Mental Health Unit 3: Schizophrenia-3
The nurse is working with a client with schizophrenia who has cognitive deficits. It is time for the client to get up and eat breakfast. Which statement by the nurse would be most effective in helping the client prepare for breakfast?
"First, wash your face and brush your teeth. Then put your clothes on." The client needs clear direction, with tasks broken into small steps, to begin to participate in the client's own self-care. The client, not the nurse, should perform the steps.
A client in an inpatient setting has a delusion that there are a multitude of undetectable noxious gases in circulation that have the potential to poison the client and others. Which of the nurse's responses is most therapeutic?
"I can assure you that you are actually very safe here." Assuring a client of his or her safety is a more therapeutic intervention than expressing exasperation with the client's delusions, arguing against them, or implicitly confirming them.
A client diagnosed with schizophrenia tells the nurse, "I hear the voice of Elvis." Which is the most therapeutic response by the nurse?
"I don't hear the voice, but I know you hear what sounds like a voice." Acknowledging that the client hears what sounds like a voice states reality about the client's hallucination. The other options are judgmental and demeaning.
After teaching a client with schizoaffective disorder about the condition and treatment, the nurse determines that the education was successful when the client states what?
"I need to eat properly so that I can control my weight." Client education should focus on nutrition and prevention of weight gain, which is a side effect of medication therapy. Establishing a regular sleep pattern by setting a routine can help to promote or reestablish normal patterns of rest. Establishing a daily routine can help address mood symptoms. Medication should not be stopped if the client feels better.
In working with the individual and family, which is the most accurate statement the nurse can make in order to teach the client and family about schizophrenia?
"Individuals with schizophrenia do have differences in brain structure and function that cause a variety of symptoms such as lack of motivation and hearing voices." Excessive amount of the neurotransmitter dopamine allows nerve impulses to bombard the mesolimbic pathway, the part of the brain normally involved in arousal and motivation. Normal cell communications are disrupted, resulting in the development of hallucinations and delusions. Abnormalities in brain shape and brain circuitry are being researched.
The nurse 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 has been shown to be an illness in which the dopamine system is affected. It is not caused by pathology in the cerebellum nor is it curable. It is responsive to medications.
A client with schizophrenia is prescribed clozapine because other prescribed medications have been ineffective. After educating the client and family about the drug, the nurse determines that the education was successful when they state what?
"We'll need to make sure that the client has the client's blood count checked at least weekly." Clozapine is associated with agranulocytosis, so clients taking clozapine should have regular blood tests. White blood cell and granulocyte counts should be measured before treatment is initiated, and at least weekly or twice weekly after treatment begins. Although cardiac dysrhythmias can occur, they are more likely to occur with ziprasidone. Cigarette smoking can reduce the concentration of clozapine, thus necessitating a higher dose of this medication. Clozapine is associated with weight gain, not weight loss.
Which client statement is suggestive of a sexual delusion?
"You've been watching me and my partner while we are together, haven't you?" Sexual delusions involve a client's belief that his or her sexual behavior is known to others; that the client is a rapist, prostitute, or pedophile; or that the client is pregnant. Questioning that the client and the client's partner are being watched is consistent with the definition for sexual delusions.
A mental health client has been prescribed clozapine for the treatment of schizophrenia. The nurse should be alert to which potentially life-threatening adverse effects of this medication?
Agranulocytosis Agranulocytosis is a life-threatening adverse effect of clozapine. White blood cell counts should be monitored frequently due to extremely low levels of white blood cells. Weight gain occurs with certain antipsychotics. Palpitations and hemorrhage are not generally associated with antipsychotics.
A client diagnosed with schizophrenia has been prescribed clozapine. Which is a potentially fatal side effect of this medication?
Agranulocytosis Agranulocytosis is manifested by a failure of the bone marrow to produce adequate white blood cells. Neuroleptic malignant syndrome is a life-threatening reaction to neuroleptic medication that requires immediate treatment. Tardive dyskinesia causes involuntary movements of the tongue, mouth, facial muscles, and arm and leg muscles. Dystonia is characterized by cramps and rigidity of the tongue, face, neck, and back muscles.
A nurse monitoring client medication needs to recognize side effects quickly and intervene promptly for which reason?
Alleviate the side effects and help client maintain adherence Recognizing a medication's side effects quickly and intervening promptly to alleviate them will help maintain adherence.
A client with schizophrenia believes that the client has discovered how to jump to the moon. The nurse would document this belief as what?
Grandiose delusion Grandiose delusions occur when a client believes that he or she possesses unrecognizable talent or insight or has made an important discovery. The example given does not reflect high self-esteem, paradoxical conduct, or inappropriate affect.
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 Ziprasidone carries a risk of dysrhythmias, extrapyramidal side effects, tardive dyskinesia, and Neuroleptic malignant syndrome. As such, cardiac and neurological assessments are a priority over the other components of a comprehensive assessment.
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 Delusions involve disturbances in thought content. They are firmly held false beliefs that reasoning cannot correct and for which there is no support in reality.
A 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 Positive symptoms reflect an excess or distortion of normal functions, including delusions and hallucinations. Negative symptoms reflect a lessening (or complete loss) of normal functions, such as restriction or flattening in the range and intensity of emotion (diminished emotional expression); reduced fluency and productivity of thought and speech (alogia); withdrawal and inability to initiate and persist in goal-directed activity (avolition); and inability to experience pleasure (anhedonia).
A nurse is assessing a client diagnosed with delusional disorder. The nurse would expect to find what?
Delusions with a prominent theme Delusional disorder is a diagnosis of exclusion. Delusions tend to have a predominant theme. Prominent hallucinations are not common in delusional disorder. If mood episodes occur, the duration is relatively brief compared to the delusional period. The delusions are not caused by the direct physiologic effects of a substance.
The nurse is developing a care plan for a client with somatic delusions. Which would be an appropriate nursing diagnosis for this client?
Disturbed thought process The most appropriate nursing diagnosis for this client is disturbed thought process related to misperception of environmental stimuli. Disturbed sleep pattern, risk for self-directed violence, and chronic low self-esteem would not be the most appropriate nursing diagnosis for this client.
A client has been taking haloperidol for 5 years when the client is admitted to the inpatient unit for relapse of symptoms of schizophrenia. Upon assessment, the client demonstrates akathisia, dystonia, a stiff gait, and rigid posture. The nurse correctly identifies these symptoms are indicative of what?
Extrapyramidal side effects Extrapyramidal side effects include severe restlessness, muscle spasms, or contractions; chronic motor problems such as tardive dyskinesia; and the pseudoparkinsonian symptoms of rigidity, masklike faces, and stiff gait.
A client with schizophrenia is hearing voices that tell the client to kill the self. What term is used to identify this type of false sensory perception?
Hallucination A hallucination is a sensory perception, such as hearing voices and seeing objects, that only the client experiences. A delusion is a false belief. Flight of ideas refers to a speech pattern in which the client skips from one unrelated subject to another. Ideas of reference refers to the mistaken belief that someone or something outside the client is controlling the client's ideas or behavior.
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 Hyponatremia is a life-threatening complication of unknown cause. When a client ingests an unusually large volume of water, the kidneys' capacity to excrete water is overwhelmed, and serum sodium concentrations rapidly fall below the normal range.
A client with delusions presents with strong defensiveness, even when watching the news or listening to the radio. The nurse would document this finding in the health history as what?
Ideas of reference Ideas of reference occur when a client has self-centered thoughts and falsely believes ideas are centered on something the client is doing, thinking, or feeling. Looseness of association is the inability to think logically. Ambivalence refers to contradictory or opposing emotions, attitudes, ideas, or desires for the same person or things or toward the environment. Echolalia is a pathological parrot-like response of a word or phrase.
Positive symptoms seen in schizophrenia are believed to be a result of which type of neurological dysfunction?
Increased amount of dopamine Positive (or productive) symptoms reflect an increased amount of dopamine affecting the cortical areas of the brain. Negative symptoms reflect an inadequate amount of dopamine, cerebral atrophy, and organic functional changes in the brain.
A client with schizophrenia is prescribed clozapine. The nurse would monitor the client closely for specific signs of what?
Infection Agranulocytosis can develop with the use of all antipsychotic drugs, but it is most likely to develop with clozapine use. Therefore, the nurse needs to be alert for signs of infection, particularly bacterial infection. Hypotension may occur with any antipsychotic drug. Nausea is a common side effect of many drugs. Weight gain, not loss, can occur with olanzapine and clozapine.
Which is the central focus of persecutory delusions?
Injustice that must be remedied by legal action The focus of persecutory delusions is often on some injustice that must be remedied by legal action. Clients often see satisfaction by repeatedly appealing to courts and other government agencies. The central theme of somatic delusions involves bodily functioning or sensations. The central theme of the jealous subtype is the unfaithfulness or infidelity of a spouse or lover. Clients representing with grandiose delusions are convinced they have a great, unrecognized talent or have made an important discovery.
The nurse is providing teaching to a client diagnosed with schizoaffective disorder. The nurse should explain to the client that which is true about this disorder?
It is a mix of psychotic and mood symptoms. Schizoaffective disorder is a mix of psychotic and mood symptoms and is typically diagnosed in early adulthood. It is not more common than schizophrenia and is not commonly adjunct to somatoform disorder although people diagnosed with schizoaffective disorder can present with somatic delusions.
A client has been prescribed quetiapine for delusional disorder. In teaching the client about this medication, the nurse must be certain to include which information?
One of the common side effects is dry mouth. Dry mouth is a common, sometimes bothersome, side effect. Quetiapine does not cause breast milk production. Dizziness may occur due to orthostatic hypotension but will decrease as the body becomes accustomed to the medication. It is not an emergency. Quetiapine can cause changes in blood sugar but will not induce sugar cravings.
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 Family education can help family members deal more effectively with a loved one who has schizohprenia, enabling them to contribute to a better outcome for the client, especially because they may be more able to recognize relapse.
A client with schizophrenia is prescribed an antipsychotic medication. Which immediate side effects would the nurse include in the education plan for this medication?
The potential for sedation Sedation with antipsychotic medication will likely happen immediately after initiating the medication. The nurse should be sure to inform the client they he or she will experience this side effect readily. The other options are examples of side effects that are possible with longer term treatment using antipsychotic medications. Weight gain is commonly associated with many antipsychotic medications. The potential for weight loss with antipsychotic medication is not typically discussed with clients.
The nurse is caring for a client with schizoaffective disorder with depression. The nurse should instruct the client that the most effective medication therapy for this disorder is:
atypical antipsychotic medications. Atypical antipsychotic medications may have mood stabilizing effects as well as antipsychotic effects; in many cases, symptoms of depression disappear when the psychotic symptoms decrease.
A client diagnosed with schizophreniform disorder must have symptoms present for at least 1 month but with a duration of less than how long?
6 months The essential features of schizophreniform disorder are identical to those of criteria A for schizophrenia, with the exception of the duration of the illness, which can be less than 6 months. Symptoms must be present for at least 1 month to be classified as a schizophreniform disorder.
Which client exhibits the characteristics that are typical of the prodromal phase of schizophrenia?
A 20-year-old is experiencing a gradual decrease in the ability to concentrate, be productive, and sleep restfully. Gradual, subtle behavioral changes appear during the prodromal phase of schizophrenia, such as tension, the inability to concentrate, insomnia, withdrawal, or cognitive deficits. No symptoms are present in the premorbid phase, and relapses occur in the progressive and chronic phases. Diagnosis of the disease marks the beginning of the onset phase.
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 Hospitalization may be required during acute psychotic episodes or when suicidal ideations are present. This structured environment protects the client from self-harm (e.g., suicidal, assaultive, financial, legal, vocational, or social). Emergency care also is needed during periods of symptom exacerbation. Psychosis, mood disturbance, and medication-related adverse effects account for most emergency situations. The nurse would expect psychiatric hospitalization for the following clients with schizoaffective disorder experiencing delusional thoughts: 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, and a 30-year-old person who also has a diagnosis of depression.
A nurse teaching a client about prescribed antipsychotic medication informs the client to contact a health care provider immediately if the client notices:
A dramatic change in temperature. Advise clients to contact their case coordinators or health care providers immediately if they experience dramatic changes in body temperature. The client may be at risk for neuroleptic malignant syndrome.
When assuming the management of the care of a delusional client, which should be the nurse's priority intervention?
Assure the client that he or she is safe in this milieu Assuring the client that he or she is in a safe environment is the first step in the establishment of a therapeutic relationship that is vital to successful psychiatric treatment.
A client with schizoaffective disorder is prescribed medication therapy. Which would be most likely?
Atypical antipsychotics Although numerous drugs may be prescribed, atypical antipsychotics are generally prescribed because of their efficacy for psychosis and for their thymoleptic (mood stabilizing) properties. Atypical antipsychotics have been used more often than typical antipsychotics. If depressive symptoms persist despite antipsychotic use, antidepressants may be prescribed. Mood stabilizers are an alternative adjunct for mood states associated with the bipolar type of the disorder.
A client has been diagnosed with schizophrenia. Assessment reveals that the client lives alone. The client's clothing is disheveled, the client's hair is uncombed and matted, and the client's body has a strange odor. During an interview, the client's family members voice a desire for the client to live with them when the client is discharged. Based on the assessment findings, which nursing diagnosis would be the priority?
Bathing self-care deficit related to symptoms of schizophrenia The negative symptom of avolition may be so profound that simple activities of daily living, such as dressing, bathing, or combing hair, may not get done. Therefore, a priority nursing diagnosis for the client is [bathing] self-care deficit related to the symptoms of schizophrenia. The family's desire to care for the client does not support a nursing diagnosis of dysfunctional family processes. There is no evidence of ineffective role performance or social isolation at this time.
Which statement is true about delusional disorder?
Behavior is relatively normal except when focused on the delusion. The course of delusional disorder is variable. The onset can be acute, or the disorder can occur gradually and become chronic. Clients usually live with delusions for years, rarely receiving psychiatric treatment unless their delusion relates to their health (somatic delusion) or they act on the basis of their delusion and violate laws or social rules. Apart from the direct impact of the delusion, psychosocial functioning is not markedly impaired. Behavior is remarkably normal except when the client focuses on the delusion. At that time, the client's thinking, attitudes, and mood may change abruptly. Personality does not usually change, but the client is gradually, progressively involved with the delusional concern.
Which group of theories is believed currently to explain the etiology of schizophrenia?
Biologic Schizophrenia is thought to have multiple etiologies. The overwhelming body of scientific evidence suggests that schizophrenia is a brain disease. Computed tomography scanning and magnetic resonance imaging have shown frequent enlargement of the lateral cerebral ventricles in people with schizophrenia.
A nurse is preparing to document information obtained from a client diagnosed with a delusional disorder who is experiencing somatic delusions. Which would the nurse most likely document?
Body complaints Somatic delusions involve bodily functions or sensations, with clients believing that they have physical ailments. Clients with delusional disorder show few, if any, psychological deficits. These clients characteristically have average or marginally low intelligence. Mental status generally is not affected. Thinking, orientation, affect, attention, memory, perception, and personality are generally intact.
A client with schizoaffective disorder is engaging in an extremely long conversation about a current affairs in the world. The client goes on to provide the nurse with minute details. The nurse interprets this as suggesting what?
Circumstantiality The client is demonstrating circumstantiality, which refers to extremely detailed and lengthy discourse about a topic.This can be commonly found in a client with euphoric or elevated mood due to the affective component of schizoaffective disorder. Clang associations are ideas that are related to one another based on sound or rhyming rather than meaning. Neologisms are words invented by the client. A verbigeration is the stereotyped repetition of words or phrases that may or may not have meaning to the listener.
A nurse is interviewing a client with schizophrenia when the client begins to say, "Kite, night, right, height, fright." The nurse documents this as what?
Clang association The client is manifesting clang association, which is the repetition of words or phrases that are similar in sound but are in no other way connected. Stilted language is the use of overly and inappropriate artificial formal language. Verbigeration is the purposeless repetition of words or phrases. Neologisms are words that are made up that have no common meaning and are not recognized.
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 Clozapine may be used if the client has not responded favorably to the use of two different neuroleptics. It is not normally a drug of first resort, however, due to significant adverse effects.
A client with schizophrenia is exhibiting hallucinations and delusions. The mental health nurse knows that these symptoms are associated with hyperactivity of which neurotransmitter?
Dopamine Positive symptoms of schizophrenia (specifically hallucinations and delusions) are thought to be related to dopamine hyperactivity in the mesolimbic tract at the D2 receptor site of the striatal area, where memory and emotion are regulated. Other receptors are also involved in dopamine neurotransmission, especially serotonergic receptors. It is becoming clear that schizophrenia does not result from dysregulation of a single neurotransmitter or biogenic amine (e.g., norepinephrine, dopamine, or serotonin). Investigators are also hypothesizing a role for glutamate and GABA because of the complex interconnections of neuronal transmission and the complexity and heterogeneity of schizophrenia symptoms. The N-methyl-D-aspartate (NMDA) class of glutamate receptors is being studied because of the actions of phencyclidine (PCP) at these sites and the similarity of the psychotic behaviors that are produced when someone takes PCP.
Positive symptoms of schizophrenia, specifically hallucinations and delusions, are thought to be caused by hyperactivity of which neurotransmitter?
Dopamine Positive symptoms of schizophrenia, such as delusions and hallucinations, are thought to be caused by dopamine hyperactivity in the mesolimbic tract at the D2 receptor site in the striatal area, where memory and emotion are regulated. Hyperactivity of acetylcholine, norepinephrine, and epinephrine are not associated with schizophrenia.
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 what?
Echolalia The nurse should document the client's speech pattern as echolalia, or parrot-like and inappropriate repetition of another's words. Echopraxia refers to an involuntary imitation of another person's movements or gestures. Neologisms are made-up words that have no common meaning and are not recognized. Tangentiality is a disorganized thinking pattern in which the topic of conversation changes to an entirely different topic; the change is a logical progression but causes a permanent detour from the original focus.
A client is being released from the inpatient psychiatric unit with a diagnosis of schizophrenia and treatment with antipsychotic medications. After teaching the client and family about managing the disorder, the nurse determines that the education was effective when they state that which should be reported immediately?
Elevated temperature Clients receiving antipsychotic therapy need to be alerted to the potential for complications, including neuroleptic malignant syndrome, a life-threatening condition that can occur with antipsychotic agents. This syndrome is manifested by severe muscle rigidity and elevated temperature that can rapidly accelerate. The nurse should instruct the client to seek immediate care if an elevated temperature develops. Tremor also should be reported, but this is not a life-threatening manifestation. Decreased blood pressure and weight gain can occur with antipsychotic agents, but these are not life threatening.
A client diagnosed with schizoaffective disorder and severe depression is being treated with antipsychotic medications. The client tells the nurse about difficulty with self-care activities. With which intervention should the nurse respond?
Establish a routine and set goals. The most useful approach for the nurse to try is to help the client establish a routine and set goals for accomplishing the activities of daily living.
How often must clients receiving clozapine get white blood cell counts drawn?
Every week for the first 6 months Clients taking clozapine must have weekly white blood cell counts for the first 6 months of clozapine therapy and every 2 weeks thereafter.
The nurse should consider which during a psychiatric assessment of a newly immigrated client who is being evaluated for possible religious delusions?
Some cultures hold religious beliefs that might be confused with delusional thought Some cultures have widely held and culturally sanctioned beliefs that might be considered delusional in other cultures.
The experienced psychiatric nurse shares with the novice nurse that effective nursing care for the delusional client depends on what? Select all that apply
Managing the milieu so as to minimize situations that will frustrate or anger the client Being relaxed during frequent client-nurse interactions Expecting the client to adhere to all unit rules The experienced psychiatric nurse shares with the novice nurse that effective nursing care for the delusional client depends on being relaxed during frequent client-nurse interactions, expecting the client to adhere to all unit rules, and managing the milieu to minimize situations that will frustrate or anger the client. Confronting the client's delusions is not effective until medication has taken effect and can lead to a poor nurse-client relationship. Supporting the delusion when the client is extremely agitated is ineffective and can promote perpetuation of the false fixed belief.
Schizoaffective disorder has symptoms typical of both schizophrenia and which type of disorder?
Mood disorders Schizoaffective disorder has symptoms typical of both schizophrenia and mood disorders, but it is a separate disorder. Symptoms of anxiety, substance use, and eating disorders are not typically part of schizoaffective disorder.
A comprehensive nursing assessment for neuroleptic malignant syndrome (NMS) should include checking for which in a client taking an antipsychotic medication?
Muscular rigidity, tremors, and difficulty swallowing NMS is characterized by muscular rigidity, tremors, difficulty swallowing, fever, hypertension, and diaphoresis
The nurse must be aware that individuals from diverse ethnic groups might describe troubling experiences in terms of physical problems or specific culture-bound syndromes. The syndrome of ghost sickness is exhibited by which culture?
Native American The culture-bound syndrome of ghost sickness is seen in the Native American tribal culture. This culture exhibits a preoccupation with death and the deceased. Bad dreams, weakness, feelings of danger, anxiety, and hallucinations may occur. The other options are not related to the culture-bound syndrome of ghost sickness
A nurse provides care to a client with schizoaffective disorder during hospitalization for acute psychosis. Nursing interventions to help the client to establish trust with the health care team is best accomplished by what?
Offering reassurance in a soft, nonthreatening voice During periods of acute psychosis, offering reassurance in a soft, nonthreatening voice and avoiding confrontational stances will help the client begin to trust the staff and nursing care.
A 44-year-old client has been experiencing intense job stress. In recent weeks, the client has confided in the client's spouse that the client believes the client's firm monitors every aspect of the client's personal performance and that the firm is engaged in deception and cover-up of its "true purpose." A nurse would recognize that the primary theme of the client's delusional disorder is what
Persecutory Clients who exhibit persecutory delusions believe that they are being conspired against, spied on, poisoned or drugged, cheated, harassed, maliciously maligned, or obstructed in some way. This delusion is not characteristic of somatic, conjugal, or grandiose subtype.
A 44-year-old client has been experiencing intense job stress. In recent weeks, the client has confided in the client's spouse that the client believes the client's firm monitors every aspect of the client's personal performance and that the firm is engaged in deception and cover-up of its "true purpose." A nurse would recognize that the primary theme of the client's delusional disorder is what?
Persecutory Clients who exhibit persecutory delusions believe that they are being conspired against, spied on, poisoned or drugged, cheated, harassed, maliciously maligned, or obstructed in some way. This delusion is not characteristic of somatic, conjugal, or grandiose subtype.
A client with schizophrenia believes that the cook at the psychiatric hospital is trying to poison the client. The nurse would record this type of delusion as what?
Persecutory Clients with persecutory delusions believe that they are being conspired against, spied on, poisoned, drugged, cheated, harassed, maliciously maligned, or obstructed in some way. A client convinced that a spouse or significant other is unfaithful exhibits conjugal paranoia. Grandiose delusions exist when a client believes that he or she possesses unrecognized talent or insight or has made an important discovery. A person with erotomanic delusions believes that someone of elevated social status loves him or her.
A client with delusional disorder believes that the cook at the psychiatric hospital is trying to poison the client. The nurse would record this type of delusion as what?
Persecutory The central theme of persecutory delusions is the client's belief that he or she is being conspired against, cheated on, spied on, followed, poisoned, drugged, maliciously maligned, harassed, or obstructed in pursuit of long-term goals. Erotomanic delusions are characterized by the delusional belief that the client is loved intensely by the loved object who is usually married, of a higher economic status, or otherwise unattainable. Grandiose delusions involve the belief that the person has a great, unrecognized talent or has made an important discovery or has a special relationship with a prominent person (or of actually being a prominent person). Somatic delusions involve bodily functions or sensations, with the client believing that he or she has physical ailments.
During a client interview, a client diagnosed with delusional disorder states, "I know my spouse is being unfaithful to me with a colleague from work."The nurse interprets the client's statements as suggesting which type of delusion?
Persucatory/paranoid The client's statements reflect persucatory/paranoid delusions that focus on the unfaithfulness or infidelity of a spouse or lover. Such delusions involve the belief that others are untrustworthy in some way. With referential delusions, the ideas of reference involve the client's belief that television broadcasts, music, or newspaper articles have special meaning for him or her. In the sexual delusion subtype, ideas involve the belief that the client's sexual behavior is known to others. With grandiose delusions, individuals believe that they have a great, unrecognized talent or have made an important discovery.
A client is being seen in the health clinic. The nurse observes a shuffling gait, drooling, and slowness of movement. The client is currently taking an antipsychotic for treatment of schizophrenia. The nurse knows that which side effect is occurring?
Pseudoparkinsonism Pseudoparkinsonism is exhibited by a shuffling gait, drooling, and slowness of movement. Dystonia is characterized by cramps and rigidity of the tongue, face, neck, and back muscles. Akathisia causes restlessness, anxiety, and jitteriness. Neuroleptic malignant syndrome causes rigidity, fever, hypertension, and diaphoresis.
A client has been prescribed clozapine for schizoaffective disorder (SCA) with depression. The nurse should explain to the client that one advantage of clozapine is that it can provide what?
Reduction of hospitalizations and risk for suicide Clozapine, reported effective for SCA by several authorities, can reduce hospitalizations and risk for suicide. A significant portion of clients whose symptoms have resisted other neuroleptic agents improve on clozapine.
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 what?
Referential thinking The client is exhibiting referential thinking, that is, the belief that neutral stimuli, such as the radio, have special meaning to that person, such that the radio commentator is talking directly to him. Autistic thinking involves restriction of thinking to the literal and immediate so that the individual has private rules of logic and reasoning that make no sense to anyone else. Concrete thinking reflects a lack of abstraction in thinking with the inability to understand punch lines, metaphors, and analogies. Illusional thinking occurs when a person misperceives or exaggerates stimuli that actually exist in the external environment.
A client begins to exhibit hallucinations and delusions along with disorganized speech after forgetting to take antipsychotic medication. The nurse suspects that the client is at which point in the clinical course of the disorder?
Relapse Relapse involves a return of the symptoms, most often due to the client's failure to follow the medication regimen. The prodromal phase is associated with small changes in overall function, such as difficulties at work or school, within relationships, or in daily activities accompanied by transient or weak symptoms of psychosis. Acute illness is the initial onset of changes in thought and bizarre or disruptive behavior. Stabilization occurs when symptoms become less acute, following the initial diagnosis and initiation of treatment.
A nurse is caring for a client diagnosed with schizophreniform disorder. The nurse demonstrates understanding of this disorder when identifying that the client is at risk for developing what?
Schizophrenia About one third of the individuals with schizophreniform disorder recover with the other two thirds developing schizophrenia. Schizophreniform disorder is not associated with the development of personality disorder, major depression, or substance abuse.
Some research has suggested that schizophreniform disorder may be an early manifestation of which other mental health condition?
Schizophrenia Some research has suggested that schizophreniform may be an early manifestation of schizophrenia. A client exhibiting an acute reactive psychosis for less than the 6 months necessary to meet the diagnostic criteria for schizophrenia is given the diagnosis of schizophreniform disorder. Symptoms lasting beyond the 6 months warrant a diagnosis of schizophrenia.
What are the signs and symptoms of schizophrenia according to the Diagnostic and Statistical Manual of Mental Disorders?
Schizophrenia lasts at least 6 months and includes at least 1 month of 2 or more active-phase symptoms. According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, (DSM-5), schizophrenia lasts at least 6 months and includes at least 1 month of 2 or more active-phase symptoms such as bizarre delusions, hallucinations (e.g., a running commentary of two voices conversing), disorganized speech, grossly disorganized or catatonic behavior, and negative behavior.
A client diagnosed with delusional disorder who uses excessive health care resources most likely has which type of delusions
Somatic Persons who have somatic delusions believe they have a physical ailment. Clients with somatic delusions use excessive health care resources. The central theme of the jealous subtype is the unfaithfulness or infidelity of a spouse or lover. Erotomanic delusions are characterized by the delusional belief that the client is loved intensely by the "loved object," who is usually married, of a higher socioeconomic status, or otherwise unattainable. Clients presenting with grandiose delusions are convinced they have a great, unrecognized talent or have made an important discovery; a less common presentation is the delusion of a special relationship with a prominent person or actually being a prominent person.
A nurse is assessing a client who is reporting the sensation of "bugs crawling under the skin" and intense itching and burning. The client states, "I know bugs have invaded my body." There is no evidence to support the client's report. The nurse interprets this as which type of delusion?
Somatic Somatic delusions involve bodily functions or sensations, such as insects having infested the skin. The client vividly describes crawling, itching, burning, swarming, and jumping on the skin surface or below the skin. The client maintains the conviction that he or she is infested with parasites in the absence of objective evidence to the contrary. Nihilistic delusions focus on impending death or disaster. Clients presenting with grandiose delusions are convinced they have a great, unrecognized talent or have made an important discovery. The central theme of persecutory delusions is the client's belief that he or she is being conspired against, cheated, spied on, followed, poisoned, drugged, maliciously maligned, harassed, or obstructed in pursuit of long-term goals.
While being interviewed, a client diagnosed with a delusional disorder states, "I have this really strange odor coming out of my mouth. I stop to brush my teeth almost every hour and then rinse with mouthwash every half hour to get rid of this smell. I've seen so many doctors, and they can't tell me what's wrong." The nurse interprets the client's statement as reflecting which type of delusion?
Somatic The client's statements reflect a somatic delusion, which involves bodily functions or sensations. Those with somatic delusions use excessive health care resources and often go through elaborate rituals to cleanse themselves or their surroundings. Erotomanic delusions focus on the belief that the client is loved intensely by a "loved object," who is usually married, of a higher economic status, or otherwise unattainable. With grandiose delusions, the client is convinced that he or she has a great unrecognized talent or has made an important discovery. Jealous delusions focus on the unfaithfulness or infidelity of a spouse or lover.
A client diagnosed with schizophrenia states to the nurse, "My intestines are being eaten by snakes." This statement represents which type of delusion?
Somatic delusion Somatic delusions are generally vague and unrealistic beliefs about the client's health or bodily functions. Persecutory delusions involve the client's belief that "others" are planning to harm the client or are spying, following, or belittling the client in some way. Grandiose delusions are characterized by the client's claim to associate with famous people or celebrities or the client's belief that he or she is famous or capable of great feats. Referential delusions or ideas of reference involve the client's belief that television broadcasts, music, or newspaper articles have special meaning for him or her.
A client with schizoaffective disorder is prescribed an atypical antipsychotic agent. The nurse understands that this drug is effective in controlling the psychotic symptoms as well as helping with what?
Stabilizing the client's mood symptoms Atypical antipsychotic agents are generally prescribed because of their efficacy for psychosis and for their thymoleptic (mood stabilizing) properties. Reduction of acute anxiety symptoms is not one of the results of treatment with a second generation antipsychotic. There is a sedative effect; however, this may not be effective in the reduction of anxiety. A client with acute anxiety symptoms would be better served with the administration of an antianxiolytic medication such as lorazepam. Electroconvulsive therapy is considered when symptoms are refractory to other interventions or when the client's life is at risk and a rapid response is required.
Although a psychotic episode can be brief, the client impact can last a long time. For this reason, the nurse is aware of what?
Supervision may be required to protect the person Although episodes are brief, impairment can be severe. Consequently, supervision may be required to protect the person during a brief psychotic episode.
A client with command auditory hallucinations and a history of aggressive outbursts is observed pacing and grimacing while in the day room. Which should be the nurse's priority?
Support the client in returning to the client's room Removing the client from the milieu is the initial intervention that best addresses the safety of all the clients including the agitated client. The other provided options are not necessarily inappropriate, but none represents the best course of action.
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 Unusual movements of the tongue, neck, and arms suggest tardive dyskinesia, an adverse reaction to neuroleptic medication. Dystonia is characterized by cramps and rigidity of the tongue, face, neck, and back muscles. Neuroleptic malignant syndrome causes rigidity, fever, hypertension, and diaphoresis. Akathisia causes restlessness, anxiety, and jitteriness.
Which is an appropriate intervention for a client having auditory hallucinations?
Tell the client to talk back to the voices and tell them to go away. Interventions for managing hallucinations include dismissal intervention (i.e., telling the voices to go away), various coping strategies (e.g., jogging, telephoning, playing games, seeking out others, employing relaxation techniques), or competing stimuli (e.g., listening to music or the voice of oneself or another to overcome auditory hallucinations and using visual stimuli to overcome visual hallucinations).
Which assessment findings in a client who is suspected of having a delusional disorder would be suggestive of a diagnosis of schizophrenia?
The client experiences frequent and sustained hallucinations. The presence of prominent and sustained hallucinations is suggestive of schizophrenia rather than delusional disorder. Nonbizarre delusions are associated with delusional disorder, and people with either diagnosis lack insight. Response to therapy does not differentiate between the two diagnoses.
The client's diagnosis of schizoaffective disorder is supported when the nurse documents what?
The client reports "hearing voices" for the last 3 months The client's diagnosis of schizoaffective disorder is supported when the nurse documents that the client reports "hearing voices" for the last 3 months. The documentation is objective and includes a direct quote from the actual client. What is being documented is consistent with the criteria for schizoaffective disorder.
Schizophrenia is most often characterized by which assessment finding?
Thought disturbances and hallucinations Common features of schizophrenia include thought disturbances and preoccupation with frightening inner experiences (e.g., delusions and hallucinations), affect disturbances (e.g., flat or inappropriate affect), and behavioral or social disturbances (e.g., unpredictable, bizarre behavior or social isolation).
A client states, "My boss keeps putting thoughts into my head. Yesterday my boss made me copy 25 reports and then told me I had wasted company time and money!" The nurse knows the client is experiencing which perceptual disturbance?
Thought insertion Clients exhibiting thought insertion are convinced that their thoughts are not their own but rather the thoughts of others that have become implanted in their heads
Assessment of genetic predisposition supports asking a client who is exhibiting symptoms of a delusional disorder what?
Whether any family members have been diagnosed with schizophrenia Some studies have found that delusional disorders are more common among relatives of individuals with schizophrenia than would be expected by chance; thus, asking whether any family members have been diagnosed with schizophrenia could be helpful.
A nurse is caring for a client who has been taking clozapine for 2 weeks. The client tells the nurse, "My throat is sore, and I feel weak." The nurse assesses the client's vital signs and finds that the client has a fever. The nurse notifies the physician, expecting an order to obtain which laboratory test?
White blood cell count Clients who are taking clozapine are at risk for developing agranulocytosis; therefore, they should have their white blood cells and granulocytes monitored while taking this medication. An immediate evaluation of blood cell status is necessary when symptoms of infection are present. Liver function studies and serum potassium and sodium concentration would not be necessary based on the assessment findings.
