Chapter 16: Schizophrenia
What are the signs and symptoms of schizophrenia according to the Diagnostic and Statistical Manual of Mental Disorders?
Schizophrenia lasts at least 6 months and includes at least 1 month of 2 or more active-phase symptoms. Explanation: According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, (DSM-5), schizophrenia lasts at least 6 months and includes at least 1 month of 2 or more active-phase symptoms such as bizarre delusions, hallucinations (e.g., a running commentary of two voices conversing), disorganized speech, grossly disorganized or catatonic behavior, and negative behavior
The psychiatric nurse recognizes that a client's cultural background can contribute to the misdiagnosis of schizophrenia primarily for which reason?
Clinicians diagnose culturally accepted beliefs as psychotic thinking Explanation: Always consider cultural differences when assessing clinical symptoms in clients with suspected psychotic disorders. Ideas that appear delusional in one culture may be acceptable in another; speaking in tongues and visual or auditory hallucinations with religious content are possible examples.
The nurse is caring for a client who was just admitted with a diagnosis of schizoaffective disorder with depression. Which agent would the nurse anticipate as being prescribed for this client?
Clozapine Explanation: Atypical antipsychotic agents are generally prescribed because of their efficacy and safe side effect profile. These agents have a mood-stabilizing, as well as antipsychotic, effect. Clozapine has been reported to be effective for this disorder. Lithium might be an alternative for clients experiencing mood states associated with the bipolar type. Haloperidol and chlorpromazine are typical antipsychotic agents.
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 Explanation: Grandiose delusions focus on the belief that the person has a great, unrecognized talent or has made an important discovery. The delusion may be religious in nature, such as a special message from a deity. With mixed delusions, no one delusional theme predominates. Somatic delusions involve bodily functions or sensations. Erotomanic delusions are characterized by the belief that the person is loved intensely by a loved object who is usually married, of a higher socioeconomic status, or otherwise unattainable.
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?
Aripiprazole Explanation: The medication regimen for a client with schizoaffective disorder is complex and may include antipsychotics, mood stabilizers, antidepressants, and occasional antianxiety agents. The use of these agents can lead to multiple side effects and possible interactions. Aripiprazole exerts an antidepressant effect and may replace polypharmacy, thus reducing drug costs, the risk of drug interactions, and potential adverse drug effects and possibly enhancing adherence.
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.
Which would a nurse expect to administer to a client with schizophrenia who is experiencing a dystonic reaction?
Benztropine Explanation: A client experiencing a dystonic reaction should receive immediate treatment with benztropine. Risperidone and aripiprazole are antipsychotics that may cause dystonic reactions. Trihexyphenidyl is used to treat parkinsonism due to antipsychotic drugs.
Which medication is used to control the extrapyramidal effects associated with antipsychotic medications?
Benztropine Explanation: Benzotropine is an anticholinergic drug used to relieve drug-induced extrapyramidal adverse effects, such as muscle weakness, involuntary muscle movement, pseudoparkinsonism, and tardive dyskinesia.
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.
Which client exhibits the characteristics that are typical of the prodromal phase of schizophrenia?
A 20-year-old is experiencing a gradual decrease in the ability to concentrate, be productive, and sleep restfully. Explanation: Gradual, subtle behavioral changes appear during the prodromal phase of schizophrenia, such as tension, the inability to concentrate, insomnia, withdrawal, or cognitive deficits. No symptoms are present in the premorbid phase, and relapses occur in the progressive and chronic phases. Diagnosis of the disease marks the beginning of the onset phase.
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 Explanation: 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. Usually the voices are obscene, accusatory, or insulting. They may call clients names and make nasty remarks.
A client was admitted to the psychiatric intensive care unit with schizophrenia. Among the client's signs and symptoms, the client was experiencing nihilistic delusions. The nurse understands that these delusions involve a belief about what?
An impending calamity, such as death Explanation: Delusions are erroneous, fixed beliefs that cannot be changed by reasonable argument. Nihilistic delusions involve the belief that one is dead or a calamity is impending; when these delusions involve bodily illness, they take hypochondriacal concerns to the utmost extreme. Grandiose delusions involve the belief that one has exceptional powers, wealth, skill, influence, or destiny. Persecutory delusions involve the belief that one is being watched, ridiculed, harmed, or plotted against. Referential delusions, or ideas of reference, involve a belief that communications such as television broadcasts or website posts are directed toward the client or have special meaning for the client.
The nurse is working with a client with schizophrenia who has cognitive deficits. It is time for the client to get up and eat breakfast. Which statement by the nurse would be most effective in helping the client prepare for breakfast?
"First, wash your face and brush your teeth. Then put your clothes on." Explanation: The client needs clear direction, with tasks broken into small steps, to begin to participate in the client's own self-care. The client, not the nurse, should perform the steps.
A client in an inpatient setting has a delusion that there are a multitude of undetectable noxious gases in circulation that have the potential to poison the client and others. Which of the nurse's responses is most therapeutic?
"I can assure you that you are actually very safe here." Explanation: Assuring a client of his or her safety is a more therapeutic intervention than expressing exasperation with the client's delusions, arguing against them, or implicitly confirming them.
The psychiatric nurse documents that a client is expressing nihilistic delusions when the client makes which statement?
"I can't eat; I have no mouth or stomach." Explanation: The client expresses a nihilistic delusion when denying reality or existence of self, part of self, or some external object. Believing oneself to have a unique cancer represents a somatic delusion, while believing oneself to be friends with a president or the sister to a queen represents delusions of grandeur.
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.
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." 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." Explanation: Excessive amount of the neurotransmitter dopamine allows nerve impulses to bombard the mesolimbic pathway, the part of the brain normally involved in arousal and motivation. Normal cell communications are disrupted, resulting in the development of hallucinations and delusions. Abnormalities in brain shape and brain circuitry are being researched.
The 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." Explanation: 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.
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. Explanation: The client's illogical, symbolic, and disorganized speech often holds a message that he or she cannot express clearly. The nurse listens for themes and reflects back to the client the meaning that the nurse has deciphered. The nurse does not dismiss the client's verbal and nonverbal behaviors as meaningless or nonsense. In effect, the nurse tries to decode the communication that the client offers and validate its meaning.
Which constitutes a negative symptom associated with schizophrenia?
Asociality Explanation: Asociality is characterized by social withdrawal, few or no relationships, and lack of closeness. These are recognized as negative symptoms of schizophrenia in accordance with the DSM-V. The other options listed are examples of positive symptoms of schizophrenia.
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 with schizoaffective disorder is engaging in an extremely long conversation about a current affairs in the world. The client goes on to provide the nurse with minute details. The nurse interprets this as suggesting what?
Circumstantiality Explanation: The client is demonstrating circumstantiality, which refers to extremely detailed and lengthy discourse about a topic.This can be commonly found in a client with euphoric or elevated mood due to the affective component of schizoaffective disorder. Clang associations are ideas that are related to one another based on sound or rhyming rather than meaning. Neologisms are words invented by the client. A verbigeration is the stereotyped repetition of words or phrases that may or may not have meaning to the listener.
Which speech pattern is exhibited by the client stating, "I will take a pill if I go up the hill but not if my name is Jill, I don't want to kill?"
Clang association Explanation: Clang associations are ideas that are related to one another based on sound or rhyming rather than meaning. Neologisms are words invented by the client. A verbigeration is the stereotyped repetition of words or phrases that may or may not have meaning to the listener. A word salad is a combination of jumbled words and phrases that are disconnected or incoherent and make no sense to the listener.
A nurse is 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 Explanation: Positive symptoms reflect an excess or distortion of normal functions, including delusions and hallucinations. Negative symptoms reflect a lessening (or complete 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).
A hospitalized client diagnosed with schizophrenia is receiving antipsychotic medications. While assessing the client, a nurse identifies signs and symptoms of a dystonic reaction. Which agent would the nurse expect to administer?
Diphenhydramine Explanataion: 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.
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 Explanation: The most appropriate nursing diagnosis for this client is disturbed thought process related to misperception of environmental stimuli. Disturbed sleep pattern, risk for self-directed violence, and chronic low self-esteem would not be the most appropriate nursing diagnosis for this client.
A group of nursing students is reviewing the various theories related to the etiology of schizophrenia. The students demonstrate understanding of the information when they identify which neurotransmitter as being responsible for hallucinations and delusions?
Dopamine 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.
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 Explanation: 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. Other receptors are also involved in dopamine neurotransmission, especially serotonergic receptors. It is becoming clear that schizophrenia does not result from dysregulation of a single neurotransmitter or biogenic amine (e.g., norepinephrine, dopamine, or serotonin). Investigators are also hypothesizing a role for glutamate and GABA because of the complex interconnections of neuronal transmission and the complexity and heterogeneity of schizophrenia symptoms. The N-methyl-D-aspartate (NMDA) class of glutamate receptors is being studied because of the actions of phencyclidine (PCP) at these sites and the similarity of the psychotic behaviors that are produced when someone takes PCP.
A nurse is caring for a client in an inpatient mental health setting. The nurse notices that when the client is conversing with other clients, the client repeats what they are saying word for word. The nurse interprets this finding and documents it using which term?
Echolalia Explanation: The nurse should document the client's speech pattern as echolalia, or parrot-like and inappropriate repetition of another's words. Echopraxia refers to an involuntary imitation of another person's movements or gestures. Neologisms are made-up words that have no common meaning and are not recognized. Tangentiality is a disorganized thinking pattern in which the topic of conversation changes to an entirely different topic; the change is a logical progression but causes a permanent detour from the original focus.
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 education was effective when they state that which should be reported immediately?
Elevated temperature explanation: Clients receiving antipsychotic therapy need to be alerted to the potential for complications, including neuroleptic malignant syndrome, a life-threatening condition that can occur with antipsychotic agents. This syndrome is manifested by severe muscle rigidity and elevated temperature that can rapidly accelerate. The nurse should instruct the client to seek immediate care if an elevated temperature develops. Tremor also should be reported, but this is not a life-threatening manifestation. Decreased blood pressure and weight gain can occur with antipsychotic agents, but these are not life threatening.
A client diagnosed with schizoaffective disorder and severe depression is being treated with antipsychotic medications. The client tells the nurse about difficulty with self-care activities. With which intervention should the nurse respond?
Establish a routine and set goals. Explanation: The most useful approach for the nurse to try is to help the client establish a routine and set goals for accomplishing the activities of daily living.
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.
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 Explanation: 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.
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 Explanation: 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.
Clients diagnosed with schizophrenia may experience disordered water balance that may lead to water intoxication. Which may occur as a result of water intoxication?
Hyponatremia Explanation: Hyponatremia is a life-threatening complication of unknown cause. When a client ingests an unusually large volume of water, the kidneys' capacity to excrete water is overwhelmed, and serum sodium concentrations rapidly fall below the normal range.
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.
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 serotonin and dopamine Explanation: Lack of volition and motivation, social withdrawal, and anhedonia (inability to feel pleasure) are negative signs of schizophrenia. Hallucinations are a positive sign of the disease. Second-generation antipsychotic medications, which are antagonists of dopamine and serotonin, lessen both positive and negative symptoms; this suggests that excess dopamine and serotonin are both involved in schizophrenia. The etiology of schizophrenia is still very much under investigation, but it is hypothesized that an excess of dopamine is a factor in psychosis and that, while a certain amount of serotonin can help modulate the effects of dopamine, an excess of serotonin contributes to schizophrenia. The involvement of brain anatomy, metabolism, and neurotransmitter and neuroconnectivity are also being investigated; the exact etiology of schizophrenia is complex.
A client who is newly admitted to an inpatient unit is exhibiting acute delusional thoughts. The most therapeutic intervention for this client would include what?
Individual therapy Explanation: Individual psychotherapy is the treatment of choice because clients with delusional thoughts do not respond well to insight-oriented, problem-oriented, or group therapy in which delusions are confronted by peers or therapists. Establishing the therapeutic relationship with the client is the critical first step. Individual therapy would be the most therapeutic intervention for the client's current circumstance.
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.
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. Explanation: Schizoaffective disorder is a mix of psychotic and mood symptoms and is typically diagnosed in early adulthood. It is not more common than schizophrenia and is not commonly adjunct to somatoform disorder although people diagnosed with schizoaffective disorder can present with somatic delusions.
A student nurse has been assigned to provide care for an inpatient psychiatric-mental health client who has a diagnosis of schizophrenia. The student nurse is apprehensive about interacting with the client. The client's detailed explanations of the client's delusions accompanied by unpredictable movements have prompted fear in the student. How should this nursing student interpret such feelings?
It is natural to feel fear when a client exhibits unpredictable behavior, and this can cause the student to be reasonably cautious Explanation: A student may experience fear if the client exhibits unpredictable behavior. Fear is a normal response that results in the exercise of caution. Experiencing fear is not evidence of stereotyping, and divulging fear to the client is unlikely to benefit either the student or the client. The risk of violence is a reality, though the risk differs with each client.
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 Explanation: Meeting all of the client's physiologic needs is most important because clients with catatonic schizophrenia cannot meet their own needs by themselves. Clients with catatonic schizophrenia are unable to express their concerns. Lithium is used for the manic phase of bipolar disorder. The nurse needs to give support to the client and be present for him or her as reassurance.
A client is diagnosed with schizoaffective disorder (SAD). The nurse understands that in addition to psychosis, the client must also exhibit:
Mood disorder Explanation: SAD is characterized by periods of intense symptom exacerbation alternating with quiescent periods, during which psychosocial functioning is adequate. This disorder is at times marked by psychosis; at other times, by mood disturbance. When psychosis and mood disturbance occur at the same time, a diagnosis of schizoaffective disorder is made.
Schizoaffective disorder has symptoms typical of both schizophrenia and which type of disorder?
Mood disorders Explanation: Schizoaffective disorder has symptoms typical of both schizophrenia and mood disorders, but it is a separate disorder. Symptoms of anxiety, substance use, and eating disorders are not typically part of schizoaffective disorder.
A 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 Explanation: 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.
A client has been prescribed quetiapine for delusional disorder. In teaching the client about this medication, the nurse must be certain to include which information?
One of the common side effects is dry mouth. Explanation: Dry mouth is a common, sometimes bothersome, side effect. Quetiapine does not cause breast milk production. Dizziness may occur due to orthostatic hypotension but will decrease as the body becomes accustomed to the medication. It is not an emergency. Quetiapine can cause changes in blood sugar but will not induce sugar cravings.
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 Explanation: Paranoid delusions include false suspicions. Grandiose delusions include false belief of inflated self-importance. Erotomanic delusions include false beliefs of being loved by a celebrity. Somatic delusions include false beliefs about bodily functions.
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 Explanation: Clients who exhibit persecutory delusions believe that they are being conspired against, spied on, poisoned or drugged, cheated, harassed, maliciously maligned, or obstructed in some way. This delusion is not characteristic of somatic, conjugal, or grandiose subtype.
A mental health client insists that the client's spouse is trying to poison the client. In this instance, the client is exhibiting which type of delusion?
Persecutory Explanation: Clients who exhibit persecutory delusions believe that they are being conspired against, spied on, poisoned, or drugged. Somatic delusions demonstrate a preoccupation with the body. A client exhibiting erotomanic delusions believes that a person of elevated social status loves him or her. Grandiose delusions are present when the client believes that he or she possesses unrecognized talent or insight or has made an important discovery.
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 Explanation: To prevent or minimize hallucinations, the nurse should help present and maintain reality by frequent contact and communication with the client. Limiting sleep or modifying the timing of medication administration is not likely to prevent or lessen hallucinations.
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 Explanation: Quetiapine is an example of a second-generation antipsychotic agent. Fluphenazine, thiothixene, and chlorpromazine are examples of first-generation antipsychotic agents.
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?
Respect the client's need for personal space and avoid physical contact. Explanation: A newly admitted client with paranoid schizophrenia needs a sense of trust before the nurse attempts to touch the client. Using emphatic tones and veiled threats will only increase the client's anxiety and lead to increased potential for hostility and anger.
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 Explanation: 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.
A client diagnosed with delusional disorder who uses excessive health care resources most likely has which type of delusions?
Somatic Explanation: Persons who have somatic delusions believe they have a physical ailment. Clients with somatic delusions use excessive health care resources. The central theme of the jealous subtype is the unfaithfulness or infidelity of a spouse or lover. Nihilistic delusions focus on death or calamity. Clients presenting with grandiose delusions are convinced they have a great, unrecognized talent or have made an important discovery; a less common presentation is the delusion of a special relationship with a prominent person or actually being a prominent person.
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.
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 Explanation: The client's statements reflect a somatic delusion, which involves bodily functions or sensations. Those with somatic delusions use excessive health care resources and often go through elaborate rituals to cleanse themselves or their surroundings. Erotomanic delusions focus on the belief that the client is loved intensely by a "loved object," who is usually married, of a higher economic status, or otherwise unattainable. With grandiose delusions, the client is convinced that he or she has a great unrecognized talent or has made an important discovery. Jealous delusions focus on the unfaithfulness or infidelity of a spouse or lover.
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 Explanation: 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.
Which treatment would be inappropriate for a client with delusional disorder?
Somatic therapy Explanation: Somatic and alternative therapies generally are not used to treat delusional or shared psychotic disorders because the mark of successful treatment usually depends on a satisfactory social adjustment rather than a suppression of the client's delusions.
The nurse should consider which during a psychiatric assessment of a newly immigrated client who is being evaluated for possible religious delusions?
Some cultures hold religious beliefs that might be confused with delusional thought Explanation: Some cultures have widely held and culturally sanctioned beliefs that might be considered delusional in other cultures.
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 55-year-old client was admitted to the psychiatric unit after an incident in a department store in which the client accused a sales clerk of following the client around the store and stealing the client's keys. The client was subdued by the police after destroying a window display because voices had told the client that it was evil. As the nurse approached the client, the client says, "You're all out to get me, and you're one of them. They're Rostoputians and grog babies here." This demonstrates what?
Suspiciousness and neologisms Explanation: The client is demonstrating suspiciousness ("you're all out to get me") and neologisms (use of the words "Rostoputians and grog babies"). Loose associations and flight of ideas occur when the client talks about many topics in rapid sequence, but they are not connected with each other. Illusions are when the client sees something that is not there; echolalia is the repetition of words (or words that sound similar) said by someone else.
A client has been taking neuroleptic medications for many years as a treatment for schizophrenia. The client is exhibiting tongue protrusion, facial grimacing, and excessive blinking. These manifestations are characteristic of which side effect?
Tardive dyskinesia Explanation: Unusual movements of the tongue, neck, and arms suggest tardive dyskinesia, an adverse reaction to neuroleptic medication. Dystonia is characterized by cramps and rigidity of the tongue, face, neck, and back muscles. Neuroleptic malignant syndrome causes rigidity, fever, hypertension, and diaphoresis. Akathisia causes restlessness, anxiety, and jitteriness.
A client with a delusional disorder has been undergoing individual psychotherapy. The therapy would be deemed ultimately successful when the client meets which outcome?
The client will differentiate between reality and fantasy. Explanation: The ultimate goal of all forms of treatment for clients with delusional disorders is to foster the ability to distinguish between fantasy and reality. Promoting healthy coping, anxiety awareness, and healthy relationships are therapeutic outcomes, but the priority in treatment is the delusional thinking itself.
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.
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. Explanation: Delusions are fixed, false beliefs that cannot be changed by conflicting evidence. They can be situations that could occur in real life and are plausible in the context of the person's ethnic and cultural background, or they may be clearly fantastical. They usually involve a misinterpretation of the client's experience.
Clients with delusional disorder do not normally seek help independently because of their inability to establish what?
Trust Explanation: Clients with delusional or shared psychotic disorders do not normally seek help independently because of their inability to establish trust.
A client is diagnosed with a delusional disorder. While providing care to the client, the nurse assesses the client's delusions. Which would be least appropriate for the nurse to do?
Try to change the client's delusional belief Explanation: By definition, delusions are fixed, false beliefs that cannot be changed by reasonable arguments. The nurse should assess the client's delusion to evaluate its significance to the client, to the client's safety, and to the safety of others. The nurse should not dwell on the delusion or try to change it.
A client diagnosed with schizophrenia states, "I want to go home, go home, go home." This is an example of which speech pattern?
Verbigeration Explanation: A verbigeration is the stereotyped repetition of words or phrases that may or may not have meaning to the listener. Clang associations are ideas that are related to one another based on sound or rhyming rather than meaning. Neologisms are words invented by the client. A word salad is a combination of jumbled words and phrases that are disconnected or incoherent and make no sense to the listener.
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. Explanation: Atypical antipsychotic medications may have mood stabilizing effects as well as antipsychotic effects; in many cases, symptoms of depression disappear when the psychotic symptoms decrease.
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 Explanation: Outcome research has shown that schizophrenia can be successfully treated and managed. Continuity of care has been identified as a major goal of recovery for clients with schizophrenia because they are at risk for becoming lost to services if left alone after discharge. Although inpatient hospitalizations that are brief and focus on client stabilization, crisis management as key to emergency care, and decreased social isolation through social engagement are all important, they are not considered major goals for recovery.
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.
