Psych Exam 2 - Ch. 12 (Schizophrenia Spectrum Disorders)
A patient diagnosed with schizophrenia was experiencing paranoid thinking. Which statement by this patient most clearly indicates the antipsychotic medication was effective?
"I think the staff wants to help me." Recognizing that the staff desires to be helpful suggests the paranoia is gone or has subsided. Finishing an art project, thinking the nurse is giving too much medicine, and believing that one no longer has a problem show a statement of accomplishment, paranoia, and anosognosia. pp. 203-205, Case Study and Nursing Care Plan
Which statement by a person with paranoid schizophrenia most clearly indicates that the antipsychotic medication is effective?
"I used to hear scary voices but now I don't hear them anymore." Auditory hallucinations are a common manifestation of paranoid schizophrenia, so their absence is an indicator of medication effectiveness. "My medicine is working fine. I'm not having any problems" and "Sometimes it's hard for me to fall asleep, but I usually sleep all night" are too vague. "I think some of the staff members don't like me. They're mean to me" indicates paranoid thinking. p. 209, Box 12.3
The nurse is teaching a patient and the patient's family about first- and second-generation antipsychotics for schizophrenia. What will the nurse include in the teaching? (SATA)
"Second-generation antipsychotics are usually better than first-generation antipsychotics because they have fewer side effects." Both first- and second-generation antipsychotics are used to treat schizophrenia. Second-generation antipsychotics are used more frequently than and are starting to replace first-generation antipsychotics, because they are more effective with fewer side effects. Second-generation antipsychotics are used to treat positive symptoms of schizophrenia, not negative symptoms. First-generation antipsychotics are used less frequently than second-generation drugs, not more frequently. First-generation antipsychotics cause more negative side effects, not fewer side effects. Test-Taking Tip: Avoid looking for an answer pattern or code. There may be times when four or five consecutive questions have the same letter or number for the correct answer. p. 201
A young adult is hospitalized with schizophrenia. The parents are distraught and filled with guilt. What would be an appropriate nursing response?
"There are many theories about the cause of schizophrenia, but this illness is not your fault." It is important for the nurse to give accurate information without adding to the parent's emotional burden. There are many theories about the etiology of schizophrenia; asking whether anyone in the family has schizophrenia is not a therapeutic statement and may induce guilt. Telling the family to look on the bright side is not realistic and does not respond to their feelings. Recommending websites for research is an incorrect response because the parents are not ready to learn details about mental illness. pp. 194-196
A patient has reached the stable plateau phase of schizophrenia. An appropriate clinical focus for planning would be
Social, vocational, and self-care skills During the stable plateau phase of schizophrenia, planning is geared toward the patient and family education and skills training that will help maintain the optimal functioning of schizophrenic individuals in the community. p. 196
Which side effect of antipsychotic medication is generally nonreversible?
Tardive dyskinesia Tardive dyskinesia is not always reversible with discontinuation of the medication and has no proven cure. The side effects of anticholinergic effects, pseudoparkinsonism, and dystonic reaction often appear early in therapy and can be minimized with treatment. pp. 211, 213, 215, Table 12.6
The achievement of long-term treatment goals for a patient diagnosed with schizophrenia is reliant upon which factor? (SATA)
-A trusting nurse-patient relationship -Patient adherence to treatment plan -Medication therapy that is reviewed regularly for effectiveness -Patient interaction with community-based therapeutic services Effective long-term care of persons with schizophrenia relies on a three-pronged approach: medication administration/adherence, relationships with trusted care providers, and community-based therapeutic services. Cognitive and social skills are not relevant. p. 203
What intervention is focused on supporting the overall goal of the acute phase of illness for a psychotic patient? (SATA)
-Assessment of patient regarding the existence of command hallucinations. -Providing a low-stimulation environment to minimize aggressive behavior. For the acute phase, the overall goal is patient safety and stabilization. Phase II focuses on helping the patient understand the illness and treatment, becoming stabilized on medications, and controlling or coping with symptoms. Outcome criteria for phase III focuses on maintaining achievement, adhering to treatment, preventing relapse, and achieving independence and a satisfactory quality of life. p. 201
The type of altered perception most commonly experienced by patients with schizophrenia is
-Auditory hallucinations Hallucinations, especially auditory hallucinations, are the major example of alterations of perception in schizophrenia. They are experienced by as many as 90% of individuals with schizophrenia. pp. 198-199
Which diagnostic finding associated with structural brain anomalies has been observed in patients diagnosed with schizophrenia? (SATA)
-Enlargement of the lateral cerebral ventricles -Reduced connectivity in various brain regions -Increased size of the sulci (fissures) on the brain's surface Brain imaging techniques provide substantial evidence that some people with schizophrenia have structural brain abnormalities that include the following: enlargement of the lateral cerebral ventricles, reduced frontal lobe volume, increased size of the sulci (fissures) on the surface of the brain, reduced cortical thickness, and reduced connectivity in various brain regions. p. 194
A patient with schizophrenia is prescribed clozapine. Which physiological conditions of the patient should the nurse monitor? (SATA)
-Liver function -Total white blood cell count Agranulocytosis is the most common symptom of clozapine. It is characterized by a reduced white blood cell count (less than 3000/mm 3) and liver impairment. Hence, the nurse should frequently monitor the liver function and total white blood cell count. Clozapine does not have an effect on the kidneys; therefore the total water intake and output and kidney function do not need to be monitored. Clozapine reduces white blood cell count but does not affect red blood cell count; therefore, it is not required to monitor red blood cell count. pp. 214, 216, Table 12.6
Which assessment finding supports the presence of extrapyramidal side effects (EPSs)? (SATA)
-Near constant pacing -Hand tremors observable bilaterally -Sustained contraction of the neck muscle First-generation antipsychotics are dopamine D2 antagonists in both the limbic and motor centers. This blockage of D2 dopamine receptors in the motor areas causes EPSs. Three of the more common EPSs are acute dystonia (acute sustained contraction of muscles, usually of the head and neck), akathisia (psychomotor restlessness evident as pacing or fidgeting, sometimes pronounced and very distressing to patients), and pseudoparkinsonism (a medication-induced, temporary constellation of symptoms associated with Parkinson's disease: tremor, reduced accessory movements, impaired gait, and stiffening of muscles). Nausea and photosensitivity are not considered EPSs. p. 211
The nurse is caring for five patients on a unit who have schizophrenia. Which patients are presenting with alterations in perception? (SATA)
-Patient who reports seeing the his or her dead relative -Patient who reports hearing babies crying in a quiet room -Patient who reports feeling like ants are crawling on his or her skin Hallucinations are alterations in perception and include auditory (hearing the sounds of babies crying), visual (seeing people or things that are not there), and tactile (feeling ants crawling on the skin). Patients who feel disoriented or depressed are experiencing affective signs, not alterations in perception. p. 198
What statement is true regarding schizophrenia? (SATA)
-Schizophrenia is a potentially devastating brain disorder. -Social behavior and emotions are affected by schizophrenia. -The disorder often affects an individual's language and thinking skills. -The disorder disturbs a person's ability to determine what is or is not real. Schizophrenia spectrum and other psychotic disorders disturb the fundamental inability to determine what is or is not real. Schizophrenia is a potentially devastating brain disorder that affects a person's thinking, language, emotions, social behavior, and ability to perceive reality accurately. It affects more than 3.5 million people in the United States and is among the most disruptive and disabling of mental disorders. p. 192
A patient with schizophrenia says, "I could hear the dog barking. It is trying to bite me." The nurse has taught hallucination-coping techniques to the patient's family to facilitate the patient's rehabilitation at home. What would be the most appropriate action by the patient's family in this case? (SATA)
-The family members should ask the patient to read loudly. -The family members would ask the patient to clean the house. It is helpful if family members are included in the treatment of a patient with schizophrenia. They form a support group for the patient and thus are taught different coping techniques for hallucinations and delusions. It is useful to use other auditory stimuli to overcome auditory hallucination in patients with schizophrenia. The patient should be asked to read loudly or listen to music in such cases. The patient may also be engaged in an activity like cleaning the house. Asking the patient to cover the ears will not help the patient to overcome auditory hallucinations. The patient should be taken to a favorite place so he or she can relax. Asking the patient to close his or her eyes will not help the patient to overcome hallucinations. pp. 208-210
A nurse is educating a patient's family about schizophrenia. What is the most appropriate advice the nurse can give to the patient's family? (SATA)
-The nurse should advise them to adhere to the treatment plan. -The nurse should advise them to keep in touch with support groups. The nurse should advise the family of the patient to join support groups such as National Alliance on Mental Illness and other local support groups. These groups would help to provide optimal patient care as well as support to the family. Adherence to the treatment plan would result in positive outcomes for the patient. The patient's family must be educated about the possible side effects of the prescribed drugs. This would help in effective monitoring and reducing panic in the patient and family members. The patient should be encouraged to interact with others. Keeping the patient isolated can make the patient either aggressive or withdrawn. The medications should not be stopped immediately after the symptoms are relieved because it could cause relapse of the schizophrenic symptoms. Gradually decreasing the dosage of the drug would be useful to prevent a relapse. p. 210, Box 12.5
A patient with schizophrenia often becomes aggressive and bangs his head on the wall. What is the most appropriate action toward the patient by the nurse? (SATA)
-The nurse should seclude the patient. -The nurse should make frequent visits to the patient. -The nurse should find out the reason for the patient's aggressiveness. Patients with schizophrenia become aggressive during the acute phase and may try to harm themselves as a result of hallucinations. A nurse should seclude such patients to avoid the risk of patients harming themselves or others. A nurse should also try to determine the cause of the aggressive impulse and minimize or avoid it. Such patients must always be kept under continuous supervision. Therefore, it is also appropriate that the nurse frequently visits the patient. Shouting at the patient may cause the patient to withdraw or may make the patient more aggressive. Leaving the patient unattended can cause potential harm to the patient. p. 207, Table 12.3
The nurse is caring for four patients with schizophrenia. Which patient is exhibiting grandiose delusions?
A patient who believes he or she is the President of the United States Grandiose delusions involve believing that one is a powerful or important person, such as the President of the United States. Believing that food is being poisoned is an example of persecutory delusions. Believing that the brain is rotting away is an example of somatic delusions. Believing that the healthcare provider has romantic feelings for the patient is an example of erotomanic delusions. p. 198
Which symptom would NOT be assessed as a positive symptom of schizophrenia?
Affective flattening Positive symptoms are those symptoms that should not be present, but are. They include hallucinations, delusions, bizarre behavior, and paranoia and are referred to as florid symptoms. Affective flattening is one of the negative symptoms that contribute to rendering the person inert and unmotivated. pp. 197-199, 201, Table 12.2
A patient who has been receiving antipsychotic medication for 6 weeks tells the nurse that the hallucinations are nearly gone and that concentration has improved. When the patient reports flulike symptoms, including a fever and a very sore throat, the nurse should
Arrange for the patient to have blood drawn for a white blood cell count Antipsychotic medications may cause agranulocytosis, the first manifestation of which may be a sore throat and flulike symptoms. Agranulocytosis with infection could be life threatening, so recommending rest does not address the underlying problem. The patient may not need to be admitted to the hospital but should have blood drawn to guide the next step. A nurse would not recommend a change of medication. The medication has been effective and might not need to be changed. p. 216, Table 12.6
A patient diagnosed with schizophrenia is most likely to experience which type of hallucination?
Auditory Patients diagnosed with schizophrenia may experience hallucinations arising out of any of the senses; however, auditory hallucinations are experienced by 60% of people with schizophrenia at some time during their lives. Visual hallucinations more commonly are associated with substance abuse and withdrawal. Tactile and olfactory hallucinations are rare. p. 198
A patient with schizophrenia was prescribed antipsychotics. After daily observation, the nurse finds the patient's blood pressure has decreased. What is the most appropriate action by a nurse before administering the prescribed drug to the patient?
The nurse should tell the patient to rise slowly. Antipsychotics block the α 2-receptor, which may cause hypotension. The nurse can give advice to the patient to rise slowly from the bed because the patient may feel dizzy as a result of reduced blood pressure. The nurse cannot administer the adrenergic agonist but can report to the health care provider if the patient's diastolic pressure falls below 80 mm Hg. The nurse should not stop administering the drug because that may worsen the schizophrenic symptoms. The nurse should not advise the patient to avoid fluid intake, because the patient may feel dehydrated and the total pressure exerted on the blood vessels maybe reduced. pp. 215-216, Table 12-6
In a clinical interview conducted at a community health care center, the nurses observe that a patient with schizophrenia is very sensitive and feels extremely guilty about previous actions. What is the appropriate nursing diagnosis?
The patient has risk for self-directed violence. The patient with schizophrenia shows negative symptoms such as self-blaming, guilt, and becoming sensitive. It indicates that the patient is at risk for self-directed violence and can do self-harm. Impaired verbal communication is characterized by dissociative ideas. Positive symptoms of schizophrenia include hallucination and associative looseness. Feeling guilty and being sensitive are negative symptoms of schizophrenia. Schizophrenia is not associated with a history of child abuse. pp. 201, 207, Table 12.2, Table 12.3
A patient with schizophrenia was prescribed perphenazine. During the follow-up visit after 12 weeks on the medication, the nurse suggests that the patient go on bed rest and follow a diet rich in proteins and carbohydrates. Which is the most appropriate reason for the nurse to give this suggestion?
The patient has the symptoms of cholestatic jaundice. Schizophrenic patients taking perphenazine, a first-generation antipsychotic drug, may have toxic effects as a result of long-term therapy. The nurse should identify the signs and symptoms of the toxic effects, like cholestatic jaundice, which is due to collection of bile juice in the gallbladder. The patient should be instructed to go on bed rest and consume a diet rich in proteins and carbohydrates. Postural hypotension is characterized by a drop in blood pressure with a change in position. It cannot be managed by a protein-rich diet. Agranulocytosis is characterized by dangerously low levels of white blood cells; this condition is not related to bed rest and diet changes. Autonomic nervous system controls involuntary actions of the body. An autonomic dysfunction is not treated by bed rest and diet changes. p. 212, Table 12.5
A nurse is caring for a patient with schizophrenia. Upon the nurse's report, the primary health care provider prescribed 25 mg of diphenhydramine hydrochloride to the patient. What had the nurse reported to the primary health care provider about the patient?
The patient has tremors and tardive dyskinesia. Patients with schizophrenia are generally prescribed antipsychotic drugs. These drugs cause extrapyramidal side effects, like tremors, and abnormal involuntary movements, like tardive dyskinesia. Diphenhydramine hydrochloride 25 mg by the intramuscular or intravenous route is prescribed to such patients to treat extrapyramidal side effects. Diphenhydramine hydrochloride is contraindicated in patients with peptic ulcer and asthma because it causes stomach distress like nausea, vomiting, and diarrhea. Physostigmine and benzodiazepines are administered to control these symptoms. Photosensitivity and mydriasis are symptoms of anticholinergic toxicity. Dry mucous membranes can be a symptom of anticholinergic toxicity but are not a major concern with the administration of diphenhydramine hydrochloride. p. 211
A patient diagnosed with schizophrenia and experiencing command hallucinations had a brief stay on an inpatient unit. Afterward, the patient was transferred to a partial hospitalization program. Which outcome is most appropriate to achieve by the end of the first week of partial hospitalization? The patient will
Verbalize an understanding that hallucinations are a sign of the illness Anosognosia refers to an inability to realize an illness exists. This problem occurs in many persons diagnosed with schizophrenia. If the patient recognizes that hallucinations are an aspect of the illness, he or she has made initial progress in management of the illness. It will take longer than 1 week for the patient to communicate clearly and in organized sentences. The patient does not know the source of hallucinations and it is not productive to explore their content in detail. The patient should take medication daily, not just when experiencing hallucinations. pp. 200, 206, Table 12.3
A patient with undifferentiated schizophrenia lives in a community care home and takes olanzapine daily with supervision. During the patient's monthly outpatient visits with a psychiatric nurse, which assessment parameter takes priority?
Weight An important part of the nurse's role in the community is monitoring the patient's response to medications, compliance, and potential side or adverse effects. Key side effects of sexual dysfunction and weight gain are particularly important to monitor for persons taking antipsychotic medications. Olanzapine is an atypical antipsychotic drug that can cause significant weight gain, which results in diabetes for many patients. Neither height, mucous membrane integrity, nor pupil response takes priority over weight. p. 202, Box 12.2
A patient with schizophrenia was changed to clozapine 3 weeks ago. The patient calls the clinic nurse complaining of sore throat, fever, and malaise. Which laboratory test would be most helpful in determining the cause of these findings?
Complete blood cell count Agranulocytosis is the reduction of white blood cells (WBCs) and is a possible adverse effect of antipsychotic drugs, particularly clozapine. Chief complaints are flulike symptoms. A complete blood cell count would show the reduction in WBCs. Serum lithium level, liver panel, and urinalysis are not necessary. p. 217
A patient with schizophrenia who is experiencing symptoms of disorganized thinking would have the greatest difficulty when the nurse
Gives multistep directions The thought processes of the patient with disorganized schizophrenia are severely disordered, and severe perceptual problems are present, making it extremely difficult for the patient to understand what others are saying. All communication should be simple and concrete and may need to be repeated several times. p. 205, Table 12.3
The nurse is confident that an individual prescribed antipsychotic medication has been experiencing medication efficacy and showing insight when the patient
Is able to assess effectively the reality of his or her thinking processes Attaining insight is demonstrated by the ability to make reliable reality checks. This takes 6 to 18 months and depends on medication efficacy and ongoing support. Although attending therapy sessions and restating the importance of medication compliance are positive behaviors, they do not show insight because there is no critical thinking involved. The lack of hallucinations or delusional thinking reflects positive outcomes but not necessarily insight because there is no critical thinking involved. p. 197
A patient's dose of haloperidol was increased earlier today. The patient now is experiencing laryngeal dystonia. What is the nurse's priority action?
Maintain a patent airway. Laryngeal dystonia is associated with an acute dystonic reaction and may impair the integrity of the patient's airway. The nurse will document the events after they are managed. Oral fluids could be aspirated. Immediate nursing action is indicated; it would be inappropriate to try to engage the patient in an alternate activity. p. 215, Table 12.6
A patient diagnosed with residual schizophrenia is uninterested in community activities, lacks initiative, demonstrates both poverty of content and poverty of speech, and seems unable to follow the schedule for taking prescribed antipsychotic medication. The case manager continues to direct care with the knowledge that this behavior most likely is prompted by
Neural dysfunction Schizophrenia is considered a neurobiological disorder. The course of schizophrenia involves recurrences. With each relapse further deterioration is noted. Residual schizophrenia refers to the disorder when active phase symptoms are no longer present and the individual is left with two or more of the following symptoms: lack of initiative, social withdrawal, impaired role function, marked speech deficits, and odd beliefs. p. 194
The nurse is addressing a primary symptom of schizophrenia when
Reinforcing the patient's ability to interrupt intrusive paranoid thoughts Primary symptoms are ones that are directly caused by the mental illness, such as paranoid thoughts. Stress is a secondary symptom of schizophrenia resulting from stressors related to coping with the illness. A need for assistance while living independently is a secondary symptom of schizophrenia resulting from stressors created by the illness. Alcohol abuse is a secondary symptom of schizophrenia resulting from the use of alcohol to manage the stress of the hallucinations (a primary symptom). p. 193