NUR 1511 Mental Health Chapter 16: Schizophrenia

What are the signs and symptoms of schizophrenia according to the Diagnostic and Statistical Manual of Mental Disorders?

Schizophrenia lasts at least 6 months and includes at least 1 month of 2 or more active-phase symptoms.

Although a psychotic episode can be brief, the client impact can last a long time. For this reason, the nurse is aware of what?

Supervision may be required to protect the person

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.

The psychiatric nurse recognizes that a client's cultural background can contribute to the misdiagnosis of schizophrenia primarily for which reason?

Clinicians diagnose culturally accepted beliefs as psychotic thinking

The nurse is caring for a client who was just admitted with a diagnosis of schizoaffective disorder with depression. Which agent would the nurse anticipate as being prescribed for this client?

Clozapine

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

When developing the plan of care for a client with schizophrenia who is in the acute phase of illness, the nurse understands that the client is at high risk for what?

Suicide

Which assessment findings in a client who is suspected of having a delusional disorder would be suggestive of a diagnosis of schizophrenia?

The client experiences frequent and sustained hallucinations.

The client who hesitates 30 seconds before responding to any question is described as having

latency of response

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

A client in an inpatient setting has a delusion that there are a multitude of undetectable noxious gases in circulation that have the potential to poison the client and others. Which of the nurse's responses is most therapeutic?

"I can assure you that you are actually very safe here."

A teaching plan for the client taking an antipsychotic medication will include which of the following? (Select all that apply)

A teaching plan for the client taking an antipsychotic medication will include which of the following? (Select all that apply) Apply sunblock before going outdoors Drink sugar free beverages for dry mouth Rise slowly from a sitting position

How often must clients receiving clozapine get white blood cell counts drawn?

Every week for the first 6 months

Which treatment would be inappropriate for a client with delusional disorder?

Somatic therapy

A client with schizophrenia is prescribed clozapine. The nurse would monitor the client closely for specific signs of:

infection.

The overall goal of psychiatric rehabilitation is for the client to gain

recovery from illness

The client's diagnosis of schizoaffective disorder is supported when the nurse documents what?

The client reports "hearing voices" for the last 3 months

A nurse is caring for a client in an inpatient mental health setting. The nurse notices that when the client is conversing with other clients, the client repeats what they are saying word for word. The nurse interprets this finding and documents it using which term?

Echolalia

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

A mental health client has been prescribed clozapine for the treatment of schizophrenia. The nurse should be alert to which potentially life-threatening adverse effects of this medication?

Agranulocytosis

Which medication is used to control the extrapyramidal effects associated with antipsychotic medications?

Benztropine

Which would a nurse expect to administer to a client with schizophrenia who is experiencing a dystonic reaction?

Benztropine

Which medication classification has been most effective in treating akathisia?

Beta-blockers

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?

Body complaints

A nurse monitoring client medication needs to recognize side effects quickly and intervene promptly for which reason?

Alleviate the side effects and help client maintain adherence

When the client describes fear of leaving his apartment as well as the desire to get out and meet others, it is called

ambivalence

When describing the difference between schizoaffective disorder (SAD) and schizophrenia, the nurse would address which as associated with SAD?

increased mood responses

During an admission assessment with a psychiatric-mental health nurse, a client 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. How should the nurse document this symptom?

A hallucination

A client is diagnosed with schizophreniform disorder. The nurse is reviewing the client's medical record and finds that the client's symptoms have been present for at least how long?

1 month

Which has not been proposed as a potential mechanism for the etiology of thought disorders?

Neglect in childhood

A teaching plan for the client taking an antipsychotic medication will include which of the following? (Select all that apply)

Apply sunblock before going outdoors Drink sugar free beverages for dry mouth Rise slowly from a sitting position

The nurse is working with a client with schizophrenia who has cognitive deficits. It is time for the client to get up and eat breakfast. Which statement by the nurse would be most effective in helping the client prepare for breakfast?

"First, wash your face and brush your teeth. Then put your clothes on."

Which of the following statements would indicate that family teaching about schizophrenia had been effective?

"It's a relief to find out that we did not cause our son's schizophrenia."

The nurse is planning discharge teaching for a client taking clozapine (Clozaril). Which of the following is essential to include?

Remind the client to go to the lab to have blood drawn for a WBC count

Which is an appropriate intervention for a client having auditory hallucinations?

Tell the client to talk back to the voices and tell them to go away.

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

Which statement made by a client would indicate that the client has delusions of grandeur?

"I am a magician, and my magic powers are good when the moon is full."

The psychiatric nurse documents that a client is expressing nihilistic delusions when the client makes which statement?

"I can't eat; I have no mouth or stomach."

A client diagnosed with schizophrenia states to the nurse, "My intestines are being eaten by snakes." This statement represents which type of delusion?

Somatic delusion

A client with schizophrenia tells the nurse, "I'm being watched constantly by the Federal Bureau of Investigation because of my job." Which response by the nurse would be most appropriate?

"It must be frightening to feel like you're always being watched."

A client tells the nurse that the client has bugs in the client's brain and asks the nurse if the nurse can see them. Which response by the nurse is most therapeutic?

"No, I don't see any bugs. That sounds scary for you."

A nurse is assessing a client who reports the sensation of "bugs crawling under the skin" and intense itching and burning. The client states, "I know bugs have invaded my body." There is no evidence to support the client's statement. The nurse interprets this as which type of delusion?

somatic

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."

A client in the psychiatric unit of the hospital has a diagnosis of schizophrenia. The client has approached the nurse in the hallway of the hospital and is elaborating in great detail about the client's delusions of persecution involving secret societies, the Vatican, and the mafia. How should the nurse respond to the client's expression of these delusions?

"That sounds very stressful for you. Would you like to join me and the others in the lounge?"

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

Which client exhibits the characteristics that are typical of the prodromal phase of schizophrenia?

A 20-year-old is experiencing a gradual decrease in the ability to concentrate, be productive, and sleep restfully.

A nurse teaching a client about prescribed antipsychotic medication informs the client to contact a health care provider immediately if the client notices:

A dramatic change in temperature.

A client diagnosed with schizophrenia has been prescribed clozapine. Which is a potentially fatal side effect of this medication?

Agranulocytosis

A client was admitted to the psychiatric intensive care unit with schizophrenia. Among the client's signs and symptoms, the client was experiencing nihilistic delusions. The nurse understands that these delusions involve a belief about what?

An impending calamity, such as death

A client with schizoaffective disorder is prescribed long-term medication therapy. The nurse would most likely expect what to be prescribed as the mainstay of treatment?

Atypical antipsychotic

The family of a client with schizophrenia asks the nurse about the difference between conventional and atypical antipsychotic medications. The nurse's answer is based on which of the following?

Atypical antipsychotics are dopamine and serotonin antagonists; conventional antipsychotics are only dopamine antagonists

A client has been diagnosed with schizophrenia. Assessment reveals that the client lives alone. The client's clothing is disheveled, the client's hair is uncombed and matted, and the client's body has a strange odor. During an interview, the client's family members voice a desire for the client to live with them when the client is discharged. Based on the assessment findings, which nursing diagnosis would be the priority?

Bathing self-care deficit related to symptoms of schizophrenia

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

A client has been taking haloperidol for 5 years when the client is admitted to the inpatient unit for relapse of symptoms of schizophrenia. Upon assessment, the client demonstrates akathisia, dystonia, a stiff gait, and rigid posture. The nurse correctly identifies these symptoms are indicative of what?

Extrapyramidal side effects

The nurse is providing teaching to a client diagnosed with schizoaffective disorder. The nurse should explain to the client that which is true about this disorder?

It is a mix of psychotic and mood symptoms.

The nurse is assigned to a client with catatonic schizophrenia. Which intervention should the nurse include in the client's care plan?

Meeting all of the client's physical needs

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?

Native American

The experience of delusions that are plausible in the context of a client's ethnic background are reflective of what?

Nonbizarre delusions

A client with a diagnosis of schizophrenia believes that the client is an undercover operative for the Central Intelligence Agency and that voices of various representatives of the organization give the client regular updates on the client's missions. The client is unwilling to participate in many interventions because the client is "too busy with things that are more important than you could possibly understand." The primary theme of the client's delusions is consistent with what?

Paranoia

A client diagnosed with schizophrenia is having delusions that the client is being plotted against by the government. This would be documented as which type of delusion?

Persecutory

A client with schizophrenia believes that the cook at the psychiatric hospital is trying to poison the client. The nurse would record this type of delusion as what?

Persecutory

A client with a diagnosis of schizophrenia has a history of auditory and visual hallucinations. Which intervention is most likely to minimize the client's hallucinations?

Provide frequent contact and communication with the client

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

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?

Reduction of hospitalizations and risk for suicide

A client begins to exhibit hallucinations and delusions along with disorganized speech after forgetting to take antipsychotic medication. The nurse suspects that the client is at which point in the clinical course of the disorder?

Relapse

The nurse documents that the client is exhibiting negative symptoms of schizophrenia when observing the client doing what? Select all that apply.

Repeatedly turning down invitations to join in unit activities Inability to maintain to complete a goal-directed activity

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?

Suspiciousness and neologisms

A client has been taking neuroleptic medications for many years as a treatment for schizophrenia. The client is exhibiting tongue protrusion, facial grimacing, and excessive blinking. These manifestations are characteristic of which side effect?

Tardive dyskinesia

While being assessed, a client with schizophrenia states, "Everywhere I turn, the government is watching me because I know too much. They are afraid that I might go public with the information about all those conspiracies." The nurse interprets this statement as indicating which type of delusion?

Persecutory

After teaching a class on antipsychotic agents, the instructor determines that the education was successful when the class identifies which as an example of a second-generation antipsychotic agent?

Quetiapine

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

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

The severity of a client's positive and negative symptoms of schizophrenia has not significantly improved since treatment began, despite the use of three different neuroleptic medications. The nurse should anticipate that this client may benefit from treatment with which medication?

Clozapine

Which of the following are considered to be positive signs of schizophrenia? (Select all that apply)

Delusions Hallucinations Disorganized thinking

Nurse is caring for a client who has been taking fluphenazine (Prolixin) for 2 days. The client suddenly cries out, his neck twists to one side, and his eyes appear to roll back in the sockets. The nurse finds the following PRN medication for the client. Which one should the nurse administer?

Diphenhydramine (Benadryl), 25mg IM, PRN

The nurse is developing a care plan for a client with somatic delusions. Which would be an appropriate nursing diagnosis for this client?

Disturbed thought process

A group of nursing students is reviewing the various theories related to the etiology of schizophrenia. The students demonstrate understanding of the information when they identify which neurotransmitter as being responsible for hallucinations and delusions?

Dopamine

During a client interview, a client states that "God has sent me a special message. I'm the only one who can carry out his plan." The nurse interprets this statement as suggesting which type of delusion?

Grandiose

Clients diagnosed with schizophrenia may experience disordered water balance that may lead to water intoxication. Which may occur as a result of water intoxication?

Hyponatremia

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?

Ideas of reference

A mental health nurse is caring for a client with a diagnosis of schizophrenia. The client presents with catatonia. Which clinical manifestations should the nurse expect?

Immobility

Catatonia as seen in clients with schizophrenia is unique in the existence of which feature?

Immobility like being in a trance

A client with schizophrenia is exhibiting positive and negative symptoms. The nurse anticipates that the client would be prescribed what?

Second generation antipsychotic

A client diagnosed with delusional disorder who uses excessive health care resources most likely has which type of delusions?

Somatic

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?

Somatic

A novice nurse on a psychiatric unit may find it challenging to care for a client newly diagnosed with schizophrenia primarily for which reason?

The nurse may feel defensive when a delusional client makes accusations

A nurse who works in a psychiatry unit finds that young clients with schizophrenia have worse prognoses when compared with clients who are diagnosed later in life. Which reasons should lead the nurse to make this observation? Select all that apply.

They have less sense of personal identity. They are inherently more susceptible to a poor prognosis. They are less likely to have experiences of independent living.

A psychiatric-mental health nurse is teaching a class about schizophrenia. When describing delusions, which information would the nurse most likely include?

They may include elements of a situation that could occur in real life.

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 insertion

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

Which of the following are considered to be positive signs of schizophrenia? (Select all that apply)

Which of the following are considered to be positive signs of schizophrenia? (Select all that apply) Delusions Hallucinations Disorganized thinking

The nurse is caring for a client with schizoaffective disorder with depression. The nurse should instruct the client that the most effective medication therapy for this disorder is:

atypical antipsychotic medications.

A nursing instructor is preparing a class lecture about schizophrenia and outcomes focusing on recovery. Which would the instructor include as a major goal?

continuity of care