Psychiatric Nursing Exam Two

Type two bipolar disorder

Diminished version of type 1 symptoms, such as hypomania. No history of mania but one or more episodes of hypomania and a history of depressive disorder. On the end of a manic episode, violence is probable

What are the nursing implications for tricyclic antidepressants?

Do not use with suicidal patients because they can kill themselves with the bottle - you can give them a weekly prescription instead

What are the nursing implications for lithium?

Draw blood after first dose 10 to 12 hours. Wait for level to come back before giving next dose. Know therapeutic range, toxic range, what to do with level is toxic

Homeless mentally ill persons

High incidence of mental illness, many are difficult to engage.

What is the importance in inquiring about a manic episode while interviewing an acutely depressed person?

History is very important because different meds used and needed for depressed vs manically depressed

Characteristics of mania

Hyper verbal, grandiosity, flight of ideas, pressured speech, insomnia (2-3 hrs/nt at most), hypersexual, spending money, funny. Must see 5/8 of these symptoms to be classified as mania

Atypical antipsychotics that treat positive and negative symptoms, are associated too with?

Hyperglycemia and diabetes

What types of delusions do people with schizophrenia have?

Ideas of reference, persecution, grandiosity, jealousy and control. All our beliefs that cannot be corrected by reasoning.

Nanda label: dysfunctional grieving

Is stuck like the old man who writes his dead wife letters every day, leaves everything the same, keeps talking to her.

Neuroleptics and benzodiazepines

Klonopin & Ativan- administer with lithium initially

Religiosity

Kneels to pray in front of water fountain, praise during group therapy and during other group activities

A mood stabilizer/anticonvulsant that is particularly good for people in bipolar.

Lamictal

Incongruent affect

Laughs when told his mother just died

ECT therapy

Relatively safe even for the elderly, expensive, may cause transient memory loss and confusion, have to redo every couple of years

Echolalia

Repeating of another's words by imitation

What are the first line antidepressant medications?

SSRIs (Selective Serotonin Reuptake Inhibitors)

What are the nursing implications for someone taking SSRIs?

SSRIs interact with numerous meds, monitor the vitals because SSRIs can potentially lower her elevated blood pressure, monitor weight, admin w/a snack or meal. Prozac should be taken early in the day. Monitor liver and renal function, WBC and neutrophil count.photosensitivity. Discontinuation syndrome and serotonin syndrome.

Major depression signs and symptoms

Sadness lasting between 2 to 4 weeks minimum, change in appetite, decreased energy, decreased self-esteem, negatively views/pessimism,

Nic activities for schizophrenia

Safety first! Try to develop trusting relationship, observe for signs of hallucinations, explore hallucinations for dangerousness, do not challenge or reinforce hallucinations

Which drugs used to treat depression have the least side effects and are the most prescribed?

Selective serotonin reuptake inhibitors (SSRIs)

What nanda diagnosis do we replace disturb thought processes with?

Sensory perceptual alteration

nursing interventions for depression

Structured activity, encourage participation and socialization, discourage rumination, encourage verbalization of feelings, holistic care: monitor food and fluid intake, sleep patterns and encourage good hygiene

Side effects of MAO inhibitors

Sweating, tremors, elevated temperature, bounding heart, increase in or ⬆️ blood pressure, hypertensive crisis

Which mood stabilizer/anticonvulsant is used for bipolar depression the most?

Symbyak

Toxic side effects of antipsychotics?

Tardive dyskinesia, neuroleptic malignant syndrome

What are the Kubler Ross stages of grieving?

Denile , anger, disorganization, panic, depression, loneliness and acceptance

Known as the safest mood stabilizer/anticonvulsant and specifically good for someone who has violent tendencies?

Depakote

Seasonal affective disorder

Depression during the cold months when there is no sun. Nov-April. Light therapy and vitamin D supplements work

What antipsychotics are used for positive symptoms only?

Haldol (low dose drug), Prolixin, Thorazine (start at 75 ml)

If lithium level is too high what do you do?

Stop and call physician stat, and hold the dose

Responding to internal stimuli

Stops talking in midsentence, tilts head to one side, and listens

Magical thinking

"we can't close the drapes, for if we do the sun won't still shine"

What is the maintenance range for lithium?

0.4-1.3 mEq/L

What is the therapeutic range for lithium?

0.8-1.4 mEq/L

What level is considered lithium toxicity?

1.8 mEq/L or higher

Crisis duration

4-6 weeks. Something happens when we are in crisis, perception Narrows, thinking of next food source, loved ones, shelter become a priority

What is the therapeutic range for Depakote?

50-100mcg

Major depression can be resolved on its own in

6 months to a year

What is the therapeutic level for Tegretol?

6-8 mg/l. Is used most often with rapid cyclers

Adverse effects of Clozaril ?

Agranulocytosis/decreased WBC and 1% of the population can cause WBC to fall under 500

What type of episode of bipolar disorder do women tend to start with?

A depressive episode

Cyclothymic disorder

A moody person, nothing like manic person

Wellbutrin

Half normal dose used in smoking cessation - fewer sexual side effects - we give until euthymic because if not we would push them into mania- novel antidepressant

What is neuroleptic malignant syndrome?

A toxic side effect of antipsychotics, is life-threatening, usually manifests after first two weeks of treatment

What are the positive symptoms of schizophrenia?

Hallucinations, delusions, aggression, disorganized thinking, paranoia

What are some side effects of try cyclic antidepressants?

Anti-cholinergic symptoms - dry mouth, difficulty urinating etc.

Typical antipsychotics/positive symptoms drugs

Are very high in sedation and anti-cholinergic properties such as dryness in sleepiness. Have a lot of bad side effects, is a reason why people go off meds

Drug that has high potency/low dosage- is high in EPS

Haldol

Tardive dyskinesia

Assessed using AIM scale, elderly female's most susceptible, irreversible

Olanzapine

Atypical antipsychotic that causes huge weight gain

Geodon

Atypical antipsychotic that is used a lot more with bipolar and schizophrenia, doesn't cause weight gain, but isn't as good as antipsychotic

Why is it important to not challenge or reinforce hallucinations when exploring them for dangerousness?

Because too much acknowledgment is validation for someone who is hallucinating

In the nursing process for mental illness, evaluation is particularly important why?

Because we want to make sure the treatment is working and change it if it's not

Used in Pseudoparkinsonism

Benadryl, Cogentin, arfane

How do SSRIs work?

By increasing amount of serotonin and bloodstream. Takes 2 to 4 weeks to work.

How do typical antipsychotics/positive symptoms drugs work?

By lowering dopamine

Other NIC activities you should observe for someone with schizophrenia

Cast doubt subtly, validate reality, focus on feelings, be consistent, predictable, manipulate environment, redirect,teach distracting techniques

What are the atypical antipsychotics that treat positive and negative symptoms?

Clazuril, Risperdal, Risperdal long acting injection (consta), Zyprexa, Seroquel, Geodon, Abilify, invega

What is the dangerous Antipsychotic that is the drug of last resort?

Clozaril

What are the two sides of crisis

Danger (nose dive), and opportunity (moving/life changes in a positive way)

Adverse side effects of antipsychotics?

EPS, anti-cholinergic symptoms, sedation, cardiovascular SE

What symptom is a hallmark sign of a biological causes of depression?

Early morning wakening

SSRIs with a sprinkling of norepinephrine

Effexor & Remeron

Examples of try cyclic antidepressants

Elavil, Tofranil, Sinequan, Pamelor- common, cheap, go to drugs

Often thought of as last resort and must have given or tried everything first

Electroconvulsive therapy - induced a seizure in brain

What happens if someone takes an overdose of tricyclic antidepressants?

Fatal arrhythmia very hard to fix

What are signs of neuroleptic malignant syndrome ?

Fever, increased BP, diaphoresis, tachycardia, muscular rigidity, stupor

What is the timeline for SSRIs to work?

First things that happen vegetative symptoms start to resolve, mood symptoms take longer. You can see effectiveness begin in 2 to 4 weeks

Factors causing affective disorders

Genetic factors, biochemical - serotonin - norepinephrine, stressful life events, loss events/death, divorce

What are the nursing implications for someone who is prescribed and MAO inhibitors?

Give pt a list of foods they can't eat such as cheese, wine, fish, chocolate, preserved meats- picked foods, no tyramine. No. Barbiturates, try cyclic antidepressants, antihistamines, CNS depressants, antihypertensives, and OTC cold meds

Mixed episode

In the morning they are mania, in group depression. Very difficult to get under control

Clozaril

Indicated for treatment resistant clients, no tardive dyskinesia - maybe used to treat tardive dyskinesia

Decanoate

Long acting drugs

In terms of bipolar disorder in men, what type of episodes generally appear first?

Manic episode

What are the nursing actions for these medications

Monitor for side effects, evaluate therapeutic effect (usually can see a difference after five days), teach, AIMs, informed consent, *pregnancy test before initiation of medication*

Other medications used for schizophrenia include

Mood stabilizer such as lithium, Tegretol, or Neurontin

What are the nursing implications for Clozaril ?

Must monitor CBC. May cause rebound psychosis with abrupt D/C. Blood drawn every two weeks for the whole time they're on it or pharmacist won't give med. stop Clozaril if WBC is too low

EXAMPLES of MAO inhibitors

Nardil, Parnate, Marplan

Maturational crisis example

Normal steps in life - developmental - often happens at college - first episode, no one can tell they're acting different/See symptoms

We use then when overall symptom is fatigue

Novel antidepressants such as Effexor and Remeron

What antidepressants are the safest and least likely to cause mania?

Novel antidepressants such as Welbutrin, Cymbalta, Desyrel, Effexor, Remeron

Type 1 bipolar disorder

One or more manic episodes and a hx of a depressive disorder. Must have mania episode. Very idiosyncratic disease, has no rhyme or reason for consistency.

What's the number one thing to remember about people who are grieving?

People can jump around. Every person goes through grief uniquely, when people are ready to invest in new relationships and ready to invest in the future that is considered healthy.

Dysthymic disorder

Persistent mild depression for at least two years

What are some trade names for SSRIs?

Prozac, Celexa, axle, Zoloft, Luvox, Lexapro

Extra pyramidal symptoms (less commonly seen with atypical antipsychotics)

Pseudoparkinsonism, akathisia (continual restlessness - patient doesn't know that it's coming from drug), dystonia (stiffness)

All atypical antipsychotics that treat positive and negative symptoms except Geodon have the potential to do what?

Raise blood sugar, raise triglycerides

Labile

Rapidly shifting moods

Bad side effect of Lamictal

Rash, Stevens - Johnson syndrome - occurs in one out of 100

What Is the biggest side effect for SSRIs?

Sexual dysfunction

How long is a normal grieving period?

Six months to two years

What happens if someone takes too much Depakote?

Sometimes liver toxicity, or hair loss. Is much better tolerated then lithium.

Lithium

Started as a cardiac drugs and accidentally helped very unstable people become stabilized. Have been in use for around 45 to 50 years

Mood stabilizers/anticonvulsants

Tegretol, Depakote, Neurontin, lamictal, Trileptal

Affect

The way the person looks in their face. It can be flat, wanted or constricted; incongruent or inappropriate, exaggerated, labile.

What are indications that someone is grieving properly?

They report a decrease preoccupation with the deceased, have periods of stability, are willing to take on new roles and responsibilities, has more energy, positive expectations about the future

Ruminating

Thinking negatively. A symptom of depression

Low potency/high dosage antipsychotics- hi and sedation and anti-cholinergic side effects

Thorazine

What are some side effects of lithium?

Tremors, thirst, gait problems, cognition problems, eventually get stuporous, between 2.3 and five, they can die

What is unresolved grief?

Unfinished business such as anger that you don't get to talk to them because they are dead. You can never fix it. If people want to stay stuck they will. If they want to get better they will try to move on.

Adventitious crisis

Unplanned such as hurricane, tornado, fire

Desyrel - trazadone

Used as a sleep aid

What are the first symptoms that pop out when someone is depressed

Vegetative symptoms

Nursing implications for ECT therapy

We don't want person making major decisions right after therapy we want to give 2 to 3 weeks to see if decision-making has returned to normal

Biological signs/ vegetative symptoms of depression

Weight changes, sleep disturbance, low energy and sex drive, constipation, psychomotor disturbances such as agitation, moving quick, can't stop fidgeting

What does ideas of reference mean?

When two people are talking, the person with ideas of reference thinks that the other people are talking about him

Nursing interventions for mania

Work through denial, set limits with manipulation, use distractibility, decreased stimulation, holistic care: food, fluids, rest. Have doc order benzo to get person sleeping so that their illness starts to come down

Do both children and elderly get depression?

Yes and if child's parents have it there's a higher percent of the child having it

A patient asks why he has been prescribed a selective serotonin reuptake inhibitor (SSRI) rather than one of the other classifications of antidepressants. The nurse addresses the patient's question best when responding: a. "This classification is usually effective and generally causes fewer side effects." b. "SSRIs are far less expensive that TCAs or MAOIs." c. "Your mental health provider has determined that your symptoms will be best managed with this classification of antidepressants." d. "It sounds like you have some doubts about the effectiveness of this classification of antidepressants."

a. "This classification is usually effective and generally causes fewer side effects." SSRIs are effective antidepressants that have fewer side effects than TCAs and are far less dangerous than MAOIs. SSRIs have fewer anticholinergic, cardiovascular, and sedating side effects. It is not necessarily true that SSRIs are less expensive than other classifications of antidepressants.

Which side effect of MAOI therapy will the nurse be particular concerned about when this classification of antidepressants is precribed to an older adult patient? a. Orthostatic hypotension resulting in falls b. Hypertension-induced strokes c. Hypertensive crisis resulting from eating tyramine-rich foods d. Drug-induced reflex tachycardia

a. Orthostatic hypotension resulting in falls Precautions for orthostatic hypotension should be observed in older patient prescribed MAOIs. Hypotension rather than hypertension is associated with this classification of medications. Hypertensive crisis resulting in the ingestion of high-tyramine foods is a concern for any age. Reflex tachycardia is associated with TCA therapy.

The nurse demonstrates an understanding of the most common co-morbid condition observed in a schizophrenic individual when asking: a. "Have you ever been diagnosed with an eating disorder?" b. "How often do you drink enough alcohol to get drunk?" c. "How old were you when you became sexually active?" d. "Would you describe yourself as being depressed?"

b. "How often do you drink enough alcohol to get drunk?" Rationale: About 50% of patients with schizophrenia have a co-occurring substance abuse disorder, most frequently alcohol or cannabis. Assessing alcohol consumption patterns will help identify this co-morbid condition. While depression may occur, it is not a primary co-morbid condition.

A patient on a TCA for chronic depression is recovering from a myocardial infarction. Which intervention will the nurse anticipate as a result of the patient's medical condition? a. Preparing to wean the patient off of the prescribed TCA medication b. Increasing the dose of the patient's prescribed TCA medication c. Adding an MAOI antidpressant medication to the patient's medication regime d. Discontinuing the patient from all antidepressant medications temporarily

a. Preparing to wean the patient off of the prescribed TCA medication TCAs are contraindicated during the recovery phase of myocardial infarction, and so the patient will be weaned off that medication. Increasing the dose would be contraindicated in this situation. There is no guarantee that an MAOI would be the antidepressant of choice. It is not necessarily prudent to discontinue antidepressant therapy for a patient diagnosed with chronic depression.

Which statement is true concerning the use of antipsychotic medications during pregnancy? a. Their use should be monitored closely by the mother's healthcare provider. b. Such medication poses severe risks when used during pregnancy. c. Medications in this class do not cross the placental barrier. d. There is no record of side effects in newborns exposed to such medications.

a. Their use should be monitored closely by the mother's healthcare provider. While antipsychotics do pose some risks to the pregnant woman, these risks are not generally considered severe; nonetheless, their use should be carefully monitored by the woman's healthcare provider. These drugs do pass the placental barrier and can cause EPSEs in some newborns but the risks of such exposure is small and levels are carefully monitored when a pregnant woman is prescribed this classification of medications in order to minimize the risk.

The symptoms of tardive dyskinesia are associated with: a. a dopamine hypersensitivity. b. a histamine blockade. c. an elevated prolactin level. d. an elevated alpha-1 level.

a. a dopamine hypersensitivity. Hypersensitivity to dopamine in the nigrostriatal tract causes tardive dyskinesia. Elevated prolactin related to dopamine blockade causes amenorrhea, galactorrhea, impotency, and decreased libido. Histamine blockade causes sedation, while alpha-1 blockade causes orthostatic hypotension.

A therapeutic benefit of fluphenazine decanoate (Prolixin Decanoate) is that the individual: a. does not have to remember to take medication daily. b. will not experience extrapyramidal side effects (EPSEs). c. may have daily doses titrated up or down. d. will experience a reduction in both negative and positive symptoms.

a. does not have to remember to take medication daily. This medication is not given daily but rather by injection every 2 to 3 weeks and does not require titration. Fluphenazine, a traditional first-generation antipsychotic drug, targets only positive symptoms of schizophrenia.

In working with a patient experiencing hallucinations, the nurse will direct the unlicensed assistive personnel to: a. speak to patients about real people and real events. b. listen while patients talk about disordered perceptions. c. avoid the use of distraction with patients. d. consistently expect bizarre behavior.

a. speak to patients about real people and real events. Providing reality (real people talking about real events in real time), emotional support, and the presence of caring staff are important in working with the patient experiencing hallucinations. Allowing the patient to speak about hallucinations and delusions consistently following the initial assessment of same is counterproductive and nontherapeutic and further validates (i.e., makes them more real) to the patient. Distraction from the hallucinations is a therapeutic nursing intervention. Not all patients experiencing hallucinations exhibit bizarre behavior.

Which statement regarding behaviors of psychotic clients made by a float nurse requires follow-up by the mental health unit's nurse manager? a. "It must be so frightening to be psychotic since no one else can understand what you are feeling." b. "Psychotic individuals are difficult to manage since they are unpredictable and dangerous." c. "You must monitor psychotic clients closely since they are at risk for hurting themselves." d. "Individuals demonstrating psychotic tendencies are usually out of touch with reality."

b. "Psychotic individuals are difficult to manage since they are unpredictable and dangerous." Rationale: Psychosis refers to the mental state of not being in touch with reality. During an episode of psychosis, the person does not realize that others are not experiencing the same things and wonders why others are not reacting in the same way. One should be watchful but not assume the psychotic individual is unpredictable or dangerous. The statements in the incorrect options are true and do not require follow-up.

Which statement made by a nurse interviewing a client who reports the fear that people are trying to poison him requires follow-up by the nurse's unit manager? a. "Have other members of your family ever experienced this kind of thing?" b. "Tell me more about how someone keeps trying to poison your food." c. "How has this affected your ability to keep a job or care for yourself?" d. "Let's discuss the stressors you have in your life right now."

b. "Tell me more about how someone keeps trying to poison your food." Rationale: It is nontherapeutic to reinforce the delusion by encouraging the individual to focus on the details such as suggested in the correct option. The incorrect options do not reinforce the delusion. Rather, they help gain knowledge about the history of the disorder in the family, the extent of the dysfunction the fear is causing, and the triggers that may have resulted in this behavior.

When an older adult is prescribed an antipsychotic medication, which intervention has priority regarding the patient's safety? a. Wearing sunglasses when outdoors b. Changing from a sitting to standing position slowly c. Being frequently monitored for suicidal ideations d. Avoiding foods with high fat content

b. Changing from a sitting to standing position slowly Hypotension is the major antiadrenergic effect of antipsychotic drugs. Hypotension occurs most often in older adults and when the individual stands or changes positions suddenly (orthostatic hypotension); thus, precautions against falls must be instituted.

Which modification to a person's personality is most associated with schizophrenia? a. Change b. Deterioration c. Splitting d. Hypersensitivity

b. Deterioration Schizophrenia is not characterized by a changing, splitting, or hypersensitive personality; it is characterized by a deteriorating personality.

Prior to initiating a tricyclic antidepressant (TCA), the nurse will evaluate the patient's: a. electroencephalogram (EEG). b. electrocardiogram. c. lipids. d. complete blood count (CBC).

b. electrocardiogram. Anticholinergic effects on the cardiovascular system caused by tricyclic medication are common enough to warrant serious consideration. Tachycardias and arrhythmias can lead to myocardial infarction. The medication does not cause effects that would warrant an EEG, lipids, or CBC.

The nurse is confident that an individual prescribed antipsychotic medication has been experiencing medication efficacy and showing insight when he: a. has been regularly attending his prescribed therapy sessions. b. is able to effectively assess the reality of his thinking processes. c. can restate the importance of medication compliance. d. no longer experiences hallucinations or delusional thinking.

b. is able to effectively assess the reality of his thinking processes. Rationale: 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. While attending therapy sessions and restating the important of medication compliance are positive behaviors, they do not show insight since there is no critical thinking involved. The lack of hallucinations or delusion thinking reflects positive outcomes but not necessarily insight since there is no critical thinking involved

Knowing that a patient is demonstrating positive symptoms of schizophrenia has a role in predicting the patient's: a. risk for relapse. b. response to prescribed medication. c. return to precrisis function. d. reluctance to adhere to the treatment plan.

b. response to prescribed medication. We find the subtyping approach based on type I (or positive) versus type II (or negative) symptoms clinically helpful, because it can be predictive of medication response. Relapse, function, and adherence to treatment is not as well associated with the existence of symptoms.

What nutritional education should a nurse provide when managing the care of a patient who has been prescribed a newer antipsychotic medication? a. Limit protein intake. b. Increase fluid intake by 200 ml daily. c. Prepare to cope with a craving for carbohydrates. d. Increase calories to manage an expected weight loss.

c. Prepare to cope with a craving for carbohydrates. Carbohydrate craving is a common feature of this type of medication therapy. Weight gain can be significant, particularly for patients taking the newer agents. There is no need to limit protein or to increase fluid intake above normal consumption.

The multidisciplinary team discusses the patient's negative symptoms of schizophrenia. The nurse expects which medication to be ordered? a. Prolixin (fluphenazine) b. Haldol (haloperidol) c. Seroquel (quetiapine) d. Thorazine (chlorpromazine)

c. Seroquel (quetiapine) Quetiapine, an atypical second-generation antipsychotic drug, targets both the positive and negative symptoms of schizophrenia. Fluphenazine predominantly treats the positive symptoms of schizophrenia as a traditional first-generation antipsychotic medication. Haloperidol predominantly treats the positive symptoms of schizophrenia as a traditional first-generation antipsychotic medication. Chlorpromazine predominantly treats the positive symptoms of schizophrenia as a traditional first-generation antipsychotic medication.

The depressed patient who could most benefit from a trial of bupropion (Wellbutrin) would be: a. a female older adult with a history of epilepsy. b. an underweight prima ballerina. c. a male young adult with a nicotine addiction. d. a female young adult taking Risperdal (risperidone).

c. a male young adult with a nicotine addiction. The medication is a nicotinic antagonist, thus acting as a smoking-cessation agent. The medication has no specific benefits regarding epilepsy, weight gain, or psychosis.

A patient comes to the clinic for a 4-week follow-up after starting Prozac (fluoxetine). The highest priority question the nurse will ask is: a. "How have you been doing?" b. "Who brought you to the clinic today?" c. "Has your stomach felt uncomfortable?" d. "Have you experienced thoughts of hurting yourself?"

d. "Have you experienced thoughts of hurting yourself?" The risk for self-harm increases in the weeks immediately after antidepressant therapy begins. Questions concerning mood and possible side effects are appropriate but do not have priority. Who brought the patient to the clinic is generally irrelevant.

A preceptor is working with a new RN. The preceptor will note understanding of Clozaril (clozapine) by the new RN when he or she says: a. "I need to carefully assess each patient for EPSEs, since it is a major risk factor with clozapine." b. "The team decided to offer clozapine to the patient who was newly admitted and diagnosed with schizophrenia. I will discuss it with his family today." c. "I gave the first dose of clozapine this morning. He is experiencing no abnormal motor movements so far." d. "The patient's WBC and ANC meet the criteria to start clozapine."

d. "The patient's WBC and ANC meet the criteria to start clozapine." The new RN demonstrates knowledge of clozapine with establishing a baseline for the white blood cell count (WBC)/absolute neutrophil count ANC with the potential risk of agranulocytosis in mind. EPSE liability is lower with clozapine rather than higher. Clozapine is not the first-line treatment for schizophrenia because of the expense and dedication necessary to monitor bone marrow health and WBC. Abnormal motor movements are not expected following a first dose of clozapine

When a patient is initially prescribed carbamazepine (Tegretol) when lithium is ineffective at managing the symptoms of bipolar disorder, the nurse will include what information in the patient education plan? a. The possible development of a skin rash b. Symptom recognition of Stevens-Johnson syndrome c. May prevent weight loss d. At first complete blood counts (CBCs) to be scheduled weekly

d. At first complete blood counts (CBCs) to be scheduled weekly Although carbamazepine is generally well tolerated, side effects include nausea, anorexia, and occasional vomiting. Sedation and drowsiness are other relatively common side effects. The most serious potential side effect of carbamazepine is agranulocytosis. CBCs should be determined weekly when this drug treatment is initiated. Lamotrigine (Lamictal) can cause somewhat moderate skin rashes (about 10% of patients) and the potentially fatal Stevens-Johnson syndrome (1% to 2% of children). Topiramate (Topamax) has been reported responsible for weight loss in some patients.

Which breakfast selections demonstrate that a patient understands the nurse's dietary instructions while taking monoamine oxidase inhibitor (MAOI) antidepressants? a. Bacon, eggs, cheddar cheese, and avocado slices in a flour tortilla b. Banana slices and raisins in whole-grain cereal with milk c. Blueberry pancakes with yogurt d. Oatmeal with almonds and milk

d. Oatmeal with almonds and milk Oatmeal, almonds, and milk are not considered tyramine-rich food and so can be eaten when taking MAOIs. Yogurt, bananas, aged cheeses, and avocados are high in tyramine and should be avoided.

A patient experiencing delusions is noted to have more anxiety and difficulty with attention following 2 days on the inpatient unit. Which nursing intervention would be most helpful for the patient? a. Walking with a group of staff and other patients off the unit b. Listening to music or reading c. Discussing treatment goals for the inpatient stay d. Participating in a noncompetitive creative activity

d. Participating in a noncompetitive creative activity Participation in such activities facilitates engagement with an activity that generates less stress, is creative, and is hopefully distracting (from the delusions). A walk off the unit does not provide the patient with the needed structure and safety; indeed, the delusional patient may be at risk for elopement from the group while off the clinical unit. A delusional patient may be unable to focus and concentrate on those sensory experiences. Discussing treatment goals is too high a level of cognition in the case of a delusional patient.

Prior to administering Clozaril (clozapine) and at regular intervals during treatment, the nurse will evaluate the patient's: a. electroencephalogram (EEG). b. electrocardiogram (ECG). c. lipids. d. complete blood count (CBC).

d. complete blood count (CBC). Related to the risk for agranulocytosis from bone marrow suppression, monitoring of the WBC count by the prescriber, nurse, and/or pharmacist is required. This medication does not require monitoring of EEG, ECG, or serum lipids.

The nurse documents that a client is demonstrating a negative symptom of schizophrenia when observing the client: a. refusing to eat anything that is not tasted by the staff first. b. reporting hearing voices telling him that the world will end soon. c. communicating using a pattern of speech identified as "word salad." d. having difficulty focusing on any task for more than a few minutes.

d. having difficulty focusing on any task for more than a few minutes. Rationale: Attention impairment is considered a negative symptom since it represents a diminution or loss of normal brain function. Paranoia, hallucinations, and distorted speech are considered positive symptoms since they are an exaggeration or distortion of normal brain function.

Word salad

"Get by for anyone just to answer fortune cookies"

What are Therapeutic Lithium Levels

.8-1.4

What does ambivalence mean?

A person can maintain two opposite beliefs about something that they hold at the same time

What is the major dangerous side effect of Mood Stabilizers?

Agranulocytosis

What is the most dangerous Clozaril Side Effect?

Agranulocytosis

Thought broadcasting

Believing one's thoughts can be heard by others

Mutism

Does not talk

Catatonia

Severe muscle rigidity, normally don't speak, very regressed

What are 3rd line antidepressant medications?

Tricyclic Antidepressants (TCAs)

The nurse assesses a client with schizophrenia who states, "I'm Jesus Christ, your Lord and Savior. Confess your sins to me." The nurse records the quote and uses which term to document this behavior? a. Positive symptoms b. Negative symptoms c. Affective flattening d. Attention impairment

a. Positive symptoms Delusions and hallucinations are positive symptoms

A client with paranoid schizophrenia tells the nurse "I have to get away. The volmers are coming to execute me." The term "volmers" can be assessed as a. a neologism. b. clang association. c. blocking. d. a delusion.

a. a neologism. A neologism is a newly coined word that has meaning only for the client.

What is the most common course of schizophrenia? Initial episode followed by a. recurrent acute exacerbations and deterioration. b. recurrent acute exacerbations. c. continuous deterioration. d, complete recovery.

a. recurrent acute exacerbations and deterioration. Schizophrenia is usually a disorder marked by an initial episode followed by recurrent acute exacerbations. With each relapse of psychosis an increase in residual dysfunction and deterioration occurs.

The purpose for a nurse periodically performing the Abnormal Involuntary Movement Scale (AIMS) assessment on a persistently mentally ill client who has schizophrenia is early detection of a. acute dystonia. b. tardive dyskinesia. c. cholestatic jaundice. d. pseudoparkinsonism.

b. tardive dyskinesia. An AIMS assessment should be performed periodically on clients who are being treated with antipsychotic medication known to cause tardive dyskinesia.

Interventions a nurse would implement when caring for a patient who has paranoid schizophrenia with poor ego boundaries include a. staying physically close during interactions. b. touching the patient often. c. prolonged interactions. d. eliminating physical contact.

d. eliminating physical contact. Rationale: Having personal space invaded intensifies anxiety, which in turn causes increased ego boundary problems.

Idea of reference

"I saw them talking and no they were making plans to hurt me"

Loose associations

"I'm going to the circus. Jesus is God. The police are playing for keeps"

Flight of ideas

"Say Babe, how's it going? Going to my sisters house to get money. Money Honey, you got any bread? Bread-and-butter."

Clang association

"Test, test, this is a test. We don't just, we get no rest"

Auditory hallucination

"The voices keep telling me I am no good"

Grandiose delusions

"When I speak, presidents and Kings listen!" "I own Heaven and Hell and they pay me rent."

Neologism

"when I get out of the hospital I'm going to get me a sprogle"

What are Maintenance Lithium Levels?

.4-1.3

What are 7 Side Effects of SSRIs?

1. Agitation 2. Anxiety 3. Insomnia (Prozac) 4. Sexual dysfunction 5. Weight Gain 6. Sedation 7. Tremor

What are the 4 Side Effects of Clozaril?

1. Agranulocytosis 2. Seizures 3. Bedwetting 4. Excessive Salivation

What are the 6 Side Effects of TCAs?

1. Anticholinergic 2. Postural Hypotension 3. Sedation 4. Weight Gain 5. Sexual Dysfunction 6. CV- LETHAL IN OD

What are 6 medications (Antiparkinson Agents) used to treat EPS (but not TD)?

1. Artane-Trihexyphenide 2. Cogentin-Benztropine 3. Akineton-Biperiden 4. Benadryl-Diphenhydramine 5. Kemadrin-Procyclidine 6. Parlodel-Bromocriptine

What are the 4 Extrapyramidal Symptoms that can occur when taking AntiPsychotic Medicatons?

1. Dystonia -muscle cramps of the head and neck 2. Akathisia- internal and external restlessness 3. Pseudoparkinsonism- tremors, rigidity, drooling, mask-like face, shuffling gait. 4. Tardive Dyskinesia (TD) - involuntary muscle spasms involving tongue, fingers, toes neck and trunk, lip smacking.

What are 9 TCAs?

1. Elavil-Amitryptyline 2. Vivactil-Protriptyline 3. Norpramine-Desipramine 4. Sinequan-Doxeprin 5. Tofranil-Imipramine 6. Aventyl-Nortiplyline 7. Ascendin-Amoxapine 8. Anafranil-Comipramine 9. Ludiomil-Maprotiline

What are the 5 Side Effects of Lithium?

1. Fine Hand Tremors 2. Mild Nausea 3. Weight Gain 4. Polyuria 5. Thirst

What are 9 signs of Lithium Toxicity?

1. N&V 2. Diarrhea 3. Slurred Speech 4. Ataxia 5. Shaking Hands 6. Muscle Twitching 7. HeadAche 8. Lethargy 9. Coma

What are 2 Long Acting IM AntiPsychotic Injectable Decanoate Medications?

1. Prolixin 2. Haldol

What are the 7 SSRIs?

1. Prozac-Fluoxetine 2. Zoloft-Sertraline 3. Paxil - Paroxetine 4. Celexa-Citalopram 5. Luvox-Fluvoxamine 6. Lexapro-Escitalopram 7. Vilbryd-Vilazodone

What are 2 Long-Acting Atypical/Novel Antipsychotic/Neuroleptic Drugs?

1. Risperdal Consta 2. Invega Sustenna

What are 11 Atypical/Novel Antipsychotic/Neuroleptic Drugs?

1. Risperdal-Resperidone 2. Risperdal M tabs 3. Zyprexa-Olanzapine 4. Zydis wafer- Quick dissolving 5. Seroquel-Quetiapine 6. Geodon-Ziprasidone 7. Abilify-Aripiprazole 8. Invega-Paliperidone 9. Saphris-Asenapine 10. Fanapt-Iloperidone 11. Latuda-Lurasidone

What are 8 Mood Stabilizer medications?

1. Tegretol-Carbamazepine 2. Depakote-Valproate Acid 3. Divalproex Sodium 4. Neurontin-Gabapentin 5. Lamictal-Lamotrigine 6. Topamax-Topiramate 7. Trileptal-Oxcarbazepine 8. Keppra-Levetiracetam

What are 4 Standard/Traditional Antipsychotic Medications?

1. Thorazine-Chlorpromazine 2. Haldol-Haloperidol 3. Prolixin-Fluphenazine 4. Navane-Thiothixene

What are the lab values to check for Clozaril?

1. WBC Count 2. Absolute Neutrophil Count

What are 4 Side Effects of Antipsychotic/Neuroleptic Drugs?

1. Weight Gain 2. Less EPS than traditional neuroleptics 3. High Blood Sugar 4. High Lipids

What are 6 Novel/Atypical Antidepressants?

1. Wellbutrin-Buproprion 2. Cymbalta-Duloxetine 3. Effexor-Venlafaxine 4. Pristiq-Desvenlafaxine 5. Remeron-Mirtazapine 6. Desyrel-Trazodone

What is the incidence of schizophrenia?

About 1% of the population.

At what age is the prognosis of schizophrenia most likely to occur

Between 17 and 29

Behavior and body disturbances of someone with schizophrenia are

Deserve behavior, ego boundary distortion, catatonia, ritualistic behavior, impulsivity, withdrawal, regression, poor ADLs

What foods must you avoid when taking MAOIs to avoid hypertensive crisis?

Foods with Tyramine

Tangentiality

Goes off topic every time after being refocused to topic

What is the definition of schizophrenia?

Group of related disorders with common features including hot disturbances, affect disturbances, behavioral disturbances, and cognitive disturbances

Concrete thinking

In ability to think abstractly

Regression

In response to stressful situation, begins to suck for him and soiles clothing

Is Tardive Dyskinesia associated with long term or short term use of antipsychotics?

Long Term Use

What are the old, 4th, last line antidepressant medications?

MAOIs (Monoamine oxidase inhibitors)

What is ego boundary distortion?

Means that the person can't tell where you begin in the end. Can't tell the difference between self and other person

What are 2nd line antidepressant medications?

Novel/Atypical

Paranoid delusion

Refuses to eat food that comes on tray stating, "they are trying to poison me."

What are some cognitive symptoms of schizophrenia?

Very distractible, very poor memory, poor problem-solving and decision-making, poor judgment.

When should you HOLD THE LITHIUM?

WHEN SERUM LITHIUM LEVEL IS OVER 1.5

What are the negative symptoms of schizophrenia?

Withdrawal, apathy, lack of energy, poverty of thought, anhedonia, flat affect

Which statement by a person with paranoid schizophrenia most clearly indicates the antipsychotic medication is effective? a. "I used to hear scary voices but now I don't hear them anymore." b. "My medicine is working fine. I'm not having any problems." c. "Sometimes it's hard for me to fall asleep, but I usually sleep all night." d. "I think some of the staff members don't like me. They're mean to me."

a. "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. Options 2 and 3 are too vague. Option 4 indicates paranoid thinking.

A young adult is hospitalized with undifferentiated schizophrenia. The parents are distraught and filled with guilt. An appropriate nursing response would be: a. "There are many theories about the cause of schizophrenia, but this illness is not your fault." b. "Does anyone in your family have mental illness? Schizophrenia is a genetically transmitted disease." c. "Look on the bright side. With the right medications and treatment, this disease can be cured." d. "I'll recommend some excellent websites to learn about schizophrenia and other mental illnesses."

a. "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, but without adding to the parent's emotional burden. There are many theories about the etiology of schizophrenia. Option 2 is not a therapeutic statement and may induce guilt. Option 3 is not realistic and does not respond to their feelings. Option 4 is incorrect because the parents are not ready to learn details about mental illness.

Which of the following would be assessed as a negative symptom of schizophrenia? a. Anhedonia b. Hostility c. Agitation d. Hallucinations

a. Anhedonia Negative symptoms include the crippling symptoms of affective blunting, anergia, anhedonia avolition, poverty of content of speech, poverty of speech, and thought blocking.

The causation of schizophrenia is currently understood to be a. a combination of inherited and nongenetic factors. b. excessive amounts of the neurotransmitter dopamine. c. excessive amounts of the neurotransmitter serotonin. d. stress related.

a. a combination of inherited and nongenetic factors. Causation is a complicated matter. Schizophrenia most likely occurs as a result of a combination of inherited genetic factors and extreme nongenetic factors (such as virus, birth injuries, nutritional factors) that can affect the genes governing the brain or directly injure the brain.

A desired outcome for a client with schizophrenia who has a nursing diagnosis of Disturbed sensory perception: auditory hallucinations related to neurobiological dysfunction would be that the client will a. ask for validation of reality. b. describe content of hallucinations. c. demonstrate a cool, aloof demeanor. d. identify prodromal symptoms of disorder.

a. ask for validation of reality. Beginning to question his or her own altered perceptions by seeking input from staff is highly desirable.

When a client with schizophrenia hears hallucinated voices saying he is a vile human being, the nurse can correctly assume that the hallucination a. is a projection of the client's own feelings. b. derives from neuronal impulse misfiring. c. is a retained memory fragment. d. may signal seizure onset.

a. is a projection of the client's own feelings. One theory about derogatory hallucinations is that the content is a projection of the individual's feelings about self. The derogatory hallucinations are an extension of the strong feelings of rejection and lack of self-respect experienced by the individual during the prodromal period.

A newly admitted patient has the diagnosis of catatonic schizophrenia. The nurse would expect to assess: a. psychomotor symptoms. b. intense suspiciousness. c. inappropriate affect. d. clanging communication.

a. psychomotor symptoms. Rationale: Catatonic schizophrenia is characterized by extremes of psychomotor activity ranging from frenzied behavior to immobilization and may include echopraxia and posturing. 2. Paranoid thinking is characteristic of paranoid schizophrenia. 3 and 4. Inappropriate affect and clanging are seen in disorganized schizophrenia.

To establish a relationship with a severely socially withdrawn patient who has schizophrenia, the nurse should a. sit with the patient several times a day for short periods, accept silence, state when nurse will return. b. arrange to spend 1 hour each day with the patient, ask questions about what the patient is thinking or experiencing, avoid silences. c. sit beside the patient, place hand on patient's arm occasionally, ask if patient would like you to leave if patient does not respond within 10 minutes. d. sit facing the patient, tell patient that although he or she is unwilling to talk, you will read aloud from the daily newspaper to promote orientation.

a. sit with the patient several times a day for short periods, accept silence, state when nurse will return. Rationale: A severely withdrawn patient should be met "at the patient's own level " with silence being accepted. Short contacts are helpful to minimize both the patient's and the nurse's anxiety.

A newly admitted patient is mute and immobile. The patient will hold her limbs in whatever position is imposed. This symptom would be documented as: a. waxy flexibity. b. ambivalence. c. negativism. d. echopraxia.

a. waxy flexibity. Rationale: A patient is said to have waxy flexibility when he/she remains for a long period of time in a position that has been imposed upon him/her.

A young patient with schizophrenia is standing in his pajamas next to the shower. The nurse observes that he seems dazed and indecisive. The most helpful nursing intervention would be to say: a. "It's time for you to take your shower." b. "Take off your pajamas and step into the shower." c. "Is something the matter?" d. "Why are you waiting to get into the shower?"

b. "Take off your pajamas and step into the shower." Rationale: Preoccupied patients or patients who have cognitive dysfunction may have problems with executive functioning. They may be unable to determine what to do even in simple situations. When this occurs, they require simple, concrete directions.

A nurse plans a series of psycho-educational groups for persons with schizophrenia. Which topic would take priority? a. How to complete an application for employment b. The importance of taking your medication correctly c. Ways to dress and behave when attending community events d. How to give and receive compliments

b. The importance of taking your medication correctly Although all of these outcomes are important, correct self-management of pharmacotherapy takes priority. The client cannot maintain remission without the appropriate medication.

A young adult diagnosed with paranoid schizophrenia is transferred to the partial hospitalization program after spending 4 days in an inpatient unit. Select the appropriate outcome for the first week of treatment. The client will: a. Know all other clients by name. b. Voluntarily attend all group sessions. c. Verbalize an absence of hallucinations and delusions. d. Verbalize events that create feelings of anxiety.

b. Voluntarily attend all group sessions. For the first week, voluntarily attending all group sessions is a realistic outcome. It is not necessary for the client to know every name, and it may be difficult for the client to remember and to organize thoughts (A). It is not realistic for hallucinations and delusions to be absent within the first week. The client will still experience some hallucinations and delusions but will learn to adapt (C). Clients with schizophrenia often have difficulty naming and describing emotions; option D is not realistic for the first week.

A patient has received standard antipsychotics for a year. His hallucinations are less intrusive, but the patient remains apathetic, has poverty of thought, cannot work, and is socially isolated. To address these symptoms, the nurse might expect the psychiatrist to prescribe a. haloperidol. b. olanzapine. c. diphenhydramine. d. chlorpromazine.

b. olanzapine. Rationale: Olanzapine is an atypical antipsychotic that targets both positive and negative symptoms of schizophrenia. Options 1 and 4 are standard antipsychotics that target only positive symptoms. Option 3 is an antihistamine.

A nursing intervention designed to help a schizophrenic client manage relapse is to a. schedule the client to attend group therapy. b. teach the client and family about behaviors associated with relapse. c. remind the client of the need to return for periodic blood draws. d. help the client and family adapt to the stigma of chronic mental illness.

b. teach the client and family about behaviors associated with relapse. By knowing what behaviors signal impending relapse, interventions can be quickly invoked when the behaviors occur. The earlier the intervention, the greater the likelihood that a recurrence can be averted.

A client with paranoid schizophrenia refuses food. He states the voices are telling him the food is contaminated and will change him from a male to a female. A therapeutic response for the nurse would be a. "You are safe here in the hospital, nothing bad will happen to you." b. "The voices are wrong about the hospital food. It is not contaminated." c. "I understand that the voices are very real to you, but I do not hear them." d. "Other people are eating the food and nothing is happening to them."

c. "I understand that the voices are very real to you, but I do not hear them." This reply acknowledges the client's reality but offers the nurse's perception that he or she is not experiencing the same thing.

Which symptom would not be assessed as a positive symptom of schizophrenia? a. Delusion of persecution b. Auditory hallucinations c. Affective flattening d. Idea of reference

c. Affective flattening Positive symptoms are the attention-getting symptoms such as hallucinations, delusions, bizarre behavior, and paranoia. They are referred to as florid symptoms. Affective flattening is one of the negative symptoms that contribute to rendering the person inert and unmotivated.

A male patient with the diagnosis of paranoid schizophrenia loses control, punches the door and throws his coffee down the hallway. Which of the following actions will the nurse take to help the patient regain control? a. Speak loudly and quickly to the patient b. Move to within two feet of the patient c. Keep his or her hands visible at his or her side d. Give a detailed explanation of rules

c. Keep his or her hands visible at his or her side Rationale: Keeping one's hands visible and assuming an open posture is important for defusing any patient who is threatening to lose control or who has lost control, but it is especially important if the patient is suspicious of the motives of others, as most paranoid schizophrenic patients are. 1. The nurse should speak calmly and slowly enough to be clearly understood. 2. The patient needs increased bodily space. Two feet is too close. 4. Explanations should be brief and clear.

A client has been receiving antipsychotic medication for 6 weeks. At her clinic appointment she tells the nurse that her hallucinations are nearly gone and that she can concentrate fairly well. She states her only problem is "the flu" that she's had for 2 days. She mentions having a fever and a very sore throat. The nurse should a. suggest that the client take something for her fever and get extra rest. b. advise the physician that the client should be admitted to the hospital. c. arrange for the client to have blood drawn for a white blood cell count. d. consider recommending a change of antipsychotic medication.

c. arrange for the client 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.

The parents of a 17-year-old who has been diagnosed with schizophrenia ask the nurse what the future will be like for their child. The nurse's answer should be predicated on knowledge that the course of the illness is usually: a. a steady, downward decline. b. positive following recovery from the first episode. c. characterized by alternating acute and stable phases. d. totally different for each individual patient.

c. characterized by alternating acute and stable phases. Rationale: Most patients with schizophrenia experience alternating acute and stable phases throughout life. Complete and permanent remission is rare.

A patient displays disorganized, difficult-to-understand speech, behavioral disorganization, and a silly, inappropriate affect. The patient prefers to sit alone and be uninvolved in unit activities, and often appears to be listening and responding to unseen stimuli. The nurse assesses that this patient's behavior most closely conforms to the characteristic behavior of: a. catatonic schizophrenia. b. paranoid schizophrenia. c. disorganized schizophrenia. d. residual schizophrenia.

c. disorganized schizophrenia. Rationale: The presence of disorganization and inappropriate affect characterizes the disorganized type of schizophrenia.

A descriptor for a subtype of schizophrenia is a. delusional. b. dissociated. c. disorganized. d. developmental.

c. disorganized. Disorganized schizophrenia is a subtype of schizophrenia listed in the DSM-IV-TR and refers to the most regressed and socially impaired of all the schizophrenic disorders.

If a patient developed extrapyramidal symptoms (EPS), the nurse would interpret this as resulting from: a. overabundance of dopamine in the extrapyramidal system. b. use of a low-potency, high-dosage antipsychotic. c. dopamine depletion in response to antipsychotic medication administration. d. high doses of antidepressant medications.

c. dopamine depletion in response to antipsychotic medication administration. Rationale: Typical antipsychotic medications reduce symptoms of psychosis by blocking dopamine receptors. However, the extrapyramidal system requires sufficient dopamine for smooth motor movements. When dopamine is depleted due to medication administration, extrapyramidal symptoms result. 1. The opposite is true. 2. Symptoms are not dosage-related. 4. EPS are not commonly seen with use of antidepressant medications.

A client with disorganized schizophrenia would have greatest difficulty with the nurse a. interacting with a neutral attitude. b. using concrete language. c. giving multistep directions. d. providing nutritional supplements.

c. giving multistep directions. The thought processes of the client with disorganized schizophrenia are severely disordered and severe perceptual problems are present, making it extremely difficult for the client to understand what others are saying. All communication should be simple and concrete and may need to be repeated several times.

A client with residual schizophrenia is uninterested in community activities. He lacks initiative, demonstrates both poverty of content of speech and poverty of speech, and seems unable to follow the schedule for taking his antipsychotic medication. The case manager continues to direct his care with the knowledge that his behavior is most likely prompted by a. chronic uncooperativeness. b. personality conflict. c. neural dysfunction. d. dependency needs.

c. 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.

The nurse would evaluate that a patient who has auditory hallucinations has improved when the patient can: a. tell the nurse what the voices say. b. tell the voices to be quiet. c. validate what is real. d. do what the voices command.

c. validate what is real. Rationale: Improvement would be evaluated when the patient can validate with the nurse, or others, what is real. 1. Reporting what the voices say does not indicate improvement. 2. Telling the voices to be quiet is a technique for managing hallucinations and does not indicate improvement. 4. Doing as the voices command is not a sign of improvement, in fact, it can be dangerous

A schizophrenic patient approaches the nurse and says, "The voices are bothering me. They're yelling and telling me I'm bad. Can't you hear them?" The most helpful reply for the nurse to make would be a. "Do you hear the voices often?" b. "Have you been taking your medication regularly?" c. "Forget the voices and ask some other patients to play cards with you." d. "I can't hear the voices, but I can see that you're upset."

d. "I can't hear the voices, but I can see that you're upset." Rationale: The nurse should honestly say that he or she does not hear the voices the patient hears. Yet, for the patient, the experience is real. Acknowledging the patient's distress encourages the patient to identify feelings associated with the experience.

When a client with paranoid schizophrenia tells the nurse "I have to get away. The volmers are coming to execute me," an appropriate response for the nurse would be a. "You are safe here. This is a locked unit and no one can get in." b. "I do not believe I understand the word volmers. Tell me more about them." c. "Why do you think someone or something is going to harm you?" d. "It must be frightening to think something is going to harm you."

d. "It must be frightening to think something is going to harm you." This response focuses on the client's feelings and neither directly supports the delusion nor denies the client's experience. Option 1 gives global reassurance. Option 2 encourages elaboration about the delusion. Option 3 asks for information that the client will likely be unable to answer.

Which nursing diagnosis listed below is of highest priority for a stuporous catatonic patient? a. Noncompliance b. Impaired verbal communication c. Ineffective denial d. Feeding self-care deficit

d. Feeding self-care deficit Rationale: Physical needs must be met to preserve life. Self-care deficit related to immobility as evidenced by inability to feed self is the priority diagnosis.

A client with catatonic schizophrenia has sat mute and rigid for 2 hours. Which nursing intervention would be most appropriate? a. Encourage the client to participate in a group sporting activity. b. Put the client's extremities through passive range of motion exercises. c. Seclude the client until voluntary movement is observed. d. Offer short but frequent verbal phrases to communicate caring.

d. Offer short but frequent verbal phrases to communicate caring. Catatonic schizophrenia may present as stupor or excitement. This client is experiencing stupor, but these phases may shift rapidly. Safety and the risk for violence are primary concerns. Touching the client may result in violence. The client is unable to participate in group activities. Seclusion is not indicated.

A person with disorganized schizophrenia participates in a rehabilitative outpatient program. Select the most appropriate initial outcome for this individual. The individual will: a. Identify environmental triggers that produce feelings of fear. b. Have increased organization of thought patterns. c. Report the absence of auditory and visual hallucinations. d. Set lunch tables correctly and fill cups with ice daily.

d. Set lunch tables correctly and fill cups with ice daily. Outcomes should be measurable. Clients with disorganized schizophrenia have many cognitive and psychomotor deficits. Setting the lunch table and filling cups with ice are simple but challenging activities that support the client in organizing thoughts and behaviors. It is a measurable outcome.

Which side effect of antipsychotic medication can be considered irreversible? a. Anticholinergic effects b. Pseudoparkinsonism c. Dystonic reaction d. Tardive dyskinesia

d. Tardive dyskinesia Tardive dyskinesia is not always reversible with discontinuation of the medication and has no proven cure. Options 1, 2, and 3 often appear early in therapy and can be minimized with treatment.

The type of altered perception most commonly experienced by clients with schizophrenia is a. delusions. b. illusions. c. tactile hallucinations. d. auditory hallucinations.

d. 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 schizophrenic individuals.

Schizophrenia is best characterized as a. split personality. b. multiple personalities. c. ambivalent personality. d. deteriorating personality.

d. deteriorating personality. The course of the disease is marked by recurrent acute exacerbations. With each relapse of psychosis, an increase in residual dysfunction and deterioration occurs.

A nurse who works in the posthospitalization clinic for patients with schizophrenia should assess each patient for signs and symptoms of impending relapse such as a. weight gain and loss of libido. b. loss of appetite and increased sedation. c. increased ability to concentrate and plan. d. difficulty sleeping and feeling tense.

d. difficulty sleeping and feeling tense. Rationale: Signs of potential relapse include feeling tense, difficulty concentrating, trouble sleeping, increased withdrawal, and increase in bizarre or magical thinking.

A patient smiles and giggles while telling the nurse, "My mother died yesterday." The nurse can make the assessment that the patient is displaying: a. autism. b. ambivalence. c. associative looseness. d. inappropriate affect.

d. inappropriate affect. Rationale: Speaking of a sad topic while laughing exemplifies inappropriate affect. 1. Autism is characterized by having little concern for external reality. 2. Ambivalence is the simultaneous presence of opposite emotions. 3. Associative looseness is characterized by stringing unrelated topics together.

A client has reached the stable plateau phase of schizophrenia. An appropriate clinical focus for planning would be a. safety and crisis intervention. b. acute symptom stabilization. c. stress and vulnerability assessment. d. social, vocational, and self-care skills.

d. social, vocational, and self-care skills. During the stable plateau phase of schizophrenia, planning is geared toward client and family education and skills training that will help maintain the optimal functioning of schizophrenic individuals in the community.