16: Schizophrenia

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." Explanation: The client needs clear direction, with tasks broken into small steps, to begin to participate in the client's own self-care. The client, not the nurse, should perform the steps.

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." Explanation: Assuring a client of his or her safety is a more therapeutic intervention than expressing exasperation with the client's delusions, arguing against them, or implicitly confirming them.

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." Explanation: 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. Normal cell communications are disrupted, resulting in the development of hallucinations and delusions. Abnormalities in brain shape and brain circuitry are being researched.

The client diagnosed with schizophrenia a year ago is being prescribed clozapine because other medications have been ineffective. The nurse educates the client and family about this medication. The nurse determines the education was successful when the client makes which statement?

"It is important to keep appointments for weekly lab draws to check the blood count." Explanation: Clozapine is associated with the life-threatening side effect of agranulocytosis, so clients taking clozapine should have regular blood tests, and keeping appointments for scheduled labs is a priority. White blood cell and granulocyte counts should be measured before treatment is initiated, and at least weekly or twice weekly after treatment begins. Although cardiac arrhythmias can occur, cardiomyopathy and heart failure would present with symptomology. Cigarette smoking can lower the concentration of clozapine, thus necessitating a higher dose of this medication and not result in toxic levels. Clozapine is also associated with weight gain, not weight loss, so weekly weights are not indicated.

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 Explanation: The essential features of schizophreniform disorder are identical to those of criteria A for schizophrenia, with the exception of the duration of the illness, which can be less than 6 months. Symptoms must be present for at least 1 month to be classified as a schizophreniform disorder.

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. Explanation: Gradual, subtle behavioral changes appear during the prodromal phase of schizophrenia, such as tension, the inability to concentrate, insomnia, withdrawal, or cognitive deficits. No symptoms are present in the premorbid phase, and relapses occur in the progressive and chronic phases. Diagnosis of the disease marks the beginning of the onset phase.

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 Explanation: Agranulocytosis is a life-threatening adverse effect of clozapine. White blood cell counts should be monitored frequently due to extremely low levels of white blood cells. Weight gain occurs with certain antipsychotics. Palpitations and hemorrhage are not generally associated with antipsychotics.

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

Agranulocytosis Explanation: Agranulocytosis is manifested by a failure of the bone marrow to produce adequate white blood cells. Neuroleptic malignant syndrome is a life-threatening reaction to neuroleptic medication that requires immediate treatment. Tardive dyskinesia causes involuntary movements of the tongue, mouth, facial muscles, and arm and leg muscles. Dystonia is characterized by cramps and rigidity of the tongue, face, neck, and back muscles.

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 Explanation: Recognizing a medication's side effects quickly and intervening promptly to alleviate them will help maintain adherence.

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 Explanation: Assuring the client that he or she is in a safe environment is the first step in the establishment of a therapeutic relationship that is vital to successful psychiatric treatment.

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

Benztropine Explanation: A client experiencing a dystonic reaction should receive immediate treatment with benztropine. Risperidone and aripiprazole are antipsychotics that may cause dystonic reactions. Trihexyphenidyl is used to treat parkinsonism due to antipsychotic drugs.

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

Benztropine Explanation: Benzotropine is an anticholinergic drug used to relieve drug-induced extrapyramidal adverse effects, such as muscle weakness, involuntary muscle movement, pseudoparkinsonism, and tardive dyskinesia.

A nurse is preparing to document information obtained from a client diagnosed with a delusional disorder who is experiencing somatic delusions. Which characteristic would the nurse document?

Body issues Explanation: Clients usually live with delusions for years, rarely receiving psychiatric treatment unless their delusion relates to their health (somatic delusion). Clients with delusional disorder show few, if any, psychological deficits. These clients characteristically have average or marginally low intelligence. Mental status generally is not affected. Thinking, orientation, affect, attention, memory, perception, and personality are generally intact.

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 Explanation: The client is demonstrating circumstantiality, which refers to extremely detailed and lengthy discourse about a topic.This can be commonly found in a client with euphoric or elevated mood due to the affective component of schizoaffective disorder. Clang associations are ideas that are related to one another based on sound or rhyming rather than meaning. Neologisms are words invented by the client. A verbigeration is the stereotyped repetition of words or phrases that may or may not have meaning to the listener.

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 Explanation: Clang associations are ideas that are related to one another based on sound or rhyming rather than meaning. Neologisms are words invented by the client. A verbigeration is the stereotyped repetition of words or phrases that may or may not have meaning to the listener. A word salad is a combination of jumbled words and phrases that are disconnected or incoherent and make no sense to the listener.

A nurse is preparing a presentation about schizophrenia and outcomes focusing on recovery for families of clients with schizophrenia. Which main goal would the nurse include?

Continuity of care Explanation: Outcome research has shown that schizophrenia can be successfully treated and managed. Continuity of care has been identified as a major goal of recovery for clients with schizophrenia because they are at risk for becoming lost to services if left alone after discharge. Although inpatient hospitalizations that are brief and focus on client stabilization, and crisis management is key to emergency care, and decreased social isolation through social engagement are all important, they are not considered major goals for recovery.

Which are key diagnostic criteria of schizophrenia? Select all that apply. Continuous signs for at least 6 months One or more major areas of social or occupational functioning markedly below previously achieved levels Delusions present for a significant portion of time during a 1-month period A direct physiologic effect of a substance or medical condition Major depression occurring concurrently with active symptoms

Continuous signs for at least 6 months One or more major areas of social or occupational functioning markedly below previously achieved levels Delusions present for a significant portion of time during a 1-month period Explanation: Key diagnostic criteria include continuous signs for at least 6 months, one or more major areas of social or occupational functioning markedly below previously achieved levels, and delusions present for a significant portion of time during a 1-month period. Other criteria include the absence, or insignificant duration, of major depressive, manic, or mixed episodes occurring concurrently with active symptoms and that the disease is not a direct physiologic effect of a substance or medical condition.

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

Correct response: Tell the client to talk back to the voices and tell them to go away. Explanation: Interventions for managing hallucinations include dismissal intervention (i.e., telling the voices to go away), various coping strategies (e.g., jogging, telephoning, playing games, seeking out others, employing relaxation techniques), or competing stimuli (e.g., listening to music or the voice of oneself or another to overcome auditory hallucinations and using visual stimuli to overcome visual hallucinations). Some clients desire to discuss their hallucinations with health care staff to gain understanding. In any event, the nurse may elicit a description of the hallucination to seek understanding of how to calm or reassure the client, protecting the client and others. While the nurse should never endorse a hallucination as real, the nurse should also not scold the client for having hallucinations. Isolation is not helpful for the client with hallucinations; the nurse should help maintain reality through frequent contact with client, and the client should be engaged in reality-based activities and reintegrated into the treatment milieu as soon as possible.

A hospitalized client diagnosed 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 Explanation: For dystonic reactions, the drug of choice is benztropine mesylate or diphenhydramine. Propranolol could be used to treat akathisia. Risperidone and aripiprazole are antipsychotic agents used to treat 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 Explanation: Echolalia is the involuntary imitation of another person's speech and gestures, is a disorganized behavior. Neologism, and tangentiality reflect disorganized thinking. Perseveration is the persistent adherence to a single idea or topic and verbal repetition of a sentence, phrase or word even when another persona attempts to change the topic.

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

Immobility like being in a trance Explanation: Catatonia, as seen in clients with schizophrenia, is a psychologically induced immobility occasionally marked by periods of agitation or excitement; the client seems motionless as if in a trance.

A client diagnosed with schizoaffective disorder and severe depression is being treated with antipsychotic medications. The client tells the nurse about difficulty with self-care activities. With which intervention should the nurse respond?

Establish a routine and set goals. Explanation: The most useful approach for the nurse to try is to help the client establish a routine and set goals for accomplishing the activities of daily living.

A client is diagnosed with schizoaffective disorder. Which would the nurse identify as supporting this diagnosis?

Evidence of hallucinations and delusions accompanied by major depression Explanation: For the diagnosis of 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. In addition, the positive symptoms must be present without the mood symptoms at some time during this period for at least 2 weeks. The ability to maintain functioning would not be possible. Disorganized speech is only one of the symptoms that may be present. It also may be present with schizophrenia. A smaller thalamus and hippocampus are associated with schizophrenia.

Which type of antipsychotic medication is most likely to produce extrapyramidal effects?

First-generation antipsychotic drugs Explanation: The conventional, or first-generation, antipsychotic drugs are potent antagonists of dopamine receptors D2, D3, and D4. This makes them effective in treating target symptoms but also produces many extrapyramidal side effects because of the blocking of the D2 receptors. Newer, atypical or second-generation antipsychotic drugs are relatively weak blockers of D2, which may account for the lower incidence of extrapyramidal side effects. The third generation of antipsychotics, called dopamine system stabilizers, is being developed. These drugs are thought to stabilize dopamine output that results in control of symptoms without some of the side effects of other antipsychotic medications.

Positive symptoms seen in schizophrenia are believed to be a result of which type of neurological dysfunction?

Increased amount of dopamine Explanation: Positive (or productive) symptoms reflect an increased amount of dopamine affecting the cortical areas of the brain. Negative symptoms reflect an inadequate amount of dopamine, cerebral atrophy, and organic functional changes in the brain.

Which is the central focus of persecutory delusions?

Injustice that must be remedied by legal action Explanation: The focus of persecutory delusions is often on some injustice that must be remedied by legal action. Clients often see satisfaction by repeatedly appealing to courts and other government agencies. The central theme of somatic delusions involves bodily functioning or sensations. The central theme of the jealous subtype is the unfaithfulness or infidelity of a spouse or lover. Clients representing with grandiose delusions are convinced they have a great, unrecognized talent or have made an important discovery.

A student nurse has been assigned to provide care for an inpatient psychiatric-mental health client who has a diagnosis of schizophrenia. The student nurse is apprehensive about interacting with the client. The client's detailed explanations of the client's delusions accompanied by unpredictable movements have prompted fear in the student. How should this nursing student interpret such feelings?

It is natural to feel fear when a client exhibits unpredictable behavior, and this can cause the student to be reasonably cautious. Explanation: A student may experience fear if the client exhibits unpredictable behavior. Fear is a normal response that results in the exercise of caution. Experiencing fear is not evidence of stereotyping, and divulging fear to the client is unlikely to benefit either the student or the client. The risk of violence is a reality, though the risk differs with each client.

A client is diagnosed with schizoaffective disorder (SAD). The nurse understands that in addition to psychosis, the client must also exhibit:

Mood disorder Explanation: SAD is characterized by periods of intense symptom exacerbation alternating with quiescent periods, during which psychosocial functioning is adequate. This disorder is at times marked by psychosis; at other times, by mood disturbance. When psychosis and mood disturbance occur at the same time, a diagnosis of schizoaffective disorder is made.

Schizoaffective disorder has symptoms typical of both schizophrenia and which type of disorder?

Mood disorders Explanation: Schizoaffective disorder has symptoms typical of both schizophrenia and mood disorders, but it is a separate disorder. Symptoms of anxiety, substance use, and eating disorders are not typically part of schizoaffective disorder.

A comprehensive nursing assessment for neuroleptic malignant syndrome (NMS) should include checking for which in a client taking an antipsychotic medication?

Muscular rigidity, tremors, and difficulty swallowing Explanation: NMS is characterized by muscular rigidity, tremors, difficulty swallowing, fever, hypertension, and diaphoresis.

A client with schizophrenia is receiving antipsychotic therapy. The nurse understands that which is a medical emergency should it develop in the client?

Neuroleptic malignant syndrome Explanation: Although tardive dyskinesia, parkinsonism, and akathisia can occur with antipsychotic therapy, neuroleptic malignant syndrome is a life-threatening condition and medical emergency that requires immediate treatment.

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?

One of the common side effects is dry mouth. Explanation: Dry mouth is a common, sometimes bothersome, side effect. Quetiapine does not cause breast milk production. Dizziness may occur due to orthostatic hypotension but will decrease as the body becomes accustomed to the medication. It is not an emergency. Quetiapine can cause changes in blood sugar but will not induce sugar cravings.

A mental health client insists that the client's spouse is trying to poison the client. In this instance, the client is exhibiting which type of delusion?

Persecutory Explanation: Clients who exhibit persecutory delusions believe that they are being conspired against, spied on, poisoned, or drugged. Somatic delusions demonstrate a preoccupation with the body. A client exhibiting erotomanic delusions believes that a person of elevated social status loves him or her. Grandiose delusions are present when the client believes that he or she possesses unrecognized talent or insight or has made an important discovery.

After teaching a class of nursing students about the different types of delusions, the instructor determines that the education was successful when the class identifies which type as most common?

Persecutory Explanation: Of the different types of delusions, persecutory delusions are the most common.

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 Explanation: Pseudoparkinsonism is exhibited by a shuffling gait, drooling, and slowness of movement. Dystonia is characterized by cramps and rigidity of the tongue, face, neck, and back muscles. Akathisia causes restlessness, anxiety, and jitteriness. Neuroleptic malignant syndrome causes rigidity, fever, hypertension, and diaphoresis.

A client is brought to the emergency department stating, "I'm scared because the Federal Bureau of Investigation is now tapping my home phone, and I can hear them talking between my two telephones during the night." The client's eyes dart around the room while the nurse is trying to interview the client, and the client is tapping the client's fingers on the table. The nursing priority with this client is what?

Reassure the client that the client is in a safe place where the client will be helped. Explanation: Safety needs are paramount. The person with schizophrenia is likely to be anxious and fearful around others due to disordered thought processes. Therefore the nurse builds a trusting relationship and assumes responsibility for the client's well-being by reassuring the client of the client's safety and security.

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 Explanation: Clozapine, reported effective for SCA by several authorities, can reduce hospitalizations and risk for suicide. A significant portion of clients whose symptoms have resisted other neuroleptic agents improve on clozapine.

While caring for a hospitalized client diagnosed with schizophrenia, a nurse observes that the client is listening to the radio. The client tells the nurse that the radio commentator is speaking directly to the client. The nurse interprets this finding as which type of thinking?

Referential Explanation: The client is exhibiting referential thinking, that is, the belief that neutral stimuli, such as the radio, have special meaning to that person, such that the radio commentator is talking directly to him. Autistic thinking involves restriction of thinking to the literal and immediate so that the individual has private rules of logic and reasoning that make no sense to anyone else. Concrete thinking reflects a lack of abstraction in thinking with the inability to understand punch lines, metaphors, and analogies. Illusional thinking occurs when a person misperceives or exaggerates stimuli that actually exist in the external environment.

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 Explanation: Relapse involves a return of the symptoms, most often due to the client's failure to follow the medication regimen. The prodromal phase is associated with small changes in overall function, such as difficulties at work or school, within relationships, or in daily activities accompanied by transient or weak symptoms of psychosis. Acute illness is the initial onset of changes in thought and bizarre or disruptive behavior. Stabilization occurs when symptoms become less acute, following the initial diagnosis and initiation of treatment.

Some research has suggested that schizophreniform disorder may be an early manifestation of which other mental health condition?

Schizophrenia Explanation: Some research has suggested that schizophreniform may be an early manifestation of schizophrenia. A client exhibiting an acute reactive psychosis for less than the 6 months necessary to meet the diagnostic criteria for schizophrenia is given the diagnosis of schizophreniform disorder. Symptoms lasting beyond the 6 months warrant a diagnosis of schizophrenia.

A 20-year-old son of a client who was diagnosed with schizophrenia at the age of 25 is concerned that he may also develop the disorder. Which statement regarding schizophrenia and genetics is true?

Schizophrenia has shown a strong genetic contribution. Explanation: Many studies strongly suggest a genetic contribution. Relatives of people with schizophrenia have a higher incidence of the disorder than found in the general population. First-degree relatives (i.e., parents, siblings, children) of clients with schizophrenia are at greater risk for the illness than are second-degree relatives (e.g., grandparents, grandchildren, aunts, uncles, half-siblings). Schizophrenia is 13% more likely to develop in children with one parent who has schizophrenia than in those with unaffected parents; when both parents have schizophrenia, a child has a 46% risk for the illness.

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. Explanation: According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, (DSM-5), schizophrenia lasts at least 6 months and includes at least 1 month of 2 or more active-phase symptoms such as bizarre delusions, hallucinations (e.g., a running commentary of two voices conversing), disorganized speech, grossly disorganized or catatonic behavior, and negative behavior.

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 with the ability to function at work. The client also is exhibiting catatonic excitement, echopraxia, loose associations, and pressured speech. Which condition does the nurse suspect?

Schizophreniform disorder Explanation: 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.

A client with a long history of schizophrenia has managed well on fluphenazine. The client reports smacking of the lips and sticking out the tongue. Based on this report, what does the nurse suspect is occurring with the client?

Signs of tardive dyskinesia (TD) associated with neuroleptic medication Explanation: TD is a type of extrapyramidal side effect characterized by abnormal, involuntary, irregular, choreoathetoid (writhing) movements, which may include lip smacking, neck twisting, facial grimacing, and tongue and chewing movements. TD can occur after several months to years of therapy with traditional antipsychotics.

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

Somatic Explanation: Persons who have somatic delusions believe they have a physical ailment. Clients with somatic delusions use excessive health care resources. The central theme of the jealous subtype is the unfaithfulness or infidelity of a spouse or lover. Nihilistic delusions focus on death or calamity. Clients presenting with grandiose delusions are convinced they have a great, unrecognized talent or have made an important discovery; a less common presentation is the delusion of a special relationship with a prominent person or actually being a prominent person.

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 Explanation: Some cultures have widely held and culturally sanctioned beliefs that might be considered delusional in other cultures.

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

Somatic therapy Explanation: Somatic and alternative therapies generally are not used to treat delusional or shared psychotic disorders because the mark of successful treatment usually depends on a satisfactory social adjustment rather than a suppression of the client's delusions.

A client is receiving antipsychotic therapy. When describing dystonic reactions to the client,the nurse would instruct the client to watch for:

Spasms of the eye muscles Explanation: Dystonic reactions are also believed to result from the imbalance of dopamine and acetylcholine, with the latter dominant. This side effect, which develops rapidly and dramatically, can be very frightening for clients as their muscles tense and their body contorts. The experience often includes spasms of the eye muscles called oculogyric crisis, in which the muscles that control eye movements tense and pull the eyeball so that the client is looking toward the ceiling. Restless is otherwise called akathesia. This is considered one form of extrapyramidal symptoms but is not an acute dystonic reaction. Lip smacking and facial grimacing are characteristic of tardive dyskinesia.

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 Explanation: The client is demonstrating suspiciousness ("you're all out to get me") and neologisms (use of the words "Rostoputians and grog babies"). Loose associations and flight of ideas occur when the client talks about many topics in rapid sequence, but they are not connected with each other. Illusions are when the client sees something that is not there; echolalia is the repetition of words (or words that sound similar) said by someone else.

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. Explanation: The presence of prominent and sustained hallucinations is suggestive of schizophrenia rather than delusional disorder. Nonbizarre delusions are associated with delusional disorder, and people with either diagnosis lack insight. Response to therapy does not differentiate between the two diagnoses.

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

The client reports "hearing voices" for the last 3 months Explanation: The client's diagnosis of schizoaffective disorder is supported when the nurse documents that the client reports "hearing voices" for the last 3 months. The documentation is objective and includes a direct quote from the actual client. What is being documented is consistent with the criteria for schizoaffective disorder.

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 differentiate between reality and fantasy. Explanation: The ultimate goal of all forms of treatment for clients with delusional disorders is to foster the ability to distinguish between fantasy and reality. Promoting healthy coping, anxiety awareness, and healthy relationships are therapeutic outcomes, but the priority in treatment is the delusional

Research related to the development of schizophrenia has shown what?

The disorder is thought to arise from the interaction of a biological predisposition and environmental stressors. Explanation: The likelihood of first-degree relatives (including siblings and children) developing schizophrenia has long been recognized as 10 times more likely than individuals in the general population. While this likelihood clearly suggests a strong genetic factor, the concordance for schizophrenia among monozygotic (identical) twins is 50%, suggesting that there are also environmental factors. Schizophrenia is believed to be caused by the interaction of a biologic predisposition or vulnerability and environmental stressors.

A client with schizophrenia is prescribed an antipsychotic medication. Which immediate side effects would the nurse include in the education plan for this medication?

The potential for sedation Explanation: Sedation with antipsychotic medication will likely happen immediately after initiating the medication. The nurse should be sure to inform the client they he or she will experience this side effect readily. The other options are examples of side effects that are possible with longer term treatment using antipsychotic medications. Weight gain is commonly associated with many antipsychotic medications. The potential for weight loss with antipsychotic medication is not typically discussed with clients.

Which data support a nursing diagnosis of impaired verbal communication?

The presence of neologism, echolalia, and clanging Explanation: Although the client may be indecisive, have false beliefs, and lack motivation, these do not support a diagnosis of impaired verbal communication. Invented words, repetition of words heard, and rhyming do get in the way of the ability to use or understand language in the human interaction. Fixed false beliefs and an absence of energy do not support a diagnosis of impaired verbal communication, nor do pacing and running.

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 Explanation: By definition, delusions are fixed, false beliefs that cannot be changed by reasonable arguments. The nurse should assess the client's delusion to evaluate its significance to the client, to the client's safety, and to the safety of others. The nurse should not dwell on the delusion or try to change it.

A client diagnosed with schizophrenia states, "I want to go home, go home, go home." This is an example of which speech pattern?

Verbigeration Explanation: A verbigeration is the stereotyped repetition of words or phrases that may or may not have meaning to the listener. Clang associations are ideas that are related to one another based on sound or rhyming rather than meaning. Neologisms are words invented by the client. A word salad is a combination of jumbled words and phrases that are disconnected or incoherent and make no sense to the listener.

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 Explanation: Waxy flexibility, the ability to assume and maintain awkward or uncomfortable positions for long periods, is characteristic of catatonic schizophrenia. Clients commonly remain in these awkward positions until someone repositions them. Exchopraxia refers to the involuntary imitation of another person's movements and gestures. Hypervigilance refers to the sustained attention to external stimuli, as if expecting something important or frightening to occur. Retardation refers to slowed movements.

Which is a nonneurologic side effect of antipsychotic medications?

Weight gain Explanation: Weight gain is a nonneurologic side effect of antipsychotic medications.

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

increased mood responses Explanation: Clients with SAD have many similar responses to their disorder as people with schizophrenia, with one exception. These clients have many more "mood" responses and are very susceptible to suicide. Persons with SAD usually have higher functioning than those with schizophrenia, with severe negative symptoms and early onset of illness. To be diagnosed with SAD, a 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.

A client who has a major fear of people dressed in black tells the nurse that, for the past 2 weeks, the client has been hearing voices and at times thinks that they are being followed. The nurse interprets these findings as suggesting which condition?

paranoid type schizophrenia Explanation: Individuals with paranoid type schizophrenia experience prominent hallucinations and delusions. The hallucinations are often auditory in nature with delusions of being persecuted or followed. The delusions are usually very organized and focus on a theme. Because this is threatening to them, they assume a defensive behavior toward anyone who is wearing black. The individual with the undifferentiated subtype of schizophrenia exhibits classic symptoms such as delusions, hallucinations, disorganized speech, atypical behavior, and blunted affect. The symptoms are not clearly defined to meet the criteria for any other subtype. Those with disorganized type schizophrenia exhibit disorganized and unintelligible speech, atypical behavior, and a flat affect. Delusions do not center on any specific theme but tend to be fragmented and varied in focus. Unusual mannerisms and posturing may prevent these individuals from eating, toileting, or attending to personal hygiene. Schizoaffective disorder is considered primarily a form of schizophrenia as the individual must have primary symptoms such as delusions, hallucinations, and disorganized behaviors. To be given the diagnosis of schizoaffective, the individual must also at times have demonstrated symptoms of major depression or mania.

The client with schizophrenia tells the nurse, "I can't go outside or answer the phone; the boss man has people watching me because I know too much. The boss is afraid I will rat out the operation to the Feds." The nurse documents the client's statement as which type of delusion?

persecutory Explanation: The client is experiencing persecutory delusions. These delusions, for example, are that the boss is out to kill them, or perhaps a mob, the mafia, or a gang. An example of a grandiose delusion is believing they are stronger than a superhero in a movie. An example of a nihilistic delusion is that a part of their body no longer exists (e.g., their arm, leg, eye, etc.). A somatic delusion is one believing their body is disintegrating into another substance or infested with insects, such as spiders under the skin or bugs.