Schizophrenia, psychotic, Antipsychotic/Anxiolytic drugs

A client with schizophrenia states, "I hear the voice of King Tut." Which response by the nurse is therapeutic? A. "I don't hear the voice, but I know you hear what sounds like a voice." B. "King Tut has been dead for years, so that can't be his voice." C. "You shouldn't focus on that voice; it is not real." D. "Does the voice sound like someone you know?"

A. "I don't hear the voice, but I know you hear what sounds like a voice." This response makes a factual statement about the client's hallucination. Telling the client not to focus on the voice is judgmental. Telling the client not to worry because the voice is not real is a flippant, dismissive response. Saying "King Tut has been dead for years" is dismissive.

A client is admitted with a diagnosis of schizophrenia. The client is paranoid and the student nurse asks the charge nurse about the approach to take with the client. The client has been exhibiting hostility and isolation. Which response by the student indicates understanding of the correct approach toward this client? A. Tell the client that if they do not comply with the rules, you will inform the doctor. B. Respect the client's need for personal space and avoid physical contact with the client. C. Greet the client by gently touching their arm, and telling the client they can trust you. D. Inform the client that they are unwell and you will assist them.

B. Respect the client's need for personal space and avoid physical contact with the client. A newly admitted client who is paranoid needs to have a sense of trust before the nurse attempts to touch the client. Touch is not therapeutic with someone who is suspicious. Using statements that imply the client is unwell or that potentially contain veiled threats will only increase the client's anxiety and lead to increased potential for hostility and anger.

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? A. akathisia B. neuroleptic malignant syndrome C. dystonia D. tardive dyskinesia

B. neuroleptic malignant syndrome

A young client diagnosed with 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? A. "With whom do you want to do things?" B. "What kind of transportation do you use?" C. "What activities did you enjoy in the past?" D. "How much money can you spend?"

C. "What activities did you enjoy in the past?" Knowing the client's interests is the best place to begin to help the client resocialize. Knowing with whom the client wishes to socialize, what transportation she has, or how much spending money she has may be relevant questions, but these questions should be asked after the question concerning what activities the client enjoyed in the past.

A client with schizophrenia repeatedly uses profanity during an activity therapy session. Which response by the nurse is appropriate? A. "Your behavior won't be tolerated. Go to your room immediately." B. "I'm disappointed in you. You can't control yourself for even a few minutes." C. "You're just doing this to get back at me for making you come to therapy." D. "Your cursing is interrupting the activity. Take time out in your room for 10 minutes."

D. "Your cursing is interrupting the activity. Take time out in your room for 10 minutes." The nurse should set limits on client behavior to ensure a comfortable environment for all clients. The nurse should accept hostile or quarrelsome client outbursts within limits without becoming personally offended. Stating that the client's behavior is a way of punishing the nurse is incorrect because it implies that the client's actions reflect feelings toward the staff instead of the client's own misery. Judgmental remarks, such as "I'm disappointed in you" and "You can't control yourself" may decrease the client's self-esteem.

Teaching for women of childbearing years who are receiving antipsychotic medications includes which statement? A. Incidence of dysmenorrhea may increase while taking this drug. B. Amenorrhea is irreversible. C. This medication may result in heightened libido. D. Continue previous contraceptive use even if you're experiencing amenorrhea.

D. Continue previous contraceptive use even if you're experiencing amenorrhea. Women may experience amenorrhea, which is reversible, while taking antipsychotics. Because amenorrhea doesn't indicate cessation of ovulation, the client who experiences amenorrhea can still become pregnant. She should be instructed to continue contraceptive use even when experiencing amenorrhea. Dysmenorrhea isn't an adverse effect of antipsychotics, and the depressant effect generally decreases libido.

What is the most appropriate long-term goal for an outpatient client with schizophrenia who has been withdrawn from friends and family for 3 weeks? A. calling the client's mother once a day B. allowing two friends to visit every day C. remaining out of bed for 10 hours a day D. attending day therapy three times a week

D. attending day therapy three times a week Attending day therapy three times per week is a long-term goal that will show the most progress in overcoming withdrawal. The client's calling his mother is a first step in getting out of a severe withdrawal. Allowing two friends to visit every day would be appropriate if the client is successful with calling his mother once a day. Insufficient information is presented in the scenario to indicate that excessive sleep is a problem.

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? A. "Are you thinking of hurting yourself?" B. "What do you mean by that statement?" C. "Have you been taking your medications?" D. "Have you felt like this before?"

A. "Are you thinking of hurting yourself?" Risk of suicide is greater in patients with a serious illness, including mental or emotional disorders. The nurse should recognize the client's statement as a warning for possible self-harm. With this concern, the nurse should ask the client a yes/no question regarding self-harm. Using an open-ended question is therapeutic, but assessing the risk of self-harm requires a more direct approach. Asking about medications or past feelings should wait until after the risk for self-harm is determined.

A client with schizophrenia is responding well to risperidone and is no longer psychotic. After the nurse teaches the client about managing the illness, which statement by the client reflects a need for further intervention? A. "I just don't know if I can remember to keep taking medicines every day." B. "I can name the side effects of risperidone, but I'm not having any." C. "I don't listen to my mom's religious beliefs about not using medicines." D. "When my thoughts start racing, I know I need to relax more."

A. "I just don't know if I can remember to keep taking medicines every day." The major cause of relapse is nonadherence to the medication treatment plan. If the client is worried about remembering to take the medicines on a regular basis, it is a warning sign to the nurse that the client may be at risk for noncompliance. The nurse needs to discuss strategies to help the client establish a new routine such as using digital reminders, integrating medications into a daily routine, and utilizing family support systems when available. Understanding when to relax and the side effects of medicines are positive findings. Choosing not to listen to a family member's negative beliefs about medication is also a positive finding.

A client experiencing a schizophrenic episode is hospitalized. The client is attempting to hit and bite the staff. When the nurse phones the primary care provider for orders to help calm the client, the nurse anticipates what medication is likely to be ordered? A. haloperidol B. chlorpromazine C. lithium carbonate D. amitriptyline hydrochloride

A. haloperidol Haloperidol administered I.M. or I.V. is the drug of choice for acute aggressive psychotic behavior. Chlorpromazine is also an antipsychotic drug; however, it causes more pronounced sedation than haloperidol. Lithium carbonate is useful in bipolar disorder, and amitriptyline is used for depression.

A client with schizophrenia tells the nurse, "My intestines are rotted from the worms chewing on them." This statement indicates a: A. delusion of persecution. B. somatic delusion. C. delusion of grandeur. D. jealous delusion.

B. somatic delusion. Somatic delusions focus on bodily functions or systems and commonly include delusions about foul odor emissions, insect infestations, internal parasites, and misshapen parts. Delusions of persecution are morbid beliefs that one is being mistreated and harassed by unidentified enemies. Delusions of grandeur are gross exaggerations of one's importance, wealth, power, or talents. Jealous delusions are delusions that one's spouse or lover is unfaithful.

A client's nursing care plan includes the following prescription: "Assess for auditory hallucinations." What behavior would suggest to the nurse the client may be experiencing auditory hallucinations? A. performing rituals, avoiding open places B. distrust, fear, suspicion C. elevated mood, hyperactivity, distractibility D. poor eye contact, tilted head, mumbling to self

D. poor eye contact, tilted head, mumbling to self Cues that the client is experiencing auditory hallucinations include eyes looking around the room as though looking for a speaker, tilting the head to one side as though listening, and mumbling or talking aloud as though responding to someone. Performing rituals and avoiding open places is associated with anxiety and compulsive behaviors. Elevated mood and hyperactivity are features of a manic episode. Distrust and suspicion are prevalent in paranoia.

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? A. "Let's talk to your health care provider about taking most of the drug at bedtime." B. "Going to bed earlier at night might help." C. "Sleep as long as you need to, and nap fairly often." D. "Try waking up an hour earlier to see if that helps."

A. "Let's talk to your health care provider about taking most of the drug at bedtime." Sedation and drowsiness are common adverse effects of clozapine. Usually, taking the majority of the dose at bedtime is helpful. By suggesting that the client and the nurse talk to the health care provider about taking most of the drug at bedtime, the nurse addresses the client's concern and advocates for the client's needs. The other statements are inappropriate because they minimize the client's concern, possibly leading to noncompliance if the problem continues without appropriate intervention.

Which intervention is essential when caring for a client who is experiencing delirium? A. controlling behavioral symptoms with low-dose psychotropics B. identifying the underlying causative condition or illness C. manipulating the environment to increase orientation D. decreasing or discontinuing all previously prescribed medications

B. identifying the underlying causative condition or illness The most critical aspect of caring for the client with delirium is to institute measures to correct the underlying causative condition or illness. Controlling behavioral symptoms with low-dose psychotropics, manipulating the environment, and decreasing or discontinuing all medications may be dangerous to the client's health.

A client with schizophrenia reports doing very little all day except sleeping and eating. Which intervention should the nurse use with this client? A. Arrange for the client to move to a group home with structured activities. B. Schedule three meals per day to increase the amount of time the client spends out of bed. C. Help the client set up a daily activity schedule to include setting a wake-up alarm. D. Ask a relative to call the client at least 10 times a day to decrease the sleeping.

C. Help the client set up a daily activity schedule to include setting a wake-up alarm. The client with schizophrenia needs more structure every day to improve functioning. Therefore, helping the client to set up a daily activity schedule is most appropriate. However, a group home is not necessary. The client is already eating. Having meals brought in would increase the client's dependence, not his activity level. Asking a relative to call the client 10 times per day is unrealistic given the typical daily responsibilities of a healthy relative.

A client is sitting in the dining area and laughing out loud, shaking her head, and whispering behind her hand. Suddenly the client begins banging her head against the wall. Which intervention by the nurse is most appropriate? A. Stand in the doorway and say, "I'll have to put you in restraints if you don't stop that." B. Call the operator and page the emergency response team immediately to the unit. C. Approach the client calmly and say, "You need to write your feelings down in your journal." D. Calmly walk over to the client and say, "Tell me what's going on."

D. Calmly walk over to the client and say, "Tell me what's going on." Asking the client to tell the nurse what is going on encourages the client to discuss altered perceptions rather than feel guilt or shame, while supporting the client with your presence. Approaching the client to encourage journal writing is incorrect because clients experiencing psychosis have difficulty following abstract instructions and focusing attention. Calling the operator and paging the emergency response team immediately to the unit is incorrect because the client is not exhibiting violence toward others and verbal de-escalation techniques have not been tried first. Standing in the doorway and saying, "I'll have to put you in restraints if you don't stop that," is threatening to punish the client rather than helping the client gain control of their behaviors.

A client with chronic schizophrenia has received 10 mg of fluphenazine hydrochloride PO q.i.d. Now the client has a temperature of 102° F (38.9° C), a heart rate of 120 beats/minute, a respiratory rate of 20 breaths/minute, and a blood pressure of 210/140 mm Hg. Because the client is also confused and incontinent, the nurse suspects neuroleptic malignant syndrome. What steps should the nurse take? A. Withhold the client's next dose of fluphenazine, administer an antipyretic agent, and increase the client's fluid intake. B. Give the client the next dose of fluphenazine and restrict the client to an empty room to decrease stimulation. C. Give the client the next dose of fluphenazine, call the physician, and monitor the client's vital signs. D. Withhold the client's next dose of fluphenazine, call the physician, and monitor the client's vital signs.

D. Withhold the client's next dose of fluphenazine, call the physician, and monitor the client's vital signs. Neuroleptic malignant syndrome is a dangerous adverse effect of neuroleptic drugs such as fluphenazine. The nurse should withhold the next dose, notify the physician, and continue to monitor the client's vital signs. Although an antipyretic agent may be used to reduce fever, increased fluid intake is contraindicated because additional fluid may further increase the client's fluid volume, elevating the blood pressure even more.

An outpatient client who has a history of paranoid schizophrenia and chronic alcohol dependency has been taking risperidone for several months. She reports that she 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? A. interaction of alcohol and risperidone B. ineffectiveness of risperidone C. alcohol intoxication D. alcohol withdrawal

D. alcohol withdrawal Tactile hallucinations are more common in alcohol withdrawal than in schizophrenia. Therefore, the nurse should explain that these hallucinations are the result of withdrawal from alcohol. Because the client stopped drinking 4 days ago, the client is not intoxicated. Risperidone has little effect on symptoms of alcohol withdrawal. It is prescribed for symptoms of schizophrenia. Alcohol and risperidone have an additive effect, not one of causing hallucinations.