PrepU Videbeck Ch 16 Schizophrenia

The psychiatric nurse documents that a client is expressing nihilistic delusions when the client makes which statement? "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." "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 can't eat; I have no mouth or stomach."

A client with schizophrenia tells the nurse, "I'm being watched constantly by the Federal Bureau of Investigation because of my job." Which response by the nurse would be most appropriate? "It must be frightening to feel like you're always being watched." "You are experiencing a delusion because of your illness." "You're not being watched; it's all in your mind." "Tell me more about how you are being watched."

"It must be frightening to feel like you're always being watched."

A client who is delusional and paranoid refuses to take antipsychotic medication as prescribed. Which is the most therapeutic response by the nurse to this refusal?

"What is it about the medicine that you don't like?"

The nurse is preparing a client with schizophrenia a history of command hallucinations for discharge by providing instructions on interventions for managing hallucinations and anxiety. Which statement in response to these instructions suggests to the nurse that the client has a need for additional information? "My medications will help my anxious feelings." "I'll go to support group and talk about what I am feeling." "When I have command hallucinations, I'll call a friend for help." "I need to get enough sleep and eat well to help prevent feeling anxious."

"When I have command hallucinations, I'll call a friend for help." The risk for impulsive and aggressive behavior may increase if a client is receiving command hallucinations to harm self or others. If the client is experiencing a hallucination, the nurse or health care counselor, not a friend, should be contacted to discuss whether the client has intentions to hurt herself or himself or others.

A client diagnosed with schizophrenia has been prescribed clozapine. Which is a potentially fatal side effect of this medication? Agranulocytosis Dystonia Tardive dyskinesia Neuroleptic malignant syndrome

Agranulocytosis

The nurse reviewing a client's diagnostic results recognizes that which is a possible positive indication for a diagnosis of schizophrenia? Abnormally high blood flow to the frontal lobes Atrophy of both the limbic structures and cerebellum Abnormally small fissures on the surface of the brain Atrophy of the lateral and/or third ventricles of the brain

Atrophy of the lateral and/or third ventricles of the brain

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

Behavior is relatively normal except when focused on the delusion.

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

Benztropine

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

Benztropine

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? Depression, elation, hyperactivity, and pressure of speech Blunted inappropriate affect, withdrawal, incoherence, and confusion Abnormal, bizarre posturing; stupor; echolalia; and negativism Hostility, aggression, persecutory hallucinations, and argumentativeness

Blunted inappropriate affect, withdrawal, incoherence, and confusion

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

Disturbed thought process

The nurse is assessing a client with schizophrenia who has a history of successfully managing the symptoms. The client has few social activities and speaks in a flat tone when interacting with others. Currently the client is experiencing acute psychosis with active hallucinations and social withdrawal. The nurse identifies improved social skills as an important therapeutic goal. How should the nurse implement this plan? Enter the client in the ongoing social skills training program on the unit. Have the client begin on the following day. Wait a few days to enter the client in the social skills training program. Enter the client in a social skills training program when acute psychosis subsides. Refer the client to a social skills training program after discharge.

Enter the client in a social skills training program when acute psychosis subsides.

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 Echolalia Ideas of reference Flight of ideas

Ideas of reference

The nurse caring for a client diagnosed with schizophrenia should include which interventions in the plan of care to assist in managing the client's concrete thinking? Provide the client with written instructions regarding the routine of the unit. Present verbal instructions regarding expectations in single, simple commands. Assess the client's understanding of instructions by requiring restatement of expectations. Incorporate family members in determining the emotional and physical needs of the client.

Present verbal instructions regarding expectations in single, simple commands.

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 Weight loss Combination with lithium for greater effect Cost savings

Reduction of hospitalizations and risk for suicide

A client with schizophrenia is exhibiting positive and negative symptoms. The nurse anticipates that the client would be prescribed what?

Second generation antipsychotic

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

When developing the plan of care for a client with schizophrenia who is in the acute phase of illness, the nurse understands that the client is at high risk for what? Mania Water intoxication Suicide Depression

Suicide

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

Suspiciousness and neologisms

Which client behavior is indicative of negative symptoms associated with schizophrenia? Select all that apply. Verbal communication is almost nonexistent. Gross motor skills are impacted by involuntary body movements. The client needs frequent redirection because of short attention span. Interpersonal relationships are negatively impacted because of delusional thoughts. Conversations are difficult to follow because of demonstration of loose associations of thought.

Verbal communication is almost nonexistent. The client needs frequent redirection because of short attention span.

A client with schizophrenia has been started on medication therapy with clozapine. The nurse should assess the results of which laboratory study to monitor for adverse effects from this medication? Platelet count Blood glucose level Liver function studies White blood cell count

White blood cell count

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

continuity of care

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 attends social functions. 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 attends social functions.

The nurse is caring for a client diagnosed with schizophrenia who states, "I decided not to take my medication because I realize that it really can't help me. Only I can help me." Which question asked by the nurse has the best therapeutic value? "Why do you think this is a wise decision?" "I don't understand. Only you can help you?" "You've decided not to take your medication. Is that right?" "Do you recall what it was like before you started your medication?"

"Do you recall what it was like before you started your medication?"

Which client exhibits the characteristics that are typical of the prodromal phase of schizophrenia? A 30-year-old has experienced a relapse after deciding that the client's atypical antipsychotic is unnecessary. A 20-year-old is experiencing a gradual decrease in the ability to concentrate, be productive, and sleep restfully. A 25-year-old does not express any of the symptoms of schizophrenia. A 28-year-old has been displaying the behaviors characteristic of schizophrenia for many months and has just been diagnosed with the disease.

A 20-year-old is experiencing a gradual decrease in the ability to concentrate, be productive, and sleep restfully.

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

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 thirst. A dramatic change in temperature. An increase in weight of 2 lbs in 1 month. A feeling of dizziness when the client stands up.

A dramatic change in temperature.

A client diagnosed with schizoaffective disorder is prescribed clozapine to treat symptoms. Which instructions would the nurse provide? "If you experience any drowsiness, discontinue taking this medication." "Monitor your urinary output and notify your doctor if your urine changes color." "Keep an eye on your weight, and if you gain weight rapidly, notify your doctor." "Keep a record of how often and how long you experience the side effect of dry mouth."

"Keep an eye on your weight, and if you gain weight rapidly, notify your doctor."

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

Delusions with a prominent theme

Catatonia as seen in clients with schizophrenia is unique in the existence of which feature? Presence of negative symptoms Preoccupation with a delusion Immobility like being in a trance Disorganized speech patterns

Immobility like being in a trance

The nurse is planning relapse prevention information for a client diagnosed with schizophrenia. The nurse understands that it is important to ensure which primary intervention? Including the client's support system in the teaching Facilitating weekly maintenance therapy for the client Having the client restate discharge goals and strategies Stressing the importance of client compliance with the medication plan

Including the client's support system in the teaching

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

Increased amount of dopamine

The nurse caring for a client with a diagnosis of acute schizophrenia should use which approach when planning care? Allow the client to set the goals for the plan of care. Let the client act out initially, and use the quiet room and restraints as needed. Provide assistance with grooming and nutrition until the client's thinking has cleared. Repeatedly point out inconsistencies in the client's communication during initial treatment.

Provide assistance with grooming and nutrition until the client's thinking has cleared.

A client is being seen at his primary health care provider (PHCP) office. The client has a history of schizophrenia and has been taking a new psychotropic medication for 3 weeks. Which finding(s) indicate a need for follow-up? Select all that apply. The client has reported sleeping less. The client's cholesterol level is elevated. The client reports a decrease in appetite. The client gained 8 pounds since the last visit. The client's blood pressure is increased from baseline.

The client's cholesterol level is elevated. The client gained 8 pounds since the last visit. The client's blood pressure is increased from baseline.

Which situation will present the most prominent problem when attempting to manage the outpatient care of a client diagnosed with schizophrenia? The client's noncompliance with medication therapy The community's opposition to outpatient mental health clinics The associated increased risk that the client may become homeless The family's negative reaction to transferring the client to community-based care

The client's noncompliance with medication therapy