Chapter 16: Schizophrenia (Prep U)
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? Formal thought disorder Bizarre behavior Delusional thinking Hallucinatory experiences
Delusional thinking Delusions involve disturbances in thought content. They are firmly held false beliefs that reasoning cannot correct and for which there is no support in reality.
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? Ideas of reference Flight of ideas Hallucination Delusion
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.
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? Avolition Hallucination Delusion Alogia
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.
Clients diagnosed with schizophrenia may experience disordered water balance that may lead to water intoxication. Which may occur as a result of water intoxication? Hypernatremia Weight loss Hyponatremia Oliguria
Hyponatremia 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.
Schizoaffective disorder has symptoms typical of both schizophrenia and which type of disorder? Eating disorders Substance use disorders Mood disorders Anxiety disorders
Mood disorders Schizoaffective disorder has symptoms typical of both schizophrenia and mood disorders, but it is a separate disorder. Symptoms of anxiety, substance use, and eating disorders are not typically part of schizoaffective disorder.
A comprehensive nursing assessment for neuroleptic malignant syndrome (NMS) should include checking for which in a client taking an antipsychotic medication? Muscular rigidity, tremors, and difficulty swallowing Dry mouth, flushing, and urinary retention Headache, muscle aches, and paresthesias Confusion, giddiness, and hyperalertness
Muscular rigidity, tremors, and difficulty swallowing NMS is characterized by muscular rigidity, tremors, difficulty swallowing, fever, hypertension, and diaphoresis.
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 platelets hematocrit hemoglobin
white blood cells Agranulocytosis can develop with the use of all antipsychotic drugs but it is most likely to develop with clozapine use. Clients taking clozapine should have regular blood tests. White blood cell and granulocyte counts should be measured before treatment is initiated and at least weekly or twice weekly after treatment begins.
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? "Stay right there and I'll get your clothes." "I'll expect you in the dining room in 20 minutes." "First, wash your face and brush your teeth. Then put your clothes on." "Why don't you stay here and I'll get your tray for you."
"First, wash your face and brush your teeth. Then put your clothes on." 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.
Which statement made by a client would indicate that the client has delusions of grandeur? "I hear messages from aliens that tell me to steal cars." "I can't eat this food. It's poisoned." "I am a magician, and my magic powers are good when the moon is full." "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." The correct answer is the only statement that reflects that the client believes the client has powers, abilities, or characteristics that go beyond those of normal individuals (delusions of grandeur).
A client diagnosed with schizophrenia tells the nurse, "I hear the voice of Elvis." Which is the most therapeutic response by the nurse? "You shouldn't focus on Elvis's voice." "You know that Elvis has been dead for years." "I don't hear the voice, but I know you hear what sounds like a voice." "Don't worry about the voice as long as it doesn't belong to anyone real."
"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.
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? "I don't see or hear anything, but it sounds as though you are very frightened." "Just tell the man to go away." "There is no man under your bed. Let's go to the dining room now." "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." Nurses make it clear that they do not hear the voices or see the visual images but do communicate concern that the client is bothered, upset, or frightened by the hallucination.
The nurse working with a client who is newly diagnosed with schizophrenia would include which in the client's education? "Schizophrenia is caused by pathology in the cerebellum, and there are medications that are helpful in this area." "Schizophrenia is curable if the correct medication and dosages are achieved." "Schizophrenia has been found to be nonresponsive to medications, and we will work mostly on helping you with daily activities." "Schizophrenia is an illness that involves neurotransmitters, more specifically dopamine."
"Schizophrenia is an illness that involves neurotransmitters, more specifically dopamine." Schizophrenia has been shown to be an illness in which the dopamine system is affected. It is not caused by pathology in the cerebellum nor is it curable. It is responsive to medications.
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: "We need to watch to make sure that the client doesn't lose too much weight." "The client might develop toxic levels of the drug if the client smokes cigarettes." "The client needs to have an electrocardiogram periodically when taking this drug." "We'll need to make sure that the client has the client's blood count checked at least weekly."
"We'll need to make sure that the client has the client's blood count checked at least weekly." Clozapine is associated with agranulocytosis, so clients taking clozapine should have regular blood tests. White blood cell and granulocyte counts should be measured before treatment is initiated, and at least weekly or twice weekly after treatment begins. Although cardiac dysrhythmias can occur, they are more likely to occur with ziprasidone. Cigarette smoking can reduce the concentration of clozapine, thus necessitating a higher dose of this medication. Clozapine is associated with weight gain, not weight loss.
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? "I've told you before that I can't just snap my fingers and change the way I think." "I know I've got delusions, but you would too if you had to live my life." "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."
"You're so naïve. You just don't understand what's really happening out there." 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.
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 Determine adequate dosage is maintained to control symptoms Provide support to the client and let the client know this is normal Provide support to the client and encourage adherence as past side effects rarely reoccur
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.
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? Avolition Alogia Anhedonia Diminished emotional expression
Anhedonia Anhedonia refers to the inability to experience pleasure. Diminished emotional expression is reflected by a restriction or flattening in the range and intensity of emotion. Alogia refers to a reduced fluency and productivity of thought and speech. Avolition refers to withdrawal and inability to initiate and persist in goal-directed activity.
When assuming the management of the care of a delusional client, which should be the nurse's priority intervention? Identify what triggers the delusion Acknowledge that there may be some truth in the delusion Assure the client that he or she is safe in this milieu Encourage the client to talk about the reasoning behind his or her delusion
Assure the client that he or she is safe in this milieu Assuring the client that he or she is in a safe environment is the first step in the establishment of a therapeutic relationship that is vital to successful psychiatric treatment.
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 Somatic delusions involve bodily functions or sensations, with clients believing that they have physical ailments. Clients with delusional disorder show few, if any, psychological deficits. These clients characteristically have average or marginally low intelligence. Mental status generally is not affected. Thinking, orientation, affect, attention, memory, perception, and personality are generally intact.
A client with schizoaffective disorder is engaging in an extremely long conversation about a current affairs in the world. The client goes on to provide the nurse with minute details. The nurse interprets this as suggesting what? Neologism Clang association Verbigeration Circumstantiality
Circumstantiality 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 assessing a client diagnosed with schizophrenia. When documenting the findings, which would the nurse identify as a positive symptom? Select all that apply. Hallucinations Avolition Anhedonia Delusions Alogia
Delusions Hallucinations 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 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 Serotonin Norepinephrine Gamma-aminobutyric acid (GABA)
Dopamine 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 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. Outline the side effects of the medications. Gain assistance from family members. Contact the physician for a change in medications.
Establish a routine and set goals. 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 3 months Every week for the first 6 months Every 6 months Every year
Every week for the first 6 months 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 is diagnosed with schizoaffective disorder. Which would the nurse identify as supporting this diagnosis? Reports of client repeating everything the client's family has said in the past 24 hours Ability to maintain role function despite signs and symptoms Evidence of hallucinations and delusions accompanied by major depression Radiologic evidence of decreased size of the hippocampus and thalamus
Evidence of hallucinations and delusions accompanied by major depression For the diagnosis of schizoaffective disorder, the client must have an uninterrupted period of illness when there is a major depressive, manic, or mixed episode along with two of the following symptoms of schizophrenia: delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, or negative symptoms. In addition, the positive symptoms must be present without the mood symptoms at some time during this period for at least 2 weeks. The ability to maintain functioning would not be possible. Disorganized speech is only one of the symptoms that may be present. It also may be present with schizophrenia. A smaller thalamus and hippocampus are associated with schizophrenia.
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? Mixed Somatic Erotomanic Grandiose
Grandiose 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 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 Erotomanic delusion Grandiose delusion Somatic delusion
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.
Which is the central focus of persecutory delusions? A great, unrecognized talent Involving bodily functions or sensations Injustice that must be remedied by legal action Unfaithfulness
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.
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 Thought disorder Positive symptoms Delusions
Negative symptoms Common negative symptoms of schizophrenia include alogia, affective blunting, avolition, anhedonia, and attentional impairment.
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 Conjugal Grandiose Somatic
Persecutory 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? Somatic Erotomanic Grandiose Persecutory
Persecutory 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 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? Conjugal Grandiose Persecutory Erotomanic
Persecutory Clients with persecutory delusions believe that they are being conspired against, spied on, poisoned, drugged, cheated, harassed, maliciously maligned, or obstructed in some way. A client convinced that a spouse or significant other is unfaithful exhibits conjugal paranoia. Grandiose delusions exist when a client believes that he or she possesses unrecognized talent or insight or has made an important discovery. A person with erotomanic delusions believes that someone of elevated social status loves him or her.
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 Grandiose type Unspecified type
Persecutory type Persecutory type delusion refers to a situation whereby a person or someone close to person is being malevolently treated in some way.
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? Neuroleptic malignant syndrome Akathisia Pseudoparkinsonism Dystonic movements
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.
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? Greet the client by gently touching the client's arm and telling the client that the client can trust you. Inform the client that the client must receive care and you will assist the client. Respect the client's need for personal space and avoid physical contact. Tell the client that if the client does not comply with the rules, you will inform the doctor.
Respect the client's need for personal space and avoid physical contact. 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.
Some research has suggested that schizophreniform disorder may be an early manifestation of which other mental health condition? Bipolar affective disorder Schizophrenia Schizoaffective disorder Delusional disorder
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 can only be passed from a father to his children. Schizophrenia has shown a strong genetic contribution. Schizophrenia can only be passed from a mother to her children. Schizophrenia has not been shown to be genetic.
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.
What are the signs and symptoms of schizophrenia according to the Diagnostic and Statistical Manual of Mental Disorders? 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 2 or more active-phase symptoms. Schizophrenia can be diagnosed as soon as an individual states he or she is hearing voices. Schizophrenia lasts at least 1 month and must include the symptom of hallucinations.
Schizophrenia lasts at least 6 months and includes at least 1 month of 2 or more active-phase symptoms. 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.
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? Anticholinergic side effect associated with neuroleptic medications Psychomotor agitation associated with schizophrenia Signs of tardive dyskinesia (TD) associated with neuroleptic medication Typical bizarre behavior associated with schizophrenia
Signs of tardive dyskinesia (TD) associated with neuroleptic medication TD is a type of extrapyramidal side effect characterized by abnormal, involuntary, irregular, choreoathetoid (writhing) movements, which may include lip smacking, neck twisting, facial grimacing, and tongue and chewing movements. TD can occur after several months to years of therapy with traditional antipsychotics.
A 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? Illusions and loss of ego boundaries Loose associations and flight of ideas Suspiciousness and neologisms Echolalia and echopraxia
Suspiciousness and neologisms The client is demonstrating suspiciousness ("you're all out to get me") and neologisms (use of the words "Rostoputians and grog babies"). Loose associations and flight of ideas occur when the client talks about many topics in rapid sequence, but they are not connected with each other. Illusions are when the client sees something that is not there; echolalia is the repetition of words (or words that sound similar) said by someone else.
Which assessment findings in a client who is suspected of having a delusional disorder would be suggestive of a diagnosis of schizophrenia? The client experiences frequent and sustained hallucinations. The client does not have insight into his or her delusions. The client responds to group psychotherapy. The client's beliefs are considered delusional but nonbizarre.
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.
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 identify alternatives to present coping patterns. The client will differentiate between reality and fantasy. The client will describe problems relating to others. The client will identify situations that evoke anxiety.
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.
A client with schizophrenia is prescribed an antipsychotic medication. Which immediate side effects would the nurse include in the education plan for this medication? Risk for hypertension The potential for weight loss Risk for hypoprolactinemia The potential for sedation
The potential for sedation 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 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? Determine the impact of the delusion on the client's safety Evaluate the significance to the client Avoid dwelling on the delusion Try to change the client's delusional belief
Try to change the client's delusional belief 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.