schizo

Mr. Carter has been prescribed olanzapine 10 mg by mouth daily prior to admission. He tells the nurse he will not "take that medication ever again." What is the most therapeutic response from the nurse?

"Gaining weight can be frustrating. Let's consider some changes in your diet and exercise." Weight gain is a common side effect of atypical antipsychotics. Weight gain is both detrimental to the patient's health as well as frustrating to the patient. Many patients will abruptly stop the medication due to the weight gain. The most therapeutic response of the nurse at this point is to both acknowledge the patient's frustration with the weight gain and to take action to address it. Although the other answers may be true, none are therapeutic because they do not address the patient's frustration with the weight gain.

Mr. Carter is at the window and states, "The voices are telling me to jump out the window." Which is the best response from the nurse?

"I am sorry; you must be scared. I will stay here with you to keep you safe." Reflecting the experience of hallucinations to the patient shows empathy and helps him or her feel validated. Safety is the first priority, so the nurse should stay with a patient who is having command hallucinations. Calling security is necessary, but the patient may feel judged being told not to jump.

The patient is experiencing a delusion of grandeur and says, "I invented planes, do you ever fly, I did that, it was my patent." Which is the nurse's best response?

"I understand that you believe you invented planes." When a patient expresses delusional thinking, the providers should not argue with the patient, as it is a fixed belief. It is not therapeutic to play into the delusion; rather, the nurse should validate the feelings the patient has surrounding the delusion.

Which of the following explanations should the nurse give to Mr. Carter's family when asked the cause of schizophrenia?

"It is caused by a combination of factors, including genetics and neurotransmitters." Schizophrenia is a complex disorder with no one specific cause. Its etiology is thought to involve an interaction of genetics, brain chemistry, and psychosocial and environmental factors.

David has been recently started on an antipsychotic medication. He asks the nurse whether the medication will cure his schizophrenia. Which is the best response by the nurse?

"No, the medication does not cure the disease, but it will help to control the symptoms you are having." Antipsychotic medications can help to control the symptoms if taken as prescribed and follow-up care is received. There is no overt cure for this disease. The nurse should answer the patient directly and not assume that the patient is trying to get out of taking the prescribed medications.

The patient asks the nurse, "What type of a disease is schizophrenia?" Which statement is the nurse's best response?

"Schizophrenia is a syndrome with many different types and symptoms." Schizophrenia is a known syndrome with variable symptoms, making individualized care essential. Historically, these patients were institutionalized due to their bizarre presentations. Schizophrenia does not necessarily lead to homelessness and is not associated with seizures. Treatments are available for schizophrenia.

Mr. Carter tells the nurse, "That is not nice. I can tell you are listening to my thoughts." Which statement is the best response from the nurse?

"That is frightening. Consider taking your as-needed medication." Thought broadcasting is when a patient believes someone can hear his or her thoughts. This positive symptom can be regulated with antipsychotic medication.

Mr. Carter's family is concerned about his psychosis and are uncertain as to his future. They ask the nurse whether they should attend therapy sessions with Mr. Carter. Which is the best response from the nurse?

"Therapy can aid you in understanding the disorder and to plan for what is ahead of all of you." Therapy for both the patient and the family is essential in defining social skills, helping them understand the pathology of symptoms, aiding in recovery, and helping prevent readmissions.

5A patient who is taking an antipsychotic medication tells the nurse, "I am having difficulty with my leg; it keeps shaking." What is the priority intervention of the nurse?

Administer a screening test for movement disorders. The Abnormal Involuntary Movement Scale (AIMS) is a screening tool administered to assess for side effects of antipsychotic medications. The AIMS will aid in discerning symptoms of tardive dyskinesia, indicating a movement disorder.

In reviewing Mr. Carter's medications, the provider mentions possibly changing to Clozapine. The nurse understands that which side effect must be monitored closely with this medication?

Agranulocytosis Agranulocytosis, a life-threatening complication of clozapine, is an acute condition involving a severe and dangerous leukopenia (lowered white blood cell count), which increases the risk of serious infections due to the suppressed immune system. If the patient's absolute neutrophil count is below 1.0, the medication will be discontinued.

Mr. Carter is in the day room rapidly pacing, his fists clenched and mumbling angrily to himself. What is the nurse's priority intervention?

Ask the other patients in the day room to leave. Patients who are agitated—as evidenced by pacing, clenched fists, and self-dialogue—may become unpredictable. Safety is the top priority. The nurse should encourage the patient to calm down and offer an as-needed medication; seclusion and restraints are interventions of last resort. Clearing the room of other patients is a priority to ensure safety on the unit for all the patients.

Schizophrenia is characterized by both positive and negative symptoms. Which of the following is an example of a positive symptom?

Auditory hallucinations Hallucinations and delusions are the positive symptoms of schizophrenia, as they reflect an excess or distortion of normal functions. Such symptoms can be treated with psychotropic medications. The other symptoms listed are negative or soft symptoms, meaning they reflect a loss or decrease of normal functions. Negative symptoms typically persist even after treatment.

Mr. Carter is disheveled and has not showered in 4 days. Given his diagnosis, which of the following are likely causes of his self-care deficit? (Select all that apply.)

Disorganized thought processes, Negative symptoms, Psychosis Someone whose thoughts are disorganized, who is psychotic, or who is experiencing negative symptoms associated with schizophrenia (avolition) may not have the ability to tend to activities of daily living.

Some patients with schizophrenia display a bizarre speech pattern. Which pattern below is characterized by the patient repeating what the nurse has said to him or her?

Echolalia Echolalia is repeating what someone else says. Neologism is when a patient makes up a nonsensical word for something. Echopraxia is mimicking movement of someone else. Word salad is multiple words in a sentence without conjoining meaning.

What is the primary reason that patients stop taking antipsychotic medications?

Extrapyramidal side effects Although many of the antipsychotic medications cause weight gain, the degree of extrapyramidal side effects (acute dystonic reactions, akathisia, and pseudoparkinsonism) can be life-altering, and if they develop, patients often discontinue the medication on their own.

Mr. Carter, who is diagnosed with schizophrenia, is exhibiting paranoid behavior. Which nursing intervention is a priority?

Form a therapeutic relationship through brief, frequent interactions with Mr. Carter. Forming a therapeutic relationship aids in the care and decreases the amount of paranoia. Mr. Carter would not be able to tolerate sitting, reading directions, or being told what to do. Spending 5 minutes at a time with Mr. Carter is likely an effective way to build trust with him.

What is the average age of peak onset of symptoms of schizophrenia?

Men 15-25 years and women 25-35 years Men develop symptoms earlier in life, with peak onset from 15 to 25 years of age, and therefore have a more difficult treatment and recovery. The peak onset of symptoms for women is from 25 to 35 years of age. The older the patient is when symptoms first appear, the better the prognosis.

When admitting a patient experiencing visual and auditory hallucinations, the nurse discovers the patient is from another culture. Given this information, what should be the priority of the nurse in the development of the nursing care plan?

The nurse should ask the patient and family about the ethnic or cultural significance of the hallucinations. Ethnicity and culture shape our worldview and our beliefs about all aspects of life, including the experience and expression of symptoms. Hallucinations in some cultures are a way of life and need to be explored. Oftentimes a patient may state he or she is seeing Jesus and is not hallucinating. Cultural considerations and exploration are priority when designing an individualized plan of care.