HESI Schizophrenia

The nurse is conducting medication teaching with a client about clozapine (Clozaril). The nurse should include information about what weekly intervention? A. Blood work B. Follow-up visits with a physician C. Urinalysis D. Physical exam by psychiatrist

**A. Blood work

A dystonic reaction can be caused by which medication? A. Clonazepam B. Diazepam C. Amitriptyline hydrochloride D. Haloperidol

**D. Haloperidol

A client with a history of schizophrenia attends the mental health clinic for a regularly scheduled group therapy session. The client arrives agitated and exhibits behaviors that indicate that the client is hearing voices. When a nurse begins to walk toward the client, the client pulls out a large knife. What is the best approach by the nurse? 1 Firm 2 Passive 3 Empathetic 4 Confrontational

1 A firm approach prevents anxiety transference and provides structure and control for a client who is out of control. A passive approach for a client who may be out of control does not provide structure, which may increase the client's anxiety. Although the nurse should always base a therapeutic response on empathy, an obviously empathetic response may indicate to the client that the behavior is acceptable. A confrontational approach in this situation may escalate the client's agitation and precipitate further acting out.

A young client is admitted to the hospital with a diagnosis of acute schizophrenia. The family reports that one day the client looked at a linen sheet on a clothesline and thought it was a ghost. What is the most appropriate conclusion to make about what the client was experiencing? 1 Illusion 2 Delusion 3 Hallucination 4 Confabulation

1 An illusion is a misinterpretation of an actual sensory stimulus. A delusion is a false, fixed belief. A hallucination is a false sensory perception that occurs with no stimulus. Confabulation is a filling in of blanks in memory.

A client with schizophrenia reports having ongoing auditory hallucinations and describes them as "voices telling me that I'm a bad person" to the nurse. What is the best response by the nurse? 1 "Try to ignore the voices." 2 "What are the voices saying to you?" 3 "Do you believe what the voices are saying?" 4 "They're only voices, so just try not to be afraid."

1 Clients can sometimes learn to push auditory hallucinations aside, particularly within the framework of a trusting relationship; it may provide the client with a sense of power to manage the voices. Once it has been established by the nurse that the voices are not commanding the client to self-harm or harm others, focusing on the content of the hallucinations is not therapeutic. Asking whether the client believes what the voices are saying or encouraging the client not to be afraid of them is irrelevant to the situation; clients believe in and are frightened by hallucinations.

The nurse is caring for a client with newly diagnosed schizophrenia. What factor in the client's history indicates a greater potential for recovery? 1 Vague prepsychotic symptoms 2 Brain abnormalities on PET scan 3 Insidious onset of the client's illness 4 A relative who also has schizophrenia

1 The presence of vague prepsychotic symptoms is associated with decreased morbidity related to schizophrenia. Brain abnormalities on PET scan, insidious onset of the client's illness, and a relative who also has schizophrenia tend to contribute to a poor prognosis.

A client with acute schizophrenia tells the nurse, "Everyone hates me." What is the best response by the nurse? 1 "Tell me more about this." 2 "Everyone does not hate you." 3 "That feeling is part of your illness." 4 "You may be promoting this feeling yourself."

1 The response "Tell me more about this" explores more fully the client's ideas, experiences, or relationships; this response promotes communication. Arguing about delusions increases anxiety and diminishes trust. The response "That feeling is part of your illness" denies the client's feelings and implies that the client is wrong; it may cause the client to defend the feelings further. The response "You may be promoting this feeling yourself" puts the blame on the client and implies that the feelings are based on reality.

A nurse is preparing a teaching plan to educate a relative of a client with schizophrenia about the early signs of relapse. What signs should the nurse plan to include? Select all that apply. 1 Appearing disheveled 2 Socializing with peers 3 Staying alone in the house 4 Joining a local church singing group 5 Exhibiting indifference to family activities

1, 3, 5 Appearing disheveled, a negative sign, may indicate schizophrenic relapse, because the individual does not have the interest or energy to complete the activities of daily living. Staying at home alone can be a sign of mental illness relapse, because the individual is becoming isolated and not socializing. Indifference to family activities may indicate mental illness relapse, because it may reflect feelings of apathy or a lack of emotional energy to become involved with others. Socializing with peers is a sign of mental health, because the individual is interacting with others; humans are highly social beings. Joining a church singing group indicates mental health, because the individual is interacting with others and is interested in an activity

A 22-year-old client with the diagnosis of schizophrenia has been in a mental health facility for approximately 2 weeks. After the parents visit the client is seen pacing in the hall, talking loudly alone. What should the nurse's initial intervention be? 1 Obtaining a prescription for a tranquilizer 2 Asking the client about the events of the day 3 Calling the parents to find out what happened 4 Assigning a nursing assistant to remain with the client

2 A broad opening encourages communication that may elicit the client's perception of the day's events. Obtaining a prescription for a tranquilizer is premature. What is most important is the client's, not the parents', perception of what has occurred. Assigning a nursing assistant to remain with the client is premature; there are no data to indicate that the client may self-harm or harm others.

When a nurse enters a room to administer an oral medication to an agitated and angry client with schizophrenia, paranoid type, the client shouts, "Get out of here!" What is the most therapeutic response? 1 Stating, "You must take your medicine now." 2 Saying, "I'll be back in a few minutes so we can talk." 3 Explaining why it is necessary to take the medication 4 Withholding the medication before notifying the primary healthcare provider

2 Saying, "I'll be back in a few minutes so we can talk" allows the angry client time to regain self-control; announcing a plan to return will ease fears of abandonment or retribution. Staying and insisting that the client take the medication may provoke increased anger and further loss of control. Clients will not accept logical explanations when angry. Alternative nursing interventions should be attempted before withholding the medication and notifying the primary healthcare provider, although these may become necessary.

Which client characteristic is an initial concern for the nurse when caring for a client with the diagnosis of paranoid schizophrenia? 1 Continual pacing 2 Suspicious feelings 3 Inability to socialize with others 4 Disturbed relationship with the family

2 The nurse must consider the client's suspicious feelings and establish basic trust to promote a therapeutic milieu. Continual pacing is not a problem, because the nurse can walk back and forth with the client. Inability to socialize with others and disturbed relationship with the family may be of long-range importance but have little influence on the nurse-client relationship at this time.

A client with a diagnosis of schizophrenia, undifferentiated type, was admitted to the mental health hospital 3 days ago. The client stays in the bedroom except to eat and has no verbal interaction with other clients. When the nurse approaches, the client walks away and says, "Just leave me alone." What is the best response by the nurse? 1 "We need to talk." 2 "I'll talk to you later." 3 "What are you angry about?" 4 "Is there a reason to be so upset?"

2 The response "I'll talk to you later" allows the client to have the choice of communicating and leaves channels of communication open. The response "We need to talk" does not provide for any choice by the client. The response "What are you angry about?" assumes that the nurse knows the client's feelings; the nurse should not make this assumption. "Is there a reason to be so upset?" is a judgmental response; the nurse should not make the assumption that the client is upset.

A client with the diagnosis of schizophrenia who has been hospitalized on a mental health unit for 2 weeks is to be discharged home. The client is vacillating between being happy and sad about going home. What term best describes these conflicting emotions? 1 Double bind 2 Ambivalence 3 Loose association 4 Inappropriate affect

2 The simultaneous existence of two conflicting emotions, impulses, or desires is known as ambivalence. A single communication containing two conflicting messages is known as a double-bind message. A lack of connections between thoughts is known as loose associations. Inappropriate affect is not two conflicting emotions but instead the inappropriate expression of emotions.

A client who has been hospitalized with schizophrenia tells the nurse, "My heart has stopped and my veins have turned to glass!" What should the nurse conclude that the client is experiencing? 1 Echolalia 2 Hypochondriasis 3 Somatic delusion 4 Depersonalization

3 A somatic delusion is a fixed false belief about one's body. Echolalia is the automatic and meaningless repetition of another's words or phrases. Hypochondriasis is a severe, morbid preoccupation with an unrealistic interpretation of real or imagined physical symptoms. Depersonalization is a feeling of unreality and alienation from one's self.

A nurse is assessing an adolescent client with the diagnosis of schizophrenia, undifferentiated type. Which signs and symptoms should the nurse expect the client to experience? 1 Paranoid delusions and hypervigilance 2 Depression and psychomotor retardation 3 Loosened associations and hallucinations 4 Ritualistic behavior and obsessive thinking

3 Loosened associations and hallucinations are the primary behaviors associated with a thought disorder such as schizophrenia. Paranoid delusions and hypervigilance are more common in paranoid-type schizophrenia than in the undifferentiated type. Depression and psychomotor retardation are not characteristic of schizophrenia. Ritualistic behavior and obsessive thinking are generally associated with obsessive-compulsive disorders, not schizophrenia.

A client with the diagnosis of schizophrenia, paranoid type, is admitted to the hospital. The client says to the nurse, "I know they're spying on me in here, too. I'm not safe anywhere!" What is the most therapeutic response by the nurse? 1 "Nobody's spying on you in here." 2 "Why do you feel they'd want to follow you here?" 3 "You don't feel safe anywhere, not even in the hospital?" 4 "You're safe in the hospital; nothing can happen to you here."

3 Rephrasing facilitates further communication, helps the nurse express understanding, and does not belittle the client's feelings. Presenting reality to the client at this time will only increase the client's anxiety and lead the client to defend the delusion. "Why" questions make a client defensive, and the wording implies that the client's delusion is true. Saying the client is safe constitutes false reassurance; also, a suspicious client will not believe the nurse.

What clinical manifestation best indicates to the nurse that the mental status of a client with the diagnosis of schizophrenia, paranoid type, is improving? 1 Absence of mild to moderate anxiety 2 Development of insight into the problem 3 Decreased need to use defense mechanisms 4 Ability to function effectively in activities of daily living

4 A person who can handle the activities of daily living and function in society is considered mentally stable. Some anxiety is necessary and unavoidable; anxiety causes problems when it is overwhelming for an extended period. Insight into one's problems is of no use if one is unable to function in society. Everyone uses defense mechanisms; the extent to which they are used helps determine mental health.

A client with paranoid schizophrenia wraps the legs in toilet paper, believing that this will provide protection from deadly germs contaminating the floor. What is the best nursing intervention? 1 Limiting the client's access to toilet paper 2 Providing the client with antimicrobial soap 3 Explaining to the client why this action is ineffective 4 Talking with the client about anxiety that focuses on health

4 Exploring the feelings expressed in the delusion is more therapeutic than discussing specific content. Limiting the client's access to toilet paper may frustrate the client, who will probably seek other ways of "protection." Providing the client with antimicrobial soap reinforces the client's delusion about deadly germs. Trying to talk this client out of the delusion will not be effective and may precipitate hostility.

A client with schizophrenia tells the nurse, "There are foreign agents conspiring against me; they're out to get me at every turn." How should the nurse respond? 1 "It must be scary to believe that people are out to trick you at every opportunity." 2 "Those people you call foreign agents are out to do you in. What else is happening?" 3 "What's happened to make you believe that these people you call foreign agents are after you?" 4 "I can understand how frightening your thoughts are to you, but there are not foreign agents out to get you."

4 Noting how frightening the client's thoughts must seem but also telling the client that the thoughts do not seem factual acknowledges the client's feelings and points out reality. Although "It must be scary to believe that people are out to trick you at every opportunity" is an empathic response, it does not point out reality; the word "trick" does not have the same connotation as "do me in." The response "Those people you call foreign agents are out to do you in. What else is happening?" reinforces the client's delusional system. The response "What's happened to make you believe these people you call foreign agents are after you?" does not focus on feelings and places the client on the defensive.

A male client with the diagnosis of schizophrenia, paranoid type, often displays overt sexual behavior toward female clients and nurses. What is the nurse's best response when the client engages in sexually explicit behavior? 1 Refusing to speak with the client until he stops the behavior 2 Sending the client to his room when the behavior is observed 3 Ignoring this behavior until the client is more in control of his responses 4 Telling the client in a matter-of-fact manner that his behavior is unacceptable

4 Telling the client that the behavior is unacceptable rejects the behavior, not the client; it helps separate the client from the behavior. Refusing to speak with the client does not help the client learn self-control; it rejects both the client and the behavior. Isolating the client limits his ability to learn more acceptable responses. Part of recovery is learning acceptable behavior; ignoring inappropriate behavior is not therapeutic.

After 2 days on the unit a client with the diagnosis of schizophrenia refuses to take a shower. What is the most appropriate intervention by the nurse? 1 Having the staff give the client a shower 2 Simply stating that the client must shower now 3 Gently pointing out that the client's appearance is upsetting the other clients 4 Gently asking whether the client would wash the hands and face if given a basin of water

4 The client needs to feel comfortable in the environment before establishing enough trust to undress for showering; the nurse's statement allows the client to make the decision. Stating that the client must shower now or having the staff give the client a shower may add to the client's anxiety and feelings of loss of control; it may also worsen any delusional thoughts the client is having. Gently pointing out that the client's appearance is upsetting the other clients will not help the client's self-image, and it does not matter what other clients think.

A client with schizophrenia is demonstrating waxy flexibility. Which intervention is the best way to manage the possible outcome of this behavior? 1 Providing thickened liquids to minimize the risk of aspiration 2 Documenting intake and output each shift to monitor hydration 3 Reinforcing appropriate social boundaries through staff role modeling 4 Performing passive range-of-motion exercises three times a day for effective joint health

4 Waxy flexibility is an excessive and extended maintenance of posture that can lead to a variety of problems, including joint trauma. Passive range-of-motion exercises focus on the effective management of joint mechanics. Although aspiration precautions, documentation of intake and output, and staff role modeling may address issues experienced by a client with schizophrenia, passive range-of-motion exercises address waxy flexibility.

Some patients with schizophrenia express lack of insight or awareness that there is anything wrong or that any disorder is present. This symptom is referred to as _____________.

Anosognosia This symptom is often apparent when a client is asked what prompted admission to the hospital. A response such as "for some reason, the police just came over and told me I had to go to the hospital," is evidence of anosognosia. It is considered a symptom of the illness rather than a defense mechanism. A comparable symptom occurs following brain damage.

How should the nurse interpret Sam's belief that he is a famous movie star and that a limousine driver will arrive to get him later in the day? A. Psychotic thinking. B. Delusional thoughts. C. Flight of ideas. D. Confabulation.

B. Delusional thoughts.

Which nursing problem should be included on the treatment plan? A. Impaired adjustment. B. Social isolation. C. Anxiety. D. Confusion.

B. Social isolation.

Which nursing assessment accurately describes Sam's lack of energy? A. Apathy. B. Anhedonia. C. Avolition. D. Affective.

C. Avolition.

Which side effect(s) are characteristic of atypical antipsychotics? A. Increased tardive dyskinesia. B. Less incidence of weight gain. C. Fewer extrapyramidal effects. D. More extrapyramidal effects. E. Dry mouth.

C. Fewer extrapyramidal effects. E. Dry mouth.

Which finding depicts negative symptoms of schizophrenia? A. Difficulty sitting still. B. Rapid and disorganized speech. C. Flat affect and social inattentiveness. D. Delusional statements.

C. Flat affect and social inattentiveness.

A client is experiencing paranoia and states, "the FBI and phone company are plotting against me." Which charting entry best describes this client's symptom? A. experiencing delusions of grandeur B. experiencing erotomanic delusions C. experiencing delusions of persecution D. experiencing somatic delusions

C. experiencing delusions of persecution Individuals experiencing delusions of persecution feel that they are being threatened and believe that others have harmful intentions. The client in the question believes that the FBI and the phone company are plotting harm.

The client hears the word "match". the client replies, "A match. I like matches. They are the light of the world. God will light the world. Let your light so shine." Which communication pattern does the nurse identify? A. word salad B. clang association C. Loose association D. ideas of reference

C. loose association Loose association is characterized by communication in which ideas shift from one unrelated topic to another. The situation in the question represents this communication pattern.

The client hears the word "match". The client says, "A match. Tomorrow is the end of the world. Nothing is better than hot coffee." Which communication pattern does the nurse identify? A. word salad B. clang association C. loose association D. ideas of reference

C. loose association Loose association is characterized by communication in which ideas shit from one unrelated topic to another. The situation in the question clearly represents this communication pattern

A client diagnosed with schizophrenia is experiencing disorganized thinking. Which technique should the nurse use to promote communication? A. giving broad openings B. probing C. verbalizing the implied D. using open-ended questions

C. verbalizing the implied When working with clients who have greatly impaired communication ability, the nurse can use the technique of verbalizing the implied. By putting into words what the client may be experiencing, the nurse helps the client to organize his or her thinking.

A client is being discharged on haloperidol (Haldol). Which teaching should the nurse include about the medication? A. "If you forget to take your morning dose of Haldol, double the dose at bedtime." B. "Limit your alcohol intake to no more than 3 ounces per day. " C. "When you go home, sit outside and enjoy the sunshine." D. "Do not stop taking Haldol abruptly."

D. "Do not stop taking Haldol abruptly." The client should be taught not to stop taking Haldol abruptly after long-term use. To do so might produce withdrawal symptoms, such as N/V, dizziness, gastritis, headache, tachycardia, insomnia and/or tremulousness

Clint, a client on the psychiatric unit, has been diagnosed with schizophrenia. He begins to tell the nurse about how the CIA is looking for him and will kill him if they find him. The most appropriate response by the nurse is: A. "That's ridiculous, Clint. No one is going to hurt you." B. "The CIA isn't interested in people like you, Clint." C. "Why do you think the CIA wants to kill you?" D. "I know you believe that, Clint, but it's really hard for me to believe."

D. "I know you believe that, Clint, but it's really hard for me to believe."

Which speech process should the nurse document on the daily mental status exam record? A. Loose associations. B. Tangential. C. Monotone. D. Poverty of speech.

D. Poverty of speech.

The nurse is caring for a client with schizophrenia. Orders from the physician include 100 mg chlorpromazine IM STAT, and then 50 mg PO bid; 2 mg benztropine PO bid PRN. Because benztropine was ordered on a PRN basis, which of the following assessments by the nurse would convey a need for this medication? A. The client's level of agitation increases B. The client complains of a sore throat C. The client's skin has a yellowish cast. D. The client develops tremors and a shuffling gait.

D. The client develops tremors and a shuffling gait.

Which thought process does this exemplify? A. Concrete thinking. B. Flight of ideas. C. Word salad. D. Thought blocking.

D. Thought blocking.

To deal with a client's hallucinations therapeutically, which nursing intervention should be implemented? A. Reinforce the perceptual distortions until the client develops new defenses B. Provide an unstructured environment C. Avoid making connections between anxiety-producing situations and hallucinations D. distract the client's attention

D. distract the client's attention The nurse should first empathize with the client by focusing on feelings generated by the hallucination, present objective reality, and then distract or redirect the client to reality-based activities.

A patient on antipsychotic medication reports to the nurse that her muscles feel very stiff, and she appears diaphoretic. Her temperature is 105 degrees. Her symptoms are indicative of the potentially fatal adverse reaction to antipsychotic medication known as ________________________

Neuroleptic Malignant Syndrome Although neuroleptic malignant syndrome is rare, its rapid progression and potential to cause death make it a priority to assess for regularly and to intervene aggressively when symptoms are apparent. Antipsychotic medication should be immediately discontinued

13. Bob tells the nurse he has allergies to haloperidol (Haldol), that he gets a real stiff neck and can't move it. What type of reaction should the nurse suspect?

a. akathisia b. dystonia c. parkinsonism d. synergistic ans: B acute, tonic muscle spasms, often of the tongue, jaw, eyes, and neck but sometimes of the whole body. occur during the first few days of antipsychotic admin.

9. Which client behavior validates the need for involuntary hospitalization?

a. beliefs about FBI surveillance b. diagnosis of schizophrenia c. violence towards fathers d. guarded and suspicious ans: C risk for violence toward self or others is a criterion for involuntary hospitalization

5. Which finding depicts negative symptoms of schizophrenia?

a. difficulty sitting still b. rapid and disorganized speech c. flat affect and social inattentiveness d. delusional statements ans: C spaciness, flat affect and social inattentiveness

12. Which side effects would the nurse most likely observe with fluphenazine, a traditional antipsychotic?

a. high extrapyramidal effects, low anticholinergic effects b. high anticholinergic effects and low extrapyramidal effects c. risk for agranulocytosis, fever, and elevated blood pressure d. blood dyscrasias such as thrombocytopenia ans: A traditional antipsychotics generally have high extrapyramidal effects and low anticholinergic effects

6. Which nursing problem has priority?

a. ineffective community coping b. disturbed thought processes c. sensory-perceptual disturbance d. ineffective denial ans: B This is a priority problem because Bob is delusional

Which hormonal effects do antipsychotic medications have? A. Dysmenorrhea B. Sexual dysfunction C. Akinesia D. Polydipsia

**A. Dysmenorrhea

A nurse is teaching a psychiatric client about his ordered drugs, chlorpromazine and benztropine. What evaluation would indicate a therapeutic response to these drugs? A. The client is experiencing less psychosis and a decrease in extrapyramidal symptoms B. The client does not report nausea and vomiting C. The client displays akathisia while sitting. D. The client expresses a decrease in anxiety

**A. The client is experiencing less psychosis and a decrease in extrapyramidal symptoms

A health care provider prescribes haloperidol p.o. 1 mg t.i.d. When assessing the client for adverse effects, which nursing measures would be initiated? Select all that apply. A. Monitor blood glucose levels B. Observe for increased pacing and restlessness. C. Closely monitor vital signs, especially temperature. D. Review subcutaneous injection technique E. Monitor for signs and symptoms of urticaria.

**B. Observe for increased pacing and restlessness. **C. Closely monitor vital signs, especially temperature.

In patients taking first generation (conventional) antipsychotics, Propranolol is used for which of the following: A. to reduce of ritualistic behavior B. to treat of antipsychotic-induced akathisia C. to alleveiate delusions D. to stabilize mood in the manic phase of bipolar illness

**B. to treat of antipsychotic-induced akathisia

First generation (conventional) antipsychotics work by which of the following mechanisms? A. Blocking monoamine reuptake B. Blocking norepinephrine and serotonin C. Blocking dopamine and norepinephrine D. Blocking serotonin and dopamine

**C. Blocking dopamine and norepinephrine

When teaching a group of nursing students in a psychiatric assistant class about the use of antipsychotic medications, the nurse advises them that certain symptoms can occur within the first few weeks of treatment. Which symptoms are likely to occur? Select all that apply. A.Tardive dyskinesia B. Hearing loss. C. Neuroleptic malignant syndrome. D. Acute dystonic reactions E. Akathisia. F. Orthostatic hypotension

**C. Neuroleptic malignant syndrome. **D. Acute dystonic reactions **E. Akathisia. **F. Orthostatic hypotension

Important teaching for clients receiving antipsychotic medication such as haloperidol includes which instruction? A. Do not eat aged cheese B. Have routine blood tests to determine medication levels C. Use sunscreen whenever going outside D. Take the antipsychotic medication on an empty stomach.

**C. Use sunscreen whenever going outside

The nurse understands that assessment of blood pressure in clients receiving antipsychotic drugs is important. What is a reason for this assessment? A. This provides additional support for the client. B. It will indicate the need to institute antiparkinsonian drugs C. Most antipsychotic drugs cause elevated blood pressure. D. Orthostatic hypotension is a common side effect.

**D. Orthostatic hypotension is a common side effect.

The night nurse reports that a young client with paranoid schizophrenia has been awake for several nights. The day nurse reviews the client's record and finds that this client did not have an interrupted sleep pattern disorder before transfer from a private room to a four-bed room 3 days ago. What factor should the nurse identify as most likely related to the client's sleeplessness? 1 Fear of the other clients 2 Concern about family at home 3 Watching for an opportunity to escape 4 Trying to work out emotional problems

1 Because the client has paranoid feelings that other people are out to do harm, assignment to a four-bed room may be threatening. Concern about family at home seems unlikely, because the disruption appears to have started with the transfer to a four-bed room. Watching for an opportunity to escape is possible but unlikely; planning an escape is usually not part of a schizophrenic pattern of behavior. Trying to work out emotional problems is possible but not likely; clients with schizophrenia have difficulty solving problems.

A nurse is caring for a client with the diagnosis of schizophrenia. What should the nurse plan to do to increase the self-esteem of this client? 1 Reward healthy behaviors. 2 Explain the treatment plan. 3 Identify various means of coping. 4 Encourage participation in community meetings.

1 By realistically rewarding the healthy behaviors, the nurse provides secondary gains and encourages the continued use of healthy behaviors. Explaining the treatment plan, identifying various means of coping, and encouraging participation in community meetings are important but will do little to increase the client's self-esteem.

A client with schizophrenia plans an activity schedule with the help of the treatment team. A written copy is posted in the client's room. What should the nurse say when it is time for the client to go for a walk? 1 "It's time for you to go for a walk now." 2 "Do you want to take your scheduled walk now?" 3 "When would you like to go for your walk today?" 4 "You're supposed to be going for your walk now."

1 Telling the client that it is time to take a walk is concise and does not require decision-making; it is therefore less likely to increase anxiety. "Do you want to take your scheduled walk now?" asks the client to make a decision when a refusal is unacceptable. Requiring the client to make a decision when acutely ill may increase anxiety; also, it permits the unacceptable answer of "never." "You're supposed to be going for your walk now" is somewhat accusatory; it may increase anxiety by placing responsibility on the client.

. A client is admitted to a psychiatric unit with the diagnosis of schizophrenia, undifferentiated type. When assessing the client, the nurse identifies the presence of several characteristics related to this disorder. What may this include? Select all that apply. 1 Bizarre behavior 2 Extreme negativism 3 Disorganized speech 4 Persecutory delusions 5 Auditory hallucinations

1, 3, 5 Bizarre behavior, disorganized speech, and auditory hallucinations are associated with undifferentiated schizophrenia. Extreme negativism is associated with catatonic schizophrenia. Persecutory delusions are associated with paranoid schizophrenia.

A client is experiencing extrapyramidal symptoms secondary to neuroleptic drug therapy. The physician ordered biperiden (Akineton), 2mg tid IV. If a 5mg/mL vial is used, what is the total amount, in mL per day, that the nurse will administer?

1.2

A nurse is monitoring a client with the diagnosis of schizophrenia who is experiencing opposing emotions simultaneously. When providing a change-of-shift report, how should the nurse refer to this emotional experience of the client? 1 Double bind 2 Ambivalence 3 Loose association 4 Inappropriate affect

2 Ambivalence is the existence of two conflicting emotions, impulses, or desires. Double bind is two conflicting messages, not emotions, in a single communication. Loose associations are not two conflicting emotions but instead the loosening of connections between thoughts. Inappropriate affect is the inappropriate expression of emotions.

A young adult client is admitted to the hospital with a diagnosis of schizophrenia, paranoid type. The client has been saying, "The voices in heaven are telling me to come home to God." What should initial nursing care be focused on? 1 Disturbed self-esteem 2 Potential for self-harm 3 Dysfunctional verbal communication 4 Impaired perception of environmental stimuli

2 Client safety always is the priority over any other client need, and command hallucinations increase the risk of injury. Although promoting self-esteem is important, this is not a priority at this time. There are no data to support the need to focus on the client's ability to verbally communicate. Verbal hallucinations occur within the individual; they are not precipitated by an environmental stimulus.

A nurse who is working on a psychiatric unit notes that a client with schizophrenia is beginning to pace around the lounge while glaring at other clients. How should the nurse respond to this behavior? 1 By pointing out the behavior to the client 2 By walking with the client to a quiet area on the unit 3 By suggesting that the client go to the gym to work out 4 By arranging for an additional staff member to be present in the vicinity of the client

2 The client is demonstrating signs of agitation, and stimuli from the environment must be reduced. Pointing out the behavior is confrontational and may increase the client's agitation. The client should not be left unattended at this time; aggressive physical activity at this time may increase the agitation. Arranging for the presence of another staff member will not interrupt the client's behavior, which is the priority at this time. 69%of students nation

A client with schizophrenia is admitted to a psychiatric unit. The client is talking while walking in the hall, is unkempt, and obviously has not washed in several days. What should the nurse say when trying to help this client shower? 1 "Would you like a shower?" 2 "I'll help you take your shower now." 3 "When do you want your shower, now or later?" 4 "You'll feel so much better if you have a shower."

2 The client is displaying a self-care deficit; stating the intention of helping the client shower is direct, does not require the client to make a decision, provides help, and meets the client's physiologic and psychological needs. The client may or may not be capable of making a decision; if the client says no, the nurse will be confronted with a dilemma: meeting the client's physiologic needs will contradict the client's wish not to bathe. The client may not be able to tell the nurse when the shower is desired, because the client may be incapable of making a decision. "You'll feel so much better if you have a shower" may be false reassurance; the client may not be able to process cause and effect.

A nurse is caring for a client with the diagnosis of schizophrenia, paranoid type. What should the nurse plan for the client's initial care? 1 Discussing important life events 2 Providing a nonthreatening environment 3 Concentrating on the content of delusions 4 Limiting topics for discussion to recent situations

2 These clients are hypersensitive to external stimuli and respond with less anxiety to a minimally threatening environment. Discussing prominent life events is too threatening an approach and interferes with the goals of therapy. Focusing on delusional material will reinforce the delusional system. Limiting topics for discussion to recent situations is not therapeutic; it may trigger suspiciousness and hostile outbursts.

A client with schizophrenia says to the nurse, "I've been here 5 days. There are five players on a basketball team. I like to play the piano." How should the nurse document this cognitive disorder? 1 Word salad 2 Loose association 3 Thought blocking 4 Delusional thinking

2 These ideas are not well connected and there is no clear train of thought. This is an example of loose association. Word salad is incoherent expressions containing jumbled words. This client's thoughts are coherent but not connected. Thought blocking occurs when the client loses the train of thinking and ideas are not completed. Each of the client's thoughts is complete but not linked to the next thought. These statements are reality based and not reflective of delusional thinking.

A client with schizophrenia uses the word "worriation" when talking with the nurse. How should the nurse respond? 1 By correcting the pronunciation of the word 2 By asking for clarification of the word's meaning 3 By ignoring its use while interacting with the client 4 By telling the client to use words that everyone can understand

2 This is an example of a neologism, a self-coined word whose meaning is known only to the client. It is not a mispronunciation. The word's meaning must be explored. The use of a neologism should not be ignored, because the word usually has significance to the individual who is using it. Telling the client to use words everyone else can understand is a demeaning response that may cut off communication.

Schizophrenia is associated with both positive and negative symptoms. While assessing a client with schizophrenia, the nurse notes that the client is experiencing positive symptoms; what does the nurse observe that leads to this conclusion? Select all that apply. 1 Poverty of speech 2 Agitated behavior 3 Lack of motivation 4 Delusions of grandeur 5 Auditory hallucinations

2, 4, 5 Agitated and restless behaviors are positive symptoms of schizophrenia. A delusion is a fixed false belief that is resistant to reasoning; when a person believes that he or she is a famous, historical or fictional omnipotent character this is called a delusion of grandeur; a delusion is a positive symptom associated with schizophrenia. An auditory hallucination is a sensory perception involving the sense of hearing that occurs in the absence of an external stimulus and is a positive symptom associated with schizophrenia. Decreased verbalization, including a sudden stoppage in the flow of speech (blocking) and lack of inflection, is a negative symptom associated with schizophrenia. Lack of motivation (avolition) and apathy are negative symptoms associated with schizophrenia.

A client with schizophrenia is going to occupational therapy for the first time. The client doesn't want to go and tells the nurse so. What is the most therapeutic initial response by the nurse? 1 "It's only for an hour, and then you'll be back." 2 "Try it once. If you don't like it, you don't have to go back." 3 "Tell me what concerns you about going to occupational therapy." 4 "Your primary healthcare provider prescribed it as part of your treatment. You should go."

3 "Tell me what concerns you about going to occupational therapy" is an open-ended statement that allows the nurse to explore the client's concerns. If the client would feel more comfortable having the nurse go with the client to the first session, this idea may be explored next. The statement "It's only for an hour, and then you'll be back" will do nothing to allay the client's anxiety about facing a new situation. Telling the client to try it once and that the client won't have to go back is not true; even if the client does not like the therapy, the client should be encouraged to go as part of the overall therapy program. Telling the client that the primary healthcare provider has prescribed the therapy as part of the treatment and that the client should go will do nothing to allay the client's anxiety about facing a new situation.

A client with the diagnosis of schizophrenia refuses to get out of bed and becomes upset. What is the nurse's initial therapeutic response? 1 Requiring the client to get out of bed at once 2 Allowing the client to stay in bed for a while 3 Staying at the bedside until the client calms down 4 Giving the prescribed as-needed tranquilizer to the client

3 Staying at the bedside until the client calms down provides support and security without rejecting the client or placing value judgments on behavior. Eventually limits will have to be set, but this is not the immediate nursing action. Allowing the client to stay in bed for the time being ignores the problem, and isolation may imply punishment. Although medication will calm the client, it does not address the problem.

One morning a client with the diagnosis of schizophrenia claims to be Joan of Arc about to be burned at the stake. What is the most therapeutic response by the nurse? 1 "Tell me more about being Joan of Arc." 2 "We both know that you're not Joan of Arc." 3 "It seems like the world is a pretty scary place for you." 4 "You're safe here, because we won't let you be burned."

3 With the statement "It seems like the world is a pretty scary place for you" the nurse attempts to understand the symbolism, reflects and acknowledges the client's feelings, and helps preserve the client's integrity. The statement "Tell me more about being Joan of Arc" validates the client's delusion and does not test reality. The statement "We both know that you're not Joan of Arc" rejects the client's feelings and does not address the client's fears of being harmed; clients cannot be argued out of delusions. The statement "You're safe here, because we won't let you be burned" is false reassurance; the nurse cannot fully understand the symbolism and therefore cannot make this promise.

A client with schizophrenia is observed sitting alone quietly talking. The client appears sad and is tearful. Place the following nursing assessment questions in the appropriate order to best ensure client safety. 1. "What do you usually do to make the voices stop?" 2. "What are the voices telling you?" 3. "Are you hearing voices?" 4. "Are you thinking about hurting yourself or someone else?"

3, 2, 4, 1 Confirming that the client is experiencing verbal hallucinations is the priority. Determination of the nature of the message that the voices are delivering takes place next. The risk for injury to the client and others is assessed after the focus of the hallucination is identified. Finally the nurse will assist the client in managing the reaction to the hallucination.

A young client with schizophrenia says, "I'm starting to hear voices." What is the nurse's most therapeutic response? 1 "How do you feel about the voices, and what do they mean to you?" 2 "You're the only one hearing the voices. Are you sure you hear them?" 3 "The health team members will observe your behavior. We won't leave you alone." 4 "I understand that you're hearing voices talking to you and that the voices are very real to you. What are the voices saying to you?"

4 Acknowledging that client is hearing voices and that the voices are very real to the client validates the presence of the client's hallucinations without agreeing with them, which communicates acceptance and can form a foundation for trust; it may help the client return to reality. The nurse also needs to assess the content of the voices to determine the risk of self-injury or violence against others. The client's contact with reality is too tenuous to explore what the voices mean. Saying that the client is the only one hearing the voices and asking whether the client is sure the voices are being heard demeans the client, which blocks the development of a trusting relationship and future communication. Telling the client that the health team members will observe the behavior and that the client won't be left alone is condescending and may impair future communication.

After treatment, an adolescent with a history of schizophrenia improves and is to be discharged. The parents tell the nurse that they are concerned about how to respond "if our child starts to act crazy." What is the most therapeutic response by the nurse? 1 Teaching the parents how to respond to their child's bizarre behavior 2 Assuring the parents that they are capable of controlling their child's behavior 3 Referring the parents to a self-help group of parents with schizophrenic children 4 Having the parents discuss mutual concerns with their child before the discharge date

4 Both the parents and their child should be included in a discussion so that concerns can be addressed openly; this increases trust and fosters a good relationship. Teaching the parents how to respond to their child's bizarre behavior is not expected to be needed for a client who is ready to be discharged. Assuring the parents that they are capable of controlling their child's behavior is false reassurance. There is no evidence of the parents' ability to control their child's behavior. Referring the parents to a self-help group of parents with schizophrenic children may be useful for the family later, but it will not address the immediate problem.

A client's parents ask about the treatment of their child who has a recent diagnosis of schizophrenia. Before responding, what should the nurse consider? 1 Electroconvulsive therapy is more effective in treating schizophrenia than mood disorders. 2 Family therapy has not been proved effective in the treatment of clients with schizophrenia. 3 Insight therapy has been proved highly successful in the treatment of clients with schizophrenia. 4 Drug therapy, although it does not eliminate the underlying problem, reduces the symptoms of acute schizophrenia.

4 Psychoactive drugs have been shown to be capable of interrupting the acute psychiatric process, making the client more amenable to other therapies. Electroconvulsive therapy may be effective in treating depressed clients. Family therapy is effective but is a long-term, costly proposition; signs and symptoms must be reduced before the client can participate. Clients with schizophrenia usually have little insight into their problems. Confronting the client through insight therapy will increase anxiety.

While speaking with a client with schizophrenia, the nurse notes that the client keeps interjecting sentences that have nothing to do with the main thoughts being expressed. The client asks whether the nurse understands. What is the best response by the nurse? 1 "You aren't making any sense; let's talk about something else." 2 "You're so confused; I can't understand what you're saying to me." 3 "Why don't you take a rest? We can talk again later this afternoon." 4 "I'd like to understand what you're saying, but I'm having difficulty following you."

4 The statement "I'd like to understand what you are saying, but I'm having difficulty following you" lets the client know the nurse is trying to understand; it increases the client's self-esteem and points out reality. Clients with schizophrenia have problems with associative links, and these same problems will occur regardless of the topic. The statement "You're so confused; I can't understand what you're saying to me" and telling the client to take a rest and promising to talk about the client's concerns again later in the day cut off communication and tell the client that the nurse will speak only if the client's communication makes sense

The family of a patient who has been prescribed antipsychotic medication tells the nurse they understand there are potentially fatal side effects with these medications. They ask the nurse for information about what they should look for that could signal potentially dangerous or fatal side effects. Which of the following responses by the nurse are accurate with regard to the family's question? (Select all that apply) A. "If the patient has acute muscle spasms or the patient's eyes appear to be rolling back, emergency intervention should be sought." B. "if the patient has an unusually high fever and complains of muscle rigidity, any further antipsychotic medication should be discontinued and immediate emergency intervention should be sought." C. "If the patient complains of sore throat, fever, and malaise, the doctor should be contacted to evaluate for a possible dangerous side effect of the mediation." D. "if the male patient begins to show signs of breast enlargement or the female patient experiences amenorrhea, take the patient immediately to the ER." E. "If the patient's psychotic symptoms appear to be absent, call the doctor immediately."

A. "If the patient has acute muscle spasms or the patient's eyes appear to be rolling back, emergency intervention should be sought." B. "if the patient has an unusually high fever and complains of muscle rigidity, any further antipsychotic medication should be discontinued and immediate emergency intervention should be sought." C. "If the patient complains of sore throat, fever, and malaise, the doctor should be contacted to evaluate for a possible dangerous side effect of the mediation." Feedback 1: These symptoms are indicative of an acute dystonia, which can progress to laryngospasm if not treated. Emergency intervention with an anticholinergic such as Cogentin is needed to reverse this side effect. Feedback 2: These symptoms are indicative of neuroleptic malignant syndrome, which can progress rapidly and be fatal. Immediate discontinuation of antipsychotic medication and emergency intervention are critical needs. Feedback 3: These symptoms may be indicative of agranulocytosis, which can be fatal is not treated. Further bloodwork is needed.

A member of the health care team advises a colleague that when a patient expresses delusional thinking, just going along with the delusion and agreeing with whatever the patient says is the best approach. What is the most appropriate response the colleague can provide? A. "You should acknowledge the patient's distress, but agreeing with delusional thinking isn't appropriate." B. "You're right—just going along with the delusion is the best approach because you avoid an argument that might agitate the patient." C. "You should never go along with delusions. Be direct and honest about how delusional and false the patient's thinking is." D. "Point out how crazy the patient's delusions are, and say that you'll administer medicine to clear the patient's thoughts."

A. "You should acknowledge the patient's distress, but agreeing with delusional thinking isn't appropriate." Rationale: Health care team members should acknowledge the distress that a delusion causes the patient, rather than challenging the reality of its content. They can provide distraction to decrease the focus on the delusion and increase reality-based thinking. Arguing with the patient or reinforcing the delusions are not helpful responses.

A client diagnosed with schizophrenia states, "My roommate is plotting to have others kill me." Which is the appropriate nursing response? A. "i know you believe that to be true, but i find that hard to believe." B. "What would make you think such a thing?" C. "I know your roommate. He would do no such thing." D. "I can see why you feel that way."

A. "i know you believe that to be true, but i find that hard to believe." This client is experiencing a persecutory delusion. this nursing response is an example o voicing doubt, which expresses uncertainty as to the reality of the client's perceptions. this is an appropriate therapeutic communication technique in dealing with clients experiencing delusional thinking.

Which strategy is best for clients who hear voices? A. Avoid certain situations. B. Smoke more cigarettes. C. Decrease caffeine use. D. Take more medication.

A. Avoid certain situations.

Which data is most important to obtain before Sam begins the Zyprexa, which is an atypical antipsychotic? A. Baseline weight. B. Orthostatic blood pressure. C. Complete blood count. D. Screening for tardive dyskinesia.

A. Baseline weight.

Which behavior is characteristic of a thought disorder? A. Blunted affect. B. Irritability. C. Lability of mood. D. Preoccupation with guilty feelings.

A. Blunted affect.

Which medication with potentially life-threatening side effects should the nurse expect the healthcare provider to prescribe for clients who do not respond to the use of other antipsychotics? A. Clozapine (Clozaril). B. Haloperidol decanoate (Haldol decanoate). C. Fluphenazine decanoate (Prolixin decanoate). D. Perfenazine (Trilafon).

A. Clozapine (Clozaril).

What is the greatest benefit of a caseworker for this client? A. Coordinate services for Sam. B. Make sure Sam takes his medications. C. Empower Sam to be independent. D. Provide guidance for disability income.

A. Coordinate services for Sam.

Clint, a client on the psychiatric unit, has been diagnosed with schizophrenia. He begins to tell the nurse about how the CIA is looking for him and will kill him if they find him. Clint's belief is an example of a: A. Delusion of persecution B. Delusion of reference C. Delusion of control or influence D. Delusion of grandeur

A. Delusion of persecution

What is the reason that Prolixin is prescribed for this client? A. Disorganized thoughts. B. Difficulty sleeping at night. C. Feelings of depression. D. Stabilize client's mood.

A. Disorganized thoughts.

Based on this assessment, what is the most important nursing intervention? A. Establish rapport and trust. B. Assess for hallucinations. C. Maintain adequate social space. D. Plan to give a PRN antipsychotic.

A. Establish rapport and trust.

What will be the most important group activity to promote wellness in the community? A. Explore symptom management. B. Review education about medications. C. Practice social skills. D. Identify community coping resources.

A. Explore symptom management.

Which side effects would the nurse most likely observe with fluphenazine (Prolixin), a traditional antipsychotic? A. High extrapyramidal effects, low anticholinergic effects. B. High anticholinergic effects and low extrapyramidal effects. C. Risk for agranulocytosis, fever, and elevated blood pressure. D. Blood dyscrasias such as thrombocytopenia.

A. High extrapyramidal effects, low anticholinergic effects.

After implementing the first step, what step is taken next? A. Identify current ways to manage symptoms. B. Talk about specific support systems. C. Discuss other ways to manage symptoms. D. Develop a new symptom management plan.

A. Identify current ways to manage symptoms.

A client diagnosed with schizophrenia experiences identity confusion and communicates with the nurse using echolalia. What is the client attempting to do by using this form of speech? A. Identify with the person speaking B. Imitate the nurse's movements C. Alleviate alogia D. Alleviate avolition

A. Identify with the person speaking Echolalia is a parrot-like repetition of overheard words or fragments of speech. It is an attempt by the client to identify with the person who is speaking.

In planning this client's care, what is the most important short-term client outcome? A. Interact without expressing delusional thoughts. B. Create a support network within the community. C. Identify at least one symptom management technique. D. Identify actions to take to prevent relapse.

A. Interact without expressing delusional thoughts.

Which explanations are best? A. Knowing symptom triggers and how to manage them can help prevent relapse. B. Identifying symptom triggers may prevent the risk of violence and promote safety. C. Managing symptom triggers promotes communication with your caseworker. D. Keeping informed about triggers allows you to increase your medications immediately. E. Reducing exposure to triggers helps improve the client's prognosis by minimizing relapses.

A. Knowing symptom triggers and how to manage them can help prevent relapse. B. Identifying symptom triggers may prevent the risk of violence and promote safety. E. Reducing exposure to triggers helps improve the client's prognosis by minimizing relapses.

A patient on medications to manage symptoms of schizophrenia presents to the emergency department with increased symptoms of paranoia and auditory hallucinations, a blood pressure of 140/90 mm Hg, and a blood glucose level of 210 mg/dl. After the patient is stabilized, an important action in the plan of care will be to monitor the patient for which condition? A. Metabolic syndrome B. Reality orientation C. Disorganized thinking D. Poverty of speech

A. Metabolic syndrome Rationale: Patients with schizophrenia are at increased risk for metabolic syndrome; thus, the health care team member should assess the patient for visceral adiposity, hyperglycemia, hypertension, and dyslipidemia. Assessing the patient for reality orientation, disorganized thinking, and poverty of speech is important but not the priority.

A patient displays symptoms of paranoia and auditory hallucinations. What is the health care team member's priority? A. Minimize or reduce environmental stimuli. B. Provide medications to sedate the patient. C. Distract the patient from delusional thinking. D. Assure the patient that the paranoia and hallucinations are not real.

A. Minimize or reduce environmental stimuli. Rationale: Minimizing or reducing environmental stimuli reduces the potential for agitation and violence in a patient who is experiencing hallucinations. Sedating the patient may increase paranoia. Distracting the patient from delusional thinking provides only temporary relief. Assuring the patient that the paranoia and hallucinations are not real is ineffective in countering psychotic thinking.

Which nursing action is best? A. Obtain a prescription to begin the Cogentin. B. Monitor Sam for medication side effects. C. Ask Sam if he had any side effects from the Prolixin. D. Do not give the Prolixin and document the reason.

A. Obtain a prescription to begin the Cogentin.

Which group is most therapeutic for Sam? A. Structured medication group. B. Unstructured group about personal issues. C. Psychoeducational group about self-esteem. D. Supportive therapy group.

A. Structured medication group.

A client who is experiencing command hallucinations is hospitalized after jumping from a bridge. The client's parents insist that their son feel rather than jumped. Which of the following likely explain the parents' response? (Select all that apply) A. The parents are in denial about the reality of their son's mental illness B. The parents are grieving over the loss of their expectations for their child C. The parents do not understand the extent or seriousness of mental illness D. The parents reject the idea of their son having a mental illness E. The parents are showing support for their son.

A. The parents are in denial about the reality of their son's mental illness B. The parents are grieving over the loss of their expectations for their child C. The parents do not understand the extent or seriousness of mental illness D. The parents reject the idea of their son having a mental illness Feedback 1: by stating the jump was a fall, the parents are expressing denial and minimizing the problem Feedback 2: The child's attempted suicide could generate a loss of hope that their child will meet parental expectations. This can occur any time a child is physically or mentally different. Feedback 3: The parents may have a knowledge deficit and truly may not understand the implications of their child's mental illness Feedback 4: By claiming that their son feel rather than jumped from the bridge, the parents are embracing an accidental cause and rejecting the possibility of mental illness.

What is the nurse's best response? A. This can happen even if you are taking medications every day. B. Maybe you forgot to take some of your medication. C. How long have you been taking your medications? D. Compliance with medications will prevent relapse.

A. This can happen even if you are taking medications every day.

The family of a client diagnosed with schizophrenia tells the nurse that they were at a NAMI meeting and heard that the recovery model for intervention with people with schizophrenia is gaining recognition as a desirable approach. They ask the nurse to describe this model. Which of these responses by the nurse are accurate statements about the recovery model? (Select all that apply) A. This model supports that recovery is an obtainable objective for people with schizophrenia B. This approach engages the client in an Alcoholics Anonymous (AA) - like 12-step program for recovery C. the recovery model actively engages the client in determining the goals for the treatment plan. D. The recovery model should not be confused with providing a "cure" for schizophrenia E. The recovery model is controversial because it stigmatizes the person with schizophrenia

A. This model supports that recovery is an obtainable objective for people with schizophrenia C. the recovery model actively engages the client in determining the goals for the treatment plan. D. The recovery model should not be confused with providing a "cure" for schizophrenia Feedback 1: Conventional models for treatment in schizophrenia have been criticized for potentially inhibiting a client's ability to recognize his or her potential because they focus too heavily on the disease as one in which recovery is not obtainable. The recovery model shifts the focus toward recovery as an attainable goal. Feedback 3: Central to the recovery model in intervention with people with schizophrenia is a patient-centered approach in which the clinician and the client work together to develop a treatment plan that is in alignment with goals set forth by the client Feedback 4: It is important in educating clients and families that the recovery model is not to be confused with promising a remission or a cure for this illness. Instead, it focuses on potential to function more autonomously rather than a primary focus on managing an intractable illness.

A patient admitted to the psychiatric unit and diagnosed with schizophrenia reports to the nurse that there are people playing drums in his chest. Which of these would be appropriate interventions by the nurse? (Select all that apply) A. check the patient's vital signs B. tell the patient that these are tactile hallucinations and that he need not be concerned C. Ask the patient to describe more completely what he is feeling D. Give the patient PRN Cogentin as ordered E. Encourage the patient to discuss this with the music therapist.

A. check the patient's vital signs C. Ask the patient to describe more completely what he is feeling Feedback 1: This intervention is a priority to ensure that the patient's symptoms are not secondary to a medical emergency such as heart attack. Feedback 3: This is an appropriate intervention since further assessment is needed to ensure that the patient's physiological needs are being met.

A client diagnosed with schizophrenia experiences identify confusion and communicates with the nurse using echolalia. What is the client attempting to do by using this form of speech? A. identify with the person speaking B. imitate the nurse's movements C. alleviate alogia D. alleviate avolition

A. identify with the person speaking Echolalia is a parrot-like repetition of overheard words or fragments of speech. it is an attempt by the client to identify with the person who is speaking.

A withdrawn client, newly diagnosed with schizophrenia, is experiencing delusional thinking. Which nursing intervention is most appropriate? A. present objective reality B. use self-disclosure C. use physical touch for reassurance D. provide an in-depth explanation of unit rules and regulations

A. present objective reality When communicating with a client diagnosed with schizophrenia, the nurse should reinforce and focus on reality by talking about real events and real people. Discussions that focus on false ideas reinforce the client's delusions.

The family of a patient with schizophrenia requests information about Assertive Community Treatment (ACT). Which of the following responses by the nurse are consistent with this treatment model? (Select all that apply) A. "this model of treatment is based in the hospital and provides group education about how to assert oneself in the community." B. "this is a program of case management that takes a team approach in providing comprehensive community-based psychiatric services." C. This model is designed to meet the needs of people with conditions ranging from mild depression to severe and persistent illnesses such as schizophrenia." D. "One of the primary goals of ACT is to lessen the family's burden of providing care."

B. "this is a program of case management that takes a team approach in providing comprehensive community-based psychiatric services." D. "One of the primary goals of ACT is to lessen the family's burden of providing care." Feedback 1: This response demonstrates a lack of understanding of ACT. ACT is a community-based treatment model that focuses on comprehensive management of needs for patients with severe and persistent mental illnesses like schizophrenia. Feedback 4: NAMI (2012) identifies primary goals for ACT, one of which is to lessen the family's burden for providing care. ACT recognizes that patients with severe, persistent mental illness require many services beyond what one resource or the family can provide exclusively

The nurse is interviewing a client on the psychiatric unit. The client tilts his head to the side, stops talking in midsentence, and listens intently. the nurse recognizes these behaviors as a symptom of the client's illness. The most appropriate nursing intervention for this symptom is to: A. Ask the client to describe his physical symptoms B. Ask the client to describe what he is hearing C. Administer a dose of benzotropine D. Call the physician for additional orders

B. Ask the client to describe what he is hearing

The primary goal in working with an actively psychotic, suspicious client would be to: A. Promote interaction with others B. Decrease his anxiety and increase trust C. Improve this relationship with his parents D. Encourage participation in therapy activities

B. Decrease his anxiety and increase trust

What is the most accurate assessment if the client believes that the healthcare providers are FBI agents and that there are cameras in his apartment to monitor his moves? A. Hallucinations. B. Delusions. C. Confabulation. D. Thought broadcasting.

B. Delusions.

Which nursing problem has priority? A. Ineffective community coping. B. Disturbed thought processes. C. Sensory-perceptual disturbance. D. Ineffective denial.

B. Disturbed thought processes.

What type of reaction should the nurse suspect? A. Akathisia. B. Dystonia. C. Parkinsonism. D. Synergistic.

B. Dystonia.

The nurse understands that a client with schizophrenia will experience which benefit from fluphenazine decanoate (Prolixin decanoate) if it is administered intramuscularly? A. Prevent more extrapyramidal side effects. B. Maintain long-term medication compliance. C. Minimize side effects from benztropine (Cogentin). D. Prevent risk of cardiac or renal disease.

B. Maintain long-term medication compliance.

What is the most common cause of relapse in a client with schizophrenia? A. Symptom management. B. Medications. C. Lack of community support. D. Health practices.

B. Medications.

A patient is admitted to a medical unit exhibiting psychotic symptoms consistent with schizophrenia. He smells of alcohol, and his friend states that he witnessed the patient ingesting bath salts. The patient has no prior history of mental illness. The health care team member is aware that the patient's behaviors may be attributed to which factor? A. Disorganized thought process B. Substance use C. Recent job stress D. Impending divorce

B. Substance use Rationale: Disorders related to substance use and abuse may mimic psychotic symptoms. Thought processes are not a cause of schizophrenic behaviors. Occupational and social circumstances, such as feeling job stress or going through a divorce, do not cause schizophrenic behaviors.

How should the nurse explain symptom triggers to the clients? A. Symptom triggers are stressors that lead to increased difficulty handling anger. B. Symptom triggers can be related to health, the environment, or attitudes. C. Symptom triggers are behaviors that lead to medication noncompliance. D. Symptom triggers are stressors caused by hospitalization.

B. Symptom triggers can be related to health, the environment, or attitudes.

Which intervention by the nurse will best assess if this goal has been met? A. Observe sam for signs of talking to himself. B. Talk to Sam for at least 20 minutes. C. Ask Sam to describe how he feels. D. Ask Sam to explain how the medication helps him.

B. Talk to Sam for at least 20 minutes.

A client diagnosed with schizophrenia manifests the symptom of mutism. Which nursing intervention would assist the client in communicating with others? A. Providing assistance with self-care needs B. Using clear, concrete statements C. Conveying acceptance of the client's need for false beliefs D. attempting to decode incomprehensible communication patterns.

B. Using clear, concrete statements The use of clear, concrete statement shows the client what is expected. Because clients diagnosed with schizophrenia experience concrete thinking, explanations must be provided at the client's concrete level of comprehension

A client diagnosed with schizophrenia hears another patient say, "You'll be tied up for another hour." and becomes agitated because he interprets that to mean he will literally be tied up. Which cognitive symptom of schizophrenia is this client manifesting? A. nihilistic delusions B. concrete thinking C. circumstantiality D. perseveration

B. concrete thinking Concrete thinking is manifested by literal interpretation of abstract or figurative ideas. This symptom may be present in schizophrenia and is believed to represent regression to an earlier level of cognitive development

Several types of delusions may occur in an individual with schizophrenia. Which of the following types of delusion places the patient at greatest risk for agitation or aggression? A. delusions of grandeur B. delusions of persecution C. delusions of reference D. nihilistic delusions

B. delusions of persecution In delusions of persecution an individual falsely believes he or she is being threatened or persecuted in some way. This carries a high risk for increasing the individual's agitation and possibly aggression in protective efforts.

In planning care to reinforce reality for a client diagnosed with schizophrenia, the nurse should include which interventions? A. explore the client's expressions of distorted thinking B. discuss perceptions and thinking that are in touch with reality C. Encourage the client to share delusional thinking in group discussions. D. ask the client why distorted thinking and bizarre behavior have occurred.

B. discuss perceptions and thinking that are in touch with reality Discussing reality=based perceptions and thinking will assist the client to maintain orientation and will promote organized thinking.

Tony, age 21, has been diagnosed with schizophrenia. He has been socially isolated and hearing voices telling him to kill his parents. He has been admitted to the psychiatric unit from the emergency department. The initial nursing intervention for Tony is to: A. give him an injection of Thorazine B. ensure a safe environment for him and others C. Place him in restraints. D. Order him a nutritious diet

B. ensure a safe environment for him and others

A nursing home resident who has been taking antipsychotic medications for several months complains to the nurse of a stiff neck and difficulty swallowing. These symptoms are indicative of which condition? A. dysphonia B. tardive dyskinesia C. akathisia D. echolalia

B. tardive dyskinesia Tardive dyskinesia is a syndrome characterized by abnormal, involuntary movements, including bizarre facial and tongue movements, a stiff neck, and/or difficulty swallowing. This condition may occur as an adverse effect of long-term therapy with antipsychotic medications

A new member of the health care team asks a colleague if the recently admitted young adult experiencing psychosis has schizophrenia, stating, "This can't be drug induced psychosis because the patient doesn't use any drugs but marijuana." What is the best response the colleague can provide? A. "That's correct, drug- or substance-induced psychosis can be caused by cocaine or amphetamines but not by marijuana." B. "Psychosis can't be induced by drugs or substances unless the person has schizophrenia or schizoaffective disorder." C. "Psychosis can be induced by use of marijuana as well as a number of other drugs, including cocaine and amphetamines." D. "Only hallucinogenic agents such as LSD can induce psychosis in patients who don't have schizophrenia."

C. "Psychosis can be induced by use of marijuana as well as a number of other drugs, including cocaine and amphetamines." Rationale: Substance- or medication-induced psychotic disorder can be caused by cannabis, cocaine, and amphetamines as well as other substances. Saying that psychosis cannot be caused by marijuana is inaccurate, as is saying the patient must have underlying schizophrenia or schizoaffective disorder to exhibit psychosis

The nurse understands that an atypical antipsychotic like olanzapine (Zyprexa) requires what period of time to reach a steady state? A. 2 weeks. B. 4 or more weeks. C. 1 week. D. 2 days.

C. 1 week.

A client is admitted with a diagnosis of schizoaffective disorder. Which symptoms are characteristic of this diagnosis? A. strong ego boundaries and abstract thinking B. acute dystonias and tardive dyskinesia C. Altered mood and thought disturbances D. substance abuse and cachexia

C. Altered mood and thought disturbances The characteristic symptoms of schizoaffective disorder are a combination of alterations in mood (mania or depression) and thought

What is the best response by the nurse? A. What are you thinking right now? B. Tell me about how you're feeling. C. Are you hearing any voices? D. I notice that you talk to yourself.

C. Are you hearing any voices?

A client who has been taking chlorpromazine (Thorazine) for several months presents in the ED with extrapyramidal symptoms (EPS) of restlessness, drooling and tremors. What medication will the nurse expect the physician to order? A. Paroxetine (Paxil) B. Carbamazepine (Tegretol) C. Benztropine (Cogentin) D. Lorazepam (Ativan)

C. Benztropine (Cogentin) Benztropine is an anticholinergic medication that blocks cholinergic activity in the CNS, which is responsible for EPS. Anticholinergics are the drugs of choice to treat extrapyramidal symptoms associated with antipsychotic mediations

A client who has been taking chlorpromazine (Thorazine) for several months presents in the ED with extrapyramidal symptoms of restlessness, drooling, and tremors. What medication will the nurse expect the physician to order? A. Paroxetine (Paxil) B. Carbamazepine (Tegretol) C. Benztropine (Cogentin) D. Lorazepam (Ativan)

C. Benztropine (Cogentin) Cogentin is an anticholinergic medication that blocks cholinergic activity in the central nervous system, which is responsible for extrapyramidal symptoms. This is the drug of choice to treat extrapyramidal symptoms associated with antipsychotic medications.

When a client suddenly becomes aggressive and violent on the unit, which of the following approaches would be best for the nurse to use first? A. Provide large motor activities to relieve the client's pent-up tension. B. Administer a dose of PRN chlorpromazine to keep the client calm. C. Call for sufficient help to control the situation safely. D. Convey to the client that his behavior is unacceptable and will not be permitted.

C. Call for sufficient help to control the situation safely.

A patient presents to the emergency department with an elevated temperature, rigidity, confusion, and tachycardia. The family tells the health care team that the patient takes antipsychotic medication for schizophrenia. What is the most important action the health care team member should take? A. Consider that the patient has not taken the antipsychotic medication today and administer it as soon as possible. B. Consider that the patient has taken an overdose of medications and monitor the patient status. C. Consider that the patient is experiencing NMS and stop all antipsychotic medications. D. Consider that the patient has been using psychostimulants and administer a sedative medication.

C. Consider that the patient is experiencing NMS and stop all antipsychotic medications. Rationale: NMS is a medical emergency that requires immediate intervention, including stopping all antipsychotic medication. Antipsychotics can cause NMS, which is a life-threatening adverse effect. Providing this patient with any antipsychotic medication would be contraindicated. Simply monitoring the patient's status for overdose or providing a sedative medication would be inappropriate responses to the signs exhibited by this patient.

What is the first step the nurse should use to teach about effective symptom management? A. Talk about specific support systems. B. Review current ways to manage symptoms. C. Identify problem symptoms. D. Discuss other ways to manage symptoms.

C. Identify problem symptoms.

A family member asks the health care team what schizoaffective disorder is and if it is serious. What is the best response the team member can provide? A. Schizoaffective disorder is a mild form of schizophrenia, so it is not as serious as schizophrenia. B. Schizoaffective disorder is just another name for schizophrenia, so it is just as serious as schizophrenia is. C. Schizoaffective disorder involves symptoms of both schizophrenia and mood disorders and is a serious disorder. D. Schizoaffective disorder is another name for manic depression, which is not as serious as schizophrenia.

C. Schizoaffective disorder involves symptoms of both schizophrenia and mood disorders and is a serious disorder. Rationale: Schizoaffective disorder encompasses episodes consistent with schizophrenia as well as those of a mood disorder; the patient may experience depression or mania concurrent with schizophrenia symptoms. Schizoaffective disorder is not the same as schizophrenia; nor is it a milder form of schizophrenia or another name for manic depression.

A patient presents to the emergency department displaying uncooperative behaviors, a disturbed thought process, and paranoia. The family reports that the patient has been having symptoms for almost a year. The assessment reveals a negative urine drug screen and a normal blood alcohol level. The health care team member knows that the patient's symptoms may indicate which disorder? A. An acute infection B. Substance abuse-related disorder C. Schizophrenia D. Severe anxiety disorder

C. Schizophrenia Rationale: Many patients with schizophrenia present with symptoms of paranoia and disturbed thinking. A substance abuse-related disorder can cause psychosis, but the patient's laboratory work was negative for substance use. An acute infection may cause temporary psychosis, but the patient has been experiencing symptoms for almost a year. Patients with severe anxiety disorders do not typically experience disturbed thought processes or uncooperative behaviors.

A client is admitted with a diagnosis of brief psychotic disorder with catatonic features. Which symptoms are associated with the catatonic specifier? A. Strong ego boundaries and abstract thinking B. Ataxia and akinesia C. Stupor, muscle rigidity, and negativism D. substance abuse and cachexia

C. Stupor, muscle rigidity, and negativism Symptoms associated with the catatonic specifier include stupor and muscle rigidity or excessive, purposeless motor activity. Waxy flexibility, negativism, echolalia, and echopraxia are also common behaviors

The nurse is caring for a client with schizophrenia. Orders from the physician include 100 mg chlorpromazine IM STAT and then 50 mg PO bid; 2 mg benztropine PO bid PRN. Why is chlorpromazine ordered? A. To reduce extrapyramidal symptoms B. To prevent neuroleptic malignant syndrome C. To decrease psychotic symptoms D. To induce sleep

C. To decrease psychotic symptoms

Which client behavior validates the need for involuntary hospitalization? A. Beliefs about FBI surveillance. B. Diagnosis of schizophrenia. C. Violence towards father. D. Guarded and suspicious.

C. Violence towards father.

The nurse is interviewing a client on the psychiatric unit. The client tilts is head to the side, stops talking in midsentence, and listens intently. The nurse recognizes from these signs that the client is likely experiencing: A. somatic delusions B. catatonic stupor C. auditory hallucinations D. pseudoparkinsonism

C. auditory hallucinations

The nurse is providing care for an emaciated client experiencing an acute phase of catatonic stupor. Which nursing intervention would take priority when meeting this client's needs? A. minimize attempts to communicate with the client B. assist the client to ambulate C. provide nutrient-dense foods and beverages D. place the patient is seclusion for safety

C. provide nutrient-dense foods and beverages Nutrition is an essential consideration for a client with catatonic stupor. The emaciated client in the question is suffering from malnutrition. The nurse must prioritize this basic physical need.

A client has been admitted to the inpatient psychiatric unit and is manifesting mutism. His diagnosis is schizophrenia with catotonia. What would the nurse expect to observe? A. frenzied and purposeless movements B. exaggerated suspiciousness C. stuporous withdrawal D. sexual preoccupation

C. stuporous withdrawal The client's mutism indicates catatonic stupor. This client would be noted to have extreme psychomotor retardation, and efforts to move the individual may be met with bodily resistence

A patient with a history of schizophrenia has been admitted for a medical condition. The patient's family member asks the health care team member if the patient can ever get better from schizophrenia the way people can recover from other kinds of medical conditions. What is the best response the health care team member can provide? A. "Schizophrenia is not like a medical condition; patients cannot recover from it." B. "Schizophrenia is a serious psychiatric disorder that is generally untreatable." C. "Schizophrenia is a mental condition, so it's up to the patient to get better." D. "Schizophrenia is a disorder that can be treated, and patients can get better."

D. "Schizophrenia is a disorder that can be treated, and patients can get better." Rationale: The health care team member should tell the family member that schizophrenia is a disorder that can be treated, and that patients can get better. Symptoms may recur throughout the patient's life span, so adherence to medications and therapeutic interventions to manage the symptoms are important. The focus of treatment is on symptom elimination or reduction. Telling families that patients with schizophrenia cannot get better or that the disorder is untreatable is inaccurate. Implying that because schizophrenia is a mental disorder, the patient has complete control over recovery is inappropriate.

Which medication does the nurse determine will give the client the most immediate relief from neuroleptic-induced extrapyramidal side effects? A. lorazepam (Ativan), 1 mg PO B. Diazepam (Valium), 5 mg PO C. Haloperidol (Haldol), 2 mg IM D. Benztropine (Cogentin), 2 mg PO

D. Benztropine (Cogentin), 2 mg PO The symptoms of neuroleptic-induced extrapyramidal side effects include tremors, chorea, dystonia, akinesia, and akahesia. Congentin, 1-4 mg given once or twice daily, is the drug of choice to treat these symptoms.

Which statement will assist the nurse to assess if this goal has been met? A. Do you have a history of violence? B. Tell me about the relationship with your father. C. How do you feel about your father now? D. Do you think about hurting anyone now?

D. Do you think about hurting anyone now?

How should the nurse respond? A. Everything is confidential, so I doubt this will happen. B. I know that this is probably unlikely. What do you think? C. What if the limousine does not get here? D. It sounds like you are anxious to leave here.

D. It sounds like you are anxious to leave here.

The nurse understands that schizophrenia can be differentiated from psychosis by which assessment? A. Disorganized speech. B. Disorganized behavior. C. Auditory hallucinations. D. Negative symptoms.

D. Negative symptoms.

If a client who has voluntarily chosen to be hospitalized should want to leave the hospital, which assessment would be most important in deciding to release the client against medical advice (AMA)? A. Mental status of client. B. Reason that client wants to leave. C. Response to medications. D. Potential danger to self or others.

D. Potential danger to self or others.

Based on Sam's statement, which nursing problem should the nurse document for the group progress note? A. Ineffective denial. B. Knowledge deficit. C. Ineffective coping. D. Risk for adherence.

D. Risk for adherence.

What is the most important expected outcome for a patient admitted with a history of schizophrenia? A. The patient is oriented to reality. B. The patient adheres to the medication regimen. C. The patient is free of psychotic symptoms. D. The patient does not harm himself or herself or others.

D. The patient does not harm himself or herself or others. Rationale: Safety is a priority concern with individuals with schizophrenia because the risk of suicide is high. The health care team must be vigilant to maintain the patient's safety and protect him or her from self-harm. Maintaining a medication regimen, freedom from psychotic symptoms, and reality orientation are important expected outcomes, but not harming himself or herself or others is the most important expected outcome.

Which understanding is most accurate? A. There is an imbalance of the brain neurotransmitters dopamine and serotonin. B. There is a marked increase in brain volume, which causes abnormal functioning. C. Schizophrenia develops when at least one parent or distant relative has schizophrenia. D. This brain disorder has many predisposing factors and a biological basis.

D. This brain disorder has many predisposing factors and a biological basis.

The primary focus of family therapy for clients with schizophrenia and their families is: A. to discuss concrete problem solving and adaptive behaviors for coping with stress B. To introduce the family to others with the same problem C. To keep the client and family in touch with the health care system D. To promote family interaction and increase understanding of the illness

D. To promote family interaction and increase understanding of the illness

To deal with a client's hallucinations therapeutically, which nursing intervention should be implemented? A. reinforce the perceptual distortions until the client develops new defenses. B. Provide an unstructured environment C. avoid making connections between anxiety-producing situations and hallucinations D. use empathic listening and redirect the client's attention to reality-based interaction

D. use empathic listening and redirect the client's attention to reality-based interaction The nurse should first empathize with the client by focusing on feelings generarted by the hallucination, present objective reality, and then redirect the client to reality-based activites

3. The nurse knows that Bob has a thought disorder (psychosis and schizophrenia) rather than a mood disorder. Which behavior is characteristic of a thought disorder?

a. blunted affect b. irritability c. disorganized speech d. preoccupation with guilty feelings. ans: C disorganized speech is a characteristic sx. It is the manifestation of disorganized thoughts.

4. The nurse understands that schizophrenia can be differentiated from psychosis by which assessment?

a. disorganized speech b. disorganized behavior c. auditory hallucinations d. negative symptoms ans D negative symptoms are characteristic of schizophrenia: minimal eye contact, poor grooming, hygiene, and apathy

7. What is the reason that fluphenazine (Prolixin) is prescribed for this client?

a. disorganized thoughts b. difficulty sleeping at night c. feelings of depression d. stabilize client's mood ans: fluphenazine is used as an antipsychotic medication; useful to manage sx related to cognitive impairment ie: delusions, hallucinations, behaviors related to agitation and aggression

1. Based on this assessment, what is the most important nursing intervention?

a. establish rapport and trust b. assess for hallucinations c. maintain adequate social space d. plan to give a PRN antipsychotic ans:A MOST important intervention is to establish rapport and trust with a pt that is suspicious and guarded.

2. What is the most accurate assessment if the client believes that the healthcare providers are FBI agents and that there are cameras in his apartment to monitor his moves?

a. hallucinations b. delusions c. confabulation d. thought broadcasting ans: B delusions are fixed, false beliefs that the nurse should avoid trying to logically disprove to the client

10. If a client who has voluntarily chosen to be hospitalized should want to leave the hospital, which assessment would be most important in deciding to release the client against medical advice (AMA)?

a. mental status of client b. reason that client wants to leave c. response to medications d. potential danger to self or others ans: D response to medications is important to consider as it relates to the client's mental status, but it is not the most important consideration for releasing the client AMA

11. The nurse notices that the benztropine (Cogentin) has not been prescribed. Which nursing action is best?

a. obtain a prescription to begin the Cogentin b. monitor Bob for medication side effects c. ask Bob if he had any side effects from the fluphenazine d. do not give the fluphenazine and document the reason. ans: benztropine will help prevent the extrapyramidal side effects of the fluphenazine. There is a risk of decreased efficiency of fluphenazine when the client is also taking benztropine

8. The nurse understands that a client with schizophrenia will experience which benefit from fluphenazine (Prolixin) if it is administered intramuscularly?

a. prevent more extrapyramidal side effects b. maintain long-term medication compliance c. minimize side effects from benztropine (Cogentin) d. Prevent risk of cardiac or renal disease ans: fluphenazine is a long-acting medication that is administered as an injection every 7-28 days to promote compliance with the medication regimen.