Chapter 16: Schizophrenia

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A nurse provides care to a client with schizoaffective disorder during hospitalization for acute psychosis. Nursing interventions to help the client to establish trust with the health care team is best accomplished by what?

Offering reassurance in a soft, nonthreatening voice

When reviewing the diagnostic criteria for schizophrenia based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V), which would be most accurate?

Schizophrenia lasts at least 6 months and includes at least 1 month of two or more characteristic symptoms.

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.

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? Mania Water intoxication Suicide Depression

Suicide

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

Mood stabilizers & benzo

Valproate Lamotrigine Lorazepam

A client has been prescribed clozapine for treatment of schizophrenia. The client must be taught to monitor which blood concentrations weekly while taking this drug? hemoglobin platelets hematocrit white blood cells

white blood cells

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

third gen antipsychotics

Aripiprazole

A nurse is assessing a client diagnosed with schizophrenia. When documenting the findings, which would the nurse identify as a positive symptom? Select all that apply.

Delusions Hallucinations

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.

Delusional

Experiences delusional thinking for at least 1 month Self or interpersonal functioning is not markedly impaired

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

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 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.

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 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.

A client with schizophrenia is exhibiting hallucinations and delusions. The mental health nurse knows that these symptoms are associated with hyperactivity of which neurotransmitter?

Dopamine

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.

A nurse assessing a client with schizoaffective disorder should obtain a detailed history with a description of the full range and duration for which of the following reasons?

is important to predict outcomes

A week after beginning therapy with thiothixene, the client demonstrates muscle rigidity, a temperature of 103°F, an elevated serum creatinine phosphokinase level, stupor, and incontinence. The nurse should notify the physician because these symptoms are indicative of:

neuroleptic malignant syndrome.

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

somatic

What term is used to describe the speech pattern being used when the client imitates or repeats what the nurse is saying?

Echolalia

What term is used to describe the speech pattern being used when the client imitates or repeats what the nurse is saying? Neologisms Clang associations Echolalia Word salad

Echolalia

When preparing to educate a client regarding a newly prescribed antipsychotic medication, the nurse does what? Select all that apply.

Encourages the use of sugar-free gum to help manage dry mouth Suggests methods to minimize the potential for weight gain Identifies lifestyle adjustments that the resulting lethargy may require Advises the client to discuss any concerns regarding sexual dysfunction

The nurse is assessing a client with schizophrenia who has a history of successfully managing the client's symptoms. The client has few social activities and speaks in a flat tone when interacting with others. Currently the client is experiencing active hallucinations and social withdrawal. The nurse identifies improved social skills as an important therapeutic goal. How should the nurse implement this plan?

Enter the client in a social skills training program when acute psychosis subsides.

A client with schizophrenia believes that the client has discovered how to jump to the moon. The nurse would document this belief as what?

Grandiose delusion

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

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

Increased mood responses

A client with schizophrenia is exhibiting emotional withdrawal and poor eye contact. The mental health nurse knows that these symptoms are suggestive of which neurotransmitter imbalance?

Increased serotonin and dopamine

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

Infection

Which is the central focus of persecutory delusions?

Injustice that must be remedied by legal action

Which is the central focus of persecutory delusions? A great, unrecognized talent Unfaithfulness Involving bodily functions or sensations Injustice that must be remedied by legal action

Injustice that must be remedied by legal action

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 client diagnosed with delusional disorder who uses excessive health care resources most likely has which type of delusions? Jealous Grandiose Somatic Nihilistic

Somatic

A nurse is assessing a client who is complaining of 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 complaint. The nurse interprets this as which type of delusion?

Somatic

A nurse is assessing a client who is reporting 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 report. The nurse interprets this as which type of delusion?

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

Agranulocytosis 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. Videbeck, S. Psychiatric-Mental Health Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2017, Chapter 16: Schizophrenia, p. 274.

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

A client diagnosed with schizophreniform disorder must have symptoms present for at least 1 month but with a duration of less than:

6 months

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 Recognizing a medication's side effects quickly and intervening promptly to alleviate them will help maintain adherence. Videbeck, S. Psychiatric-Mental Health Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2017, Chapter 16: Schizophrenia, p. 286.

After assessing a client with schizophrenia, the nurse notes that the client exhibits signs and symptoms related to being unable to experience pleasure. The nurse documents this finding as what?

Anhedonia

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

Persecution

: feels singled out for harm by others such as being hunted down by the FBI

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.

Which client statement is suggestive of a sexual delusion?

"You've been watching me and my partner while we are together, haven't you?"

Which statement is true about delusional disorder?

Behavior is relatively normal except when focused on the delusion.

Antidepressants

Paroxetine

Which of the following would the nurse identify as a negative symptom associated with schizophrenia?

Anhedonia

Thought insertion

Believes others thoughts are being inserted into their mind

schizoaffective disorder

Both schizophrenia and depressive or bipolar disorder

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.

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

After teaching a client with schizoaffective disorder about the condition and treatment, the nurse determines that the education was successful when the client states what?

"I need to eat properly so that I can control my weight."

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

infection.

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."

Which statement made by a client would indicate that the client has delusions of grandeur? "I can't eat this food. It's poisoned." "I hear messages from aliens that tell me to steal cars." "I let my baby die. I don't deserve to live." "I am a magician, and my magic powers are good when the moon is full."

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

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."

"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.

A client diagnosed with schizophrenia tells the nurse, "I hear the voice of Elvis." Which is the most therapeutic response by the nurse?

"I don't hear the voice, but I know you hear what sounds like a voice."

A client tells the nurse, "I can see someone sticking out from underneath my bed, and he's telling me that he is going to kill me." Which is the most therapeutic response the nurse can provide? "Just tell the man to go away." "You are safe here, so don't worry about that." "I don't see or hear anything, but it sounds as though you are very frightened." "There is no man under your bed. Let's go to the dining room now."

"I don't see or hear anything, but it sounds as though you are very frightened."

After teaching a client with schizoaffective disorder about the condition and treatment, the nurse determines that the education was successful when the client states what? "I need to eat properly so that I can control my weight." "I should go to sleep at night when I feel tired." "I can vary my routines from day to day without problems." "I can stop my medication when I start to feel better."

"I need to eat properly so that I can control my weight." Explanation: Client education should focus on nutrition and prevention of weight gain, which is a side effect of medication therapy. Establishing a regular sleep pattern by setting a routine can help to promote or reestablish normal patterns of rest. Establishing a daily routine can help address mood symptoms. Medication should not be stopped if the client feels better.

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."

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.

"One day, I won't have to worry about taking any medication."

The nurse is teaching a client with schizoaffective disorders (SAD) about the client's prescribed medication therapy. The nurse determines that additional education is needed when the client states what? "One day, I won't have to worry about taking any medication." "If I notice any strange muscle movements, I should call my provider." "I need to make sure that I drink enough fluids throughout the day." "I need to change my position slowly when getting up from lying down."

"One day, I won't have to worry about taking any medication."

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 is prescribed clozapine because other prescribed medications have been ineffective. After educating the client and family about the drug, the nurse determines that the education was successful when they state what?

"We'll need to make sure that the client has the client's blood count checked at least weekly."

A client who is delusional and paranoid refuses to take antipsychotic medication as prescribed. Which is the most therapeutic response by the nurse to this refusal?

"What is it about the medicine that you don't like?"

"You're so naïve. You just don't understand what's really happening out there."

The parent of a client who has a delusional disorder spends a great deal of time and energy trying to convince the client that the client is not actually the focus of a nationwide, secret plot to track the client's activities. Which of the client's responses is most typical of an individual with a delusional disorder? "You're so naïve. You just don't understand what's really happening out there." "I'll consider what you think, but this is something I really, really need." "I know I've got delusions, but you would too if you had to live my life." "I've told you before that I can't just snap my fingers and change the way I think."

"You're so naïve. You just don't understand what's really happening out there."

"You're so naïve. You just don't understand what's really happening out there." Explanation: Individuals with delusional disorders have no insight into their condition and typically believe that others are ignorant to the true reality. The other responses imply that the client recognizes that the client's thinking is delusional.

The nurse expects psychiatric hospitalization for which of the clients diagnosed with schizoaffective disorder experiencing delusional thoughts? Select all that apply.

- A 76-year-old person whose symptoms are acute in nature - A 25-year-old person who is having a first delusional experience - A 45-year-old person who was arrested for assaulting a policeman - A 30-year-old person who also has a diagnosis of depression

A nurse is assessing a client diagnosed with schizophrenia. When documenting the findings, which would the nurse identify as a positive symptom? Select all that apply.

-Delusions -Hallucinations

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.

A client diagnosed with schizophreniform disorder must have symptoms present for at least 1 month but with a duration of less than how long?

6 months

A client diagnosed with schizophreniform disorder must have symptoms present for at least 1 month but with a duration of less than how long?

6 months 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.

A client diagnosed with schizophreniform disorder must have symptoms present for at least 1 month but with a duration of less than:

6 months.

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.

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 30-year-old has experienced a relapse after deciding that the client's atypical antipsychotic is unnecessary. A 28-year-old has been displaying the behaviors characteristic of schizophrenia for many months and has just been diagnosed with the disease. A 25-year-old does not express any of the symptoms of schizophrenia

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

The nurse expects psychiatric hospitalization for which of the clients diagnosed with schizoaffective disorder experiencing delusional thoughts? Select all that apply.

A 76-year-old person whose symptoms are acute in nature A 25-year-old person who is having a first delusional experience A 45-year-old person who was arrested for assaulting a policeman A 30-year-old person who also has a diagnosis of depression

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 nurse teaching a client about prescribed antipsychotic medication informs the client to contact a health care provider immediately if the client notices: A feeling of dizziness when the client stands up. A dramatic change in temperature. An increase in thirst. An increase in weight of 2 lbs in 1 month.

A dramatic change in temperature.

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. Explanation: Advise clients to contact their case coordinators or health care providers immediately if they experience dramatic changes in body temperature. The client may be at risk for neuroleptic malignant syndrome.

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

The nurse is caring for a client who has been taking clozapine (Clozaril) for 2 weeks. The client tells the nurse, My throat is sore, and I feel weak. The nurse assesses the client's vital signs and finds that the client has a fever. The nurse notifies the physician, expecting an order to obtain which laboratory test? A) A white blood cell count B) Liver function studies C) Serum potassium level D) Serum sodium level

A) A white blood cell count

The nurse is caring for an elderly client who has been taking an antipsychotic medication for 1 week. The nurse notifies the physician when he observes that the client has muscle rigidity that resembles Parkinson's disease. Which agent would the nurse expect the physician to prescribe? A) Anticholinergic B) Anxiolytic C) Benzodiazepine D) Beta-blocker

A) Anticholinergic

The nurse is interviewing a client with schizophrenia when the client begins to say, Kite, night, right, height, fright. The nurse documents this as which of the following? A) Clang association B) Stilted language C) Verbigeration D) Neologisms

A) Clang association

A nursing instructor is preparing a class lecture about schizophrenia and outcomes focusing on recovery. Which of the following would the instructor include as a major goal? A) Continuity of care B) Shorter in-patient stays C) Immediate crisis stabilization D) Social engagement

A) Continuity of care

A hospitalized client with schizophrenia is receiving antipsychotic medications. While assessing the client, the nurse identifies signs and symptoms of a dystonic reaction. Which agent would the nurse expect to administer? A) Diphenhydramine (Benadryl) B) Propranolol (Inderal) C) Risperidone (Risperdal) D) Aripiprazole (Abilify)

A) Diphenhydramine (Benadryl)

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? A) Dopamine B) Serotonin C) Norepinephrine D) Gamma-amino butyric acid (GABA)

A) Dopamine

A client is being released from the inpatient psychiatric unit with a diagnosis of schizophrenia and treatment with antipsychotic medications. After teaching the client and family about managing the disorder, the nurse determines that the teaching was effective when they state which of the following should be reported immediately? A) Elevated temperature B) Tremor C) Decreased blood pressure D) Weight gain

A) Elevated temperature

As part of an interdisciplinary team, a nurse is assisting in developing the plan of care for a client with a delusional disorder. Which of the following would the team be least likely to include in the plan? A) Insight-oriented therapy B) Psychoeducation C) Cognitive therapy D) Support therapy

A) Insight-oriented therapy

A nursing instructor is developing a class lecture that compares and contrasts schizoaffective disorder with schizophrenia. When describing one of the differences between these two diagnoses, which of the following would the instructor include as reflecting schizoaffective disorder? A) It is episodic in nature B) It involves difficulties with self-care. C) It has less severe hallucinations. D) It is associated with a lower suicide risk.

A) It is episodic in nature

When assessing a client with delusional disorder, the nurse would most likely expect to find impairment in which of the following? Select all that apply. A) Social functioning B) Marital functioning C) Intellectual functioning D) Occupational functioning E) Mental status functioning

A) Social functioning B) Marital functioning

The nurse is caring for a client who was diagnosed with schizoaffective disorder. Based on the nurse's understanding of this disorder, the nurse develops a plan of care to address which issue as the top priority? A) Suicide B) Aggression C) Substance abuse D) Eating disorder

A) Suicide

Negative symptoms

Absence of things normally present Affect: blunted or flat Alogia: poverty of thought or soeech(client may sit with visitor but only mumble) Anergia: lack of energy ANHE Sonia: lack of pleasure or joy Avolition: lack of motivation in activities and hygiene

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 nurse monitoring client medication needs to recognize side effects quickly and intervene promptly for which reason? Provide support to the client and encourage adherence as past side effects rarely reoccur Determine adequate dosage is maintained to control symptoms Provide support to the client and let the client know this is normal Alleviate the side effects and help client maintain adherence

Alleviate the side effects and help client maintain adherence

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.

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? Possession of exceptional powers, such as the ability to communicate with a powerful person An impending calamity, such as death Feeling of being watched, such as by the government Belief that communications intended for a broad audience have special meaning for the client

An impending calamity, such as death

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? a.Feeling of being watched, such as by the government b.Belief that communications intended for a broad audience have special meaning for the client c.Possession of exceptional powers, such as the ability to communicate with a powerful person d.An impending calamity, such as death

An impending calamity, such as death

A client with schizophrenia walks up to the nurse with the client's arm outstretched and says, "My arm went away. Dog, dog, dog." How should the nurse respond?

Ask the client if the client is trying to say that something is wrong with the client's arm.

Which constitutes a negative symptom associated with schizophrenia?

Asociality

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

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

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 Explanation: Pharmacologic intervention is needed to stabilize the symptoms, and it presents specific challenges. Long-term atypical antipsychotic agents, now the mainstay of pharmacologic treatment, are as effective as the traditional combination of a standard antipsychotic agent and an antidepressant drug. Mood stabilizers, such as lithium or valproic acid, may be used. A combination of antipsychotic and antidepressant agents is often used.

A client with schizoaffective disorder is having difficulty adhering to the medication regimen that requires the use of several agents. The client also is experiencing several side effects contributing to this nonadherence. The physician plans to change the client's medication. Which agent would the nurse anticipate that the physician would prescribe? A) Lithium B) Aripiprazole C) Clozapine D) Olanzapine

B) Aripiprazole

After assessing a client with schizophrenia, the nurse suspects that the client is experiencing an anticholinergic crisis. Which of the following would the nurse most likely have assessed? Select all that apply. A) Dilated reactive pupils B) Blurred vision C) Ataxia D) Coherent speech E) Facial pallor F) Disorientation

B) Blurred vision C) Ataxia F) Disorientation

A nurse is providing care to a client just recently diagnosed with schizophrenia during an inpatient hospital stay. Throughout the day, the nurse observes the client drinking from the water fountain quite frequently as well as carrying cans of soda and bottles of water with him wherever he goes. Upon entering the client's room, the nurse sees numerous empty cups that had been filled with fluids on his table and in the trash can. The room has an odor of urine. The nurse suspects which of the following? A) Diabetes mellitus B) Disordered water balance C) Tardive dyskinesia D) Orthostatic hypotension

B) Disordered water balance

A nurse is developing a teaching plan for a client with schizophrenia. Which method would the nurse use to be most effective? A) Engaging the client the trial and error learning B) Having the client write down information after directly being given the correct information C) Asking the client questions that encourage the client to guess at the correct answer D) Using visual aids that are very colorful and full of descriptive graphic images

B) Having the client write down information after directly being given the correct information

After teaching a group of students about the epidemiology of schizoaffective disorder, the instructor determines that the teaching was successful when the students state which of the following? A) The disorder occurs often in children. B) It is more likely to occur in women. C) Most persons are African Americans. D) The disorder is rare in family relatives.

B) It is more likely to occur in women.

A client with schizophrenia tells the nurse, I'm being watched constantly by the FBI because of my job. Which response by the nurse would be most appropriate? A) Tell me more about how you are being watched. B) It must be frightening to feel like you're always been watched. C) You're not being watched; it's all in your mind. D) You are experiencing a delusion because of your illness.

B) It must be frightening to feel like you're always been watched.

The nurse is preparing to interview a client who has a delusional disorder. Which of the following would the nurse expect? A) Cognitive impairment B) Normal behavior C) Labile affect D) Evidence of motor symptoms

B) Normal behavior

The nurse is caring for a hospitalized client who has schizophrenia. The client has been taking antipsychotic medications for 1 week when the nurse observes that the client's eyes are fixed on the ceiling. The nurse interprets this finding as which of the following? A) Akathisia B) Oculogyric crisis C) Retrocollis D) Tardive dyskinesia

B) Oculogyric crisis

A family member of a client diagnosed with schizoaffective disorder asks a nurse what causes the disorder. Which response by the nurse would be most appropriate? A) Dysfunctional family dynamics has been identified as a strong link. B) Research has suggested that the cause is predominately genetic. C) Dopamine, a substance in the brain, appears to be underactive. D) Studies have indicated that birth order is strongly associated with this disorder.

B) Research has suggested that the cause is predominately genetic.

A client with schizophrenia is prescribed clozapine because other prescribed medications have been ineffective. After teaching the client and family about the drug, the nurse determines that the teaching was successful when they state which of the following? A) He needs to have an electrocardiogram periodically when taking this drug. B) We'll need to make sure that he has his blood count checked at least weekly. C) He might develop toxic levels of the drug if he smokes cigarettes. D) We need to watch to make sure that he doesn't lose too much weight.

B) We'll need to make sure that he has his blood count checked at least weekly.

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

Being controlled

Believes that a force outside their body is controlling them

Magical thinking

Believes their actions or thought are able to control a situation or affect others, such as wearing a car than hat makes them invisible to others

Somatic delusions

Believes their body is changing in an unusual way such as growing a third arm

Jealousy

Believes their partner is sexually actively with another person with no factual basis

Thought with drawl

Believes their thoughts have been removed by an outside agency

Grandeur

Believes they are all powerful and important like GOD

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

Benzotropine

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

Benzotropine 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.

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

Benztropine

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

Benztropine

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 classification has been most effective in treating akathisia?

Beta-blockers Explanation: Beta-blockers, such as propranolol, have been most effective in treating akathisia.

Which group of theories is believed currently to explain the etiology of schizophrenia?

Biologic Explanation: Schizophrenia is thought to have multiple etiologies. The overwhelming body of scientific evidence suggests that schizophrenia is a brain disease. Computed tomography scanning and magnetic resonance imaging have shown frequent enlargement of the lateral cerebral ventricles in people with schizophrenia.

A client was admitted to the psychiatric intensive care unit with schizophrenia. The client exhibits primarily disorganized behavior. In addition to hallucinations and delusions, other assessments that the nurse would expect to find include what?

Blunted inappropriate affect, withdrawal, incoherence, and confusion

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 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? Above average intelligence Body complaints Disorientation Reduced attention span

Body complaints

Assessment of a client with schizophrenia reveals that he is hearing voices that tell him that people are staring at him and illusions. When developing the plan of care for this client, which nursing diagnosis would be most appropriate? A) Disturbed thought processes B) Risk for self-directed violence C) Disturbed sensory perception D) Ineffective coping

C) Disturbed sensory perception

A client with schizoaffective disorder is prescribed clozapine to treat her symptoms. Which of the following instructions would the nurse provide? A) Keep a record of how often and how long you experience the side effect of dry mouth. B) Monitor your urinary output and notify your doctor if your urine changes color. C) Keep an eye on your weight, and if you gain weight rapidly, notify your doctor. D) If you experience any drowsiness, discontinue taking this medication.

C) Keep an eye on your weight, and if you gain weight rapidly, notify your doctor.

A nurse is working with a group of clients diagnosed with schizophrenia in a community setting. Which of the following would least likely be a priority? A) Improving the quality of life B) Instilling hope C) Managing psychosis D) Preventing relapse

C) Managing psychosis

A nurse is preparing an in-service program for a group of psychiatric mental health nurses about schizophrenia. Which of the following would the nurse include as a major reason for relapse? A) Lack of family support B) Accessibility to community resources C) Non-adherence to prescribed medications D) Stigmatization of mental illness

C) Non-adherence to prescribed medications

While assessing a client with schizophrenia, the client 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? A) Grandiose B) Nihilistic C) Persecutory D) Somatic

C) Persecutory

After teaching a class on antipsychotic agents, the instructor determines that the teaching was successful when the class identifies which of the following as an example of a second-generation antipsychotic agent? A) Fluphenazine (Prolixin) B) Thiothixene (Navane) C) Quetiapine (Seroquel) D) Chlorpromazine (Thorazine)

C) Quetiapine (Seroquel)

While caring for a hospitalized client with schizophrenia, the nurse observes that the client is listening to the radio. The client tells the nurse that the radio commentator is speaking directly to him. The nurse interprets this finding as which of the following? A) Autistic thinking B) Concrete thinking C) Referential thinking D) Illusional thinking

C) Referential thinking

A group of nursing students is reviewing information about other psychotic disorders. The students demonstrate understanding of this information when they identify which disorder as involving an inducer? A) Brief psychotic disorder B) Schizophreniform disorder C) Shared psychotic disorder D) Psychotic disorder attributable to a substance

C) Shared psychotic disorder

Which of the following would be most important for the nurse to keep in mind when establishing the nurse patient relationship with a client with schizophrenia to promote recovery? A) The relationship typically develops over a short period of time. B) Decisions about care are the responsibility of interdisciplinary team. C) Short, time-limited interactions are best for the client experiencing psychosis. D) Typically, clients with schizophrenia readily engage in a therapeutic relationship.

C) Short, time-limited interactions are best for the client experiencing psychosis.

While interviewing a client diagnosed with a delusional disorder, the client 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? A) Erotomanic B) Grandiose C) Somatic D) Jealous

C) Somatic

The nurse is assessing a newly admitted client diagnosed with schizoaffective disorder. The nurse assesses the client's level of anxiety and reactions to stressful situations, obtaining this information for which reason? A) To help determine the client's outcomes after treatment B) To help identify whether or not the client's mental competency is intact C) To act as a predictor of the client's risk for a suicide attempt D) To provide a basis for evaluating the client's social skills

C) To act as a predictor of the client's risk for a suicide attempt

A client with a persistent delusional disorder has been prescribed ziprasidone. Which assessment should the nurse prioritize when this medication regimen begins?

Cardiac and neurological assessments

A client with a persistent delusional disorder has been prescribed ziprasidone. Which assessment should the nurse prioritize when this medication regimen begins?

Cardiac and neurological assessments Explanation: Ziprasidone carries a risk of dysrhythmias, extrapyramidal side effects, tardive dyskinesia, and Neuroleptic malignant syndrome. As such, cardiac and neurological assessments are a priority over the other components of a comprehensive assessment.

The client has been diagnosed with schizophrenia and is showing the following symptoms: immobility, rigidity, and stupor. These symptoms can be further classified as which characteristic symptoms of schizophrenia?

Catatonic

Catatonic- show motoric immobility or stupor, rigidity, excessive motor activity, extreme negativism, stupor, and peculiarities of movement, such as posturing, echolalia and echopraxia, mutism, and waxy flexibility.

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

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.

A nurse is interviewing a client with schizophrenia when the client begins to say, "Kite, night, right, height, fright." The nurse documents this as:

Clang association

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

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

When assessing a client for possible disordered water balance, the nurse checks the client's urine specific gravity. Which result would lead the nurse to suspect that the client is experiencing severe disordered water balance? A) 1.020 B) 1.011 C) 1.005 D) 1.002

D) 1.002

A client has been diagnosed with schizophrenia. Assessment reveals that the client lives alone. His clothing is disheveled, his hair is uncombed and matted, and his body has a strange odor. During an interview, the client's family voices a desire for the client to live with them when he is discharged. Based on the assessment findings, which nursing diagnosis would be the priority? A) Ineffective Role Performance related to symptoms of schizophrenia. B) Social Isolation related to auditory hallucinations. C) Dysfunctional Family Processes related to psychosis. D) Bathing Self-Care Deficit related to symptoms of schizophrenia.

D) Bathing Self-Care Deficit related to symptoms of schizophrenia.

The nurse is preparing to document information obtained from a client diagnosed with a delusional disorder who is experiencing somatic delusions. Which of the following would the nurse most likely document? A) Disorientation B) Reduced attention span C) Above average intelligence D) Body complaints

D) Body complaints

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? A) Lithium B) Haloperidol C) Chlorpromazine D) Clozapine

D) Clozapine

A client hospitalized for treatment of schizophrenia has been receiving olanzapine (Zyprexa) for the past 2 months. The nurse would be especially alert for which of the following? A) Weight loss B) Hypertension C) Diarrhea D) Diabetes

D) Diabetes

The nurse is caring for a client in an inpatient mental health setting. The nurse notices that when the client is conversing with other clients, he repeats what they are saying word for word. The nurse interprets this finding and documents it as which of the following? A) Echopraxia B) Neologisms C) Tangentiality D) Echolalia

D) Echolalia

The nurse is caring for a client diagnosed with a delusional disorder. While assessing this client, which of the following would the nurse expect to find? A) History of chronic major depression B) Consistently disrupting behavior patterns C) Verbalization of bizarre delusions D) Living with one or more delusions for a period of time

D) Living with one or more delusions for a period of time

A client who has a major depressive episode tells the nurse that for the past 2 weeks, he has been hearing voices and at times thinks that someone is following him. History reveals that he had these alternating symptoms before along with times when he has experienced neither of these symptoms and has been able to function adequately. The nurse interprets these findings as suggesting which of the following? A) Paranoid schizophrenia B) Undifferentiated schizophrenia C) Brief psychotic disorder D) Schizoaffective disorder

D) Schizoaffective disorder

When obtaining a client's history, the nurse determines that the client has been experiencing delusions and hallucinations for the past 3 months, which has caused some problems in his ability to function on a daily basis at work. He also is exhibiting catatonic excitement, echopraxia, loose associations, and pressured speech. The nurse suspects which of the following? A) Schizophrenia B) Schizoaffective disorder C) Brief Psychotic disorder D) Schizophreniform disorder

D) Schizophreniform disorder

The nurse is caring for a client who has been receiving treatment for schizophrenia with chlorpromazine for the past year. It would be essential for the nurse to monitor the client for which of the following? A) Weight loss B) Torticollis C) Hypoglycemia D) Tardive dyskinesia

D) Tardive dyskinesia

A hospitalized client 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

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.

Cognitive findings

Disordered thinking Inability to make decisions Poor problem solving Difficulty concentrating Short term memory deficits Impaired abstract thinking

Assessment of a client with schizophrenia reveals that the client is hearing voices that tell the client that people are staring at the client and that the client is seeing illusions. When developing the plan of care for this client, which nursing diagnosis would be most appropriate?

Disturbed sensory perception

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

The nurse is developing a care plan for a client with somatic delusions. Which would be an appropriate nursing diagnosis for this client? Risk for self-directed violence Chronic low self-esteem Disturbed thought process Disturbed sleep pattern

Disturbed thought process

Dopamine

Dopamine Explanation: Although research is demonstrating that schizophrenia does not result from dysregulation of a single neurotransmitter or biogenic amine (such as serotonin, norepinephrine, or dopamine), positive symptoms of schizophrenia, specifically hallucinations and delusions, are thought to be caused by dopamine hyperactivity in the mesolimbic tract. Researchers are also hypothesizing a role for GABA but have yet to identify any specific information.

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

Every week for the first 6 months

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

Every week for the first 6 months Explanation: Clients taking clozapine must have weekly white blood cell counts for the first 6 months of clozapine therapy and every 2 weeks thereafter.

The nurse suspects that a client is experiencing a brief psychotic episode based on what? Select all that apply.

Evidence of hallucinations Intense changes in affect Recent life stressor Explanation: In brief psychotic disorder, the length of the episode is at least 1 day but less than 1 month. The onset is sudden and includes at least one of the positive symptoms of criteria A for schizophrenia (delusions or hallucinations). The person generally experiences overwhelming confusion and rapid, intense shifts of affect. Brief psychotic disorder can often occur in the context of a recent life stressor such as giving birth.

Extrapyramidal side effects

Extrapyramidal side effects Explanation: Extrapyramidal side effects include severe restlessness, muscle spasms, or contractions; chronic motor problems such as tardive dyskinesia; and the pseudoparkinsonian symptoms of rigidity, masklike faces, and stiff gait.

A nurse is preparing to administer prescribed antipsychotic medication to a client with psychosis. The nurse identifies the prescribed medication as a first-generation antipsychotic drug. Which drug would the nurse most likely be administering?

Fluphenazine

Folie à deux

A married couple arrives at the outpatient clinic. Upon assessment, the nurse finds that the couple believes that the police have been following them and tapping their phones for 2 months. This couple most likely suffers from which disorder? Conjugal delusion Folie à deux Psychotic disorder, not otherwise specified Delusional disorder, paranoid type

Folie à deux

A client diagnosed with delusional disorder is telling everyone that the client is the president of the United States. This client is exhibiting which type of delusion?

Grandiose

A client diagnosed with schizophrenia is telling everyone that the client is the president of the United States. This client is exhibiting which type of delusion?

Grandiose

A client with delusional disorder tells the nurse that the client has discovered how to jump to the moon. The nurse would document this belief as what?

Grandiose delusion

A client with delusional disorder tells the nurse that the client has discovered how to jump to the moon. The nurse would document this belief as what? Jealous delusion Grandiose delusion Somatic delusion Erotomanic delusion

Grandiose delusion

A client with delusional disorder tells the nurse that the client has discovered how too jump to the moon. The nurse would document this belief as what?

Grandiose delusion

first generation antipsychotics

Haloperidol Lo spine Chlorpromazine Fluphenazine

Affective findings

Hopeless Suicidal Unstable or rapidly changing moods

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

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 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 Explanation: Ideas of reference occur when a client has self-centered thoughts and falsely believes ideas are centered on something the client is doing, thinking, or feeling. Looseness of association is the inability to think logically. Ambivalence refers to contradictory or opposing emotions, attitudes, ideas, or desires for the same person or things or toward the environment. Echolalia is a pathological parrot-like response of a word or phrase.

Alterations in thought(delusions)

Ideas of reference: misconstrues trivial events and attaches personal significance

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

Schizotypal

Impaired personality Not as severe as schizophrenia

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

Increased amount of dopamine

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

Increased amount of dopamine

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.

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.

positive symptoms of schizophrenia

Manifestation of things not normally present Hallucinations Delusions Alterations in speech Bizarre behavior

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

Illusion

Misperceptions or misinterpreted of a real experience

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

Mood disorders

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 nursing instructor is developing an education plan for a group of students about schizophrenia and schizoaffective disorders. The instructor identifies that in addition to psychosis, what other condition must be present at the same time for a diagnosis of schizoaffective disorder?

Mood disturbance

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

A comprehensive nursing assessment for neuroleptic malignant syndrome (NMS) should include checking for which in a client taking an antipsychotic medication? Headache, muscle aches, and paresthesias Muscular rigidity, tremors, and difficulty swallowing Confusion, giddiness, and hyperalertness Dry mouth, flushing, and urinary retention

Muscular rigidity, tremors, and difficulty swallowing

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.

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

A client had been withdrawn in the client's room for 3 days, not eating or sleeping, prior to his admission to the inpatient unit. Upon interview, the client demonstrates difficulty answering questions, appears to have no facial expressions, and cannot follow simple instructions. This cluster of symptoms can be described as what?

Negative symptoms

Which has not been proposed as a potential mechanism for the etiology of thought disorders? Genetic predispositions Dysregulation of neurotransmitter systems Hemispheric brain dysfunction Neglect in childhood

Neglect in childhood

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 Parkinsonism Tardive dyskinesia Akathisia

Neuroleptic malignant syndrome

A client with a diagnosis of schizophrenia has been brought to the emergency department by a worker from the group home where the client resides. The worker states that the client has stopped taking medications and drank 2 to 3 gallons of water over the past several hours. What assessments should the nurse who is caring for this client prioritize?

Neurological assessment and monitoring of electrolyte levels

Chapter 16 schizophrenia PREP-U

A nurse is preparing an in-service program about schizophrenia for a group of psychiatric-mental health nurses. Which would the nurse include as a major reason for relapse?

Nonadherence to prescribed medications

Depersonalization

Nonspecific feeling that the client lost their identify

A nurse is caring for a hospitalized client who has schizophrenia. The client has been taking antipsychotic medications for 1 week when the nurse observes that the client's eyes are fixed on the ceiling. The nurse interprets this finding as what?

Oculogyric crisis

Which should the nurse anticipate when providing therapy and evaluating outcomes for a client with delusional disorder? Easily attained Maintained for a short period only Achieved when delusions completely disappear within 6 months' time Often not met completely

Often not met completely Explanation: In evaluating progress, the nurse must remember that outcomes are often not met completely.

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.

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. Quetiapine can cause one to crave sugar. If dizziness is experienced, the client must call the doctor immediately. Quetiapine can cause breast milk production.

One of the common side effects is dry mouth.

Throat broadcasting

Openly expressing their need to have *something* in their throat

A nurse is caring for a client in the mental health unit. The client states, "They are poisoning my food by telepathy." This is an example of which type of delusion?

Paranoid

While conducting a mental status examination, the client accuses the nurse of recording the interview so that it can be sent to the Federal Bureau of Investigation. What type of delusion is this client experiencing?

Paranoid

Derealization

Perception that the environment has changed

Which type of delusion refers to a situation whereby a person or someone close to person is being malevolently treated in some way?

Persecutor type

A 44-year-old client has been experiencing intense job stress. In recent weeks, the client has confided in the client's spouse that the client believes the client's firm monitors every aspect of the client's personal performance and that the firm is engaged in deception and cover-up of its "true purpose." A nurse would recognize that the primary theme of the client's delusional disorder is what?

Persecutory

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 delusional disorder 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 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? a.Grandiose b.Conjugal c.Persecutory d. Erotomanic

Persecutory

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

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

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

Which type of delusion refers to a situation whereby a person or someone close to person is being malevolently treated in some way?

Persecutory type

Which type of delusion refers to a situation whereby a person or someone close to person is being malevolently treated in some way? Persecutory type Somatic type Unspecified type Grandiose type

Persecutory type

During a client interview, a client diagnosed with delusional disorder states, "I know my spouse is being unfaithful to me with a colleague from work."The nurse interprets the client's statements as suggesting which type of delusion? Sexual Referential Grandiose Persucatory/paranoid

Persucatory/paranoid

A client with delusional disorder is hospitalized. The most common reason for this is what?

Protect the client legally

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

Schizophrenia

Psychotic behavior or thinking for at least 6 months Self care, school or work, interpersonal relationships impaired

Psychotic or catatonic disorder

Psychotic features(impaired relating testing) Bizarre behavior(psychotic) Significant change i motor activity behavior(catatonic)

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 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 Explanation: Negative symptoms reflect a lessening or loss of normal functions, such as restriction or flattening in the range and intensity of emotion (diminished emotional expression), reduced fluency and productivity of thought and speech (alogia), withdrawal and inability to initiate and persist in goal-directed activity (avolition), and inability to experience pleasure (anhedonia).

Respect the client's need for personal space and avoid physical contact.

second generation antipsychotics

Risperidone Olanzapine Olanzapine Quetiapine Zip raid one Clozapine

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

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.

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.

When reviewing the diagnostic criteria for schizophrenia based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V), which would be most accurate? Schizophrenia lasts at least 1 month and must include the symptom of hallucinations. Schizophrenia can be diagnosed as soon as an individual states he or she is hallucinating and delusional. Schizophrenia lasts at least 6 months and includes at least 1 month of two or more characteristic symptoms. Schizophrenia can be diagnosed as soon as an individual states he or she is hearing voices.

Schizophrenia lasts at least 6 months and includes at least 1 month of two or more characteristic symptoms.

When reviewing the diagnostic criteria for schizophrenia based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V), which would be most accurate?

Schizophrenia lasts at least 6 months and includes at least 1 month of two or more characteristic symptoms. Explanation: According to the DSM-V, schizophrenia lasts at least 6 months and includes at least 1 month of two or more characteristic symptoms (e.g., delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior) and negative symptoms (e.g., diminished emotional expression, alogia, or avolition).

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

Second generation antipsychotic Explanation: The second-generation antipsychotics are effective in treating negative and positive symptoms. These newer drugs also affect several other neurotransmitter systems, including serotonin. This is believed to contribute to their antipsychotic effectiveness. None of the other agents would be appropriate.

Shared psychotic disorder

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

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

Somatic

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

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

Somatic therapy

The nurse should consider which during a psychiatric assessment of a newly immigrated client who is being evaluated for possible religious delusions? Most cultures contain well-accepted religious beliefs Delusions are often focused on the client's cultural religious beliefs Some cultures hold religious beliefs that might be confused with delusional thought The nurse's cultural religious beliefs may differ from those of the client's

Some cultures hold religious beliefs that might be confused with delusional thought

A client is receiving antipsychotic therapy. When describing dystonic reactions to the client, which should the nurse instruct the client to watch for?

Spasms of the eye muscles

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 Explanation: Although episodes are brief, impairment can be severe. Consequently, supervision may be required to protect the person during a brief psychotic episode.

A client with command auditory hallucinations and a history of aggressive outbursts is observed pacing and grimacing while in the day room. Which should be the nurse's priority?

Support the client in returning to the client's room

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? Echolalia and echopraxia Illusions and loss of ego boundaries Loose associations and flight of ideas Suspiciousness and neologisms

Suspiciousness and neologisms

A client comes to the clinic for an evaluation. During the interview, the client states that the client feels insects crawling all over the skin on the client's arms and legs. The nurse interprets this as which type of sensorium or processing deficit?

Tactile hallucination

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 extrapyramidal side effects (EPS)?

Tardive dyskinesia

A nurse is caring for a client who has been receiving treatment for schizophrenia with chlorpromazine for the past year. It would be essential for the nurse to monitor the client for what?

Tardive dyskinesia

Which would be the benefit of including a client's family members in the long-term treatment of a client with schizophrenia?

The onset of a possible relapse can be detected early and effective treatment can be initiated

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. 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).

The student nurse correctly recognizes that which finding is best supported by genetic studies in the etiology of schizophrenia?

That schizophrenia is at least partially inherited.

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.

Which assessment findings in a client who is suspected of having a delusional disorder would be suggestive of a diagnosis of schizophrenia? The client responds to group psychotherapy. The client experiences frequent and sustained hallucinations. The client's beliefs are considered delusional but nonbizarre. The client does not have insight into his or her delusions.

The client experiences frequent and sustained hallucinations.

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

The client's diagnosis of schizoaffective disorder is supported when the nurse documents what? a.Diagnosis testing confirmed a right parietal brain lesion b.The client reports "hearing voices" for the last 3 months c.The client's spouse reported that the client "repeated everything I said" for 48 hours Td.he client's mother shares that "the client never missed work" even with the disorder

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

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.

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.

Which data support a nursing diagnosis of impaired verbal communication?

The presence of neologism, echolalia, and clanging

hich data support a nursing diagnosis of impaired verbal communication? The presence of neologism, echolalia, and clanging Rapid pacing and running Ambivalence, delusional thinking, and avolition The presence of neologism, delusions, and anergi

The presence of neologism, echolalia, and clanging

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

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. They are implausible within the person's ethnic background. They are variable in nature. They are easily changed with conflicting evidence.

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

Treat side effects to ensure adherence to medications.

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? Avoid dwelling on the delusion Determine the impact of the delusion on the client's safety Evaluate the significance to the client Try to change the client's delusional belief

Try to change the client's delusional belief

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. Explanation: Traditional antipsychotics treat the positive symptoms of schizophrenia (i.e., hallucinations and delusions). Atypical antipsychotics relieve both the positive and negative symptoms (e.g., apathy, avolition, social withdrawal) of schizophrenia and are less likely to cause distressing extrapyramidal side effects typically seen with traditional antipsychotics.

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

Verbigeration

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? Retardation Waxy flexibility Echopraxia Hypervigilance

Waxy flexibility

A nurse is caring for a client who has been taking clozapine for 2 weeks. The client tells the nurse, "My throat is sore, and I feel weak." The nurse assesses the client's vital signs and finds that the client has a fever. The nurse notifies the physician, expecting an order to obtain which laboratory test?

White blood cell count

A client has been prescribed clozapine for treatment of schizophrenia. The client must be taught to monitor which blood concentrations weekly while taking this drug?

White blood cells

Which would be the benefit of including a client's family members in the long-term treatment of a client with schizophrenia? a. The onset of a possible relapse can be detected early and effective treatment can be initiated b.The client's compliance with treatment can be monitored and supported effectively c.It shows the client that he/she is loved and so it elevates the client's self-esteem d.The family can provide more effective care when it is based on an understanding of the disease

a. The onset of a possible relapse can be detected early and effective treatment can be initiated

A client with schizophrenia is exhibiting emotional withdrawal and poor eye contact and describing hallucinations. The mental health nurse knows that these symptoms are suggestive of which neurotransmitter imbalance? a.Increased serotonin and dopamine b.Decreased serotonin and dopamine c.Increased GABA d.Increased histamine

a.Increased serotonin and dopamine

Which is the central focus of persecutory delusions? a.Injustice that must be remedied by legal action b.Unfaithfulness c.Involving bodily functions or sensations d.A great, unrecognized talent

a.Injustice that must be remedied by legal action

A 24-year-old with schizophrenia and paranoid delusions is admitted to the hospital. The student nurse asks the charge nurse about what approach to take with the client, who has been exhibiting hostility and isolation. Which approach would be the most appropriate direction from the charge nurse? a. Greet the client by gently touching the client's arm and telling the client that the client can trust you. b. Respect the client's need for personal space and avoid physical contact. c.Tell the client that if the client does not comply with the rules, you will inform the doctor. d.Inform the client that the client must receive care and you will assist the client.

b. Respect the client's need for personal space and avoid physical contact.

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

d. Thought insertion

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 as:

echolalia

echolalia.

When investigating biologic theories related to schizophrenia, which neuroanatomic findings would be consistent with this mental health disorder?

enlarged lateral ventricle Explanation: The lateral and third ventricles are somewhat larger and total brain volume is somewhat smaller in persons with schizophrenia compared with those without schizophrenia. The thalamus and the medial temporal lobe structures, including the hippocampus, superior temporal, and prefrontal cortices, also tend to be smaller.

When assessing a person with delusional disorder, which finding would the nurse expect to assess?

few, if any, psychological deficits Explanation: Clients with delusional disorder show few, if any, psychological deficits. In these clients, average or marginally low intelligence is characteristic. Mental status is not generally affected. Thinking, orientation, affect, attention, memory, perception, and personality are generally intact.

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

increased mood responses

When describing the difference between schizoaffective disorder (SAD) and schizophrenia, the nurse would address which as associated with SAD? decreased risk for suicide lower level of functioning delusions but no hallucinations increased mood responses

increased mood responses

oculogyric crisis: the muscles that control eye movements tense and pull the eyeball so that the client is looking toward the ceiling.

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 with schizophrenia is exhibiting emotional withdrawal and poor eye contact and describing hallucinations. The mental health nurse knows that these symptoms are suggestive of which neurotransmitter imbalance? Increased GABA Increased histamine Decreased serotonin and dopamine Increased serotonin and dopamine

increased serotonin and dopamine

Religiosity

is obsessed with religious beliefs

A nurse is preparing to interview a client who has a delusional disorder. Which would the nurse expect?

normal behavior Explanation: The nurse plans for the interview and expects that the client will act in a normal manner. Generally, clients diagnosed with a delusional disorder have psychosocial functioning that is not markedly impaired. They show few, if any, psychological deficits, and those that do occur are generally related directly to the delusion. General behavior and emotional responses are not odd or bizarre. Cognition is not impaired, and motor symptoms are not evident.

oculogyric crisis.

oculogyric crisis. Explanation: The nurse should contact the client's physician because the client is exhibiting a dystonic reaction termed oculogyric crisis in which the muscles that control eye movements tense and pull the eyeball so that the client is looking toward the ceiling. Akathisia is manifested by restlessness, with clients often reporting that they feel driven to keep moving. Retrocollis involves the neck muscle, causing the head to be pulled back. Tardive dyskinesia involves abnormal, involuntary movements that are constant.

persecutory

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? 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? 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? 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: A persecutory delusion is a belief that one is being watched, ridiculed, harmed, or plotted against. The belief that one has exceptional powers, wealth, skill, influence, or destiny is a grandiose delusion. A nihilistic delusion is the belief that one is dead or a calamity is impending. A somatic delusion is a belief about abnormalities in bodily functions or structures.

While caring for a hospitalized client 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:

referential thinking.

somatic

A nurse is caring for a client who has been receiving treatment for schizophrenia with chlorpromazine for the past year. It would be essential for the nurse to monitor the client for:

tardive dyskinesia.

A nurse is caring for a client who has been receiving treatment for schizophrenia with chlorpromazine for the past year. It would be essential for the nurse to monitor the client for:

tardive dyskinesia. Explanation: Tardive dyskinesia is late-appearing, abnormal involuntary movements. Therefore, it is essential that the nurse monitor the client for tardive dyskinesia at this time. Weight gain (not weight loss) and new onset of diabetes (hyperglycemia) are possible side effects of an antipsychotic. Torticollis, a dystonic reaction, would occur early in antipsychotic drug treatment.

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

verbigeration

A client has been prescribed clozapine for treatment of schizophrenia. The client must be taught to monitor which blood concentrations weekly while taking this drug?

white blood cells

Which is the most common subtype of delusion?

persecutory

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

Agranulocytosis

white blood cell count Clients who are taking clozapine are at risk for developing agranulocytosis; therefore, they should have their white blood cells and granulocytes monitored while taking this medication. An immediate evaluation of blood cell status is necessary when symptoms of infection are present. Liver function studies and serum potassium and sodium concentration would not be necessary based on the assessment findings. Videbeck, S. Psychiatric-Mental Health Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2017, Chapter 16: Schizophrenia, p. 272.

Which medication classification has been most effective in treating akathisia?

Beta-blockers

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

A client with schizophrenia is prescribed a second-generation antipsychotic. The client's mother asks, "About how long will it take until we see any changes in his symptoms?" Which response by the nurse would be most appropriate?

"Generally, it takes about 1 to 2 weeks to be effective in changing symptoms."

A client diagnosed with schizophrenia tells the nurse, "I hear the voice of Elvis." Which is the most therapeutic response by the nurse?

"I don't hear the voice, but I know you hear what sounds like a voice." Acknowledging that the client hears what sounds like a voice states reality about the client's hallucination. The other options are judgmental and demeaning. Videbeck, S. Psychiatric-Mental Health Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2017, Chapter 16: Schizophrenia, p. 283.

Which extrapyramidal side effect is noted by a client who has bradykinesia and a shuffling gait?

Pseudoparkinsonism

One evening, a client with schizophrenia leaves the client's room and begins marching in the hall. When approached by the nurse, the client says, "God says I'm supposed to guard the area." Which response would be best?

"I understand you hear a voice. You and I are the only ones in the hall, and I don't hear a voice."

A client with schizoaffective disorder is prescribed clozapine to treat symptoms. Which instructions would the nurse provide?

"Keep an eye on your weight, and if you gain weight rapidly, notify your doctor." The client should be cautioned to notify the health care provider if the client has rapid weight gain because this may be indicative of excessive fluid retention. Dry mouth and sedation, common side effects of any antipsychotic agent, do not require the client to notify the physician. Urinary changes are not associated with clozapine use. Although clozapine is associated with an increased risk of infection, it would be important to notify the physician if the client's urine odor becomes foul, possibly suggesting a urinary tract infection. Videbeck, S. Psychiatric-Mental Health Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2017, Chapter 16: Schizophrenia, p. 270

"One day, I won't have to worry about taking any medication." After the client's condition has stabilized (i.e., the client exhibits a decrease in positive and negative symptoms), the treatment that led to remission of symptoms should be continued. Titrating antipsychotic agents to the lowest dose that provides suitable protection may enable optimal psychosocial functioning while slowing the recurrence of new episodes. Clients diagnosed with SAD are unlikely to be medication free. Clients also need education about preventing orthostatic hypotension, such as changing positions slowly, as well as drinking adequate amounts of fluid each day. Clients also need to notify their health care provider if they notice any abnormal muscle movement or the inability to control motor movement. Videbeck, S. Psychiatric-Mental Health Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2017, Chapter 16: Schizophrenia, p. 269.

A client with a persecutory delusion has been explaining to the nurse the specifics of the conspiracy against the client. The client pauses and says, "I get the feeling that you don't actually believe that what I'm telling you is true." How should the nurse respond?

"What you're telling me is difficult for me to believe. This may be real for you, but not me."

The nurse enters the room of a client with schizophrenia the day after the client has been admitted to an inpatient setting and says, "I would like to spend some time talking with you." The client stares straight ahead and remains silent. Which would be the best response by the nurse?

"You don't need to talk right now. I'll just sit here for a few minutes."

Which statement is true about delusional disorder?

Behavior is relatively normal except when focused on the delusion. The course of delusional disorder is variable. The onset can be acute, or the disorder can occur gradually and become chronic. Clients usually live with delusions for years, rarely receiving psychiatric treatment unless their delusion relates to their health (somatic delusion) or they act on the basis of their delusion and violate laws or social rules. Apart from the direct impact of the delusion, psychosocial functioning is not markedly impaired. Behavior is remarkably normal except when the client focuses on the delusion. At that time, the client's thinking, attitudes, and mood may change abruptly. Personality does not usually change, but the client is gradually, progressively involved with the delusional concern. Videbeck, S. Psychiatric-Mental Health Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2017, Chapter 16: Schizophrenia, p. 267.

A client with schizophrenia is being treated with olanzapine 10 mg daily. The client asks the nurse how this medicine works. The nurse explains that the mechanism by which the olanzapine controls the client's psychotic symptoms is believed to be what?

Blocking dopamine receptors in the brain.

Catatonic Catatonic clients show motoric immobility or stupor, rigidity, excessive motor activity, extreme negativism, stupor, and peculiarities of movement, such as posturing, echolalia and echopraxia, mutism, and waxy flexibility. Videbeck, S. Psychiatric-Mental Health Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2017, Chapter 16: Schizophrenia, p. 267.

A nurse is developing a plan of care for a client diagnosed with delusional disorder. Which of the following would the nurse need to keep in mind?

Clients with delusional disorder typically have problems with medication adherence.

After teaching a group of nursing students about neurotransmitters associated with schizophrenia, the nursing instructor determines that the education was successful when the students identify what as playing a role in the positive symptoms of schizophrenia?

Dopamine

A client with schizophrenia states that the client is God's messenger and the client's mission is to become president. The nurse documents these comments as evidence of what?

Delusional thinking

The client with schizophrenia believes the student nurses are there to spy on the clients. The client is suffering from which symptom?

Delusions

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

A client with schizophrenia is exhibiting hallucinations and delusions. The mental health nurse knows that these symptoms are associated with hyperactivity of which neurotransmitter?

Dopamine Positive symptoms of schizophrenia (specifically hallucinations and delusions) are thought to be related to dopamine hyperactivity in the mesolimbic tract at the D2 receptor site of the striatal area, where memory and emotion are regulated. Videbeck, S. Psychiatric-Mental Health Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2017, Chapter 16: Schizophrenia, p. 267.

Positive symptoms of schizophrenia, specifically hallucinations and delusions, are thought to be caused by hyperactivity of which neurotransmitter?

Dopamine Positive symptoms of schizophrenia, such as delusions and hallucinations, are thought to be caused by dopamine hyperactivity in the mesolimbic tract at the D2 receptor site in the striatal area, where memory and emotion are regulated. Hyperactivity of acetylcholine, norepinephrine, and epinephrine are not associated with schizophrenia.

Schizoaffective disorder is most likely to be diagnosed at which of the following stages of life?

Early adulthood

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 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.

The nurse suspects that a client is experiencing a brief psychotic episode based on what? Select all that apply.

Evidence of hallucinations Intense changes in affect Recent life stressor

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

A client with delusional disorder tells the nurse that the client has discovered how to jump to the moon. The nurse would document this belief as what?

Grandiose delusion 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 (i.e., an adviser to the president) or of actually being a prominent person (i.e., the president). The central theme of the jealous delusion is the unfaithfulness or infidelity of a spouse or lover. The central theme of somatic delusions involves bodily functions or sensations. These clients believe they have physical ailments. Erotomanic delusions are characterized by the delusional belief that the client is loved intensely by the "loved object," who is usually married, of a higher socioeconomic status, or otherwise unattainable. The client believes that the loved object's position in life would be in jeopardy if his or her true feelings were known. Videbeck, S. Psychiatric-Mental Health Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2017, Chapter 16: Schizophrenia, p. 276.

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 hallucination is a sensory perception, such as hearing voices and seeing objects, that only the client experiences. A delusion is a false belief. Flight of ideas refers to a speech pattern in which the client skips from one unrelated subject to another. Ideas of reference refers to the mistaken belief that someone or something outside the client is controlling the client's ideas or behavior.

Hallucination Hallucinations are sensory perceptions with a compelling sense of reality but with no actual objective basis. During auditory hallucinations (the most common form), clients may hear the voice of God or close relatives, two or more voices with a running commentary about the client's behavior, or voices that command certain acts. Delusions are false, fixed beliefs. Avolition involves the withdrawal and inability to initiate and persist in goal-directed activity. Alogia refers to the reduced fluency and productivity of thought and speech. Videbeck, S. Psychiatric-Mental Health Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2017, Chapter 16: Schizophrenia, p. 265.

A client diagnosed with delusional disorder is experiencing persecutory delusions involving the belief that someone is putting poison in his food. When developing the client's plan of care, which nursing diagnosis would be most likely?

Imbalanced Nutrition, Less than Body Requirements

When preparing a class presentation about schizophrenia, what would the nurse most likely include?

Improvement in symptoms can occur as a client with a history of schizophrenia reaches older adulthood.

Which is the central focus of persecutory delusions?

Injustice that must be remedied by legal action 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. Videbeck, S. Psychiatric-Mental Health Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2017, Chapter 16: Schizophrenia, p. 276.

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

Mood disorder

Mood disturbance When psychosis and mood disturbance occur at the same time, a diagnosis of schizoaffective disorder is made. Substance abuse, delirium, or anxiety are not involved with the diagnosis of schizoaffective disorder. Videbeck, S. Psychiatric-Mental Health Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2017, Chapter 16: Schizophrenia, p. 265.

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

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 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. Videbeck, S. Psychiatric-Mental Health Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2017, Chapter 16: Schizophrenia, p. 272.

The client was conversing with the nurse when noticeable changes occurred with the client. Which is a term used to describe the occurrence of the eye rolling back in a locked position, which occurs with acute dystonia?

Oculogyric crisis

Offering reassurance in a soft, nonthreatening voice During periods of acute psychosis, offering reassurance in a soft, nonthreatening voice and avoiding confrontational stances will help the client begin to trust the staff and nursing care. Videbeck, S. Psychiatric-Mental Health Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2017, Chapter 16: Schizophrenia, p. 282.

Delusional disorders are primarily characterized by which of the following? Select all that apply.

Paranoia Jealousy Distrust

A client with delusional disorder 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 The central theme of persecutory delusions is the client's belief that he or she is being conspired against, cheated on, spied on, followed, poisoned, drugged, maliciously maligned, harassed, or obstructed in pursuit of long-term goals. Erotomanic delusions are characterized by the delusional belief that the client is loved intensely by the loved object who is usually married, of a higher economic status, or otherwise unattainable. Grandiose delusions involve the belief that the person has a great, unrecognized talent or has made an important discovery or has a special relationship with a prominent person (or of actually being a prominent person). Somatic delusions involve bodily functions or sensations, with the client believing that he or she has physical ailments. Videbeck, S. Psychiatric-Mental Health Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2017, Chapter 16: Schizophrenia, p. 276.

Persucatory/paranoid

Persucatory/paranoid The client's statements reflect persucatory/paranoid delusions that focus on the unfaithfulness or infidelity of a spouse or lover. Such delusions involve the belief that others are untrustworthy in some way. With referential delusions, the ideas of reference involve the client's belief that television broadcasts, music, or newspaper articles have special meaning for him or her. In the sexual delusion subtype, ideas involve the belief that the client's sexual behavior is known to others. With grandiose delusions, individuals believe that they have a great, unrecognized talent or have made an important discovery. Videbeck, S. Psychiatric-Mental Health Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2017, Chapter 16: Schizophrenia, p. 276.

Pseudoparkinsonism 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. Videbeck, S. Psychiatric-Mental Health Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2017, Chapter 16: Schizophrenia, p. 270.

Which extrapyramidal side effect is noted by a client who has bradykinesia and a shuffling gait?

Pseudoparkinsonism Pseudoparkinsonism is noted by a resting tremor, rigidity, a masklike face, and a shuffling gait. Akathisia occurs when the client has motor restlessness evidenced by pacing, rocking, or shifting from foot to foot. Symptoms of acute dystonia are intermittent or fixed abnormal postures of the eyes, face, tongue, neck, trunk, and extremities. Videbeck, S. Psychiatric-Mental Health Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2017, Chapter 16: Schizophrenia, p. 270.

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 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 About one third of the individuals with schizophreniform disorder recover with the other two thirds developing schizophrenia. Schizophreniform disorder is not associated with the development of personality disorder, major depression, or substance abuse. Videbeck, S. Psychiatric-Mental Health Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2017, Chapter 16: Schizophrenia, p. 267.

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

Schizophrenia 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. 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. Videbeck, S. Psychiatric-Mental Health Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2017, Chapter 16: Schizophrenia, p. 267.

When performing discharge planning for a client who has schizophrenia, the nurse anticipates barriers to adhering to the medication regimen. The nurse assesses which as improving the likelihood that the client will follow the prescribed medication regimen? Select all that apply.

Short-term memory intact Receives monthly disability checks States location of pharmacy nearest the client's residence

Somatic Somatic delusions involve bodily functions or sensations, such as insects having infested the skin. The client vividly describes crawling, itching, burning, swarming, and jumping on the skin surface or below the skin. The client maintains the conviction that he or she is infested with parasites in the absence of objective evidence to the contrary. Nihilistic delusions focus on impending death or disaster. Clients presenting with grandiose delusions are convinced they have a great, unrecognized talent or have made an important discovery. The central theme of persecutory delusions is the client's belief that he or she is being conspired against, cheated, spied on, followed, poisoned, drugged, maliciously maligned, harassed, or obstructed in pursuit of long-term goals. Videbeck, S. Psychiatric-Mental Health Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2017, Chapter 16: Schizophrenia, p. 276.

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 Somatic delusions are generally vague and unrealistic beliefs about the client's health or bodily functions. Persecutory delusions involve the client's belief that "others" are planning to harm the client or are spying, following, or belittling the client in some way. Grandiose delusions are characterized by the client's claim to associate with famous people or celebrities or the client's belief that he or she is famous or capable of great feats. Referential delusions or ideas of reference involve the client's belief that television broadcasts, music, or newspaper articles have special meaning for him or her. Videbeck, S. Psychiatric-Mental Health Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2017, Chapter 16: Schizophrenia, p. 276.

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

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 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. Videbeck, S. Psychiatric-Mental Health Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2017, Chapter 16: Schizophrenia, p. 270.

A client is diagnosed with schizoaffective disorder. The interdisciplinary plan of care includes key family members. The nurse understands that a major reason for doing so involves which of the following?

Strengthening the client's recovery

Suspiciousness and neologisms

The nurse notices the client with a shuffling gait walking in the hall. Which would not be included as a symptom of drug-induced parkinsonism?

Tachycardia

A client with severe and persistent mental illness has been taking antipsychotic medication for 20 years. The nurse observes during a therapy session that the client's behavior includes repetitive movements of the mouth and tongue, facial grimacing, and rocking back and forth. The nurse recognizes these behaviors as indicative of what?

Tardive dyskinesia

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. 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 thinking itself. Videbeck, S. Psychiatric-Mental Health Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2017, Chapter 16: Schizophrenia, pp. 278-279.

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. 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. Videbeck, S. Psychiatric-Mental Health Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2017, Chapter 16: Schizophrenia, p. 267.

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

Which data support a nursing diagnosis of impaired verbal communication?

The presence of neologism, echolalia, and clanging 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. Videbeck, S. Psychiatric-Mental Health Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2017, Chapter 16: Schizophrenia, p. 274.

Schizophrenia is most often characterized by which assessment finding?

Thought disturbances and hallucinations

Clients with delusional disorder do not normally seek help independently because of their inability to establish what?

Trust Clients with delusional or shared psychotic disorders do not normally seek help independently because of their inability to establish trust. Videbeck, S. Psychiatric-Mental Health Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2017, Chapter 16: Schizophrenia, p. 278.

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

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

Verbigeration 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. Videbeck, S. Psychiatric-Mental Health Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2017, Chapter 16: Schizophrenia, p. 274.

Waxy flexibility

Which is a nonneurologic side effect of antipsychotic medications?

Weight gain Videbeck, S. Psychiatric-Mental Health Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2017, Chapter 16: Schizophrenia, p. 271.

Assessment of genetic predisposition supports asking a client who is exhibiting symptoms of a delusional disorder what?

Whether any family members have been diagnosed with schizophrenia

Assessment of genetic predisposition supports asking a client who is exhibiting symptoms of a delusional disorder what?

Whether any family members have been diagnosed with schizophrenia Some studies have found that delusional disorders are more common among relatives of individuals with schizophrenia than would be expected by chance; thus, asking whether any family members have been diagnosed with schizophrenia could be helpful. Videbeck, S. Psychiatric-Mental Health Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2017, Chapter 16: Schizophrenia, pp. 267-268.

A nurse is working with a client that has been diagnosed with delusional thoughts. Which is an initial short-term outcome appropriate for this client?

engage in reality oriented conversation

A client diagnosed with schizophrenia is in anticholinergic crisis. The nurse would expect which finding to be noted upon assessment?

facial flushing

The nurse is caring for a client who was diagnosed with schizoaffective disorder two years ago. Which of the following assessments should the nurse prioritize?

suicide.

A nurse is caring for a client who has been receiving treatment for schizophrenia with chlorpromazine for the past year. It would be essential for the nurse to monitor the client for:

tardive dyskinesia. Tardive dyskinesia is late-appearing, abnormal involuntary movements. Therefore, it is essential that the nurse monitor the client for tardive dyskinesia at this time. Weight gain (not weight loss) and new onset of diabetes (hyperglycemia) are possible side effects of an antipsychotic. Torticollis, a dystonic reaction, would occur early in antipsychotic drug treatment. Videbeck, S. Psychiatric-Mental Health Nursing, 7th ed., Philadelphia, Wolters Kluwer, 2017, Chapter 16: Schizophrenia, p. 270.

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