistent delusional disorder has been prescribed ziprasidone. Which assessment should the nurse prioritize when this medication regimen begins? Cardiac and neurological assessments Respiratory assessment including oxygen saturation Monitoring of fluid and electrolyte levels Integumentary and gastrointestinal assessments
Cardiac and neurological assessments
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 Neologism Verbigeration Clang association
Circumstantiality
Which speech pattern is exhibited by the client stating, "I will take a pill if I go up the hill but not if my name is Jill, I don't want to kill?" Clang association Neologism Verbigeration Word salad
Clang association
A client is prescribed risperidone for the treatment of schizophrenia. The client is voiding three times each night and is always thirsty. Based on the adverse effects of risperidone, what should the nurse suspect is triggering the client's reported polyuria and polydipsia? Urinary tract infection Diabetes mellitus Renal calculi Hyperthyroidism
Diabetes mellitus
A hospitalized client with schizophrenia is receiving antipsychotic medications. While assessing the client, a nurse identifies signs and symptoms of a dystonic reaction. Which agent would the nurse expect to administer? Diphenhydramine Propranolol Risperidone Aripiprazole
Diphenhydramine (benedryl)
The nurse is developing a care plan for a client with somatic delusions. Which would be an appropriate nursing diagnosis for this client? Disturbed sleep pattern Risk for self-directed violence Chronic low self-esteem Disturbed thought process
Disturbed thought process
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 Jealous delusion Somatic delusion Erotomanic delusion
Grandiose delusion
A client with schizophrenia is hearing voices that tell the client to kill the self. What term is used to identify this type of false sensory perception? Hallucination Delusion Flight of ideas Ideas of reference
Hallucination
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 Delusion Avolition Alogia
Hallucination
A client with delusions presents with strong defensiveness, even when watching the news or listening to the radio. The nurse would document this finding in the health history as what? Ambivalence Ideas of reference Flight of ideas Echolalia
Ideas of reference
Which is the central focus of persecutory delusions? Injustice that must be remedied by legal action Involving bodily functions or sensations Unfaithfulness A great, unrecognized talent
Injustice that must be remedied by legal action
The nurse is preparing to provide education to a client who has been prescribed clozapine for schizophrenia. What is the most important aspect of client teaching? Maintaining medication regimen Reporting signs of neuralgia Stopping medications if weight gain occurs Limiting alcohol to two drinks per day
Maintaining medication regimen
Ms. James is started on olanzapine for the treatment of psychotic symptoms associated with schizophrenia. What is part of the routine monitoring for patients on olanzapine? Monitoring for signs of diabetes, including elevated blood glucose levels Monitoring of blood pressure to prevent early onset of hypertension Monitoring of level of consciousness because of the CNS effects of the drug Monitoring of bowel function due to the cholinergic effects of the drug
Monitoring for signs of diabetes, including elevated blood glucose levels Precautions should be taken if the patient has diabetes, because all use of atypical antipsychotics is associated with substantially elevated blood glucose levels.
A nursing instructor is developing an education plan for a group of students about schizophrenia and schizoaffective disorders. The instructor identifies that in addition to psychosis, what other condition must be present at the same time for a diagnosis of schizoaffective disorder? Substance abuse Mood disturbance Delirium Anxiety
Mood disturbance
A nursing instructor is developing an education plan for a group of students about schizophrenia and schizoaffective disorders. The instructor identifies that in addition to psychosis, what other condition must be present at the same time for a diagnosis of schizoaffective disorder? Substance abuse Mood disturbance Delirium Anxiety
Mood disturbance When psychosis and mood disturbance occur at the same time, a diagnosis of schizoaffective disorder is made.
The nurse must be aware that individuals from diverse ethnic groups might describe troubling experiences in terms of physical problems or specific culture-bound syndromes. The syndrome of ghost sickness is exhibited by which culture? Indian Native American West African Chinese
Native American
A client with schizophrenia is prescribed an antipsychotic medication. Which immediate side effects would the nurse include in the education plan for this medication? Risk for hypertension Risk for hypoprolactinemia The potential for weight loss The potential for sedation
The potential for sedation
Which data support a nursing diagnosis of impaired verbal communication? Ambivalence, delusional thinking, and avolition The presence of neologism, echolalia, and clanging The presence of neologism, delusions, and anergia Rapid pacing and running
The presence of neologism, echolalia, and clanging
A client states, "My boss keeps putting thoughts into my head. Yesterday my boss made me copy 25 reports and then told me I had wasted company time and money!" The nurse knows the client is experiencing which perceptual disturbance? Thought withdrawal Thought blocking Thought insertion Thought broadcasting
Thought insertion
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 Evaluate the significance to the client Determine the impact of the delusion on the client's safety Avoid dwelling on the delusion
Try to change the client's delusional belief
A client diagnosed with schizophrenia states, "I want to go home, go home, go home." This is an example of which speech pattern? Verbigeration Clang association Neologisms Word salad
Verbigeration
While being interviewed, a client diagnosed with a delusional disorder states, "I have this really strange odor coming out of my mouth. I stop to brush my teeth almost every hour and then rinse with mouthwash every half hour to get rid of this smell. I've seen so many doctors, and they can't tell me what's wrong." The nurse interprets the client's statement as reflecting which type of delusion? erotomanic grandiose somatic jealous
somatic The client's statements reflect a somatic delusion, which involves bodily functions or sensations
The nurse working with a client who is newly diagnosed with schizophrenia would include which in the client's education? "Schizophrenia is an illness that involves neurotransmitters, more specifically dopamine." "Schizophrenia is caused by pathology in the cerebellum, and there are medications that are helpful in this area." "Schizophrenia has been found to be nonresponsive to medications, and we will work mostly on helping you with daily activities." "Schizophrenia is curable if the correct medication and dosages are achieved."
"Schizophrenia is an illness that involves neurotransmitters, more specifically dopamine."
A client diagnosed with schizophrenia has been prescribed clozapine. Which is a potentially fatal side effect of this medication? Agranulocytosis Neuroleptic malignant syndrome Tardive dyskinesia Dystonia
Agranulocytosis
A nurse monitoring client medication needs to recognize side effects quickly and intervene promptly for which reason? Determine adequate dosage is maintained to control symptoms Alleviate the side effects and help client maintain adherence Provide support to the client and let the client know this is normal Provide support to the client and encourage adherence as past side effects rarely reoccur
Alleviate the side effects and help client maintain adherence
What client is being treated with a typical antipsychotic? An agitated client who was given haloperidol during acute psychosis A client with schizophrenia who received paliperidone 6 mg PO daily A client whose thought disorder requires clozapine 25 mg PO b.i.d. A client who recently began taking ziprasidone
An agitated client who was given haloperidol during acute psychosis
A client with schizophrenia, who has a history of repeated hospitalizations and homelessness, is ready for discharge. The nurse is developing a plan for the client's continued care in the community. Which discharge intervention will most likely prevent relapse for this client? Assertive community treatment Monthly follow-up in the community mental health clinic Referral to a vocational counselor Family education about relapse prevention
Assertive community treatment
A client diagnosed with schizophrenia is exhibiting disorganized behavior and imitating what the nurse is saying. What term is used to identify this behavior? Echolalia Neologism Perseveration Tangentiality
Echolalia
How often must clients receiving clozapine get white blood cell counts drawn? Every week for the first 6 months Every 3 months Every 6 months Every year
Every week for the first 6 months
A comprehensive nursing assessment for neuroleptic malignant syndrome (NMS) should include checking for which in a client taking an antipsychotic medication? Headache, muscle aches, and paresthesias Confusion, giddiness, and hyperalertness Muscular rigidity, tremors, and difficulty swallowing Dry mouth, flushing, and urinary retention
Muscular rigidity, tremors, and difficulty swallowing NMS is characterized by muscular rigidity, tremors, difficulty swallowing, fever, hypertension, and diaphoresis.
A nurse is planning the care of a client who has been diagnosed with schizophrenia and who will begin treatment with a typical antipsychotic. The nurse should identify what nursing diagnosis? Risk for injury related to central nervous system depression Risk for impaired liver function related to hepatotoxicity Risk for imbalanced body temperature related to hypothalamic suppression Bowel incontinence related to gastrointestinal adverse effects
Risk for injury related to central nervous system depression
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 Personality disorder Major depression Substance abuse
Schizophrenia
Some research has suggested that schizophreniform disorder may be an early manifestation of which other mental health condition? Delusional disorder Schizophrenia Bipolar affective disorder Schizoaffective disorder
Schizophrenia
A client with schizophrenia is exhibiting positive and negative symptoms. The nurse anticipates that the client would be prescribed what? Stimulant Antidepressant Second generation antipsychotic First generation antipsychotic
Second generation antipsychotic
Which statements characterizes the major difference between the typical and atypical antipsychotic medications? Typical antipsychotics most often relieve positive symptoms but do not have a significant impact on negative symptoms. Atypical antipsychotics relieve only negative symptoms. Atypical antipsychotics tend to cause many more extrapyramidal side effects than do the typical antipsychotics. Typical antipsychotics cause blood dyscrasias, whereas atypical ones do not.
Typical antipsychotics most often relieve positive symptoms but do not have a significant impact on negative symptoms. Traditional antipsychotics treat the positive symptoms of schizophrenia (i.e., hallucinations and delusions). Atypical antipsychotics relieve both the positive and negative symptoms (e.g., apathy, avolition, social withdrawal) of schizophrenia and are less likely to cause distressing extrapyramidal side effects typically seen with traditional antipsychotics.
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 Hypervigilance Retardation Echopraxia
Waxy flexibility
A client with schizophrenia is receiving antipsychotic therapy. The nurse understands that which is a medical emergency should it develop in the client? Tardive dyskinesia Parkinsonism Akathisia Neuroleptic malignant syndrome
Neuroleptic malignant syndrome
A client has been prescribed quetiapine for delusional disorder. In teaching the client about this medication, the nurse must be certain to include which information? Quetiapine can cause breast milk production. One of the common side effects is dry mouth. If dizziness is experienced, the client must call the doctor immediately. Quetiapine can cause one to crave sugar.
One of the common side effects is dry mouth.
A client with delusional disorder believes that the cook at the psychiatric hospital is trying to poison the client. The nurse would record this type of delusion as what? Erotomanic Persecutory Grandiose Somatic
Persecutory
A 44-year-old client has been experiencing intense job stress. In recent weeks, the client has confided in the client's spouse that the client believes the client's firm monitors every aspect of the client's personal performance and that the firm is engaged in deception and cover-up of its "true purpose." A nurse would recognize that the primary theme of the client's delusional disorder is what? Grandiose Somatic Conjugal Persecutory
Persecutory Clients who exhibit persecutory delusions believe that they are being conspired against, spied on, poisoned or drugged, cheated, harassed, maliciously maligned, or obstructed in some way.
Which type of delusion refers to a situation whereby a person or someone close to person is being malevolently treated in some way? Grandiose type Persecutory type Somatic type Unspecified type
Persecutory type
A client is being seen in the health clinic. The nurse observes a shuffling gait, drooling, and slowness of movement. The client is currently taking an antipsychotic for treatment of schizophrenia. The nurse knows that which side effect is occurring? Pseudoparkinsonism Dystonic movements Akathisia Neuroleptic malignant syndrome
Pseudoparkinsonism
A client has been prescribed clozapine for schizoaffective disorder (SCA) with depression. The nurse should explain to the client that one advantage of clozapine is that it can provide what? Cost savings Weight loss Reduction of hospitalizations and risk for suicide Combination with lithium for greater effect
Reduction of hospitalizations and risk for suicide
When obtaining a client's history, a nurse determines that the client has been experiencing delusions and hallucinations for the past 3 months, which has caused some problems in the client's ability to function at work. The client also is exhibiting catatonic excitement, echopraxia, loose associations, and pressured speech. The nurse suspects which condition? Schizophrenia Schizoaffective disorder Brief psychotic disorder Schizophreniform disorder
Schizophreniform disorder The essential features of schizophreniform disorder are identical to those of criteria A for schizophrenia (delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms), with the exception of the duration of the illness, which can be less than 6 months but with symptoms present for at least 1 month. Schizophrenia would be as described, but the symptoms must persist for at least 6 months. In brief psychotic disorder, the length of the episode is at least 1 day but less than 1 month. With schizoaffective disorder, the client must have an uninterrupted period of illness when there is a major depressive, manic, or mixed episode along with two of the following symptoms of schizophrenia: delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, or negative symptoms.
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 Most cultures contain well-accepted religious beliefs Delusions are often focused on the client's cultural religious beliefs The nurse's cultural religious beliefs may differ from those of the client's
Some cultures hold religious beliefs that might be confused with delusional thought
A 55-year-old client was admitted to the psychiatric unit after an incident in a department store in which the client accused a sales clerk of following the client around the store and stealing the client's keys. The client was subdued by the police after destroying a window display because voices had told the client that it was evil. As the nurse approached the client, the client says, "You're all out to get me, and you're one of them. They're Rostoputians and grog babies here." This demonstrates what? Loose associations and flight of ideas Suspiciousness and neologisms Illusions and loss of ego boundaries Echolalia and echopraxia
Suspiciousness and neologisms
Which assessment findings in a client who is suspected of having a delusional disorder would be suggestive of a diagnosis of schizophrenia? The client's beliefs are considered delusional but nonbizarre. The client experiences frequent and sustained hallucinations. The client does not have insight into his or her delusions. The client responds to group psychotherapy.
The client experiences frequent and sustained hallucinations.
The client's diagnosis of schizoaffective disorder is supported when the nurse documents what? The client reports "hearing voices" for the last 3 months The client's mother shares that "the client never missed work" even with the disorder The client's spouse reported that the client "repeated everything I said" for 48 hours Diagnosis testing confirmed a right parietal brain lesion
The client reports "hearing voices" for the last 3 months
A client with a delusional disorder has been undergoing individual psychotherapy. The therapy would be deemed ultimately successful when the client meets which outcome? The client will identify alternatives to present coping patterns. The client will describe problems relating to others. The client will identify situations that evoke anxiety. The client will differentiate between reality and fantasy.
The client will differentiate between reality and fantasy.