prepU SCHIZOPHRENIA
In managing the milieu for clients with schizophrenia, the nurse considers which the priority? Client and family education Recreational activities Client safety Social skills training
Correct response: 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.
Despite taking an atpyical antipsychotic medication for several years, a client with a diagnosis of schizophrenia has experienced a recent increase in the frequency and severity of command hallucinations that has resulted in a suicide attempt. The nurse should anticipate that this client may benefit from which of the following? An SSRI Lithium Naltrexone (ReVia) Clozapine (Clozaril)
Correct response: Clozapine (Clozaril) Explanation: Clozapine (Clozaril) is considered to be a highly effective medication for suicidal clients with the diagnosis of schizophrenia. Lithium is typically used with clients with bipolar disorder, and naltrexone is given to suicidal clients who have developmental disorders. SSRIs are used primarily with clients who are diagnosed with depression.
A client with schizophrenia states that the client is God's messenger and the client's mission is to become president. The nurse documents these comments as evidence of what? Delusional thinking Hallucinatory experiences Bizarre behavior Formal thought disorder
Correct response: Delusional thinking Explanation: Delusions involve disturbances in thought content. They are firmly held false beliefs that reasoning cannot correct and for which there is no support in reality.
A physician has diagnosed a client with schizophrenia. The nurse knows that schizophrenia is characterized by which of the following? Loss of identity Disturbances in affect Multiple personalities Confusion
Correct response: Disturbances in affect Explanation: The Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision, defines schizophrenia as a disturbance in multiple psychological processes that affects thought content and form, perception, affect, sense of self, volition, relationship to the external world, and psychomotor behavior. Multiple personalities occur in dissociative identity disorder.
Which should the nurse anticipate when providing therapy and evaluating outcomes for a client with delusional disorder? Easily attained Maintained for a short period only Achieved when delusions completely disappear within 6 months' time Often not met completely
Correct response: Often not met completely Explanation: In evaluating progress, the nurse must remember that outcomes are often not met completely.
Some research has suggested that schizophreniform disorder may be an early manifestation of which other mental health condition? Delusional disorder Schizophrenia Bipolar affective disorder Schizoaffective disorder
Correct response: Schizophrenia Explanation: 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 client diagnosed with delusional disorder who uses excessive health care resources most likely has which type of delusions? Somatic Jealous Nihilistic Grandiose
Correct response: Somatic Explanation: Persons who have somatic delusions believe they have a physical ailment. Clients with somatic delusions use excessive health care resources. The central theme of the jealous subtype is the unfaithfulness or infidelity of a spouse or lover. Nihilistic delusions focus on death or calamity. 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 or actually being a prominent person.
The student nurse correctly recognizes that which finding is best supported by genetic studies in the etiology of schizophrenia? That if a person has schizophrenia, distant relatives are also at risk. That there is no relationship at all between schizophrenia and genetics. That there is a weak correlation between genetics and schizophrenia. That schizophrenia is at least partially inherited.
Correct response: That schizophrenia is at least partially inherited. Explanation: The most important studies have centered on twins; these findings have demonstrated that if one identical twin has schizophrenia, the other twin has a 50% chance of developing it as well. Fraternal twins have only a 15% risk. This finding indicates that schizophrenia is at least partially inherited. An individual's risk is proportionate to how closely he or she is related to a person with the disease. Consequently, distant relatives have a low or non-existent increase in risk.
Which assessment findings in a client who is suspected of having a delusional disorder would be suggestive of a diagnosis of schizophrenia? The client's beliefs are considered delusional but nonbizarre. The client experiences frequent and sustained hallucinations. The client does not have insight into his or her delusions. The client responds to group psychotherapy.
Correct response: The client experiences frequent and sustained hallucinations. Explanation: The presence of prominent and sustained hallucinations is suggestive of schizophrenia rather than delusional disorder. Nonbizarre delusions are associated with delusional disorder, and people with either diagnosis lack insight. Response to therapy does not differentiate between the two diagnoses.
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 identify alternatives to present coping patterns. The client will describe problems relating to others. The client will identify situations that evoke anxiety. The client will differentiate between reality and fantasy.
Correct response: The client will differentiate between reality and fantasy. Explanation: 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.
A client diagnosed with schizophrenia states, "I want to go home, go home, go home." This is an example of which of the following speech patterns? Clang association Neologisms Verbigeration Word salad
Correct response: Verbigeration Explanation: A verbigeration is the stereotyped repetition of words or phrases that may or may not have meaning to the listener. Clang associations are ideas that are related to one another based on sound or rhyming rather than meaning. Neologisms are words invented by the client. A word salad is a combination of jumbled words and phrases that are disconnected or incoherent and make no sense to the listener.
A client is admitted to the psychiatric hospital with a diagnosis of schizophrenia. During the physical examination, the client's arm remains outstretched after the nurse obtains the pulse and blood pressure, and the nurse must reposition the arm. The nurse interprets this as what? Waxy flexibility Hypervigilance Retardation Echopraxia
Correct response: Waxy flexibility Explanation: Waxy flexibility, the ability to assume and maintain awkward or uncomfortable positions for long periods, is characteristic of catatonic schizophrenia. Clients commonly remain in these awkward positions until someone repositions them. Exchopraxia refers to the involuntary imitation of another person's movements and gestures. Hypervigilance refers to the sustained attention to external stimuli, as if expecting something important or frightening to occur. Retardation refers to slowed movements.
Assessment of genetic predisposition supports asking a client who is exhibiting symptoms of a delusional disorder what? Whether any family members have been diagnosed with schizophrenia When the delusion first began If the client has complied with the treatment plan If any family member shows symptoms of depression
Correct response: Whether any family members have been diagnosed with schizophrenia Explanation: 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 diagnosed with schizophrenia is in anticholinergic crisis. The nurse would expect which finding to be noted upon assessment? facial flushing bradycardia incontinence hypothermia
Correct response: facial flushing Explanation: Clinical manifestations of anticholinergic crisis include facial flushing, tachycardia, urinary retention, and hyperthermia (fever).
When describing the difference between schizoaffective disorder (SAD) and schizophrenia, the nurse would address which as associated with SAD? lower level of functioning increased mood responses decreased risk for suicide delusions but no hallucinations
Correct response: increased mood responses Explanation: 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.
The nurse observes a client with schizophrenia sitting alone, laughing occasionally, and turning their head as if listening to another person. The nurse assesses this behavior as indicating that the client is experiencing auditory hallucinations. What statement by the nurse is most appropriate? "Are you hearing something?" "It's a beautiful day, isn't it?" "Would you like to go to your room to talk?" "Would you like to take some of your PRN medication?"
Correct response: "Are you hearing something?" Explanation: Asking whether the client is hearing something validates the nurse's assessment and focuses on the client's experience. The other choices do not address the situation of the client experiencing auditory hallucinations at the present time.
A client with schizophrenia is prescribed a second-generation antipsychotic. The client's mother asks, "About how long will it take until we see any changes in his symptoms?" Which response by the nurse would be most appropriate? "You should see improvement in about 36 to 48 hours. "It will take about 6 to 12 weeks until the drug is effective." "Generally, it takes about 1 to 2 weeks to be effective in changing symptoms." "His symptoms should subside almost immediately."
Correct response: "Generally, it takes about 1 to 2 weeks to be effective in changing symptoms." Explanation: Generally, it takes about 1 to 2 weeks for antipsychotic drugs to effect a change in symptoms. During the stabilization period, the selected drug should be given an adequate trial, generally 6 to 12 weeks, before considering a change in the drug prescription. If treatment effects are not seen, another antipsychotic agent may be tried.
After teaching a client with schizoaffective disorder about the condition and treatment, the nurse determines that the education was successful when the client states what? "I need to eat properly so that I can control my weight." "I should go to sleep at night when I feel tired." "I can vary my routines from day to day without problems." "I can stop my medication when I start to feel better."
Correct response: "I need to eat properly so that I can control my weight." Explanation: Client education should focus on nutrition and prevention of weight gain, which is a side effect of medication therapy. Establishing a regular sleep pattern by setting a routine can help to promote or reestablish normal patterns of rest. Establishing a daily routine can help address mood symptoms. Medication should not be stopped if the client feels better.
A client tells the nurse that the client has bugs in the client's brain and asks the nurse if the nurse can see them. Which response by the nurse is most therapeutic? "No, I don't see any bugs. You seriously can't have any bugs in your brain." "No, I don't see any bugs. That sounds scary for you." "Your thinking is a little illogical. I wouldn't be able to see bugs if they were inside your brain. Would you like to talk more about this?" "You have a thought disorder and only think you have bugs in your brain. There really aren't any. You don't have to worry because we would give you medicine for any medical problems."
Correct response: "No, I don't see any bugs. That sounds scary for you." Explanation: The person who hallucinates is preoccupied and frightened by what he or she hears or sees. The hallucination is real to the client, and the nurse cannot argue away, dismiss, or ignore it. Although the hallucination is real to the client, nurses make it clear that they do not hear the voices or see the visual images. Nurses do, however, communicate concern that the client is bothered, upset, or frightened by the hallucination.
A client with a persecutory delusion has been explaining to the nurse the specifics of the conspiracy against the client. The client pauses and says, "I get the feeling that you don't actually believe that what I'm telling you is true." How should the nurse respond? "What you're telling me is difficult for me to believe. This may be real for you, but not me." "What's important to me is that it's real for you." "The conspiracy that you're explaining to me is actually a delusion." "What makes you think that I don't believe you?"
Correct response: "What you're telling me is difficult for me to believe. This may be real for you, but not me." Explanation: While an empathic approach is crucial when interacting with persons who have a delusional disorder, this does not involve expressing or implying that the nurse believes the person's delusions are real. If confronted by the client on this fact, this is best stated clearly.
The parent of a client who has a delusional disorder spends a great deal of time and energy trying to convince the client that the client is not actually the focus of a nationwide, secret plot to track the client's activities. Which of the client's responses is most typical of an individual with a delusional disorder? "I'll consider what you think, but this is something I really, really need." "I've told you before that I can't just snap my fingers and change the way I think." "You're so naïve. You just don't understand what's really happening out there." "I know I've got delusions, but you would too if you had to live my life."
Correct response: "You're so naïve. You just don't understand what's really happening out there." Explanation: Individuals with delusional disorders have no insight into their condition and typically believe that others are ignorant to the true reality. The other responses imply that the client recognizes that the client's thinking is delusional.
A diagnosis of delusional disorder is based on the presence of one or more nonbizarre delusions for at least what period of time? 1 month 2 months 3 months 4 months
Correct response: 1 month Explanation: A diagnosis of delusional disorder is based on the presence of one or more nonbizarre delusions for at least 1 month.
Which client best exhibits the characteristics that are typical of the prodromal period of schizophrenia? A 25-year-old woman who is free of any of the symptoms of schizophrenia. A 20-year-old man who is exhibiting a gradual decrease in his ability to concentrate and function in daily activities A 30-year-old man who has experienced an exacerbation of symptoms after deciding not to take his atypical antipsychotic A 28-year-old woman who exhibits bizarre and disruptive behavior
Correct response: A 20-year-old man who is exhibiting a gradual decrease in his ability to concentrate and function in daily activities Explanation: A prodromal period for individuals with schizophrenia has usually been identified in retrospect and is evidenced by some change in overall function (difficulties in school or work, within relationships, or daily activities) accompanied by transient or weak symptoms of psychosis. Absence of symptoms is not associated with the prodromal period. An exacerbation of symptoms after stopping medication suggests a relapse. Bizarre and disruptive behavior suggests acute illness.
A nurse teaching a client about prescribed antipsychotic medication informs the client to contact a health care provider immediately if the client notices: An increase in weight of 2 lbs in 1 month. A feeling of dizziness when the client stands up. An increase in thirst. A dramatic change in temperature.
Correct response: A dramatic change in temperature. Explanation: Advise clients to contact their case coordinators or health care providers immediately if they experience dramatic changes in body temperature. The client may be at risk for neuroleptic malignant syndrome.
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? Weight loss Agranulocytosis Palpitations Hemorrhage
Correct response: Agranulocytosis Explanation: 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.
Which of the following would the nurse identify as a negative symptom associated with schizophrenia? Hallucinations Anhedonia Bizarre behavior Loose associations
Correct response: Anhedonia Explanation: Positive symptoms reflect an excess or distortion of normal functions, including delusions and hallucinations. Negative symptoms reflect a lessening or loss of normal functions, such as restriction or flattening in the range and intensity of emotion (diminished emotional expression), reduced fluency and productivity of thought and speech (alogia), withdrawal and inability to initiate and persist in goal-directed activity (avolition), and inability to experience pleasure (anhedonia). Loose associations reflect disorganized thinking, a neurocognitive impairment.
Which statement is true about delusional disorder? The disease onset is usually gradual. Psychosocial functioning is often markedly impaired. Behavior is relatively normal except when focused on the delusion. The individual's personality changes dramatically.
Correct response: Behavior is relatively normal except when focused on the delusion. Explanation: The course of delusional disorder is variable. The onset can be acute, or the disorder can occur gradually and become chronic. Clients usually live with delusions for years, rarely receiving psychiatric treatment unless their delusion relates to their health (somatic delusion) or they act on the basis of their delusion and violate laws or social rules. Apart from the direct impact of the delusion, psychosocial functioning is not markedly impaired. Behavior is remarkably normal except when the client focuses on the delusion. At that time, the client's thinking, attitudes, and mood may change abruptly. Personality does not usually change, but the client is gradually, progressively involved with the delusional concern.
Which medication is used to control the extrapyramidal effects associated with antipsychotic medications? Benztropine Chlorpromazine Haloperidol Thioridazine
Correct response: Benztropine Explanation: 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 client with schizophrenia is being treated with olanzapine 10 mg daily. The client asks the nurse how this medicine works. The nurse explains that the mechanism by which the olanzapine controls the client's psychotic symptoms is believed to be what? Increasing the amount of serotonin and norepinephrine in the brain. Decreasing the amount of an enzyme that breaks down neurotransmitters. Normalizing the levels of serotonin, norepinephrine, and dopamine. Blocking dopamine receptors in the brain.
Correct response: Blocking dopamine receptors in the brain. Explanation: Olanzapine is an antypical antipsychotic. Like all antipychotics, its major action in the nervous system is to block receptors for the neurotransmitter dopamine. Selective serotonin reuptake inhibitors and tricyclic antidepressants act by blocking the reuptake of serotonin and norepinephrine. Monoamine oxidase inhibitors (MAOIs) prevent the breakdown of MAO, an enzyme that breaks down neurotransmitters. Lithium normalizes the reuptake of certain neurotransmitters such as serotonin, norepinephrine, acetylcholine, and dopamine.
Which speech pattern is exhibited by the client stating, "I will take a pill if I go up the hill but not if my name is Jill, I don't want to kill?" Clang association Neologism Verbigeration Word salad
Correct response: Clang association Explanation: Clang associations are ideas that are related to one another based on sound or rhyming rather than meaning. Neologisms are words invented by the client. A verbigeration is the stereotyped repetition of words or phrases that may or may not have meaning to the listener. A word salad is a combination of jumbled words and phrases that are disconnected or incoherent and make no sense to the listener.
The psychiatric nurse recognizes that a client's cultural background can contribute to the misdiagnosis of schizophrenia primarily for which reason? Clinicians diagnose culturally accepted beliefs as psychotic thinking Clients fail to communicate effectively as a result of language barriers Clients are often educationally disadvantaged Clinicians often lack knowledge of cultural psychiatric beliefs
Correct response: Clinicians diagnose culturally accepted beliefs as psychotic thinking Explanation: Always consider cultural differences when assessing clinical symptoms in clients with suspected psychotic disorders. Ideas that appear delusional in one culture may be acceptable in another; speaking in tongues and visual or auditory hallucinations with religious content are possible examples.
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? Psychosis Tardive dyskinesia Extrapyramidal side effects Progressed schizophrenia
Correct response: Extrapyramidal side effects Explanation: 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? Atypical antipsychotic drugs First-generation antipsychotic drugs Third-generation antipsychotic drugs Dopamine system stabilizers
Correct response: First-generation antipsychotic drugs Explanation: 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 diagnosed with delusional disorder is telling everyone that the client is the president of the United States. This client is exhibiting which type of delusion? Grandiose Nihilistic Somatic Jealous
Correct response: Grandiose Explanation: 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 or actually being a prominent person. Nihilistic delusions focus on impending death or disaster. Persons who have somatic delusions believe they have a physical ailment. The central theme of the jealous subtype is the unfaithfulness or infidelity of a spouse or lover.
During a client interview, a client states that "God has sent me a special message. I'm the only one who can carry out his plan." The nurse interprets this statement as suggesting which type of delusion? Grandiose Mixed Somatic Erotomanic
Correct response: Grandiose Explanation: Grandiose delusions focus on the belief that the person has a great, unrecognized talent or has made an important discovery. The delusion may be religious in nature, such as a special message from a deity. With mixed delusions, no one delusional theme predominates. Somatic delusions involve bodily functions or sensations. Erotomanic delusions are characterized by the belief that the person is loved intensely by a loved object who is usually married, of a higher socioeconomic status, or otherwise unattainable.
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? Hallucination Delusion Avolition Alogia
Correct response: Hallucination Explanation: 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.
A client with schizophrenia is hearing voices that tell him to kill himself. The nurse understands that this client is experiencing ... Hallucination Delusion Flight of ideas Ideas of reference
Correct response: Hallucination Explanation: A hallucination is a sensory perception, such as hearing voices and seeing objects, that only the client experiences. A delusion is a false belief. Flight of ideas refers to a speech pattern in which the client skips from one unrelated subject to another. Ideas of reference refers to the mistaken belief that someone or something outside the client is controlling the client's ideas or behavior.
Clients diagnosed with schizophrenia may experience disordered water balance that may lead to water intoxication. Which may occur as a result of water intoxication? Hyponatremia Hypernatremia Oliguria Weight loss
Correct response: Hyponatremia Explanation: Hyponatremia is a life-threatening complication of unknown cause. When a client ingests an unusually large volume of water, the kidneys' capacity to excrete water is overwhelmed, and serum sodium concentrations rapidly fall below the normal range.
Which is the central focus of persecutory delusions? Injustice that must be remedied by legal action Involving bodily functions or sensations Unfaithfulness A great, unrecognized talent
Correct response: Injustice that must be remedied by legal action Explanation: The focus of persecutory delusions is often on some injustice that must be remedied by legal action. Clients often see satisfaction by repeatedly appealing to courts and other government agencies. The central theme of somatic delusions involves bodily functioning or sensations. The central theme of the jealous subtype is the unfaithfulness or infidelity of a spouse or lover. Clients representing with grandiose delusions are convinced they have a great, unrecognized talent or have made an important discovery.
A comprehensive nursing assessment for neuroleptic malignant syndrome (NMS) should include checking for which in a client taking an antipsychotic medication? Headache, muscle aches, and paresthesias Confusion, giddiness, and hyperalertness Muscular rigidity, tremors, and difficulty swallowing Dry mouth, flushing, and urinary retention
Correct response: Muscular rigidity, tremors, and difficulty swallowing Explanation: NMS is characterized by muscular rigidity, tremors, difficulty swallowing, fever, hypertension, and diaphoresis.
A client had been withdrawn in the client's room for 3 days, not eating or sleeping, prior to his admission to the inpatient unit. Upon interview, the client demonstrates difficulty answering questions, appears to have no facial expressions, and cannot follow simple instructions. This cluster of symptoms can be described as what? Negative symptoms Delusions Thought disorder Positive symptoms
Correct response: Negative symptoms Explanation: Common negative symptoms of schizophrenia include alogia, affective blunting, avolition, anhedonia, and attentional impairment.
A client with schizophrenia is receiving antipsychotic therapy. The nurse understands that which is a medical emergency should it develop in the client? Tardive dyskinesia Parkinsonism Akathisia Neuroleptic malignant syndrome
Correct response: Neuroleptic malignant syndrome Explanation: Although tardive dyskinesia, parkinsonism, and akathisia can occur with antipsychotic therapy, neuroleptic malignant syndrome is a life-threatening condition and medical emergency that requires immediate treatment.
A client with a diagnosis of schizophrenia has been brought to the emergency department by a worker from the group home where the client resides. The worker states that the client has stopped taking medications and drank 2 to 3 gallons of water over the past several hours. What assessments should the nurse who is caring for this client prioritize? Neurological assessment and monitoring of electrolyte levels Monitoring for evidence of hallucinations or delusions Blood glucose levels and body weight Assessing for allergic reactions, dry mouth, and lethargy
Correct response: Neurological assessment and monitoring of electrolyte levels Explanation: Hyponatremia, electrolyte imbalances, and seizures may result from polydipsia. Consequently, close monitoring of the client's electrolytes and neurological status assessment are prioritized at this stage.
The client was conversing with the nurse when noticeable changes occurred with the client. Which is a term used to describe the occurrence of the eye rolling back in a locked position, which occurs with acute dystonia? Opisthotonus Oculogyric crisis Torticollis Pseudoparkinsonism
Correct response: Oculogyric crisis Explanation: Oculogyric crisis is the occurrence of the eye rolling back in a locked position, which occurs with acute dystonia. Opisthotonus is tightness in the entire body with the head back and an arched neck. Torticollis is twisted head and neck. Oculogyric crisis, opisthotonus, and torticollis are manifestations of acute dystonia. Pseudoparkinsonism is drug-induced parkinsonism and is often referred to by the generic label of extrapyramidal side effects.
After teaching a class of nursing students about the different types of delusions, the instructor determines that the education was successful when the class identifies which type as mostcommon? Persecutory Somatic Grandiose Erotomanic
Correct response: Persecutory Explanation: Of the different types of delusions, persecutory delusions are the most common.
What is an anticholinergic side effect associated with some antipsychotic medications? Photophobia Salivation Increased tearing Diarrhea
Correct response: Photophobia Explanation: Photophobia, dry mouth, decreased lacrimation, and constipation are anticholinergic side effects associated with some antipsychotic medications.
A client with schizophrenia reads the advice column in the newspaper daily. When asked why the client is so interested in the advice column, the client replies, "This person is my guide and tells me what I must do every day." The nurse would best describe this type of thinking as what? Referential delusion Grandiose delusion Thought insertion Personalization
Correct response: Referential delusion Explanation: 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. Grandiose delusions are characterized by the client's claim to association with famous people or celebrities or the client's belief that he or she is famous or capable of great feats. Thought insertion is the belief that others are placing thoughts in their mind against their will. Personalization is not a psychotic characteristic of schizophrenia.
A client begins to exhibit hallucinations and delusions along with disorganized speech after forgetting to take antipsychotic medication. The nurse suspects that the client is at which point in the clinical course of the disorder? Prodromal phase Acute illness Stabilization Relapse
Correct response: Relapse Explanation: Relapse involves a return of the symptoms, most often due to the client's failure to follow the medication regimen. The prodromal phase is associated with small changes in overall function, such as difficulties at work or school, within relationships, or in daily activities accompanied by transient or weak symptoms of psychosis. Acute illness is the initial onset of changes in thought and bizarre or disruptive behavior. Stabilization occurs when symptoms become less acute, following the initial diagnosis and initiation of treatment.
The nurse documents that the client is exhibiting negative symptoms of schizophrenia when observing the client doing what? Select all that apply. Repeatedly turning down invitations to join in unit activities Inability to maintain to complete a goal-directed activity Walking in circles around the unit until exhausted Talking very quietly Threatening to "slap anyone that bothers my stuff."
Correct response: Repeatedly turning down invitations to join in unit activities Inability to maintain to complete a goal-directed activity Explanation: Negative symptoms reflect a lessening or loss of normal functions, such as restriction or flattening in the range and intensity of emotion (diminished emotional expression), reduced fluency and productivity of thought and speech (alogia), withdrawal and inability to initiate and persist in goal-directed activity (avolition), and inability to experience pleasure (anhedonia).
When reviewing the diagnostic criteria for schizophrenia based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V), which would be most accurate? Schizophrenia can be diagnosed as soon as an individual states he or she is hearing voices. Schizophrenia lasts at least 6 months and includes at least 1 month of two or more characteristic symptoms. Schizophrenia lasts at least 1 month and must include the symptom of hallucinations. Schizophrenia can be diagnosed as soon as an individual states he or she is hallucinating and delusional.
Correct response: Schizophrenia lasts at least 6 months and includes at least 1 month of two or more characteristic symptoms. Explanation: According to the DSM-V, schizophrenia lasts at least 6 months and includes at least 1 month of two or more characteristic symptoms (e.g., delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior) and negative symptoms (e.g., diminished emotional expression, alogia, or avolition).
Which of the following terms describes the use of words or phrases that are flowery, excessive, and pompous? Word salad Neologisms Stilted language Clang association
Correct response: Stilted language Explanation: Stilted language is the use of words or phrases that are flowery, excessive, and pompous. A word salad is a combination of jumbled words and phrases that are disconnected or incoherent and make no sense to the listener. Neologisms are words invented by the client. Clang associations are ideas that are related to one another based on sound or rhyming rather than meaning.
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? Depression Mania Suicide Water intoxication
Correct response: 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.
A 55-year-old client was admitted to the psychiatric unit after an incident in a department store in which the client accused a sales clerk of following the client around the store and stealing the client's keys. The client was subdued by the police after destroying a window display because voices had told the client that it was evil. As the nurse approached the client, the client says, "You're all out to get me, and you're one of them. They're Rostoputians and grog babies here." This demonstrates what? Loose associations and flight of ideas Suspiciousness and neologisms Illusions and loss of ego boundaries Echolalia and echopraxia
Correct response: Suspiciousness and neologisms Explanation: The client is demonstrating suspiciousness ("you're all out to get me") and neologisms (use of the words "Rostoputians and grog babies"). Loose associations and flight of ideas occur when the client talks about many topics in rapid sequence, but they are not connected with each other. Illusions are when the client sees something that is not there; echolalia is the repetition of words (or words that sound similar) said by someone else.
A client with severe and persistent mental illness has been taking antipsychotic medication for 20 years. The nurse observes during a therapy session that the client's behavior includes repetitive movements of the mouth and tongue, facial grimacing, and rocking back and forth. The nurse recognizes these behaviors as indicative of what? Extrapyramidal side effects Loss of voluntary muscle control Posturing Tardive dyskinesia
Correct response: Tardive dyskinesia Explanation: The client's behaviors are classic signs of tardive dyskinesia. Tardive dyskinesia, a syndrome of permanent involuntary movements, is most commonly caused by the long-term use of conventional antipsychotic drugs. Extrapyramidal side effects are reversible movement disorders induced by antipsychotic or neuroleptic medication. The client's behavior is not a loss of voluntary control or posturing.
A client with schizophrenia is prescribed clozapine. The nurse would monitor the client closely for specific signs of: hypotension. nausea. weight loss. infection.
Correct response: infection. Explanation: 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.
