Chapter 16: Schizophrenia

A client in an inpatient setting has a delusion that there are a multitude of undetectable noxious gases in circulation that have the potential to poison the client and others. Which of the nurse's responses is most therapeutic? "There are actually no poison gases in the atmosphere that we don't know about." "Why do you think that you keep insisting on this belief?" "If we detect a poison gas here, I promise that you'll be the first to know." "I can assure you that you are actually very safe here."

"I can assure you that you are actually very safe here." Assuring a client of his or her safety is a more therapeutic intervention than expressing exasperation with the client's delusions, arguing against them, or implicitly confirming them.

In working with the individual and family, which is the most accurate statement the nurse can make in order to teach the client and family about schizophrenia? "Schizophrenia is being found to be related more closely to family dysfunction than to physiology, which is why family therapy is the most effective treatment for this disorder." "It is more effective to treat the individual on a one-to-one basis than to involve the family in treatment because it is a very complicated process." "Medications for schizophrenia have not changed much since the early 1950s, although there are some medications that may be helpful." "Individuals with schizophrenia do have differences in brain structure and function that cause a variety of symptoms such as lack of motivation and hearing voices."

"Individuals with schizophrenia do have differences in brain structure and function that cause a variety of symptoms such as lack of motivation and hearing voices." Excessive amount of the neurotransmitter dopamine allows nerve impulses to bombard the mesolimbic pathway, the part of the brain normally involved in arousal and motivation. Normal cell communications are disrupted, resulting in the development of hallucinations and delusions. Abnormalities in brain shape and brain circuitry are being researched.

A client is diagnosed with schizophreniform disorder. The nurse is reviewing the client's medical record and finds that the client's symptoms have been present for at least how long? 8 months 1 month 1 week 1 year

1 month The essential features of schizophreniform disorder are identical to those of criteria A for schizophrenia, with the exception of the duration of the illness, which can be less than 6 months. Symptoms must be present for at least 1 month to be classified as a schizophreniform disorder.

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

A 20-year-old is experiencing a gradual decrease in the ability to concentrate, be productive, and sleep restfully. Gradual, subtle behavioral changes appear during the prodromal phase of schizophrenia, such as tension, the inability to concentrate, insomnia, withdrawal, or cognitive deficits. No symptoms are present in the premorbid phase, and relapses occur in the progressive and chronic phases. Diagnosis of the disease marks the beginning of the onset phase

During an admission assessment with a psychiatric-mental health nurse, a client states that the client hears the voice of God in the client's head and the voice is telling the client that the client is worthless. How should the nurse document this symptom? Thought broadcasting Thought insertion A delusion A hallucination

A hallucination Hallucinations are sensory perceptions with a compelling sense of reality but with no actual objective basis. During auditory hallucinations (the most common form), clients may hear the voice of God or close relatives, two or more voices with a running commentary about the client's behavior, or voices that command certain acts. Usually the voices are obscene, accusatory, or insulting. They may call clients names and make nasty remarks.

A mental health client has been prescribed clozapine for the treatment of schizophrenia. The nurse should be alert to which potentially life-threatening adverse effects of this medication? Agranulocytosis Weight loss Hemorrhage Palpitations

Agranulocytosis Agranulocytosis is a life-threatening adverse effect of clozapine. White blood cell counts should be monitored frequently due to extremely low levels of white blood cells. Weight gain occurs with certain antipsychotics. Palpitations and hemorrhage are not generally associated with antipsychotics.

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

Agranulocytosis tăng bạch cầu hạt Agranulocytosis is manifested by a failure of the bone marrow to produce adequate white blood cells. Neuroleptic malignant syndrome is a life-threatening reaction to neuroleptic medication that requires immediate treatment. Tardive dyskinesia causes involuntary movements of the tongue, mouth, facial muscles, and arm and leg muscles. Dystonia is characterized by cramps and rigidity of the tongue, face, neck, and back muscles.

A nurse monitoring client medication needs to recognize side effects quickly and intervene promptly for which reason? Provide support to the client and encourage adherence as past side effects rarely reoccur Alleviate the side effects and help client maintain adherence Provide support to the client and let the client know this is normal Determine adequate dosage is maintained to control symptoms

Alleviate the side effects and help client maintain adherence Recognizing a medication's side effects quickly and intervening promptly to alleviate them will help maintain adherence.

When assuming the management of the care of a delusional client, which should be the nurse's priority intervention? Encourage the client to talk about the reasoning behind his or her delusion Assure the client that he or she is safe in this milieu Identify what triggers the delusion Acknowledge that there may be some truth in the delusion

Assure the client that he or she is safe in this milieu Assuring the client that he or she is in a safe environment is the first step in the establishment of a therapeutic relationship that is vital to successful psychiatric treatment.

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

Benztropine Benzotropine is an anticholinergic drug used to relieve drug-induced extrapyramidal adverse effects, such as muscle weakness, involuntary muscle movement, pseudoparkinsonism, and tardive dyskinesia.

A nurse is interviewing a client diagnosed with schizophrenia when the client begins to say, "Kite, night, right, height, fright." What term would the nurse use to document this action? Verbigeration. Stilted language. Clang association. Neologisms.

Clang association. The client is manifesting clang association, which is the repetition of words or phrases that are similar in sound but are in no other way connected. Stilted language is the use of overly and inappropriate artificial formal language. Verbigeration is the purposeless repetition of words or phrases. Neologisms are words that are made up that have no common meaning and are not recognized.

In managing the milieu for clients with schizophrenia, the nurse considers which the priority? Client safety Social skills training Client and family education Recreational activities

Client safety Explanation: Milieu management refers to providing an environment rich with therapeutic possibility. The inpatient client with a thought disorder likely has impaired judgment and reality testing. Also, safety needs are paramount. Health care staff members assume responsibility for the client's well-being and physical care when he or she cannot meet those basic needs.

A hospitalized client diagnosed with schizophrenia is receiving antipsychotic medications. While assessing the client, a nurse identifies signs and symptoms of a dystonic reaction. Which agent would the nurse expect to administer? Propranolol Risperidone Aripiprazole Diphenhydramine dystonic reaction: loan truong co

Diphenhydramine For dystonic reactions, the drug of choice is benztropine mesylate or diphenhydramine. Propranolol could be used to treat akathisia. Risperidone and aripiprazole are antipsychotic agents used to treat schizophrenia.

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

Disturbed thought process The most appropriate nursing diagnosis for this client is disturbed thought process related to misperception of environmental stimuli. Disturbed sleep pattern, risk for self-directed violence, and chronic low self-esteem would not be the most appropriate nursing diagnosis for this client.

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

Disturbed thought process Explanation: The most appropriate nursing diagnosis for this client is disturbed thought process related to misperception of environmental stimuli. Disturbed sleep pattern, risk for self-directed violence, and chronic low self-esteem would not be the most appropriate nursing diagnosis for this client.

A client diagnosed with schizophrenia is exhibiting disorganized behavior and imitating what the nurse is saying. What term is used to identify this behavior? Perseveration Tangentiality Echolalia Neologism

Echolalia Echolalia is the involuntary imitation of another person's speech and gestures, is a disorganized behavior. Neologism, and tangentiality reflect disorganized thinking. Perseveration is the persistent adherence to a single idea or topic and verbal repetition of a sentence, phrase or word even when another persona attempts to change the topic.

A client diagnosed with schizoaffective disorder and severe depression is being treated with antipsychotic medications. The client tells the nurse about difficulty with self-care activities. With which intervention should the nurse respond? Outline the side effects of the medications. Establish a routine and set goals. Gain assistance from family members. Contact the physician for a change in medications.

Establish a routine and set goals. The most useful approach for the nurse to try is to help the client establish a routine and set goals for accomplishing the activities of daily living.

The nurse suspects that a client is experiencing a brief psychotic episode based on what? Select all that apply. Gradual onset of symptoms Recent life stressor Evidence of hallucinations Mild confusion Intense changes in affect

Evidence of hallucinations Intense changes in affect Recent life stressor In brief psychotic disorder, the length of the episode is at least 1 day but less than 1 month. The onset is sudden and includes at least one of the positive symptoms of criteria A for schizophrenia (delusions or hallucinations). The person generally experiences overwhelming confusion and rapid, intense shifts of affect. Brief psychotic disorder can often occur in the context of a recent life stressor such as giving birth.

A client is diagnosed with schizoaffective disorder. Which would the nurse identify as supporting this diagnosis? Radiologic evidence of decreased size of the hippocampus and thalamus Ability to maintain role function despite signs and symptoms Reports of client repeating everything the client's family has said in the past 24 hours Evidence of hallucinations and delusions accompanied by major depression

Evidence of hallucinations and delusions accompanied by major depression For the diagnosis of schizoaffective disorder, the client must have an uninterrupted period of illness when there is a major depressive, manic, or mixed episode along with two of the following symptoms of schizophrenia: delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, or negative symptoms. In addition, the positive symptoms must be present without the mood symptoms at some time during this period for at least 2 weeks. The ability to maintain functioning would not be possible. Disorganized speech is only one of the symptoms that may be present. It also may be present with schizophrenia. A smaller thalamus and hippocampus are associated with schizophrenia.

A client has been taking haloperidol for 5 years when the client is admitted to the inpatient unit for relapse of symptoms of schizophrenia. Upon assessment, the client demonstrates akathisia, dystonia, a stiff gait, and rigid posture. The nurse correctly identifies these symptoms are indicative of what? Progressed schizophrenia Psychosis Extrapyramidal side effects Tardive dyskinesia

Extrapyramidal side effects include severe restlessness, muscle spasms, or contractions; chronic motor problems such as tardive dyskinesia; and the pseudoparkinsonian symptoms of rigidity, masklike faces, and stiff gait.

Which type of antipsychotic medication is most likely to produce extrapyramidal effects? Third-generation antipsychotic drugs First-generation antipsychotic drugs Atypical antipsychotic drugs Dopamine system stabilizers

First-generation antipsychotic drugs The conventional, or first-generation, antipsychotic drugs are potent antagonists of dopamine receptors D2, D3, and D4. This makes them effective in treating target symptoms but also produces many extrapyramidal side effects because of the blocking of the D2 receptors. Newer, atypical or second-generation antipsychotic drugs are relatively weak blockers of D2, which may account for the lower incidence of extrapyramidal side effects. The third generation of antipsychotics, called dopamine system stabilizers, is being developed. These drugs are thought to stabilize dopamine output that results in control of symptoms without some of the side effects of other antipsychotic medications.

A client with delusional disorder tells the nurse that the client has discovered how to jump to the moon. The nurse would document this belief as what? Somatic delusion Grandiose delusion Jealous delusion Erotomanic delusion

Grandiose delusion Clients presenting with grandiose delusions are convinced they have a great, unrecognized talent or have made an important discovery. A less common presentation is the delusion of a special relationship with a prominent person (i.e., an adviser to the president) or of actually being a prominent person (i.e., the president). The central theme of the jealous delusion is the unfaithfulness or infidelity of a spouse or lover. The central theme of somatic delusions involves bodily functions or sensations. These clients believe they have physical ailments. Erotomanic delusions are characterized by the delusional belief that the client is loved intensely by the "loved object," who is usually married, of a higher socioeconomic status, or otherwise unattainable. The client believes that the loved object's position in life would be in jeopardy if his or her true feelings were known.

During an admission assessment, a client with schizoaffective disorder states that the client hears the voice of God in the client's head and the voice is telling the client that the client is worthless. What would the nurse document this symptom as? Delusion Alogia Hallucination Avolition

Hallucination Hallucinations are sensory perceptions with a compelling sense of reality but with no actual objective basis. During auditory hallucinations (the most common form), clients may hear the voice of God or close relatives, two or more voices with a running commentary about the client's behavior, or voices that command certain acts. Delusions are false, fixed beliefs. Avolition involves the withdrawal and inability to initiate and persist in goal-directed activity. Alogia refers to the reduced fluency and productivity of thought and speech.

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

Increased amount of dopamine Positive (or productive) symptoms reflect an increased amount of dopamine affecting the cortical areas of the brain. Negative symptoms reflect an inadequate amount of dopamine, cerebral atrophy, and organic functional changes in the brain.

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

Increased amount of dopamine Positive (or productive) symptoms reflect an increased amount of dopamine affecting the cortical areas of the brain. Negative symptoms reflect an inadequate amount of dopamine, cerebral atrophy, and organic functional changes in the brain.

A student nurse has been assigned to provide care for an inpatient psychiatric-mental health client who has a diagnosis of schizophrenia. The student nurse is apprehensive about interacting with the client. The client's detailed explanations of the client's delusions accompanied by unpredictable movements have prompted fear in the student. How should this nursing student interpret such feelings? It is natural to feel fear when a client exhibits unpredictable behavior, and this can cause the student to be reasonably cautious. These feelings are best disclosed to the client, and doing so can foster the openness that promotes a therapeutic relationship. Being afraid of a client who has schizophrenia is a result of stereotyping. Despite their unusual behavior, clients with schizophrenia do not pose a safety risk to care providers.

It is natural to feel fear when a client exhibits unpredictable behavior, and this can cause the student to be reasonably cautious. A student may experience fear if the client exhibits unpredictable behavior. Fear is a normal response that results in the exercise of caution. Experiencing fear is not evidence of stereotyping, and divulging fear to the client is unlikely to benefit either the student or the client. The risk of violence is a reality, though the risk differs with each client.

The nurse is assigned to a client with catatonic schizophrenia. Which intervention should the nurse include in the client's care plan? Giving the client an opportunity to express concerns Administering lithium carbonate as prescribed Providing a quiet environment where the client can be alone Meeting all of the client's physical needs

Meeting all of the client's physical needs Explanation: Meeting all of the client's physiologic needs is most important because clients with catatonic schizophrenia cannot meet their own needs by themselves. Clients with catatonic schizophrenia are unable to express their concerns. Lithium is used for the manic phase of bipolar disorder. The nurse needs to give support to the client and be present for him or her as reassurance.

A nursing instructor is developing an education plan for a group of students about schizophrenia and schizoaffective disorders. The instructor identifies that in addition to psychosis, what other condition must be present at the same time for a diagnosis of schizoaffective disorder? Substance abuse Delirium Mood disturbance Anxiety

Mood disturbance When psychosis and mood disturbance occur at the same time, a diagnosis of schizoaffective disorder is made. Substance abuse, delirium, or anxiety are not involved with the diagnosis of schizoaffective disorder.

A comprehensive nursing assessment for neuroleptic malignant syndrome (NMS) should include checking for which in a client taking an antipsychotic medication? Confusion, giddiness, and hyperalertness Dry mouth, flushing, and urinary retention Headache, muscle aches, and paresthesias Muscular rigidity, tremors, and difficulty swallowing

Muscular rigidity, tremors, and difficulty swallowing NMS is characterized by muscular rigidity, tremors, difficulty swallowing, fever, hypertension, and diaphoresis

A comprehensive nursing assessment for neuroleptic malignant syndrome (NMS) should include checking for which in a client taking an antipsychotic medication? Confusion, giddiness, and hyperalertness Dry mouth, flushing, and urinary retention Muscular rigidity, tremors, and difficulty swallowing Headache, muscle aches, and paresthesias

Muscular rigidity, tremors, and difficulty swallowing NMS is characterized by muscular rigidity, tremors, difficulty swallowing, fever, hypertension, and diaphoresis

The nurse must be aware that individuals from diverse ethnic groups might describe troubling experiences in terms of physical problems or specific culture-bound syndromes. The syndrome of ghost sickness is exhibited by which culture? Indian Native American Chinese West African

Native American The culture-bound syndrome of ghost sickness is seen in the Native American tribal culture. This culture exhibits a preoccupation with death and the deceased. Bad dreams, weakness, feelings of danger, anxiety, and hallucinations may occur. The other options are not related to the culture-bound syndrome of ghost sickness

Which should the nurse anticipate when providing therapy and evaluating outcomes for a client with delusional disorder? Often not met completely Achieved when delusions completely disappear within 6 months' time Easily attained Maintained for a short period only

Often not met completely In evaluating progress, the nurse must remember that outcomes are often not met completely.

A mental health client insists that the client's spouse is trying to poison the client. In this instance, the client is exhibiting which type of delusion? Somatic Grandiose Persecutory Erotomanic

Persecutory Clients who exhibit persecutory delusions believe that they are being conspired against, spied on, poisoned, or drugged. Somatic delusions demonstrate a preoccupation with the body. A client exhibiting erotomanic delusions believes that a person of elevated social status loves him or her. Grandiose delusions are present when the client believes that he or she possesses unrecognized talent or insight or has made an important discovery.

A client with a diagnosis of schizophrenia has a history of auditory and visual hallucinations. Which intervention is most likely to minimize the client's hallucinations? Provide frequent contact and communication with the client Clustering the client's medications at 0800 hours Providing a vivid, bright environment that provides distractions from hallucinations Ensuring that the client does not sleep more than 7 hours in any 24-hour period

Provide frequent contact and communication with the client To prevent or minimize hallucinations, the nurse should help present and maintain reality by frequent contact and communication with the client. Limiting sleep or modifying the timing of medication administration is not likely to prevent or lessen hallucinations.

A client is being seen in the health clinic. The nurse observes a shuffling gait, drooling, and slowness of movement. The client is currently taking an antipsychotic for treatment of schizophrenia. The nurse knows that which side effect is occurring? Akathisia Neuroleptic malignant syndrome Pseudoparkinsonism Dystonic movements

Pseudoparkinsonism Pseudoparkinsonism is exhibited by a shuffling gait, drooling, and slowness of movement. Dystonia is characterized by cramps and rigidity of the tongue, face, neck, and back muscles. Akathisia causes restlessness, anxiety, and jitteriness. Neuroleptic malignant syndrome causes rigidity, fever, hypertension, and diaphoresis.

While caring for a hospitalized client diagnosed with schizophrenia, a nurse observes that the client is listening to the radio. The client tells the nurse that the radio commentator is speaking directly to the client. The nurse interprets this finding as which type of thinking? Illusional Concrete Autistic Referential

Referential The client is exhibiting referential thinking, that is, the belief that neutral stimuli, such as the radio, have special meaning to that person, such that the radio commentator is talking directly to him. Autistic thinking involves restriction of thinking to the literal and immediate so that the individual has private rules of logic and reasoning that make no sense to anyone else. Concrete thinking reflects a lack of abstraction in thinking with the inability to understand punch lines, metaphors, and analogies. Illusional thinking occurs when a person misperceives or exaggerates stimuli that actually exist in the external environment.

Some research has suggested that schizophreniform disorder may be an early manifestation of which other mental health condition? Schizoaffective disorder Delusional disorder Schizophrenia Bipolar affective disorder

Schizophrenia Some research has suggested that schizophreniform may be an early manifestation of schizophrenia. A client exhibiting an acute reactive psychosis for less than the 6 months necessary to meet the diagnostic criteria for schizophrenia is given the diagnosis of schizophreniform disorder. Symptoms lasting beyond the 6 months warrant a diagnosis of schizophrenia.

A 20-year-old son of a client who was diagnosed with schizophrenia at the age of 25 is concerned that he may also develop the disorder. Which statement regarding schizophrenia and genetics is true? Schizophrenia can only be passed from a father to his children. Schizophrenia can only be passed from a mother to her children. Schizophrenia has not been shown to be genetic. Schizophrenia has shown a strong genetic contribution.

Schizophrenia has shown a strong genetic contribution. Many studies strongly suggest a genetic contribution. Relatives of people with schizophrenia have a higher incidence of the disorder than found in the general population. First-degree relatives (i.e., parents, siblings, children) of clients with schizophrenia are at greater risk for the illness than are second-degree relatives (e.g., grandparents, grandchildren, aunts, uncles, half-siblings). Schizophrenia is 13% more likely to develop in children with one parent who has schizophrenia than in those with unaffected parents; when both parents have schizophrenia, a child has a 46% risk for the illness.

A nurse is assessing a client who is reporting the sensation of "bugs crawling under the skin" and intense itching and burning. The client states, "I know bugs have invaded my body." There is no evidence to support the client's report. The nurse interprets this as which type of delusion? Grandiose Persecutory Nihilistic Somatic

Somatic Somatic delusions involve bodily functions or sensations, such as insects having infested the skin. The client vividly describes crawling, itching, burning, swarming, and jumping on the skin surface or below the skin. The client maintains the conviction that he or she is infested with parasites in the absence of objective evidence to the contrary. Nihilistic delusions focus on impending death or disaster. Clients presenting with grandiose delusions are convinced they have a great, unrecognized talent or have made an important discovery. The central theme of persecutory delusions is the client's belief that he or she is being conspired against, cheated, spied on, followed, poisoned, drugged, maliciously maligned, harassed, or obstructed in pursuit of long-term goals

A nurse is assessing a client who is reporting the sensation of "bugs crawling under the skin" and intense itching and burning. The client states, "I know bugs have invaded my body." There is no evidence to support the client's report. The nurse interprets this as which type of delusion? Somatic Nihilistic Persecutory Grandiose

Somatic Somatic delusions involve bodily functions or sensations, such as insects having infested the skin. The client vividly describes crawling, itching, burning, swarming, and jumping on the skin surface or below the skin. The client maintains the conviction that he or she is infested with parasites in the absence of objective evidence to the contrary. Nihilistic delusions focus on impending death or disaster. Clients presenting with grandiose delusions are convinced they have a great, unrecognized talent or have made an important discovery. The central theme of persecutory delusions is the client's belief that he or she is being conspired against, cheated, spied on, followed, poisoned, drugged, maliciously maligned, harassed, or obstructed in pursuit of long-term goals.

A client diagnosed with delusional disorder who uses excessive health care resources most likely has which type of delusions? grandiose erotomanic jealous somatic

Somatic delusion Somatic delusions are generally vague and unrealistic beliefs about the client's health or bodily functions. Persecutory delusions involve the client's belief that "others" are planning to harm the client or are spying, following, or belittling the client in some way. Grandiose delusions are characterized by the client's claim to associate with famous people or celebrities or the client's belief that he or she is famous or capable of great feats. Referential delusions or ideas of reference involve the client's belief that television broadcasts, music, or newspaper articles have special meaning for him or her.

A client diagnosed with schizophrenia states to the nurse, "My intestines are being eaten by snakes." This statement represents which type of delusion? Referential delusion Persecutory delusion Somatic delusion Grandiose delusion

Somatic delusion Somatic delusions are generally vague and unrealistic beliefs about the client's health or bodily functions. Persecutory delusions involve the client's belief that "others" are planning to harm the client or are spying, following, or belittling the client in some way. Grandiose delusions are characterized by the client's claim to associate with famous people or celebrities or the client's belief that he or she is famous or capable of great feats. Referential delusions or ideas of reference involve the client's belief that television broadcasts, music, or newspaper articles have special meaning for him or her.

The nurse should consider which during a psychiatric assessment of a newly immigrated client who is being evaluated for possible religious delusions? Delusions are often focused on the client's cultural religious beliefs Most cultures contain well-accepted religious beliefs Some cultures hold religious beliefs that might be confused with delusional thought The nurse's cultural religious beliefs may differ from those of the client's

Some cultures hold religious beliefs that might be confused with delusional thought Some cultures have widely held and culturally sanctioned beliefs that might be considered delusional in other cultures.

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

Suicide Suicide Explanation: During the acute illness, individuals with schizophrenia are at high risk for suicide. Clients are hospitalized usually to protect themselves or others. Clients with schizophrenia who have an abnormality in the hippocampus may experience disordered water balance, whereupon individuals drink compulsively as a result of neuroendocrine dysfunction, placing them at risk for water intoxication. However, this is not the priority. Mania and depression are unrelated to schizophrenia during the acute illness.

Which is an appropriate intervention for a client having auditory hallucinations? Tell the client to talk back to the voices and tell them to go away. Encourage the client to spend quiet time alone until hallucinations cease. Mildly admonish the client for the hallucinations. Discourage the client from discussing the content of the hallucinations with anyone else.

Tell the client to talk back to the voices and tell them to go away. Interventions for managing hallucinations include dismissal intervention (i.e., telling the voices to go away), various coping strategies (e.g., jogging, telephoning, playing games, seeking out others, employing relaxation techniques), or competing stimuli (e.g., listening to music or the voice of oneself or another to overcome auditory hallucinations and using visual stimuli to overcome visual hallucinations).

A client with a delusional disorder has been undergoing individual psychotherapy. The therapy would be deemed ultimately successful when the client meets which outcome? The client will describe problems relating to others. The client will identify situations that evoke anxiety. The client will differentiate between reality and fantasy. The client will identify alternatives to present coping patterns.

The client will differentiate between reality and fantasy. The ultimate goal of all forms of treatment for clients with delusional disorders is to foster the ability to distinguish between fantasy and reality. Promoting healthy coping, anxiety awareness, and healthy relationships are therapeutic outcomes, but the priority in treatment is the delusional thinking itself.

Which data support a nursing diagnosis of impaired verbal communication? Rapid pacing and running The presence of neologism, echolalia, and clanging The presence of neologism, delusions, and anergia Ambivalence, delusional thinking, and avolition

The presence of neologism, echolalia, and clanging Sự hiện diện của chủ nghĩa mới, tiếng vang và tiếng kêu Although the client may be indecisive, have false beliefs, and lack motivation, these do not support a diagnosis of impaired verbal communication. Invented words, repetition of words heard, and rhyming do get in the way of the ability to use or understand language in the human interaction. Fixed false beliefs and an absence of energy do not support a diagnosis of impaired verbal communication, nor do pacing and running.

A client states, "My boss keeps putting thoughts into my head. Yesterday my boss made me copy 25 reports and then told me I had wasted company time and money!" The nurse knows the client is experiencing which perceptual disturbance? Thought broadcasting Thought withdrawal Thought blocking Thought insertion

Thought Insertion Clients exhibiting thought insertion are convinced that their thoughts are not their own but rather the thoughts of others that have become implanted in their heads. suy nghi cua ho kg phai cua chinh ho ma la suy nghi nguoi khac duoc cay vao dau ho

A client is diagnosed with a delusional disorder. While providing care to the client, the nurse assesses the client's delusions. Which would be least appropriate for the nurse to do? Try to change the client's delusional belief Evaluate the significance to the client Avoid dwelling on the delusion Determine the impact of the delusion on the client's safety

Try to change the client's delusional belief By definition, delusions are fixed, false beliefs that cannot be changed by reasonable arguments. The nurse should assess the client's delusion to evaluate its significance to the client, to the client's safety, and to the safety of others. The nurse should not dwell on the delusion or try to change it.

Which statements characterizes the major difference between the typical and atypical antipsychotic medications? Atypical antipsychotics tend to cause many more extrapyramidal side effects than do the typical antipsychotics. Atypical antipsychotics relieve only negative symptoms. Typical antipsychotics cause blood dyscrasias, whereas atypical ones do not. Typical antipsychotics most often relieve positive symptoms but do not have a significant impact on negative symptoms.

Typical antipsychotics most often relieve positive symptoms but do not have a significant impact on negative symptoms. Traditional antipsychotics treat the positive symptoms of schizophrenia (i.e., hallucinations and delusions). Atypical antipsychotics relieve both the positive and negative symptoms (e.g., apathy, avolition, social withdrawal) of schizophrenia and are less likely to cause distressing extrapyramidal side effects typically seen with traditional antipsychotics.

Assessment of genetic predisposition supports asking a client who is exhibiting symptoms of a delusional disorder what? When the delusion first began If the client has complied with the treatment plan If any family member shows symptoms of depression Whether any family members have been diagnosed with schizophrenia

Whether any family members have been diagnosed with schizophrenia Some studies have found that delusional disorders are more common among relatives of individuals with schizophrenia than would be expected by chance; thus, asking whether any family members have been diagnosed with schizophrenia could be helpful.

A client with delusions presents with strong defensiveness, even when watching the news or listening to the radio. The nurse would document this finding in the health history as what? Ambivalence Ideas of reference Flight of ideas Echolalia

deas of reference Explanation: Ideas of reference occur when a client has self-centered thoughts and falsely believes ideas are centered on something the client is doing, thinking, or feeling. Looseness of association is the inability to think logically. Ambivalence refers to contradictory or opposing emotions, attitudes, ideas, or desires for the same person or things or toward the environment. Echolalia is a pathological parrot-like response of a word or phrase.

When describing the difference between schizoaffective disorder (SAD) and schizophrenia, the nurse would address which as associated with SAD?

increased mood responses Clients with SAD have many similar responses to their disorder as people with schizophrenia, with one exception. These clients have many more "mood" responses and are very susceptible to suicide. Persons with SAD usually have higher functioning than those with schizophrenia, with severe negative symptoms and early onset of illness. To be diagnosed with SAD, a client must have an uninterrupted period of illness when there is a major depressive, manic, or mixed episode along with two of the following symptoms of schizophrenia: delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, or negative symptoms

A client with schizophrenia is prescribed clozapine. The nurse would monitor the client closely for specific signs of: infection. weight loss. nausea. hypotension.

infection. Agranulocytosis can develop with the use of all antipsychotic drugs, but it is most likely to develop with clozapine use. Therefore, the nurse needs to be alert for signs of infection, particularly bacterial infection. Hypotension may occur with any antipsychotic drug. Nausea is a common side effect of many drugs. Weight gain, not loss, can occur with olanzapine and clozapine.

A client with schizophrenia is experiencing delusions. The client states, "My face is melting and my nose is about to fall off. Don't let it fall off!" The nurse interprets this statement as which type of delusion? nihilistic persecutory somatic grandiose

nihilistic A nihilistic delusion involves the client belief that the client's organs aren't functioning or some body part or feature is horribly disfigured. A grandiose delusion involves the belief that one has exceptional powers, wealth, skill, influence, or destiny. A persecutory delusion involves the belief that one is being watched, ridiculed, harmed, or plotted against. A somatic delusion involves a belief about abnormalities in bodily structure or functions.

A nurse is caring for a client who has been receiving treatment for schizophrenia with chlorpromazine for the past year. It would be essential for the nurse to monitor the client for which effect? weight loss. torticollis. tardive dyskinesia. hypoglycemia.

tardive dyskinesia. The term tardive means late appearing; thus, appear after a person has taken these drugs for a period of time. Tardive dyskinesia is late-appearing, abnormal involuntary movements. It can be viewed as the opposite of parkinsonism, both in observable movements and in etiology. Therefore, it is essential that the nurse monitor the client for tardive dyskinesia at this time. Weight gain (not weight loss) and new onset of diabetes (hyperglycemia) would be possible side effects of an antipsychotic. Torticollis, a dystonic reaction, would occur early in antipsychotic drug treatment.