Mental Chap 16

The nurse is evaluating the plan of care for a client with schizophrenia. Which observation best suggests that the plan has been effective? The client no longer believes that the client has special powers. The client has resumed employment and has been attending social functions at the community center. The client reports that the client no longer has hallucinations. The client has been engaging in more conversation with the staff.

The client has resumed employment and has been attending social functions at the community center.

According to the immunovirological theory, a person is at risk for developing schizophrenia when which factors were present while the person's was in utero? Select all that apply. The mother had the influenza virus while pregnant The mother resided in a crowded urban city while pregnant The mother had a sexually transmitted disease while pregnant The birth required the use of forceps or vaccum The mother took larger doses of folic acid prenatally

The mother had the influenza virus while pregnant The mother resided in a crowded urban city while pregnant The mother had a sexually transmitted disease while pregnant

A client with schizoaffective disorder is prescribed medication therapy. Which type of medications would be most likely be ordered? atypical antipsychotics typical antipsychotics antidepressants mood stabilizers

atypical antipsychotics

A client with schizophrenia is experiencing delusions. The client states, "There's a huge apocalypse coming and the end of the world is near." The nurse interprets this statement as which type of delusion? grandiose nihilistic persecutory somatic

nihilistic

The nurse working with a client who is newly diagnosed with schizophrenia would include which in the client's education? "Schizophrenia is an illness that involves neurotransmitters, more specifically dopamine." "Schizophrenia is caused by pathology in the cerebellum, and there are medications that are helpful in this area." "Schizophrenia has been found to be nonresponsive to medications, and we will work mostly on helping you with daily activities." "Schizophrenia is curable if the correct medication and dosages are achieved."

"Schizophrenia is an illness that involves neurotransmitters, more specifically dopamine."

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

A dramatic change in temperature.

Nursing Intervention: Administer medications as ordered; assess for effectiveness.

Akathisia

A nurse monitoring client medication needs to recognize side effects quickly and intervene promptly for which reason? Determine adequate dosage is maintained to control symptoms Alleviate the side effects and help client maintain adherence 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

Tendency to speak very little or to convey little substance of meaning

Alogia Negative

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

Aripiprazole

Which constitutes a negative symptom associated with schizophrenia? Hostility Asociality Bizarre behavior Formal thought disorder

Asociality

A client with schizoaffective disorder is prescribed long-term medication therapy. The nurse would most likely expect what to be prescribed as the mainstay of treatment? Atypical antipsychotic Mood stabilizer Antidepressant Typical antipsychotic

Atypical antipsychotic

Absence of will, ambition, or drive to take action or accomplish task

Avolition Negative

A client has been diagnosed with schizophrenia. Assessment reveals that the client lives alone. The client's clothing is disheveled, the client's hair is uncombed and matted, and the client's body has a strange odor. During an interview, the client's family members voice a desire for the client to live with them when the client is discharged. Based on the assessment findings, which nursing diagnosis would be the priority? Ineffective role performance related to symptoms of schizophrenia Social isolation related to auditory hallucinations Dysfunctional family processes related to psychosis Bathing self-care deficit related to symptoms of schizophrenia

Bathing self-care deficit related to symptoms of schizophrenia

Restricted range of emotional feeling, tone or mood

Blunted Affect Negative

A client was admitted to the psychiatric intensive care unit with schizophrenia. The client exhibits primarily disorganized behavior. In addition to hallucinations and delusions, other assessments that the nurse would expect to find include what? Blunted inappropriate affect, withdrawal, incoherence, and confusion Abnormal, bizarre posturing; stupor; echolalia; and negativism Hostility, aggression, persecutory hallucinations, and argumentativeness Depression, elation, hyperactivity, and pressure of speech

Blunted inappropriate affect, withdrawal, incoherence, and confusion

A client with a persistent delusional disorder has been prescribed ziprasidone. Which assessment should the nurse prioritize when this medication regimen begins? Cardiac and neurological assessments Respiratory assessment including oxygen saturation Monitoring of fluid and electrolyte levels Integumentary and gastrointestinal assessments

Cardiac and neurological assessments

Psychologically induced immobility occasionally marked by periods of agitation and excitement, the client seems motionless, as if in a trance

Catatonia Negative

The nurse notes that a client with schizophrenia sits in a chair rocking back and forth. What does the nurse recognizes this as? A side effect of medication Catatonic stupor Catatonic excitement A sign of anxiety

Catatonic excitement

A client with schizoaffective disorder is engaging in an extremely long conversation about a current affairs in the world. The client goes on to provide the nurse with minute details. The nurse interprets this as suggesting what? Circumstantiality Neologism Verbigeration Clang association

Circumstantiality

Fixed false belief that have no basis in reality

Delusion Postive

A client with schizophrenia states that the client is God's messenger and the client's mission is to become president. The nurse documents these comments as evidence of what? Delusional thinking Hallucinatory experiences Bizarre behavior Formal thought disorder

Delusional thinking

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

Delusions Hallucinations

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

Dopamine

How often must clients receiving clozapine get white blood cell counts drawn? Every week for the first 6 months Every 3 months Every 6 months Every year

Every week for the first 6 months

Absence of any facial expression that would indicate emotions or mood

Flat Affect Negative

Continuous flow of verbalization in which the person jumps rapidly from one topic to another

Flight of ideas Positive

During an admission assessment, a client with schizoaffective disorder states that the client hears the voice of God in the client's head and the voice is telling the client that the client is worthless. What would the nurse document this symptom as? Hallucination Delusion Avolition Alogia

Hallucination

False sensory perceptual or perceptual experiences that do not exist in reality

Hallucination Postive

A client is watching the news and tells the nurse that the newscaster is sending a message to the client. What term is used to identify this symptom? Idea of reference Delusion Hallucination Flight of idea

Idea of reference

A client with delusions presents with strong defensiveness, even when watching the news or listening to the radio. The nurse would document this finding in the health history as what? Ambivalence Ideas of reference Flight of ideas Echolalia

Ideas of reference

False impressions that external events have special meaning for the person

Ideas of reference Positive

Inability to concentrate or focus on a topic or activity, regardless of its importance

Inattention Negative

Positive symptoms seen in schizophrenia are believed to be a result of which type of neurological dysfunction? Increased amount of dopamine An inadequate amount of dopamine Cerebral atrophy Organic functional changes in the brain

Increased amount of dopamine

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

Increased serotonin and dopamine

The nurse is assigned to a client with catatonic schizophrenia. Which intervention should the nurse include in the client's care plan? Meeting all of the client's physical needs Giving the client an opportunity to express concerns Administering lithium carbonate as prescribed Providing a quiet environment where the client can be alone

Meeting all of the client's physical needs

Schizoaffective disorder has symptoms typical of both schizophrenia and which type of disorder? Mood disorders Anxiety disorders Substance use disorders Eating disorders

Mood disorders

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

Often not met completely

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? Grandiose Somatic Conjugal Persecutory

Persecutory

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

Persecutory type

Persistent adherence to a single idea or topic, verbal repetition of a sentence, word or phrase; resisting attempts to change the topic

Perseveration Postive

Delusions, hallucinations, grossly disorganized thinking speech, behavior

Postive

Shuffling gait, masklike facies, muscle stiffness, cogwheel rigidity, drooling

Pseudoparkinsonism

After teaching a class on antipsychotic agents, the instructor determines that the education was successful when the class identifies which as an example of a second-generation antipsychotic agent? Fluphenazine Thiothixene Quetiapine Chlorpromazine

Quetiapine

Although a psychotic episode can be brief, the client impact can last a long time. For this reason, the nurse is aware of what? The best outcomes are achieved on an outpatient basis Family supports are required Supervision may be required to protect the person Cognitive therapy is indicated

Supervision may be required to protect the person

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

Suspiciousness and neologisms

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? Diminished emotional expression Alogia Avolition Anhedonia

Anhedonia

Imitation of the movements and gestures of another person whom the client is observing

Echopraxia Postive

In working with the individual and family, which is the most accurate statement the nurse can make in order to teach the client and family about schizophrenia? "Individuals with schizophrenia do have differences in brain structure and function that cause a variety of symptoms such as lack of motivation and hearing voices." "Schizophrenia is being found to be related more closely to family dysfunction than to physiology, which is why family therapy is the most effective treatment for this disorder." "Medications for schizophrenia have not changed much since the early 1950s, although there are some medications that may be helpful." "It is more effective to treat the individual on a one-to-one basis than to involve the family in treatment because it is a very complicated process."

"Individuals with schizophrenia do have differences in brain structure and function that cause a variety of symptoms such as lack of motivation and hearing voices."

Characterized by restless movement, pacing, inability to remain still and client report of inner restlessness

Akathisia

Holding seemingly contradictory believes of feelings about the same person, event or situation

Ambivalence Postive

Feelings of indifference toward people, activity, and events

Apathy Negative

A client with schizophrenia walks up to the nurse with the client's arm outstretched and says, "My arm went away. Dog, dog, dog." How should the nurse respond? Ignore the comments and redirect the client's attention. Ask the client if the client is trying to say that something is wrong with the client's arm. Ask the client if the client is having visual hallucinations. Tell the client that he or she can see the arm, and no dogs are around.

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

Which statement is true about delusional disorder? The disease onset is usually gradual. Psychosocial functioning is often markedly impaired. Behavior is relatively normal except when focused on the delusion. The individual's personality changes dramatically.

Behavior is relatively normal except when focused on the delusion.

The experienced psychiatric nurse shares with the novice nurse that effective nursing care for the delusional client depends on what? Select all that apply. Being relaxed during frequent client-nurse interactions Expecting the client to adhere to all unit rules Managing the milieu so as to minimize situations that will frustrate or anger the client Remaining in confrontation with the client until the delusions are neutralized Supporting the delusion only when the client is extremely agitated

Being relaxed during frequent client-nurse interactions Expecting the client to adhere to all unit rules Managing the milieu so as to minimize situations that will frustrate or anger the client

Outlandish appearance or clothing; repetitive or stereotyped, seemingly purposeless movements; unusual social or sexual behavior

Bizarre Behavior Positive

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

The presence of neologism, echolalia, and clanging

Which speech pattern is exhibited by the client stating, "I will take a pill if I go up the hill but not if my name is Jill, I don't want to kill?" Clang association Neologism Verbigeration Word salad

Clang association

A psychiatric-mental health nurse is conducting a review class for a group of colleagues about schizoaffective disorder. The nurse determines that the class was successful based on which description of the condition by the group? Delusions are present but hallucinations are absent. Clients are often misdiagnosed as having schizophrenia. The symptoms typically run a fairly constant course. Mood symptoms must occur consistently with positive symptoms.

Clients are often misdiagnosed as having schizophrenia.

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

Continuous signs for at least 6 months One or more major areas of social or occupational functioning markedly below previously achieved levels Delusions present for a significant portion of time during a 1-month period

A hospitalized client with schizophrenia is receiving antipsychotic medications. While assessing the client, a nurse identifies signs and symptoms of a dystonic reaction. Which agent would the nurse expect to administer? Diphenhydramine Propranolol Risperidone Aripiprazole

Diphenhydramine

Use ice chips or hard candy for dry mouth; observe for sedation.

Diphenhydramine (Benadryl)

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

Disturbed thought process

Appear early in course of treatment, spasms in discrete muscle groups (ex: neck or eye muscles)

Dystonic reactions

When preparing to educate a client regarding a newly prescribed antipsychotic medication, which action would be most appropriate for the nurse to do? Select all that apply. Encourage the use of sugar-free gum to help manage dry mouth Suggest methods to minimize the potential for weight gain Identify lifestyle adjustments that the resulting lethargy may require Advise the client to discuss any concerns regarding sexual dysfunction Discuss the increased difficulty the medication has on conception for both genders

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

A client has been taking haloperidol for 5 years when the client is admitted to the inpatient unit for relapse of symptoms of schizophrenia. Upon assessment, the client demonstrates akathisia, dystonia, a stiff gait, and rigid posture. The nurse correctly identifies these symptoms are indicative of what? Psychosis Tardive dyskinesia Extrapyramidal side effects Progressed schizophrenia

Extrapyramidal side effects

Reversible movement disorders induced by neuroleptic meds

Extrapyramidal side effects

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

Fluphenazine

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

Folie à deux

A nurse is caring for a client diagnosed with a delusional disorder. While assessing this client, which would a nurse expect to find? History of chronic major depression Consistent disruptive behavior patterns Verbalization of bizarre delusions Living with one or more delusions for a period of time

Living with one or more delusions for a period of time

The nurse is developing a plan for group therapy sessions for several adult clients with schizophrenia. Which goal is best for this group? Members will gain insight into unconscious factors that contribute to their illness. Members will demonstrate adaptive social skills. Members will explore situations that trigger hostility and anger. Members will learn to manage delusional thinking.

Members will demonstrate adaptive social skills.

Flat affect, lack of violation, social withdrawal or discomfort

Negative

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

Neglect in childhood

Symptoms: muscle rigidity, high fever, increased muscle enzymes and leukocytosis-- serious and sometimes fatal

Neuroleptic Malignant Syndrome (NMS)

Nursing Intervention: Stop all antipsychotic medications; notify physician immediately.

Neuroleptic malignant syndrome

A client with a diagnosis of schizophrenia believes that the client is an undercover operative for the Central Intelligence Agency and that voices of various representatives of the organization give the client regular updates on the client's missions. The client is unwilling to participate in many interventions because the client is "too busy with things that are more important than you could possibly understand." The primary theme of the client's delusions is consistent with what? Paranoia Catatonia Disorganization Undifferentiation

Paranoia

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

Paranoid

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

Persecutory

While being assessed, a client with schizophrenia states, "Everywhere I turn, the government is watching me because I know too much. They are afraid that I might go public with the information about all those conspiracies." The nurse interprets this statement as indicating which type of delusion? Grandiose Nihilistic Persecutory Somatic

Persecutory

A client with schizoaffective disorder (SAD) is prescribed clozapine. The nurse understands that in addition to the drug's antipsychotic effects, it is also effective in which area? Limiting the risk for extrapyramidal adverse effects Reducing the risk for suicide Eliminating the need for additional medications Requiring no physiological monitoring

Reducing the risk for suicide

A client has been prescribed clozapine for schizoaffective disorder (SCA) with depression. The nurse should explain to the client that one advantage of clozapine is that it can provide what? Cost savings Weight loss Reduction of hospitalizations and risk for suicide Combination with lithium for greater effect

Reduction of hospitalizations and risk for suicide

A client who has a major depressive episode tells the nurse that, for the past 2 weeks, the client has been hearing voices and at times thinks that someone is following the client. A history reveals that the client has had these alternating symptoms before. The client also has experienced time with neither of these symptoms and has been able to function adequately. The nurse interprets these findings as suggesting: Paranoid schizophrenia Undifferentiated schizophrenia Brief psychotic disorder Schizoaffective disorder

Schizoaffective disorder

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

Somatic

Abnormal involuntary movement, ex: lip smacking, tongue protrusion, chewing, blinking, grimacing

Tardive Dyskinesia

A client has been taking neuroleptic medications for many years as a treatment for schizophrenia. The client is exhibiting tongue protrusion, facial grimacing, and excessive blinking. These manifestations are characteristic of which extrapyramidal side effects (EPS)? Tardive dyskinesia Dystonia Neuroleptic malignant syndrome Akathisia

Tardive dyskinesia

Nursing Intervention: Assess using tool such as AIMS; report occurrence or score increase to physician.

Tardive dyskinesia

Which is an appropriate intervention for a client having auditory hallucinations? Encourage the client to discuss the content of the hallucinations with staff as they occur. Ask the client to keep a journal about what the voices tell the client and to bring the journal to therapy sessions. Encourage the client to spend quiet time alone until hallucinations cease. Tell the client to talk back to the voices and tell them to go away.

Tell the client to talk back to the voices and tell them to go away.

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

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

A nurse who works in a psychiatry unit finds that young clients with schizophrenia have worse prognoses when compared with clients who are diagnosed later in life. Which reasons should lead the nurse to make this observation? Select all that apply. They have less sense of personal identity. They are less adherent to the treatment schedule. They are not able to accurately communicate their issues and concerns. They are inherently more susceptible to receive a poor prognosis. They are less likely to have experiences of independent living.

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

A client in the psychiatric unit of the hospital has a diagnosis of schizophrenia. The client has approached the nurse in the hallway of the hospital and is elaborating in great detail about the client's delusions of persecution involving secret societies, the Vatican, and the mafia. How should the nurse respond to the client's expression of these delusions? "Do you think that your delusions might be causing you to think this way?" "That sounds very stressful for you. Would you like to join me and the others in the lounge?" "What can I do to help you get away from these people who want to get you?" "Remember that none of this is real and that no one at all is trying to harm you."

"That sounds very stressful for you. Would you like to join me and the others in the lounge?"

A client with schizophrenia, who has a history of repeated hospitalizations and homelessness, is ready for discharge. The nurse is developing a plan for the client's continued care in the community. Which discharge intervention will most likely prevent relapse for this client? Assertive community treatment Monthly follow-up in the community mental health clinic Referral to a vocational counselor Family education about relapse prevention

Assertive community treatment

Which is a nonneurologic side effect of antipsychotic medications? Weight gain Akathisia Dystonia Seizures

Weight gain

A nurse is assessing a client diagnosed with delusional disorder. The nurse would expect to find what? Delusions with a prominent theme Prominent hallucinations Prolonged mood episodes Underlying substance use

Delusions with a prominent theme

Some research has suggested that schizophreniform disorder may be an early manifestation of which other mental health condition? Delusional disorder Schizophrenia Bipolar affective disorder Schizoaffective disorder

Schizophrenia

A client diagnosed with schizophrenia is having delusions that the client is being plotted against by the government. This would be documented as which type of delusion? persecutory grandiose nihilistic somatic

persecutory

A mental health nurse is caring for a client with a diagnosis of schizophrenia. The client presents with catatonia. Which clinical manifestations should the nurse expect? Uninhibited behavior Perseveration Immobility Echopraxia

Immobility

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

Injustice that must be remedied by legal action

The nurse is providing teaching to a client diagnosed with schizoaffective disorder. The nurse should explain to the client that which is true about this disorder? It is more common than schizophrenia. It is usually diagnosed in late adulthood. It is most common with somatoform disorders. It is a mix of psychotic and mood symptoms.

It is a mix of psychotic and mood symptoms.

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

Muscular rigidity, tremors, and difficulty swallowing

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

clang association

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? "I'll expect you in the dining room in 20 minutes." "First, wash your face and brush your teeth. Then put your clothes on." "Stay right there and I'll get your clothes." "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."

A client in an inpatient setting has a delusion that there are a multitude of undetectable noxious gases in circulation that have the potential to poison the client and others. Which of the nurse's responses is most therapeutic? "There are actually no poison gases in the atmosphere that we don't know about." "Why do you think that you keep insisting on this belief?" "I can assure you that you are actually very safe here." "If we detect a poison gas here, I promise that you'll be the first to know."

"I can assure you that you are actually very safe here."

The psychiatric nurse documents that a client is expressing nihilistic delusions when the client makes which statement? "I can't eat; I have no mouth or stomach." "I'm dying; I'm the first to have this form of cancer." "I'll just telephone the president; he always answers my calls." "I need to leave now; I'm expecting a visit from my sister, the queen.

"I can't eat; I have no mouth or stomach."

A client diagnosed with schizophrenia tells the nurse, "I hear the voice of Elvis." Which is the most therapeutic response by the nurse? "I don't hear the voice, but I know you hear what sounds like a voice." "You shouldn't focus on Elvis's voice." "Don't worry about the voice as long as it doesn't belong to anyone real." "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."

The experienced psychiatric nurse shares with the novice nurse that effective nursing care for the delusional client depends on what? Select all that apply. Being relaxed during frequent client-nurse interactions Expecting the client to adhere to all unit rules Managing the milieu so as to minimize situations that will frustrate or anger the client Remaining in confrontation with the client until the delusions are neutralized Supporting the delusion only when the client is extremely agitated

Being relaxed during frequent client-nurse interactions Expecting the client to adhere to all unit rules Managing the milieu so as to minimize situations that will frustrate or anger the client

Which medication classification has been most effective in treating akathisia? Beta-blockers Antimanics Antianxiety Sedatives

Beta-blockers

Which group of theories is believed currently to explain the etiology of schizophrenia? Behavioral Cognitive Family system Biologic

Biologic

The nurse is caring for a client who was just admitted with a diagnosis of schizoaffective disorder with depression. Which agent would the nurse anticipate as being prescribed for this client? Lithium Haloperidol Chlorpromazine Clozapine

Clozapine

The severity of a client's positive and negative symptoms of schizophrenia has not significantly improved since treatment began, despite the use of three different neuroleptic medications. The nurse should anticipate that this client may benefit from treatment with which medication? Clozapine Haloperidol Risperidone Olanzapine

Clozapine

The relationships and associations among the words used to express thoughts are markedly disturbed in clients with schizophrenia. What is this disturbance characterized by? Disorganized speech Auditory hallucinations Flight of ideas Paucity of speech

Disorganized speech

A client with a diagnosis of schizophrenia has a history of auditory and visual hallucinations. Which intervention is most likely to minimize the client's hallucinations? Ensuring that the client does not sleep more than 7 hours in any 24-hour period Clustering the client's medications at 0800 hours Providing a vivid, bright environment that provides distractions from hallucinations Provide frequent contact and communication with the client

Provide frequent contact and communication with the client

A nurse is caring for a client diagnosed with schizophreniform disorder. The nurse demonstrates understanding of this disorder when identifying that the client is at risk for developing what? Schizophrenia Personality disorder Major depression Substance abuse

Schizophrenia

A client with command auditory hallucinations and a history of aggressive outbursts is observed pacing and grimacing while in the day room. Which should be the nurse's priority? Support the client in returning to the client's room Ask the client why the client appears to be agitated Turn off the dayroom's television Request that the other clients leave the dayroom

Support the client in returning to the client's room

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 describe problems relating to others. The client will identify situations that evoke anxiety. The client will differentiate between reality and fantasy.

The client will differentiate between reality and fantasy.

A novice nurse on a psychiatric unit may find it challenging to care for a client newly diagnosed with schizophrenia primarily for which reason? The nurse may feel defensive when a delusional client makes accusations The client will only likely be seen for a one-time admission The characteristic disintegration of the client's personality is difficult to watch The nurse worries about developing schizophrenia

The nurse may feel defensive when a delusional client makes accusations

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 Risk for hypoprolactinemia The potential for weight loss The potential for sedation

The potential for sedation

A psychiatric-mental health nurse is teaching a class about schizophrenia. When describing delusions, which information would the nurse <b>most</b> likely include? They are variable in nature. They are easily changed with conflicting evidence. They could be a real-life situation. They are implausible within the person's ethnic background.

They could be a real-life situation.

A nursing instructor is preparing a class lecture about schizophrenia and outcomes focusing on recovery. Which would the instructor include as a major goal? continuity of care shorter inpatient stays immediate crisis stabilization social engagement

continuity of care

A nurse is caring for a client in an inpatient mental health setting. The nurse notices that when the client is conversing with other clients, the client repeats what they are saying word for word. The nurse interprets this finding and documents it as: echopraxia. neologisms. tangentiality. echolalia.

echolalia

A client is being released from the inpatient psychiatric unit with a diagnosis of schizophrenia and treatment with antipsychotic medications. After teaching the client and family about managing the disorder, the nurse determines that the education was effective when they state that which should be reported immediately? elevated temperature tremor decreased blood pressure weight gain

elevated temperature

When investigating biologic theories related to schizophrenia, which neuroanatomic findings would be consistent with this mental health disorder? enlarged lateral ventricle enlarged brain volume smaller third ventricle enlarged hippocampus

enlarged lateral ventricle

A client with schizophrenia is prescribed clozapine. The nurse would monitor the client closely for specific signs of: hypotension. nausea. weight loss. infection.

infection

While caring for a hospitalized client with schizophrenia, a nurse observes that the client is listening to the radio. The client tells the nurse that the radio commentator is speaking directly to the client. The nurse interprets this finding as: autistic thinking. concrete thinking. referential thinking. illusional thinking.

referential thinking.

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

Hyponatremia

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: "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." "The client might develop toxic levels of the drug if the client smokes cigarettes." "We need to watch to make sure that the client doesn't lose too much weight."

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

A client with a persecutory delusion has been explaining to the nurse the specifics of the conspiracy against the client. The client pauses and says, "I get the feeling that you don't actually believe that what I'm telling you is true." How should the nurse respond? "What you're telling me is difficult for me to believe. This may be real for you, but not me." "What's important to me is that it's real for you." "The conspiracy that you're explaining to me is actually a delusion." "What makes you think that I don't believe you?"

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

A client is diagnosed with schizophreniform disorder. The nurse is reviewing the client's medical record and finds that the client's symptoms have been present for at least how long? 1 week 1 month 8 months 1 year

1 month

The nurse expects psychiatric hospitalization for which of the clients diagnosed with schizoaffective disorder experiencing delusional thoughts? Select all that apply. A 76-year-old person whose symptoms are acute in nature A 25-year-old person who is having a first delusional experience A 45-year-old person who was arrested for assaulting a policeman A 30-year-old person who also has a diagnosis of depression A 39-year-old person who reports minor side effects from the current medication

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

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

A dramatic change in temperature.

Feeling no joy or pleasure from life or any activities or relationship

Anhedonia Negative

Social withdrawal, few or no relationship, lack closeness

Asociality Negative

Fragmented or poorly related thoughts and ideas

Associative looseness Postive

Which medication is used to control the extrapyramidal effects associated with antipsychotic medications? Benzotropine Chlorpromazine Haloperidol Thioridazine

Benzotropine

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

Benztropine

Increase fluid and fiber intake to avoid constipation; use ice chips or hard candy for dry mouth; assess for memory impairment (another side effect).

Benztropine (Cogentin)

A nurse is preparing to document information obtained from a client diagnosed with a s disorder who is experiencing somatic delusions. Which would the nurse most likely document? Disorientation Reduced attention span Above average intelligence Body complaints

Body complaints

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

Nursing Intervention: Administer medications as ordered; assess for effectiveness; reassure client if he or she is frightened.

Dystonic reactions

When preparing to educate a client regarding a newly prescribed antipsychotic medication, which action would be most appropriate for the nurse to do? Select all that apply. Encourage the use of sugar-free gum to help manage dry mouth Suggest methods to minimize the potential for weight gain Identify lifestyle adjustments that the resulting lethargy may require Advise the client to discuss any concerns regarding sexual dysfunction Discuss the increased difficulty the medication has on conception for both genders

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

The nurse is performing the initial assessment of a client diagnosed with schizophrenia. What should be the nurse's approach while assessing this client? Select all that apply. Engage in a one-to-one interaction with the client Provide effective physical care Perform diagnostic testing Expect the client will have cognitive deficits Establish a therapeutic relationship

Engage in a one-to-one interaction with the client Establish a therapeutic relationship

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? Gain assistance from family members. Contact the physician for a change in medications. Establish a routine and set goals. Outline the side effects of the medications.

Establish a routine and set goals.

The nurse suspects that a client is experiencing a brief psychotic episode based on what? Select all that apply. Gradual onset of symptoms Evidence of hallucinations Intense changes in affect Mild confusion Recent life stressor

Evidence of hallucinations Intense changes in affect Recent life stressor

A client with a diagnosis of schizophrenia has been brought to the emergency department by a worker from the group home where the client resides. The worker states that the client has stopped taking medications and drank 2 to 3 gallons of water over the past several hours. What assessments should the nurse who is caring for this client prioritize? Neurological assessment and monitoring of electrolyte levels Monitoring for evidence of hallucinations or delusions Blood glucose levels and body weight Assessing for allergic reactions, dry mouth, and lethargy

Neurological assessment and monitoring of electrolyte levels

A client begins to exhibit hallucinations and delusions along with disorganized speech after forgetting to take antipsychotic medication. The nurse suspects that the client is at which point in the clinical course of the disorder? Prodromal phase Acute illness Stabilization Relapse

Relapse

The nurse documents that the client is exhibiting negative symptoms of schizophrenia when observing the client doing what? Select all that apply. Repeatedly turning down invitations to join in unit activities Inability to maintain to complete a goal-directed activity Walking in circles around the unit until exhausted Talking very quietly Threatening to "slap anyone that bothers my stuff."

Repeatedly turning down invitations to join in unit activities Inability to maintain to complete a goal-directed activity

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? Inform the client that the client must receive care and you will assist the client. Greet the client by gently touching the client's arm and telling the client that the client can trust you. 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 client who has a major depressive episode tells the nurse that, for the past 2 weeks, the client has been hearing voices and at times thinks that someone is following the client. A history reveals that the client has had these alternating symptoms before. The client also has experienced time with neither of these symptoms and has been able to function adequately. The nurse interprets these findings as suggesting: Paranoid schizophrenia Undifferentiated schizophrenia Brief psychotic disorder Schizoaffective disorder

Schizoaffective disorder

A 20-year-old son of a client who was diagnosed with schizophrenia at the age of 25 is concerned that he may also develop the disorder. Which statement regarding schizophrenia and genetics is true? Schizophrenia has not been G to be genetic. 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 shown a strong genetic contribution.

When obtaining a client's history, a nurse determines that the client has been experiencing delusions and hallucinations for the past 3 months, which has caused some problems in the client's ability to function at work. The client also is exhibiting catatonic excitement, echopraxia, loose associations, and pressured speech. The nurse suspects which condition? Schizophrenia Schizoaffective disorder Brief psychotic disorder Schizophreniform disorder

Schizophreniform disorder

A client with schizophrenia is exhibiting positive and negative symptoms. The nurse anticipates that the client would be prescribed what? Stimulant Antidepressant Second generation antipsychotic First generation antipsychotic

Second generation antipsychotic

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

Shared psychotic disorder

A client with a long history of schizophrenia has managed well on fluphenazine. The client reports smacking of the lips and sticking out the tongue. Based on this report, what does the nurse suspect is occurring with the client? Signs of tardive dyskinesia (TD) associated with neuroleptic medication Psychomotor agitation associated with schizophrenia Typical bizarre behavior associated with schizophrenia Anticholinergic side effect associated with neuroleptic medications

Signs of tardive dyskinesia (TD) associated with neuroleptic medication

A client diagnosed with schizophrenia states to the nurse, "My intestines are being eaten by snakes." This statement represents which type of delusion? Somatic delusion Persecutory delusion Grandiose delusion Referential delusion

Somatic delusion

Which treatment would be inappropriate for a client with delusional disorder? Cognitive-behavioral therapy Individual therapy Somatic therapy Psychopharmacology

Somatic therapy

A client is receiving antipsychotic therapy. When describing dystonic reactions to the client,the nurse would instruct the client to cf: Spasms of the eye muscles Restlessness Lip smacking Facial grimacing

Spasms of the eye muscles

Research related to the development of schizophrenia has shown what? The likelihood of developing schizophrenia for a sibling of a person with the disorder is less than that of individuals in the general population. The disorder is thought to arise from the interaction of a biological predisposition and environmental stressors. Behavioral family pathology, not genetics, is the primary risk factor for the development of schizophrenia. If an identical twin develops schizophrenia, the other twin will also develop the disorder.

The disorder is thought to arise from the interaction of a biological predisposition and environmental stressors.

When assessing a client with a delusional disorder who is experiencing somatic delusions, which would the nurse expect as within normal parameters? Select all that apply. Thinking Orientation Self-care patterns Attention Sleep patterns

Thinking Orientation Attention

A client states, "My boss keeps putting thoughts into my head. Yesterday my boss made me copy 25 reports and then told me I had wasted company time and money!" The nurse knows the client is experiencing which perceptual disturbance? Thought withdrawal Thought blocking Thought insertion Thought broadcasting

Thought insertion

Which statements characterizes the major difference between the typical and atypical antipsychotic medications? Typical antipsychotics most often relieve positive symptoms but do not have a significant impact on negative symptoms. Atypical antipsychotics relieve only negative symptoms. Atypical antipsychotics tend to cause many more extrapyramidal side effects than do the typical antipsychotics. Typical antipsychotics cause blood dyscrasias, whereas atypical ones do not.

Typical antipsychotics most often relieve positive symptoms but do not have a significant impact on negative symptoms.

A client diagnosed with schizophrenia states, "I want to go home, go home, go home." This is an example of which speech pattern? Verbigeration Clang association Neologisms Word salad

Verbigeration

Assessment of genetic predisposition supports asking a client who is exhibiting symptoms of a delusional disorder what? Whether any family members have been diagnosed with schizophrenia When the delusion first began If the client has complied with the treatment plan If any family member shows symptoms of depression

Whether any family members have been diagnosed with schizophrenia

When assessing a person with delusional disorder, which finding would the nurse expect to assess? few, if any, psychological deficits changes in mental status altered personality high level of intelligence

few, if any, psychological deficits

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

grandiose