MH: EAQ Psychosis

Olanzapine is prescribed for a client with bipolar disorder, manic episode. What cautionary advice does the nurse give the client?

-Sit up slowly. Olanzapine, a thienobenzodiazepine, can cause orthostatic hypotension. Blurred vision, not double vision, may occur. Decreased salivation is an effect of olanzapine. It may also cause nausea and other gastrointestinal upsets and should be taken with fluid or food.

A client who has been hospitalized with schizophrenia tells the nurse, "My heart has stopped and my veins have turned to glass!" What should the nurse conclude that the client is experiencing?

- Somatic delusion A somatic delusion is a fixed false belief about one's body. Echolalia is the automatic and meaningless repetition of another's words or phrases. Hypochondriasis is a severe, morbid preoccupation with an unrealistic interpretation of real or imagined physical symptoms. Depersonalization is a feeling of unreality and alienation from one's self.

An agitated, acting-out, delusional client is receiving large doses of haloperidol, and the nurse is concerned because this drug can produce untoward side effects. Which clinical manifestations will alert the nurse to stop the drug immediately? Select all that apply.

Jaundice Tachycardia

A primary healthcare provider prescribes antipsychotic medication, and the nurse teaches the client about the possible side effects of the drug. The nurse concludes that the client needs further teaching about these side effects when the client reports plans to call the clinic if which problem occurs?

Ringing in the ears

After reviewing the data of a client with depression, the primary healthcare provider decided not to prescribe bupropion. Which statements made by the client would support the decision? Select all that apply.

"I have a history of epilepsy. "I have a history of congestive heart failure. "I have recently been diagnosed with anorexia nervosa."

A nurse is caring for a client who has been experiencing delusions. According to psychodynamic theory, what are delusions?

-A defense against anxiety Delusions are a way the unconscious defends the individual from real or imagined threats. Magical thinking is the belief that one's thoughts and behaviors can control situations and other people. For example, having bad thoughts about someone can cause that person to die. This type of thinking is found in young children but is pathological in adults. Illusions are false interpretations of actual external stimuli. Delusions are precipitated by feelings of anxiety, not anger.

A client who is being treated for schizophrenia, paranoid type, arrives at the clinic demonstrating a shuffling gait and tilting the head toward one shoulder. What does the nurse conclude about these clinical manifestations?

-Possible side effects of the antipsychotic medication Shuffling gait and torticollis are symptoms of pseudoparkinsonism that are caused by antipsychotic medications, particularly the typical antipsychotics. Expected characteristics of schizophrenia, paranoid type, include delusions, hallucinations, suspiciousness, anger, hostility, and paranoia. An acute exacerbation of the illness reflects an increased intensity of the expected characteristics associated with paranoid schizophrenia, which include pressured speech, suicidal ideation, and aggressive, agitated behavior. Although these physical manifestations require intervention, they are not life threatening.

A client with the diagnosis of schizophrenia is given one of the antipsychotic drugs. The nurse understands that antipsychotic drugs can cause extrapyramidal side effects. Which effect may be irreversible?

-Tardive dyskinesia Tardive dyskinesia, an extrapyramidal response characterized by vermicular movements and protrusion of the tongue, chewing and puckering movements of the mouth, and puffing of the cheeks, is often irreversible, even when the antipsychotic medication is withdrawn. Akathisia (motor restlessness), parkinsonian syndrome (a disorder featuring signs and symptoms of Parkinson disease such as resting tremors, muscle weakness, reduced movement, and festinating gait), and dystonia (impairment of muscle tonus) can usually be treated with antiparkinsonian or anticholinergic drugs while the antipsychotic medication is continued.

The nurse is reviewing the data of four clients diagnosed with schizophrenia. Which client is at an increased risk of cardiovascular disease based on the given data?

Client D

A client who has a diagnosis of paranoid schizophrenia and has been violent in the past is admitted to the psychiatric unit. What should the nurse do before conducting an admission interview?

Enter the room with another staff member while remaining between the client and the door.

A client comes to the mental health clinic with the complaint of a progressing inability to be in enclosed spaces. The primary healthcare provider makes the diagnosis of claustrophobia and prescribes desensitization therapy. The nurse recalls that desensitization therapy is used successfully with clients experiencing phobias because it is focused on what?

Imagery is a therapeutic approach used to facilitate positive self-talk; mental pictures under the control of and initiated by the client may correct faulty cognitions. Modeling, role play, and assertiveness training are useful general behavioral approaches but are not specific desensitization techniques.

The nurse is providing instructions to a client who is on isocarboxazid for depression. Which statements made by the client indicate effective learning? Select all that apply.

"I will include yogurt in my diet." "I will avoid pepperoni in my diet." "I will include cream cheese in my diet." "I will avoid fermented bean curds in my diet.

A nurse is assessing an adolescent client with the diagnosis of schizophrenia, undifferentiated type. Which signs and symptoms should the nurse expect the client to experience?

-Loosened associations and hallucinations Loosened associations and hallucinations are the primary behaviors associated with a thought disorder such as schizophrenia. Paranoid delusions and hypervigilance are more common in paranoid-type schizophrenia than in the undifferentiated type. Depression and psychomotor retardation are not characteristic of schizophrenia. Ritualistic behavior and obsessive thinking are generally associated with obsessive-compulsive disorders, not schizophrenia.

Four clients are admitted to a hospital with different symptoms associated with depression. Which client would benefit from mirtazapine?

-Client 2 Mirtazapine causes substantial sedation. Therefore, client 2 would benefit from mirtazapine. Client 1 requires a central nervous system stimulant such as fluoxetine. Client 3 will benefit from duloxetine, which is a drug relieves chronic pain. Client 4 would benefit from bupropion, which enhances a person's libido.

A client who takes insulin for type 1 diabetes has a psychosis and is to receive haloperidol. Which response does a nurse anticipate with this drug combination?

-Decreased control of the diabetes Haloperidol alters the effectiveness of exogenous insulin, and the combination of haloperidol and insulin must be used with caution. The occurrence of respiratory depression is more likely with a combination of antipsychotics and barbiturates. Intensified action of both drugs would be more likely to occur if the antipsychotic were fluoxetine. There are no data to support a claim of increased danger of extrapyramidal side effects.

A nurse is caring for a client with the diagnosis of schizophrenia. During assessment the nurse identifies both positive (type I) and negative (type II) signs and symptoms. Which clinical findings should the nurse document as positive? Select all that apply.

-Disorganized thoughts -Auditory hallucinations Disorganized thoughts (e.g., derailment, tangentiality, illogicality, incoherence, and circumstantiality) are a positive sign of schizophrenia. Positive signs and symptoms, referred to as "florid psychotic symptoms," are related to alterations in thinking, speech, perception, and behavior. They usually respond to antipsychotic medications. Positive symptoms reflect an excess or distortion of function and include delusions, hallucinations, increased speech production with associations, and bizarre behavior. A lack of energy (anergy) is a negative symptom associated with schizophrenia. Negative symptoms reflect a lessening or loss of normal function. A lack of emotional expression (flat affect) is a negative sign associated with schizophrenia. Inadequate social skills leading to withdrawal and isolation are negative symptoms associated with schizophrenia.

Schizophrenia is associated with negative symptoms. In the assessment of a client with schizophrenia, which symptoms are classified as negative symptoms? Select all that apply.

-Lack of energy -Poor grooming A lack of energy (anergy) is a negative symptom associated with schizophrenia. Inadequate grooming results from apathy and lack of energy and is a negative symptom associated with schizophrenia. Illogical speech that reflects disorganized thinking is a positive symptom of schizophrenia type 1. Ideas of reference, a thought process in which a person believes he or she is the object of environmental attention, is a positive symptom of schizophrenia. Agitated, hostile, angry, and violent behaviors are positive symptoms of schizophrenia.

Upon assessment, the primary healthcare provider finds that the client is experiencing weight gain as well as elevated lipid and blood glucose levels. Which drugs in the client's prescription list are most likely to cause these metabolic side effects? Select all that apply.

Clozapine and olanzapine are second-generation antipsychotic (SGA) drugs that may cause metabolic side effects such as diabetes and dyslipidemia. Asenapine and ziprasidone are SGAs that may cause torsades de pointes by prolonging the QT interval. Quetiapine is an antipsychotic and used to treat bipolar disorders and may cause loss of appetite, but also increased blood glucose levels and elevated cholesterol.

A client is undergoing treatment for schizophrenia with antipsychotic drugs. During a client assessment, the primary healthcare provider noticed an increase in body temperature and unstable blood pressure. Which adverse effect of the antipsychotic drug caused this condition in the client?

Neuroleptic malignant syndrome

An adult with the diagnosis of schizophrenia is admitted to the psychiatric hospital. The client is ungroomed, appears to be hearing voices, is withdrawn, and has not spoken to anyone for several days. What should the nurse do during the first few hospital days?

Seek out the client frequently to spend short periods of time together Seeking out the client frequently to spend short periods of time together will help the nurse establish trust without unduly increasing anxiety. Seeing that the client bathes and changes clothes daily is not the priority unless the client is extremely dirty; this client is ungroomed, not dirty. A withdrawn client will usually not approach anyone. The client's history reveals a failure to speak.