Psychotic Disorders Prep U

A charge nurse is educating a new nurse on antipsychotic medications. The charge nurse knows teaching has been effective when the new nurse makes which statement?

"Antipsychotic medication depresses the central nervous system by blocking the postsynaptic transmission of dopamine, serotonin, and norepinephrine."

The guardian of a client diagnosed with schizophrenia indicates to the nurse a concern that the client is at risk for suicide. Which question to the client would the nurse utilize to determine the seriousness of the suicidal idealization?

"Are you planning on hurting yourself?"

At an outpatient visit 3 months after discharge from the hospital, a client says they have stopped their olanzapine even though it controls their symptoms of schizophrenia better than other medications. "I've gained 20 lb (9.1 kg) already. I can't stand it anymore." Which response by the nurse is most appropriate?

"I can help you with a diet and exercise plan to keep your weight down."

Every day for the past 2 weeks, a client with schizophrenia has stood during group therapy and screamed, "Get out of here right now! The elevator bombs are going to explode in 3 minutes!" The next time this happens, how should the nurse respond?

"I know you think there are bombs in the elevator, but there aren't."

A client comes to the mental health clinic 2 days after being discharged from the hospital. The client was given a 1-week supply of clozapine. Which client statement indicates an accurate understanding of the nurse's teaching about this medication?

"I need to keep my appointment here at the clinic this week for a blood test."

The nurse is caring for a client taking risperidone 2 mg daily. It is most important for the nurse to follow up on which client statement?

"I'm constantly sick and feel like I always have a fever."

A client taking clozapine states, "I don't like feeling so sedated during the day. I can hardly keep my eyes open." Which response by the nurse would be most appropriate?

"Let's talk to your health care provider about taking most of the drug at bedtime."

A nurse is caring for a client receiving thioridazine 300 mg TID. It would be most important for the nurse to follow up with which client statement?

"My eye doctor said I have a new pigmented layer on my retina."

A client with bipolar disorder, manic phase, begins to swear at the nurse when reminded to limit telephone calls to 10 minutes. Which response should the nurse make?

"Stop! Swearing is not appropriate behavior."

A client is admitted to the psychiatric unit with delusional thinking. The client, who is overweight and has a history of eating when stressed, now shows a lack of interest in eating at meal times. The client states, "I am unworthy of eating. My children will die if I eat." Which response by the nurse is most appropriate?

"That sounds scary. Tell me more about how you are feeling."

A client who is incoherent and agitated comes to the emergency department. The client reports visual and auditory hallucinations. The healthcare provider orders haloperidol, 5 mg IM. When educating the client on this medication, which statement by the nurse is correct?

"This medication will help decrease your tension and agitation."

A client with schizophrenia and delusions tells a nurse, "There is a man wearing a red coat who's out to get me." The client exhibits increasing anxiety when focusing on the delusion. Which response by the nurse is appropriate?

"This subject seems to be troubling you. Let's walk to the activity room."

Which response demonstrates that the parents of a child with newly diagnosed schizophrenia understand their child's diagnosis?

"We'll watch our child take the pills and call the physician if the child doesn't swallow them."

A young client diagnosed with paranoid schizophrenia is talking with the nurse and says, "You know, when I thought everyone was out to get me, I was staying in my apartment all the time. Now, I would like to get out and do things again." What is the best initial response by the nurse?

"What activities did you enjoy in the past?"

A 20-year-old client with paranoid schizophrenia is on the fourth day of hospitalization. The client's parents visit and state to the nurse, "What did we do wrong? What caused this awful thing to happen?" Which explanation by the nurse is most accurate and therapeutic?

"You did not cause schizophrenia by doing something wrong. Schizophrenia is a brain disease."

Which concept is most important for a nurse to communicate to a client preparing to sign an informed consent for electroconvulsive therapy (ECT)?

"You may experience a time of confusion after the treatment."

A client is about to be discharged with a prescription for the antipsychotic agent haloperidol, 10 mg by mouth twice per day. During a discharge teaching session, a nurse should provide which instruction to the client?

Apply a sunscreen before exposure to the sun.

A nurse is caring for a client receiving a dopamine receptor agonist for treatment of extrapyramidal symptoms caused by antipsychotic medications. What evaluation would indicate a therapeutic response to this drug?

Client experiences a decrease in dystonia.

Teaching for women of childbearing years who are receiving antipsychotic medications includes which statement?

Continue previous contraceptive use even if you're experiencing amenorrhea.

While planning the care for a client with paranoid delusions, which will be the nurse's initial goal for the client?

Establish trust with staff.

A client's admitting diagnosis is schizophrenia with an episodic delusional disorder. The nurse applies what intervention strategy while working with the client in this pronounced delusional state?

Focus on the client's underlying feelings, and redirect inappropriate responses.

A client with schizophrenia reports doing very little all day except sleeping and eating. Which intervention should the nurse use with this client?

Help the client set up a daily activity schedule.

A client is admitted to the psychiatric emergency department with difficulty sleeping, poor judgment, and incoherent speech. The client reports being a special messenger from the Messiah who needs to be "sacrificed to save the world." Which action should the nurse take first?

Institute suicide precautions.

The director of an outpatient rehab program tells the nurse that a client with schizophrenia had done well for 6 months until last week, when a new person started the program. This new person worked faster than the client did and took their place as leader of the group. Based on this information, which intervention is most appropriate?

Make an appointment to meet the client at the mental health center, and ask them about the situation.

A female client with paranoid schizophrenia has been hearing negative voices and "getting special messages from various sources." Which intervention is most appropriate for the client's symptoms?

Monitor her reactions to television programs.

A nurse is caring for a client who recently starting taking haloperidol. Which client assessment would be a priority for nurse follow up?

Neck stiffness with head tilt

A client with a chronic mental illness has worked as a hotel maid for the past 3 years. The client tells the nurse they are thinking of quitting the job because "voices on television are talking about me." What action should the nurse take first?

Obtain information about the client's medication compliance.

A nurse is caring for a client who is in a catatonic state due to schizophrenia. Which nursing intervention would be most important in the care of this client?

Predict and fulfill client needs until the client is more active.

During a meeting on the unit, a client with schizophrenia stands up and states, "snowman stuck never forget." What is the best response by the nurse?

Reply to the client with a yes or no statement asking whether the client is cold.

After assessing the blood pressure of a client with a diagnosis of catatonia, the client's arm remains outstretched in an awkward position. Which of the following is the correct action by the nurse?

Reposition the client's arm.

When assessing a hospitalized client diagnosed with major depression and borderline personality disorder, the nurse should ask the client about which of the following first?

Suicidal thoughts.

A 23-year-old client diagnosed with schizophrenia cheerfully announces, "My parents and I are so excited that I'm pregnant. They're willing to help us take care of the baby too." Which reason should cause the nurse to be concerned about this situation?

Symptom management will be difficult in early pregnancy without medications.

A nurse is teaching a client about the prescribed drugs, chlorpromazine and benztropine. What evaluation would indicate a therapeutic response to these drugs?

The client is experiencing less psychosis and a decrease in extrapyramidal symptoms.

A nurse is caring for a client with schizophrenia. Which outcome requires revising the client's care plan?

The client spends more time alone.

What should be charted by the nurse when the client has an involuntary commitment or formal admission status?

The client's receipt of information about status and rights should be charted.

The parents of a teenager recently diagnosed with schizophrenia ask the nurse about whether their other children will be susceptible as well. The nurse explains that schizophrenia is caused by:

a combination of biological, psychologic, and environmental factors.

The nurse is planning care for a client who has been experiencing a manic episode for 6 days and is unable to sit still long enough to eat meals. Which choice will best meet the client's nutritional needs at this time?

a peanut butter sandwich

A client has refused to take a shower since being admitted 4 days earlier and tells a nurse, "There are poison crystals hidden in the showerhead. They'll kill me if I take a shower." Which nursing action is most appropriate?

accepting these fears and allowing the client to take a sponge bath

A client who was prescribed clozapine 2 months ago arrives in the clinic and informs the nurse that the they have been feeling extremely fatigued and feverish and has a sore throat. The nurse observes that the client has two small ulcerations of the oropharynx. Which does the nurse suspect may be occurring with this client?

agranulocytosis

After 3 days of taking haloperidol, a client shows an inability to sit still, is restless and fidgety, and paces around the unit. The client is showing signs of which extrapyramidal adverse reactions?

akathisia

A client with schizophrenia tells the nurse that they do not go out much because they don't have anywhere to go, and they do not know anyone in the apartment building where they are staying. Which action is most beneficial for the client at this time?

arranging for the client to attend day treatment at the clinic

The nurse is planning the care of a client with schizophrenia. The nurse understands that the client will need the most extensive laboratory monitoring regimen if which medication is prescribed?

clozapine

A client has been admitted to the emergency department. The client's family tells the nurse that the client has suddenly become lethargic and is "not making sense." The client has not had anything to eat or drink for the last 8 hours. The nurse further assesses the client using the Confusion Assessment Method (CAM). The client's responses to the questions are rambling, and the client is not able to focus clearly to answer the nurse's questions. Based on these findings, the nurse should report that the client has which problem?

delirium

A client thinks he is being followed by foreign agents who are after secret papers in his briefcase. What thought process does this indicate?

delusion of persecution

A nurse is caring for a client with schizoaffective disorder. The client is currently experiencing auditory hallucinations. Which nursing actions would take first priority for this client?

engaging the client in reality-based conversations

A client with schizophrenia comes to the outpatient mental health clinic 5 days after being discharged from the hospital. The client was given a 1-week supply of clozapine. The client tells the nurse that they have too much saliva and frequently need to spit. The nurse interprets the client's statement as being consistent with which factor?

expected adverse effect of clozapine

The nurse is caring for a hospitalized client who has a disorder of the amygdala. Which symptom can the nurse anticipate the client will have?

impulsive acts of aggression

A client has catatonic behaviors. Which outcome would indicate a medication has been most effective in improving long-term behavior?

initiates simple activities without directions.

A client with schizophrenia reports hearing the voices of the client's dead parents. To help the client ignore the voices, the nurse should recommend that the client:

listen to a personal stereo through headphones and sing along with the music.

A client with schizoaffective disorder is brought to the hospital by a family member. The family member states that the client is having an increase in auditory hallucinations and is becoming significantly more withdrawn. The nurse reviewing the admission blood work expects which blood level to be subtherapeutic?

lithium carbonate

Which group of characteristics should a nurse expect to see in the client with schizophrenia?

loose associations, grandiose delusions, and auditory hallucinations

The client with histrionic personality disorder is melodramatic and responds to others and situations in an exaggerated manner. The nurse should recommend which activity for this client?

role-playing

A client has a history of schizophrenia. Because of a history of noncompliance with antipsychotic therapy, the client will receive fluphenazine decanoate injections every 4 weeks. Before discharge, what should the nurse include in the teaching plan?

sitting up for a few minutes before standing to minimize orthostatic hypotension

When discharging a client after treatment for a dystonic reaction, an emergency department nurse must ensure that the client understands:

the client must take benztropine as ordered to prevent a return of symptoms.

A client with schizophrenia is withdrawn and suspicious of others and projects blame. The client's behavior reflects problems in which stage of development as identified by Erikson?

trust versus mistrust

The nurse is reviewing laboratory values of a client receiving clozapine. Which lab value does the nurse immediately report to the health care provider (HCP)?

white blood cell (WBC) count of 3500/µL (3.5 × 109/L)

The nurse should judge client education regarding valproic acid as effective if the client states which statement?

"I might need to take the valproic acid for a long time."

A client is admitted to the psychiatric unit exhibiting extreme agitation, disorientation, and incoherence of speech with frantic and aimless physical activity and grandiose delusions. Which would the highest priority goal in planning nursing interventions?

The client will show no self-harm or harm to staff.

A client prescribed an antipsychotic medication develops a high fever, muscle rigidity, and hypertension. The nurse immediately notifies the health care provider with concerns that the client is experiencing which life-threatening condition?

neuroleptic malignant syndrome

A client who takes neuroleptic medication for treatment of chronic schizophrenia is admitted to the psychiatric unit. Nursing assessment reveals rigidity, fever, hypertension, and diaphoresis. Which life-threatening reaction do these findings suggest?

neuroleptic malignant syndrome

What is the priority symptom to assess for in the client who is taking risperidone 1 mg, orally twice a day?

orthostatic hypotension

A client with a diagnosis of schizophrenia is admitted to the inpatient unit of the mental health center. The client starts shouting, "The government of France is trying to kill me!" Which response is most appropriate?

"I don't see evidence that a foreign government is trying to hurt you. You must feel frightened by this."

A client diagnosed with schizophrenia is being discharged on aripiprazole 5 mg every night. When developing the teaching plan about the most common adverse effects, the nurse should include which information? Select all that apply.

-headaches -transient mild anxiety -insomnia

A client is admitted with a diagnosis of schizotypal personality disorder. Which signs would this client exhibit during social situations?

paranoid thoughts

A client's medication order reads, "Thioridazine 200 mg P.O. q.i.d. and 100 mg P.O. PRN" A nurse should:

question the physician about the order.

During the initial interview, a client with schizophrenia suddenly turns to an empty chair and whispers, "Now just leave. I told you to stay home. There isn't enough work here for both of us!" What is the nurse's best initial response?

"When people are under stress, they may see things or hear things that others don't. Is that what just happened?"

A client was admitted to the behavioral health unit with a diagnosis of severe depression. The client was started on bupropion. Forty-eight hours after initiating the drug therapy, the client has recovered from depression, is laughing, singing, and dancing in the hallway and in the sitting room. How should the nurse interpret this behavior?

The client is most likely bipolar rather than depressed, and the healthcare provider should be notified of the behavior.

A nurse is reviewing the medication list of a client who presents with slow, involuntary muscle spasms of the arms and legs and twisting of the neck. The nurse reviews the client's prescriptions for which medication that could correlate with these symptoms?

haloperidol

The nurse is caring for a client on the psychiatric unit. The client states, "The voices are bothering me. They are yelling and telling me stuff. They are really bad." Which responses by the nurse would be most appropriate?

"I do not hear any voices. What are you hearing?"

The parent of a young adult client diagnosed with schizophrenia is asking questions about their child's antipsychotic medication, ziprasidone. Which statement by the parent reflects a need for further teaching?

"I should give them benztropine to help prevent constipation from the ziprasidone."

A client with schizophrenia hears a voice saying the client is evil and must die. The nurse understands that this client is experiencing:

a hallucination.

A nurse is caring for a client with schizophrenia who states, "I can't handle the voices anymore! It's over! I've done all I can." Which statement by the nurse is best?

"Are you thinking of hurting yourself?"

The client tells the nurse that they stopped taking olanzapine 2 weeks ago because they are better and want "to make it on my own without this darned medicine." What would be the nurse's most therapeutic response?

"I know you get tired of taking the medication, especially when you are doing well. Is there any special reason you decided to stop right now?"

A client reports having thoughts of being followed by foreign agents who are after the client's "secret papers." Which response by the nurse is most appropriate when responding to the client's disturbed thought process?

"I think these thoughts are frightening to you."

The nurse recognizes the client in the emergency department from a picture in the local paper. The client has recently received a major scholarship for high academic achievement. The client tells the nurse that they hear voices that tell them they are worthless. The client has attempted suicide. What statement is most appropriate for the nurse to use first when attempting to establish a therapeutic relationship?

"I'm sorry this is happening to you."

A client with a 5-year history of multiple psychiatric admissions is brought to the emergency department by the police. This client was found wandering the streets disheveled, shoeless, and confused. The client points to the police officer and states, "That person was sent by the devil to kill me." Which response by the nurse is best?

"That sounds scary. That person is a police officer and brought you to the hospital."

The nurse is providing discharge teaching to a client diagnosed with schizophrenia. Which client statement(s) would cause the nurse to intervene? Select all that apply.

-"As soon as I start feeling like myself again, I'll decrease my medications." -"If the voices come back, I'll stay at home to ensure my safety."

An outpatient client with schizophrenia has been withdrawn from friends and family for 3 weeks. What is the most appropriate long-term goal for the client?

attending day therapy three times a week

A client diagnosed with paranoid personality disorder is hospitalized for physically threatening their spouse because they suspect the spouse is having an affair with a coworker. What approach should the nurse employ with this client?

matter-of-fact

Important teaching for a client receiving risperidone should include advising the client to:

notify the physician if the client notices an increase in bruising.

The nurse is facilitating a group of clients with schizophrenia when one client says, "I like to drive my car, bar, tar, far." This client is exhibiting:

clang association.

A nurse is caring for a client admitted with arching of the back, extension and rotation of the neck, and slow involuntary contractions of the arms and neck. After review of the client's medication list, the nurse would be correct in associating these symptoms with which medication?

haloperidol

A client with a diagnosis of borderline personality disorder is admitted to the psychiatric unit. What assessment data obtained by the nurse correlates with the client's disorder?

unpredictable actions and intense interpersonal relationships

A client states that they hear God's voice telling them that they have sinned and they need to be punished. Which response by the nurse is most important?

"Do you think you need to punish yourself now?"

A client with chronic schizophrenia is admitted to the hospital on an emergency detention. The client states to the nurse, "I didn't do anything wrong. I was just carrying out the orders God gave me to paint an X on the door of all sinners." Several hours after being admitted, the client wants to leave the hospital. In addition to explaining that the staff is concerned about the client's health and safety, which of the following should the nurse tell the client?

"The court has mandated that you undergo a 72-hour evaluation."

The mother of a client with schizophrenia calls the visiting nurse in the outpatient clinic to report that their child has not answered the phone in 10 days. "They were doing so well for months. I don't know what's wrong. I'm worried." Which response by the nurse is most appropriate?

"They may have stopped taking their medications. I'll check on them."

A client who is experiencing hallucinations asks if a nurse hears the voices saying that the client should never have been born. The nurse's most appropriate response would be:

"I don't hear any voices, but I believe you can hear them."

A 42-year-old female who comes to the clinic frequently for symptoms of neck pain is upset because there is no medical cause for the discomfort. Select the intervention(s) the nurse would take to help meet the client's needs.

-Acknowledge the client's pain -Ask what helps relieve the pain -Review activities to use as a distraction -Encourage participation in groups of interest

A nurse is monitoring a client who appears to be hallucinating. The client is gesturing at a figure on the television and appears agitated with speech containing paranoid content. Which nursing interventions are appropriate at this time? Select all that apply.

-Reassure the client that there is no danger. -Acknowledge the presence of the hallucinations. -Give simple commands in a calm voice.

The nurse is monitoring a client who appears to be hallucinating. The client displays paranoid speech content, seems agitated, and gestures at a figure on the television. Which nursing interventions are appropriate? Select all that apply.

-Reinforce that the client is not in any danger. -Acknowledge the presence of the hallucinations. -Use a calm voice and simple commands.

An outpatient client who has a history of paranoid schizophrenia and chronic alcohol dependency has been taking risperidone for several months. The client reports that they stopped drinking 4 days ago. The client is very frightened by the tactile hallucinations of bugs crawling under her skin. Which factor should the nurse incorporate into the plan of care when explaining the tactile hallucinations?

alcohol withdrawal

A client with a diagnosis of schizophrenia and paranoid personality disorder asks the nurse, "How do I know what's really in those pills?" Which response by the nurse is best?

"How would you feel if I allowed you to open the individual medication wrappers?"

A client tells a nurse that people from Mars are going to invade the Earth. Which response by the nurse would be therapeutic?

"That must be frightening to you. Can you tell me how you feel about it?"

A client is admitted to the psychiatric unit accompanied by their spouse. The client brings six suitcases and three shopping bags and orders the nurse to carry the bags. The client's spouse states they have been purchasing items that they cannot afford and has not slept for 4 nights. Which additional information would be a priority for the nurse to seek from the client's spouse?

the client's fluid and food intake

The parents of a 20-year-old client admitted 4 days ago with a diagnosis of paranoid schizophrenia are attending a family psychoeducation group in the hospital. Which statement indicates that the parents understand their child's illness and management?

"Tasks as simple as getting out of bed and showering in the morning may be difficult."

The nurse is observing a client who is sitting alone in the day room and is intently focused on a nearby empty chair. Suddenly the client begins laughing hysterically and making frantic hand gestures at the chair. When the nurse approaches the client, the client looks over at the chair, whispers something unintelligible, and shakes their head. How would the nurse best assess the client's behavior in this situation?

a hallucination

A client begins clozapine therapy after several other antipsychotic agents fail to relieve psychotic symptoms. The nurse instructs the client to return for weekly white blood cell (WBC) counts to assess for which adverse reaction?

granulocytopenia

A client with schizophrenia is admitted to the psychiatric unit of a local hospital. During the next several days, the client is seen laughing, yelling, and talking out loud to no one. This behavior is characteristic of:

hallucination