chapter 12: schizophrenia

A patient diagnosed with paranoid schizophrenia refuses food, stating the voices are saying the food is contaminated and deadly. A therapeutic response for the nurse would be

"I understand that the voices are very real to you, but I do not hear them."

Which statement by a person with paranoid schizophrenia most clearly indicates that the antipsychotic medication is effective?

"I used to hear scary voices but now I don't hear them anymore."

A young adult is hospitalized with schizophrenia. The parents are distraught and filled with guilt. What would be an appropriate nursing response?

"There are many theories about the cause of schizophrenia, but this illness is not your fault."

A patient with schizophrenia tells the nurse he or she has discontinued the pharmacological treatment plan because the symptoms are cured. Which is the best response by the nurse?

"You are experiencing something called anosognosia, which means it is difficult to realize you need to continue with treatment."

Which symptom seen in a patient with schizophrenia can be categorized as a positive symptom? 1 Delusions 2 Dysphoria 3 Loss of motivation 4 Impaired judgment

1 Delusions

The causation of schizophrenia currently is understood to be

A combination of inherited and nongenetic factors

A patient diagnosed with paranoid schizophrenia tells the nurse, "I have to get away. The volmers are coming to execute me." The term "volmers" can be assessed as

A neologism is a newly coined word that has meaning only for the patient. Clang association is choosing a word with similar sound like "click, clack, clutch." Blocking is related to thoughts and a stop or reduction in thoughts often related to interruptions caused by hallucinations. Delusions are false beliefs.

A nurse works with a patient in the acute phase of schizophrenia. Which assessment findings increase the risk of aggression and violence? Select all that apply.

A small percentage of patients with schizophrenia, especially during the acute phase, may exhibit a risk for physical violence, typically in response to hallucinations (especially command hallucinations), delusions, paranoia, and impaired judgment or impulse control. Poor hygiene and a flat affect are negative symptoms that usually are not associated with aggression or violence.

A patient with schizophrenia was changed to clozapine 3 weeks ago. The patient calls the clinic nurse complaining of sore throat, fever, and malaise. Which laboratory test would be most helpful in determining the cause of these findings?

Agranulocytosis is the reduction of white blood cells (WBCs) and is a possible adverse effect of antipsychotic drugs, particularly clozapine. Chief complaints are flulike symptoms. A complete blood cell count would show the reduction in WBCs. Serum lithium level, liver panel, and urinalysis are not necessary.

A patient who has been receiving antipsychotic medication for 6 weeks tells the nurse that the hallucinations are nearly gone and that concentration has improved. When the patient reports flulike symptoms, including a fever and a very sore throat, the nurse should

Arrange for the patient to have blood drawn for a white blood cell count Antipsychotic medications may cause agranulocytosis, the first manifestation of which may be a sore throat and flulike symptoms. Agranulocytosis with infection could be life threatening, so recommending rest does not address the underlying problem.

The type of altered perception most commonly experienced by patients with schizophrenia is

Auditory hallucinations

A nurse understands that antipsychotic drugs may sometimes have toxic effects. The nurse suggests to the patient's guardians to give the patient foods rich in carbohydrates and protein and to ensure that the patient undergoes a liver function test every 6 months. Which of these toxic effects was the nurse thinking about when making such a suggestion?

Cholestatic jaundice

The nurse is caring for a patient with schizophrenia who was given an injectable dose of dopamine (D2) antagonists for the limbic center. Which side effects does the nurse anticipate? Select all that apply.

Dopamine antagonists are first-generation antipsychotics that are used less frequently because of their side effects. The medications block D2 receptors, causing extrapyramidal side effects that include pacing and general restlessness (akathisia); muscular contractions (acute dystonia); gait impairment; and tremors (pseudoparkinsonism). These agents do not loosen reflexes or increase energy, though akathisia can sometimes be confused with increased energy.

Gynecomastia, amenorrhea, and galactorrhea are side effects most often associated with which medications?

First-generation antipsychotic medications commonly have side effects that relate to sexual dysfunction. These side effects include gynecomastia (enlarged breast tissue), amenorrhea (absence of menstruation), and galactorrhea (discharge from nipples).

A patient with schizophrenia who is experiencing symptoms of disorganized thinking would have the greatest difficulty when the nurse

Gives multistep directions

The nurse believes a patient may have schizophrenia based on which signs and symptoms? Select all that apply.

Hearing voices is an auditory hallucination, which is a symptom of psychosis that could be present with schizophrenia. Incoherence is a type of disorganized speech, which is also a symptom of schizophrenia. Withdrawn behavior is a sign of psychosis and schizophrenia. Headaches are general symptoms that could indicate many types of diseases or disorders, not specific to schizophrenia. Depression is not an initial symptom of schizophrenia or psychosis, but may co-occur with schizophrenia

A patient's dose of haloperidol was increased earlier today. The patient now is experiencing laryngeal dystonia. What is the nurse's priority action?

Maintain a patent airway

An adult with a 6-year history of schizophrenia begins a community rehabilitation program. Select the most appropriate initial outcome for this patient. The patient will

Participation in scheduled activities of the program should occur first. After the patient is accustomed to the program, he or she might lead a group or apply for employment. Hallucinations commonly continue to occur in patients diagnosed with schizophrenia.

A nurse is caring for a patient with schizophrenia. Upon the nurse's report, the primary health care provider prescribed 25 mg of diphenhydramine hydrochloride to the patient. What had the nurse reported to the primary health care provider about the patient?

Patients with schizophrenia are generally prescribed antipsychotic drugs. These drugs cause extrapyramidal side effects, like tremors, and abnormal involuntary movements, like tardive dyskinesia. Diphenhydramine hydrochloride 25 mg by the intramuscular or intravenous route is prescribed to such patients to treat extrapyramidal side effects

A distinguishing factor of psychosis is that it

Psychosis is disintegrative and involves a significant distortion of reality. Psychosis emerges with the panic level of anxiety. Delusional thinking may not be demonstrated by all psychotic individuals. Cognitive function is not a predisposing factor for the development of psychosis.

Which statement is accurate regarding the relationship between depression and schizophrenia?

Regular assessments should occur for both depression and suicide risk in patients diagnosed with schizophrenia.

A nurse is devising a treatment plan for a patient who is in the first phase of schizophrenia. Which of these actions by the patient supports the assumption that the patient is in the first phase of schizophrenia? Select all that apply.

Schizophrenia is characterized by three phases. The first phase is the acute phase. In this phase, the patient has positive schizophrenia symptoms such as hallucinations, echolalia, and paranoia. The patient may hear unusual voices and repeat what others have said. The patient also may have irrational fears and may believe that the primary health care provider had tried to kill him. In the second phase of schizophrenia, the patient starts taking medication and shows improvement. In this phase, the patient also develops an ability to interact with others.

Tara and Aaron are twins who are both diagnosed with schizophrenia. Aaron was diagnosed at 23 years and Tara at 31 years. Based on knowledge of early- and late-onset schizophrenia, which statement is true?

Tara has a better chance for positive outcomes because of later onset.

The purpose of the Abnormal Involuntary Movement Scale (AIMS) assessment on a persistently mentally ill patient who has been diagnosed with schizophrenia is early detection of

Tardive dyskinesia

A nurse plans a series of psychoeducational groups for persons with schizophrenia. Which topic would take priority?

The importance of taking medication correctly

A patient is on conventional antipsychotics. On clinical observation, the nurse finds that the patient has hyponatremia, increased confusion, and delirium. Which is the most likely cause of the patient's condition?

The patient has potentially fatal water intoxication.

Which drug would a nurse anticipate being given with chlorpromazine to reduce extrapyramidal side effects?

Trihexyphenidyl: Chlorpromazine is a first-generation antipsychotic drug. It can cause extrapyramidal side effects, like akathisia, tremor, impaired gait, and so on, as a result of the blockage of dopamine receptors. These side effects can be treated by administering antiparkinson drugs like trihexyphenidyl. Trihexyphenidyl is an antimuscarinic class of drug. Montelukast is a leukotriene receptor antagonist used to treat asthma. Lamivudine is a nucleoside reverse transcriptase used to treat HIV/AIDS; it cannot be used to reduce the extrapyramidal side effects of chlorpromazine. Valacyclovir is an antiviral drug used to treat viral infections.

A patient with undifferentiated schizophrenia lives in a community care home and takes olanzapine daily with supervision. During the patient's monthly outpatient visits with a psychiatric nurse, which assessment parameter takes priority?

Weight

A patient diagnosed with schizophrenia says, "Cheese dog run fast." How should the nurse document this comment?

Word salad

Which assessment finding supports the belief that the patient is demonstrating a positive symptom of schizophrenia?

he patient refuses to sleep because "I'll be abducted by the aliens."

A nurse is caring for a patient with schizophrenia. The nurse observes that the patient does opposite of any given instruction unintentionally and the patient often runs in the corridor. What is the probable diagnosis by the nurse from such behavior?

symptoms of negativism, in which patients tend toward resistance and to do the opposite of what they are told. These patients also have motor agitation, in which they run or pace rapidly in response to stimuli and show unintended excessive movements. The patient's behavior is unlikely to be due to hearing problem, restlessness, or dislike toward the nurse.