Psychosis and Schizophrenia Nursing Review

A client with schizophrenia has recently begun a new medication, clozapine (Clozaril). Which potentially fatal side effect will the nurse teach the client about? 1. Dystonia 2. Agranulocytosis 3. Akathisia 4. Akinesia

2. Agranulocytosis

Which statement is correct about a 25-year-old client with newly diagnosed schizophrenia? A. Age of onset is typical for schizophrenia. B. Age of onset is later than usual for schizophrenia. C. Age of onset is earlier than usual for schizophrenia. D. Age of onset follows no predictable pattern in schizophrenia.

A. Age of onset is typical for schizophrenia. Explanation: The primary age of onset for schizophrenia is late adolescence through young adulthood (ages 17 to 27). Paranoid schizophrenia may sometimes have a later onset. All of the other options are incorrect.

Define anosognosia

Anosognosia: a symptom of some mental illnesses, such as schizophrenia, in which the individual is manifesting overt symptoms of illness but is unaware of the presence of symptoms or unaware that there is anything wrong.

A client diagnosed with schizophrenia tells a nurse, "The 'Shopatouliens' took my shoes out of my room last night." Which is an appropriate charting entry to describe this client's statement? A. "The client is experiencing command hallucinations." B. "The client is expressing a neologism." C. "The client is experiencing a paranoid delusion." D. "The client is verbalizing a word salad."

B. "The client is expressing a neologism." The nurse should describe the client's statement as experiencing a neologism. A neologism is when a client invents a new word that is meaningless to others but may have symbolic meaning to the client. Word salad refers to a group of words that are put together randomly.

The nurse assesses for evidence of positive symptoms of schizophrenia in a newly admitted client. Which of the following symptoms are considered positive evidence? Select all that apply. A. Anhedonia B. Delusions C. Flat affect D. Hallucinations E. Loose associations F. Social withdrawal

B. Delusions D. Hallucinations E.Loose associations Explanation: These are considered positive symptoms of schizophrenia. Options A, C, and F are considered negative symptoms.

A client with schizophrenia is referred for psychosocial rehabilitation. Which of the following are typical of this type of program? Select all that apply. A. Analyzing family issues and past problems B. Developing social skills and supports C. Learning how to live independently in a community D. Learning job skills for employment E. Treating family members affected by the illness F. Participating in in-depth psychoanalytical counseling

B. Developing social skills and supports C. Learning how to live independently in a community D. Learning job skills for employment Explanation: The goal of psychosocial rehabilitation as a treatment method is to help the client develop the skills and supports necessary for successful living, learning, and working in the community. Analysis of family issues and past problems and treatment of family members are not commonly part of this type of program. The emphasis of psychosocial rehabilitation is on the client's development of skills in the here and now; consequently, psychoanalytic counselling is not part of the approach.

Which of the following client behaviors documented in the patient's chart would validate the nursing diagnosis of: Risk for other-directed violence? A. Gio's description of being endowed with superpowers B. Frequent angry outburst noted toward peers and staff C. Refusal to eat cafeteria food D. Refusal to join in group activities

B. Frequent angry outburst noted toward peers and staff Explanation: Anger is an important factor that indicated the potential for acting out. Because the client is angry with both peers and staff, any acting out would probably be directed toward others. The client's description of being endowed with superpowers and his refusal to eat cafeteria food indicate that he may have delusional beliefs, but not necessarily a risk for violence. Refusal to join in group activities indicates discomfort with a group, however, no threat of violence is apparent.

A paranoid client presents with bizarre behaviors, neologisms, and thought insertion. Which nursing action should be prioritized to maintain this client's safety? A. Assess for medication noncompliance B. Note escalating behaviors and intervene immediately C. Interpret attempts at communication D. Assess triggers for bizarre, inappropriate behaviors

B. Note escalating behaviors and intervene immediately The nurse should note escalating behaviors and intervene immediately to maintain this client's safety. Early intervention may prevent an aggressive response and keep the client and others safe.

A college student has quit attending classes, isolates self due to hearing voices, and yells accusations at fellow students. Based on this information, which nursing diagnosis should the nurse prioritize? A. Altered thought processes R/T hearing voices AEB increased anxiety B. Risk for other-directed violence R/T yelling accusations C. Social isolation R/T paranoia AEB absence from classes D. Risk for self-directed violence R/T depressed mood

B. Risk for other-directed violence R/T yelling accusations Hearing voices and yelling accusations indicates a potential for violence, and this potential safety issue should be prioritized.

A paranoid client presents with bizarre behaviors, neologisms, and thought insertion. Which nursing action should be prioritized to maintain this clients safety? A. Assess for medication nonadherance. B. Note escalating behaviors and intervene immediately. C. Interpret attempts at communication. D. Assess triggers for bizarre, inappropriate behaviors.

B. The nurse should note escalating behaviors and intervene immediately, to maintain this clients safety. Early intervention may prevent an aggressive response and keep the client and others safe.

An aging client diagnosed with chronic schizophrenia takes an antipsychotic and a beta-adrenergic blocking agent (propranolol) for hypertension. Understanding the combined side effects of these drugs, which statement by a nurse is most appropriate? A. "Make sure you concentrate on taking slow, deep, cleansing breaths." B. "Watch your diet and try to engage in some regular physical activity." C. "Rise slowly when you change position from lying to sitting or sitting to standing." D. "Wear sunscreen and try to avoid midday sun exposure."

C. "Rise slowly when you change position from lying to sitting or sitting to standing." Antipsychotic medications and beta blockers cause a decrease in blood pressure. When given in combination, this side effect places the client at risk for developing orthostatic hypotension.

Parents ask a nurse how they should reply when their child, diagnosed with schizophrenia spectrum disorder, tells them that voices command him to harm others. Which is the appropriate nursing response? A. Tell him to stop discussing the voices. B. Ignore what he is saying, while attempting to discover the underlying cause. C. Focus on the feelings generated by the hallucinations and present reality. D. Present objective evidence that the voices are not real.

C. Focus on the feelings generated by the hallucinations and present reality. The most appropriate response by the nurse is to instruct the parents to focus on the feelings generated by the hallucinations and present reality. The parents should accept that their child is experiencing the hallucination but should not reinforce this unreal sensory perception.

The healthcare provider is teaching a patient diagnosed with schizophrenia about the medication clozapine (Clozaril). Which of the following will be included in the teaching? Select all that apply. Select all answers that apply:Choose all answers that apply: A. "Remember to make position changes slowly until you get used to the medication." B. "Remember that it's important that you avoid all citrus and citrus juices." C. "You'll need to come in periodically so your lipid profile can be monitored." D. "You should eat a healthy diet with plenty of fruits, vegetables, and fiber." E. "Let us know if you experience symptoms of infection such as fever or fatigue." F. "Call our office if you experience increased thirst and increased urination."

Correct Answers: A, C, D, E, F. - only B is incorrect Clozapine blocks a variety of receptors and can cause a range of adverse effects, including metabolic problems. Clozapine blocks muscarinic cholinergic receptors, potentially causing constipation and other anticholinergic effects. Clozapine blocks alpha-1 receptors, which increases the potential for orthostatic hypotension. Metabolic effects include weight gain, dyslipidemia, and the development of diabetes. Clozapine is associated with agranulocytosis, which may be fatal. WBC count and absolute neutrophil count (ANC) will be monitored, and patients should be advised to report symptoms of infection. Grapefruit and grapefruit juice can inhibit the cytochrome P450 isoenzyme CYP3A4, which can increase serum levels of clozapine. The patient should not be told to avoid other citrus fruits and juices.

A nurse is administering risperidone (Risperdal) to a client diagnosed with schizophrenia. The therapeutic effect of this medication would most effectively address which of the following symptoms? (Select all that apply.) A. Somatic delusions B. Social isolation C. Gustatory hallucinations D. Flat affect E. Clang associations

Correct Answers: A, C, E The nurse should expect that risperidone (Risperdal) would be effective treatment for somatic delusions, gustatory hallucinations, and clang associations. Risperidone is an atypical antipsychotic that has been effective in the treatment of the positive symptoms of schizophrenia and in maintenance therapy to prevent exacerbation of schizophrenic symptoms.

A patient is prescribed ziprasidone (Geodon) for the treatment of schizophrenia. Which of the following would alert the healthcare provider that the patient is experiencing an adverse effect of the medication? Select all that apply: A. Increased temperature B. Rigidity and bradykinesia C. Palpitations and syncope D. Seizure activity E. Pulmonary crackles

Correct answers: A. Increased temperature, B. Rigidity and bradykinesia, C. Palpitations and syncope, E. Pulmonary crackles Medications rarely have just one action (such as decreasing symptoms of psychosis). Extrapyramidal symptoms (EPS) are common adverse effects of antipsychotics. Ziprasidone is associated with the development of agranulocytosis. Ziprasidone is associated with alterations in esophageal motility. In addition to blocking dopamine receptors, ziprasidone also blocks alpha-1 adrenergic receptors, which may result orthostatic hypotension. Orthostatic hypotension may also be caused by EKG changes. Alterations in esophageal motility increases the risk of aspiration. Agranulocytosis increases the patient's risk of infection.

A patient diagnosed with schizoid personality disorder asks the healthcare provider, "Does this mean I'll eventually develop schizophrenia?" Which of the following responses is most appropriate? A. "Tell me how you would feel if you were diagnosed with schizophrenia." B. "You should not worry about the possibility of a future diagnosis of schizophrenia." C. "If you develop schizophrenia there are many medications that can help you." D. "Not everyone diagnosed with schizoid personality disorder develops schizophrenia."

D. "Not everyone diagnosed with schizoid personality disorder develops schizophrenia."

Which factor is associated with increased risk for schizophrenia? A. Alcoholism B. Adolescent pregnancy C. Overcrowded schools D. Poverty

D. Poverty Explanation: Low socioeconomic status or poverty is an identified environmental factor associated with increased incidence of schizophrenia. Although alcoholism, adolescent pregnancy, and overcrowded schools may be stressful, research does not show they increase the risk of schizophrenia.

Which nursing intervention would be most appropriate when caring for an acutely agitated client diagnosed with paranoid schizophrenia? A. Provide neon lights and soft music. B. Maintain continual eye contact throughout the interview. C. Use therapeutic touch to increase trust and rapport. D. Provide personal space to respect the client's boundaries.

D. Provide personal space to respect the client's boundaries. The most appropriate nursing intervention is to provide personal space to respect the client's boundaries. Providing personal space may serve to reduce anxiety and thus reduce the client's risk for violence.

A patient who has had auditory hallucinations for many years tells the nurse that the voices prevents his participation in a social skills training program at the community health center. Which intervention is most appropriate? A. Let the patient analyze the content of the voices. B. Advise the patient to participate in the program when the voices cease. C. Advise the patient to take his medications as prescribed. D. Teach the patient to use thought stopping techniques.

D. Teach the patient to use thought stopping techniques. Explanation: Clients with long-lasting auditory hallucinations can learn to use thought stopping measures to accomplish tasks. Analyzing the content of the voices may be indicated when hallucinations first occur to establish whether the voices are threatening to the client or instructing him to harm others. However, focusing on their content at this point would reinforce this symptom. The voices have lasted many years; the client should participate despite the voices. There is no indication that the client is not taking medication as prescribed.

During an admission assessment, a nurse notes that a client diagnosed with schizophrenia has allergies to penicillin, prochlorperazine (Compazine), and bee stings. Based on this assessment data, which antipsychotic medication would be contraindicated? A. Haloperidol (Haldol), because it is used only in elderly patients B. Clozapine (Clozaril), because of a cross-sensitivity to penicillin C. Risperidone (Risperdal), because it exacerbates symptoms of depression D. Thioridazine (Mellaril), because of cross-sensitivity among phenothiazines

D. Thioridazine (Mellaril), because of cross-sensitivity among phenothiazines Prochlorperazine (Compazine) and thioridazine are both classified as phenothiazines.

TRUE or FALSE during the Residual Phase of schizophrenia, all negative and positive symptoms are absent while the patient enters a period of remission.

FALSE Schizophrenia is characterized by periods of remission and exacerbation. Following an active phase, symptoms will no longer be prominent or even become absent during a residual phase. Negative symptoms may remain. Flat affect and impairment in role functioning are common during the fourth phase.

Peak onset of schizophrenia in women: _______ to ______ years Peak onset of schizophrenia in men: _______ to ______ years

Peak onset of schizophrenia in women: 25 to 35 years Peak onset of schizophrenia in men: 10 to 25 years Approximately 90% of patients in treatment for schizophrenia present to mental health providers between the ages of 15 and 55. Most people who are diagnosed with schizophrenia have their first symptoms and episode in their 20s.

DEFINE: paranoid delusions

The fixed, false belief that one is being harmed or persecuted by a particular person or group of people.

DESCRIBE: schizophrenia spectrum disorders

The spectrum of psychotic disorders includes schizophrenia, schizoaffective disorder, delusional disorder, schizotypal personality disorder, schizophreniform disorder, brief psychotic disorder, as well as psychosis associated with substance use or medical conditions.

A client has been receiving lithium (Lithane) for the past two weeks for the treatment of bipolar illness. When planning client teaching, the nurse understands that it is important to emphasize that the client must? a. Have blood lithium levels drawn during the summer months b. Maintain a low sodium diet c. Come in for evaluation of serum lithium levels every 1-3 months d. Take a diuretic with lithium

a. Have blood lithium levels drawn during the summer months Clients taking lithium therapy need to be aware that hot weather may cause excessive perspiration, a loss of sodium and consequently an increase in serum lithium concentration.

Part of a nurse's continual assessment of the client taking antipsychotic medications is to observe for the side effect of extrapyramidal symptoms. Which of the following sets of symptoms would concern the nurse who is monitoring for extrapyramidal symptoms in the client? a. Muscular weakness, rigidity, tremors, facial spasms b. Dry mouth, blurred vision, urinary retention, orthostatic hypotension c. Amenorrhea, gynecomastia, retrograde ejaculation d. Elevated blood pressure, severe occipital headache, stiff neck

a. Muscular weakness, rigidity, tremors, facial spasms

A nurse is caring for a client with the diagnosis of schizophrenia. What should the nurse plan to do to increase the self-esteem of this client? a. Reward healthy behaviors. b. Explain the treatment plan. c. Identify various means of coping. d. Encourage participation in community meetings

a. Reward healthy behaviors. By realistically rewarding the healthy behaviors, the nurse provides secondary gains and encourages the continued use of healthy behaviors. Explaining the treatment plan, identifying various means of coping, and encouraging participation in community meetings are important but will do little to increase the client's self-esteem.

Clint, a client on the psychiatric unit, has been diagnosed with Schizophrenia. He begins to tell the nurse about how the CIA is looking for him and will kill him if they find him. Clint's belief is an example of a which of the following? a. delusion of persecution b. delusion of reference c. delusion of control or influence d. delusion of grandeur

a. delusion of persecution

match the term with its definition: Terms: a. neologism, b. clang associations, c. word salad, d. echolalia, e. echopraxia, f. flight of ideas Definitions: 1. a collection of random words; 2. repeating of others' words; 3. varied unconnected thoughts; 4. using words with special meanings to the individual; 5. repeating movements made by another person; 6. using rhyming words

a. neologisms: 4. using words with special meanings to the individual b. clang associations: 6. using rhyming words c. word salad: 1. a collection of random words d. echolalia: 2. repeating of others' words e. echopraxia: 5. repeating movements made by another person f. flight of ideas: 3. varied unconnected thoughts

The nurse observes that a client is pacing, agitated, and presenting aggressive gestures. The client's speech pattern is rapid, and affect is belligerent. Based on these observations, which is the nurse's immediate priority of care? a. provide safety for the client and other clients on the unit b. provide the clients on the unit with a sense of comfort and safety c. assist the staff in caring for the client in a controlled environment d. offer the client a less stimulating area in which to calm down and gain control

a. provide safety for the client and other clients on the unit rationale: safety of the client and other clients is the immediate priority. Address safety for all of the clients on the unit. Consider Maslow's Hierarchy of Needs to prioritize safety. Safety is the priority focus if a physiological need does not exist.

A client with bipolar disorder is reluctant to take lithium (Lithane) as prescribed. The MOST therapeutic response by the nurse to his refusal is? a. "You need to take your medicine, this is how you get well." b. "What is it about the medicine that you don't like?" c. "I can see that you are uncomfortable right now, I'll wait until tomorrow." d. "If you refuse your medicine, we'll just have to give you a shot."

b. "What is it about the medicine that you don't like?" Nursing interventions for clients with psychotic disorders are aimed at establishing a trusting relationship, establishing clear communications, presenting reality and reinforcing appropriate behavior.

Which symptom experienced by a client diagnosed with schizophrenia would predict a less positive prognosis? a. Continuously repeating what has been said. b. Having little or no interest in work or social activities. c. Hearing hostile voices. d. Thinking the TV is controlling his or her behavior.

b. Having little or no interest in work or social activities. When a client has little or no interest in work or social activities, the client is exhibiting the negative symptom of apathy. Apathy is indifference to, or disinterest in, the environment. Flat affect is a manifestation of emotional apathy. Because this client is exhibiting a negative symptom, the client has the potential for a poorer prognosis.

A patient is prescribed haloperidol (Haldol) for the management of schizophrenia. Before administering the medication to the patient, the healthcare provider observes facial grimacing and tongue thrusting. Which of the following interventions should the healthcare provider perform first? a. Perform a mental status exam and document the findings b. Hold the medication and continue to assess the patient c. Administer the prescribed benztropine (Cogentin) d. Send a blood sample to the lab to measure the haloperidol level

b. Hold the medication and continue to assess the patient The patient is demonstrating symptoms of an adverse effect of haloperidol. Tardive dyskinesia, a serious adverse effect of antipsychotic agents, may be irreversible so the medication should be withheld. Benztropine, an anticholinergic agent, may be administered next.

A patient with a history of schizophrenia is brought to the emergency department. The patient is agitated and demonstrates generalized muscle rigidity. Temperature, heart rate, and respiratory rate are elevated. These assessment findings are consistent with which of the following adverse effects of antipsychotic medications? a. Tardive dyskinesia b. Neuroleptic malignant syndrome c. Parkinsonism d. Serotonin syndrome

b. Neuroleptic malignant syndrome Antipsychotic medications primarily block dopamine receptors. Blockage of dopamine receptors can cause parkinsonism, which is characterized by bradykinesia, tremor, rigidity, and a shuffling gait. Tardive dyskinesia is also associated with prolonged use of dopamine receptor blocking agents, and is characterized by involuntary, twisting and writhing movements of the tongue and face.

Which of the following classifications of medications would be MOST often used for clients with schizophrenia? a. Anxiolytics b. Neuroleptics c. Anti-depressants d. Mood stabilizers

b. Neuroleptics Neuroleptics are antipsychotic drugs which are most beneficial in treating the signs and symptoms of schizophrenia; any of the other medications might also be used, but neuroleptics are the most widely used.

The primary healthcare provider prescribes a neuroleptic drug to a client diagnosed with schizophrenia. On what basis would the primary healthcare provider choose the drug? a. Symptoms b. Side effects c. Therapeutic effects d. Underlying pathology

b. Side effects First-generation antipsychotic drugs are also known as neuroleptics. The selection of these drugs is primarily based on side effects rather than therapeutic effects. Because all symptoms respond equally to antipsychotic drugs, the drug selection may not be based on symptoms. Because these drugs do not alter the underlying pathology, the selection may not be based on underlying pathology.

A client has been taking 3 mg of risperidone twice a day for the past 8 days. At the follow-up appointment, the client reports tremors, shortness of breath, a fever, and sweating. What will the nurse do? a. Call 911 and have the client transported to the nearest psychiatric unit. b. Take the client's vital signs and arrange for immediate transfer to a hospital. c. Check the number of risperidone tablets left in the prescription bottle to see whether there was an overdose. d. Request a prescription for 2 mg of intramuscular benztropine stat and assess the client in 10 to 15 minutes for symptom relief.

b. Take the client's vital signs and arrange for immediate transfer to a hospital. These clinical manifestations signal the presence of neuroleptic malignant syndrome; the cardinal sign of this condition is a high body temperature. Therefore the nurse first should document the hyperthermia and then arrange for immediate hospitalization. Unless the client is experiencing impaired ventilation, it is important to complete a focused assessment before transfer. The care needed can be provided in an emergency department or medical unit, not a psychiatric unit. Neuroleptic malignant syndrome may occur without an overdose; this syndrome can occur when a high-potency antipsychotic drug is prescribed, with typical onset within 3 to 9 days after initiation of the medication. Benztropine will have little or no effect on neuroleptic malignant syndrome.

Which of the following is the primary goal in working with an actively psychotic, suspicious client? a. promote interaction with others b. decrease his anxiety and increase trust c. improve his relationship with his parents d. encourage participation in therapy activities

b. decrease his anxiety and increase trust

Tony, age 21, has been diagnosed with Schizophrenia. He has been socially isolated and hearing voices telling him to kill his parents. He has been admitted to the psychiatric unit from the emergency department. What is the initial nursing intervention for Tony is to a. give him an injection of Thorazine. b. ensure a safe environment for him and others. c. place him in restraints. d. order him a nutritious diet.

b. ensure a safe environment for him and others.

A client says to the nurse, "The federal guards were sent to kill me." Which is the best response by the nurse to the client's concern? a. "I don't believe this is true." b. "The guards are not out to kill you." c. "Do you feel afraid that people are trying to hurt you?" d. "What makes you think the guards were sent to hurt you?"

c. "Do you feel afraid that people are trying to hurt you?" rationale: it is most therapeutic for the nurse to empathize with the client's experience. Eliminate options that show disagreement with the client or encourage any discussion regarding the delusion.

A client tells the nurse, "I'm a terrible, evil person. The voices are telling me that God needs to punish me." What is the most therapeutic initial response by the nurse? a. "God is loving and won't punish you." b. "Those voices you're hearing are a fantasy." c. "Tell me what you're thinking about yourself." d. "You aren't wicked—both God and I love you.

c. "Tell me what you're thinking about yourself." Encouraging the client to focus on the self will facilitate communication and foster self-perception. Stating that God will not punish the client denies the client's feelings and provides false reassurance. Stating that the voices are fantasy denies the client's experience. Stating that the client is not wicked denies the client's feelings and provides false reassurance.

Post-procedure nursing interventions for electroconvulsive therapy include? a. Expecting client to sleep for 4 to 6 hours b. Applying hard restraints if seizure occurs c. Remaining with client until oriented d. Expecting long-term memory loss

c. Remaining with client until oriented Client awakens post-procedure 20-30 minutes after treatment and appears groggy and confused. The nurse remains with the client until the client is oriented and able to engage in self-care.

A client with the diagnosis of schizophrenia refuses to get out of bed and becomes upset. What is the nurse's initial therapeutic response? a. Requiring the client to get out of bed at once b. Allowing the client to stay in bed for a while c. Staying at the bedside until the client calms down d. Giving the prescribed as-needed tranquilizer to the client

c. Staying at the bedside until the client calms down Staying at the bedside until the client calms down provides support and security without rejecting the client or placing value judgments on behavior. Eventually limits will have to be set, but this is not the immediate nursing action. Allowing the client to stay in bed for the time being ignores the problem, and isolation may imply punishment. Although medication will calm the client, it does not address the problem.

A client recently admitted to the hospital reports to the nurse, "I don't understand why I was brought here. I was simply hanging out in my apartment, and the police said I had to come with them." This is an example of what symptom of schizophrenia? a. delusions of reference b. loose association c. anosognosia d. auditory hallucinations

c. anosognosia "lack of insight," is a symptom of severe mental illness experienced by some that impairs a person's ability to understand and perceive his or her illness. It is the single largest reason why people with schizophrenia or bipolar disorder refuse medications or do not seek treatment.

The nurse is interviewing a client on the psychiatric unit. The client tilts his head to the side, stops talking in mid-sentence, and listens intently. The nurse recognizes from these signs that the client is likely experiencing which of the following? a. somatic delusions b. catatonic stupor c. auditory hallucinations d. pseudoparkinsonism

c. auditory hallucinations auditory complex perceptions that may include music, people talking, or other sounds which occur in the absence of external stimulation and which are perceived at least temporarily as real.

When a client suddenly becomes aggressive and violent on the unit, which of the following approaches would be best for the nurse to use first? a. provide large motor activities to relieve the client's pent-up tension b. administer a dose of PRN chlorpromazine to keep the client calm c. call for sufficient help to control the situation safely d. convey to the client that his behavior is unacceptable and will not be permitted

c. call for sufficient help to control the situation safely

All of the following are acceptable interventions for schizophrenia except: a. assess the client's physical needs b. maintain a safe environment c. make promises to the client to keep them calm, regardless of whether those promises can or will be met d. help the client establish what is real and unreal

c. make promises to the client to keep them calm, regardless of whether those promises can or will be met This answer violates the ethical principle of fidelity: keeping one's promises. The nurse must be faithful and true to their professional promises and responsibilities by providing high quality, safe care in a competent manner. Do not make promises to the client that cannot be kept.

Define choreiform movements

choreiform movements: jerking or writhing movements, or what appear to be minor problems with coordination; these movements, which are absent during sleep, worsen over the next few years and progress to random, uncontrollable, and often violent twitching and jerks

The types of hallucinations include - select all that apply: a. auditory b. gustatory c. external d. olfactory e. tactile f. visual

correct answers: a. auditory, b. gustatory, d. olfactory, e. tactile, f. visual incorrect option: c. external auditory = hearing voices when there are none gustatory = taste in the absence of stimuli olfactory = smells that don't exist tactile = feeling touch sensations in the absence of stimuli "there are bugs all over my arms" visual = seeing things that are not there

The nurse is preparing a client with a history of command hallucinations for discharge by providing instructions on interventions for managing hallucinations and anxiety. Which statement in response to these instructions suggests to the nurse that the client has a need for additional information? a. "my medications will help my anxious feelings." b. "I'll go to support group and talk about what I am feeling." c. "I need to get enough sleep and eat well to help prevent feeling anxious." d. "when I have command hallucinations, I'll call a friend and ask him what I should do."

d. "when I have command hallucinations, I'll call a friend and ask him what I should do." rationale: the risk for impulsive and aggressive behavior may increase if a client is receiving command hallucinations to harm self or others. If the client is experiencing a hallucination, the nurse or HCP, not a friend, should be contacted to discuss whether the client has intentions to hurt them self or others. The remaining options are interventions that a client can carry out to aid wellness.

A client on an in-patient psychiatric unit refuses to take medications because, "The pill has a special code written on it that will make it poisonous." What kind of delusion is this client experiencing? a. An erotomanic delusion. b. A grandiose delusion. c. A somatic delusion. d. A persecutory delusion.

d. A persecutory delusion is a type of delusion in which the individual believes he or she is being malevolently treated in some way. Frequent themes include being conspired against, cheated, spied on, followed, poisoned or drugged, maliciously maligned, harassed, or obstructed in the pursuit of long-term goals. The situation described in the question reflects this type of delusion. An erotomanic delusion is a type of delusion in which the individual believes that someone, usually of higher status, is in love with him or her. The situation described in the question does not reflect this type of delusion. A grandiose delusion is a type of delusion in which the individual has an irrational idea regarding self-worth, talent, knowledge, or power. The situation described in the question does not reflect this type of delusion. A somatic delusion is a type of delusion in which individuals believe they have some sort of physical defect, disorder, or disease. The situation described in the question does not reflect this type of delusion.

Which nursing intervention would be most appropriate when caring for an acutely agitated paranoid client diagnosed with schizophrenia spectrum disorder? a. Provide neon lights and soft music. b. Maintain continual eye contact throughout the interview. c. Use therapeutic touch to increase trust and rapport. d. Provide personal space to respect the clients boundaries.

d. Provide personal space to respect the clients boundaries. The most appropriate nursing intervention is to provide personal space to respect the clients boundaries. Providing personal space may serve to reduce anxiety and thus reduce the clients risk for violence.

A client diagnosed with schizophrenia is experiencing anhedonia. Which nursing diagnosis addresses concerns regarding this client's problem? a. Disturbed thought processes. b. Impaired verbal communication. c. Disturbed sensory perception. d. Risk for suicide.

d. Risk for suicide is defined as a risk for self-inflicted, life-threatening injury. The negative symptom of anhedonia is defined as the inability to experience pleasure. This is a particularly distressing symptom that generates hopelessness and compels some clients to attempt suicide.

A 60-year-old client diagnosed with schizophrenia spectrum disorder presents in an ED with uncontrollable tongue movements, stiff neck, and difficulty swallowing. Which medical diagnosis and treatment should a nurse anticipate when planning care for this client? a. Neuroleptic malignant syndrome treated by discontinuing antipsychotic medications b. Agranulocytosis treated by administration of clozapine (Clozaril) c. Extrapyramidal symptoms treated by administration of benztropine (Cogentin) d. Tardive dyskinesia treated by discontinuing antipsychotic medications

d. Tardive dyskinesia treated by discontinuing antipsychotic medications The nurse should expect that an ED physician would diagnose the client with tardive dyskinesia & discontinue antipsychotic medication. Tardive dyskinesia is a condition of abnormal involuntary movements of the mouth, tongue, trunk & extremities that can be a side effect of typical antipsychotic medications.

Which drugs are considered typical antipsychotics? Select all that apply: a. Asenapine b. Lurasidone c. Aripiprazole d. Thioridazine e. Chlorpromazine

d. Thioridazine e. Chlorpromazine First-generation antipsychotic drugs are also known as typical/conventional antipsychotics. Thioridazine and chlorpromazine are typical antipsychotics. Asenapine, lurasidone, and aripiprazole are atypical antipsychotics, also known as second-generation antipsychotics.

schizophrenia active-phase symptoms include all of the following except: a. delusions b. hallucinations c. disorganized speech d. obsessive ritualistic behavior e. grossly disorganized or catatonic behavior f. negative symptoms: flat affect, avolition, apathy, social isolation

d. obsessive ritualistic behavior while this may manifest in some patients, it is not included in the diagnostic certerion A of the DSM-5 for schizophrenia. All other options are part of the diagnostic criteria for schizophrenia and are considered active-phase symptoms.

Which of the following is the primary focus of family therapy for clients with schizophrenia and their families? a. to discuss concrete problem-solving and adaptive behaviors for coping with stress b. to introduce the family to others with the same problems c. to keep the client and family in touch with the health-care system d. to promote family interaction and increase understanding of the illness

d. to promote family interaction and increase understanding of the illness

DEFINE: anergia

deficiency of energy

DEFINE: anhedonia

inability to experience pleasure

define akathisia

restlessness, pacing, inability to remain still

DEFINE: flat affect

A lack of, or considerably diminished, emotional expression. Occurs when someone speaks robotically and shows little facial expression.

DEFINE: neologism

A neologism is a new word self invented by a person and not readily understood by another person. The use of neologisms is often associated with a thought disorder.

DEFINE: thought insertion

A person with this delusional belief is convinced of the veracity of their beliefs and is unwilling to accept such diagnosis. most commonly associated with schizophrenia.

define avolition

A severe lack of motivation Avolition is a total lack of motivation that makes it hard to get anything done. You can't start or finish even simple, everyday tasks. Avolition is often a symptom of schizophrenia, a mental disorder that affects how you think, feel, and act. It can also be a sign of severe depression or a side effect of certain medicines.

Which statement should indicate to a nurse that an individual is experiencing a delusion? A. "There's an alien growing in my liver." B. "I see my dead husband everywhere I go." C. "The IRS may audit my taxes." D. "I'm not going to eat my food. It smells like brimstone."

A. "There's an alien growing in my liver." The nurse should recognize that a client who claims that an alien is inside his or her body is experiencing a delusion. Delusions are false personal beliefs that are inconsistent with the person's intelligence or cultural background.

A client tells the nurse that psychotropic medicines are dangerous and refuses to take them. Which intervention should the nurse use first? A. Ask the client about any previous problems with psychotropic medications. B. Ask the client if an injection is preferable. C. Insist that the client take medication as prescribed. D. Withhold the medication until client is less suspicious.

A. Ask the client about any previous problems with psychotropic medications. Explanation: The nurse needs to clarify the client's previous experience with psychotropic medication in order to understand the meaning of the client's statement. Asking the client if an injection is preferable may add to the client;s suspicion and feeling threatened. Withholding medication prescribed to relieve delusional beliefs will likely intensify paranoid thinking. Insisting that the client take medication can be a violation of his right to refuse treatment.

Ray is diagnosed with schizophrenia paranoid type and is admitted in the psychiatric unit of a local medical center. Which of the following nursing interventions would be most appropriate? A. Establishing a non-demanding relationship B. Encouraging involvement in group activities C. Spending more time with Ramsay D. Waiting until Ramsay initiates interaction

A. Establishing a non-demanding relationship Explanation: A nonthreatening, non demanding relationship helps decrease the mistrust that is common in a client with paranoid schizophrenia. Encouraging involvement in group activities and spending more time with the client would be threatening for a client who is suspicious of other people's motives. This client is unlikely to initiate interaction; the nurse is responsible for initiating a relationship with the client.

Nurse Dorothy is evaluating care of a client with schizophrenia, the nurse should keep which point in mind? A. Frequent reassessment is needed and is based on the client's response to treatment. B. The family does not need to be included in the care because the client is an adult. C. The client is too ill to learn about his illness. D. Relapse is not an issue for a client with schizophrenia.

A. Frequent reassessment is needed and is based on the client's response to treatment. Explanation: Because client respond to treatment in different ways, the nurse must constantly evaluate the client and his potential. Premorbid adjustment must also be considered. Most clients with such condition go home, so the family should be involved. The client can learn about the illness if information is provided gradually. Relapse is common in schizophrenia.

After taking chlorpromazine (Thorazine) for 1 month, a client presents to an emergency department (ED) with severe muscle rigidity, tachycardia, and a temperature of 105 F (40.5C). The nurse expects the physician to recognize which condition and implement which treatment? A. Neuroleptic malignant syndrome and treat by discontinuing Thorazine and administering dantrolene (Dantrium) B. Neuroleptic malignant syndrome and treat by increasing Thorazine dosage and administering an antianxiety medication C. Dystonia and treat by administering trihexyphenidyl (Artane) D. Dystonia and treat by administering bromocriptine (Parlodel)

A. Neuroleptic malignant syndrome and treat by discontinuing Thorazine and administering dantrolene (Dantrium) Neuroleptic malignant syndrome is a potentially fatal condition characterized by muscle rigidity, fever, altered consciousness, and autonomic instability. The use of typical antipsychotics is largely being replaced by atypical antipsychotics due to fewer side effects and lower risks.

The healthcare provider is teaching a group of students about the biological basis of schizophrenia. Which of the following will be included in the teaching? Choose all answers that apply:Choose all answers that apply:(Choice A. Prenatal exposure to influenza B. GABAergic interneuron dysregulation C. Increased dopamine levels D. Family history of schizophrenia E. Stimulation of the amygdala F. Decreased norepinephrine levels

A. Prenatal exposure to influenza C. Increased dopamine levels D. Family history of schizophrenia Although the exact cause of schizophrenia is unknown, gene-environment interactions are implicated. Having a family member diagnosed with schizophrenia is a risk factor for developing schizophrenia. Perinatal complications such and maternal exposure to influenza during pregnancy are associated with an increased incidence of schizophrenia. An imbalance between excitation (via glutamate, the major CNS excitatory neurotransmitter), and GABA (the major CNS inhibitory neurotransmitter) in the cerebral cortex may be responsible for some of the pathophysiological processes involved in schizophrenia. Because antipsychotic medications block the dopaminergic D2 receptor in the central nervous system, excess dopamine has been identified as a potential cause of the psychotic symptoms associated with schizophrenia.

A client diagnosed with schizophrenia is prescribed clozapine (Clozaril). Which client symptoms related to the side effects of this medication should prompt a nurse to intervene immediately? A. Sore throat, fever, and malaise B. Akathisia and hypersalivation C. Akinesia and insomnia D. Dry mouth and urinary retention

A. Sore throat, fever, and malaise Clozapine can have a serious side effect of agranulocytosis, in which a potentially fatal drop in white blood cells can occur. Symptoms of infectious processes would alert the nurse to this potential.

If clozapine (Clozaril) therapy is being considered, the nurse should evaluate which laboratory test to establish a baseline for comparison in order to recognize a potentially life-threatening side effect? A. White blood cell count B. Liver function studies C. Creatinine clearance D. Blood urea nitrogen

A. White blood cell count The nurse should establish a baseline white blood cell count to evaluate a potentially life-threatening side effect if clozapine (Clozaril) is being considering as a treatment option. Clozapine can have a serious side effect of agranulocytosis in which a potentially fatal drop in white blood cells can occur.

A 16-year-old client diagnosed with schizophrenia spectrum disorder experiences command hallucinations to harm others. The clients parents ask a nurse, Where do the voices come from? Which is the appropriate nursing response? A. Your child has a chemical imbalance of the brain, which leads to altered perceptions. B. Your childs hallucinations are caused by medication interactions. C. Your child has too little serotonin in the brain, causing delusions and hallucinations. D. Your childs abnormal hormonal changes have precipitated auditory hallucinations.

A. Your child has a chemical imbalance of the brain, which leads to altered perceptions. The nurse should explain that a chemical imbalance of the brain leads to altered perceptions. Hallucinations, or false sensory perceptions, may occur in all five senses. The client hearing voices is experiencing an auditory hallucination.

Cersei is diagnosed as having disorganized schizophrenia. Which behaviors would Nurse Sansa most likely assess in the client? A. Absence of acute symptoms, impaired role function B. Extreme social withdrawal, odd mannerisms and behavior C. Psychomotor immobility; presence of waxy flexibility D. Suspiciousness toward others, increased hostility

B. Extreme social withdrawal, odd mannerisms and behavior Explanation: Disorganized schizophrenia is characterized by regressive behavior with extreme social withdrawal and frequently odd mannerisms. The absence of acute symptoms and impaired role function are more characteristic of residual-type schizophrenia. Psychomotor immobility and presence of waxy flexibility are more indicative of catatonic schizophrenia. Suspiciousness toward others and increased hostility is more characteristic of paranoid schizophrenia.

A client has been recently admitted to an inpatient psychiatric unit. Which intervention should the nurse plan to use to reduce the client's focus on delusional thinking? A. Present evidence that supports the reality of the situation B. Focus on feelings suggested by the delusion C. Address the delusion with logical explanations D. Explore reasons why the client has the delusion

B. Focus on feelings suggested by the delusion The nurse should focus on the client's feelings rather than attempt to change the client's delusional thinking by the use of evidence or logical explanations. Delusional thinking is usually fixed, and clients will continue to have the belief in spite of obvious proof that the belief is false or irrational.

Gio told his nurse that the FBI is monitoring and recording his every movement and that microphones have been plated in the unit walls. Which action would be the most therapeutic response? A. Confront the delusional material directly by telling Gio that this simply is not so. B. Tell Gio that this must seem frightening to him but that you believe he is safe here. C. Tell Gio to wait and talk about these beliefs in his one-on-one counselling sessions. D. Isolate Gio when he begins to talk about these beliefs.

B. Tell Gio that this must seem frightening to him but that you believe he is safe here. Explanation: The nurse must realize that these perceptions are very real to the client. Acknowledging the client's feelings provides support; explaining how the nurse sees the situation in a different way provides reality orientation. Confronting the delusional material directly will not work with this client and may diminish trust. Telling the client to wait and talk about these beliefs in his one-on-one counseling session will reinforce the delusion. Isolation will increase anxiety. Distraction with a radio or activities would be a better approach.

A client diagnosed with schizoaffective disorder is admitted for social skills training. Which information should be included in the nurses teaching? A. The side effects of medications B. Deep breathing techniques to decrease stress C. How to make eye contact when communicating D. How to be a leader

C. How to make eye contact when communicating The nurse should plan to teach the client how to make eye contact when communicating. Social skills, such as making eye contact, can assist clients to communicate needs and to establish relationships.

A client diagnosed with schizophrenia is slow to respond and appears to be listening to unseen others. Which medication should a nurse expect a physician to order to address this type of symptom? A. Haloperidol (Haldol) to address the negative symptom B. Clonazepam (Klonopin) to address the positive symptom C. Risperidone (Risperdal) to address the positive symptom D. Clozapine (Clozaril) to address the negative symptom

C. Risperidone (Risperdal) to address the positive symptom The nurse should expect the physician to order risperidone (Risperdal) to address the positive symptoms of schizophrenia. Risperidone (Risperdal) is an atypical antipsychotic used to reduce positive symptoms, including disturbances in content of thought (delusions), form of thought (neologisms), or sensory perception (hallucinations). Indications: schizophrenia in adults and adolescents aged 13-17 years. May also be indicated for treatment of acute manic or mixed episodes associated with bipolar 1 and irritability associated with autistic disorder in children. Action: may act by antagonizing dopamine and serotonin in the CNS. Ther. Effect: decreased symptoms of psychoses, bipolar mania, or autism.

A client diagnosed with schizophrenia takes an antipsychotic agent daily. Which assessment finding should a nurse immediately report to the client's attending psychiatrist? A. Respirations of 22/minute B. Weight gain of 8 pounds in 2 months C. Temperature of 104F (40C) D. Excessive salivation

C. Temperature of 104F (40C) When assessing a client diagnosed with schizophrenia who takes an antipsychotic agent daily, the nurse should immediately address a temperature of 104F (40C). A temperature this high can be a symptom of the rare but life-threatening neuroleptic malignant syndrome.

A newly admitted client has taken thioridazine (Mellaril) for 2 years with good symptom control. Symptoms exhibited on admission included paranoid delusions and hallucinations. The nurse should recognize which potential cause for the return of these symptoms? A. The client has developed tolerance to the antipsychotic medication. B. The client has not taken the medication with food. C. The client has not taken the medication as prescribed. D. The client has combined alcohol with the medication.

C. The client has not taken the medication as prescribed. Altered thinking can affect a client's insight into the necessity for taking antipsychotic medications consistently. When symptoms are no longer bothersome, clients may stop taking medications that cause disturbing side effects. Clients may miss the connection between taking the medications and an improved symptom profile.

A client states, "I hear voices that tell me that I am evil." Which outcome related to these symptoms should the nurse expect this client to accomplish by discharge? A. The client will verbalize the reason the voices make derogatory statements. B. The client will not hear auditory hallucinations. C. The client will identify events that increase anxiety and illicit hallucinations. D. The client will positively integrate the voices into the client's personality structure.

C. The client will identify events that increase anxiety and illicit hallucinations. It is unrealistic to expect the client to completely stop hearing voices. Even when compliant with antipsychotic medications, clients may still hear voices. It would be realistic to expect the client to associate stressful events with an increase in auditory hallucinations. By this recognition the client can anticipate symptoms and initiate appropriate coping skills.

A client diagnosed with schizophrenia spectrum disorder states, "Can't you hear him? Its the devil. Hes telling me I'm going to hell." Which is the most appropriate nursing response? A. Did you take your medicine this morning? B. You are not going to hell. You are a good person. C. The voices must sound scary, but the devil is not talking to you. This is part of your illness. D. The devil only talks to people who are receptive to his influence.

C. The voices must sound scary, but the devil is not talking to you. This is part of your illness. The most appropriate nursing response is to reassure the client while not reinforcing the hallucination. Reminding the client that the voices are a part of the illness is a way to help the client accept that the hallucinations are not real. It is also important for the nurse to connect with the clients fears and inner feelings.

Laboratory results reveal decreased levels of prolactin in a client diagnosed with schizophrenia. When assessing the client, which symptoms should a nurse expect to observe?(Select all that apply.) A. Apathy B. Social withdrawal C. Anhedonia D. Auditory hallucinations E. Delusions

Correct Answers: A, B, C The nurse should expect that a client with decreased levels of prolactin would experience apathy, social withdrawal, and anhedonia. Decreased levels of prolactin can cause depression which would result in the above symptoms.

When talking with a patient diagnosed with schizophrenia, the healthcare provider notes the patient continually states, "I'm the man with a plan, yes I am." The healthcare provider will document this behavior as which of the following? A. Loosening of association B. Word salad C. Tangentiality D. Clang associations

D. Clang associations All of these are manifestations of disorganized thought often seen in a patient diagnosed with schizophrenia. Word salad occurs when real words are linked together without any logical connection. This patient is demonstrating clanging, or clang associations, which is characterized by linking together words that rhyme or sound alike.

A nurse is assessing a client diagnosed with schizophrenia spectrum disorder. The nurse asks the client, Do you receive special messages from certain sources, such as the television or radio? The nurse is assessing which potential symptom of this disorder? A. Thought insertion B. Paranoid delusions C. Magical thinking D. Delusions of reference

D. Delusions of reference The nurse is assessing for the potential symptom of delusions of reference. A client that believes he or she receives messages through the radio is experiencing delusions of reference. These delusions involve the client interpreting events within the environment as being directed toward herself.

The family of a schizophrenic client asks the nurse if there is a genetic cause of this disorder. To answer the family, which fact would the nurse cite? A. Conclusive evidence indicates a specific gene transmits the disorder. B. Incidence of this disorder is variable in all families. C. There is a little evidence that genes play a role in transmission. D. Genetic factors can increase the vulnerability for this disorder.

D. Genetic factors can increase the vulnerability for this disorder. Explanation: Research shows that family history statistically increases the risk for development of schizophrenia. However, no single gene has yet been identified. Options B and and C are both incorrect because genetics plays a role in the etiology of schizophrenia.

Jaime has a diagnosis of schizophrenia with negative symptoms. In planning care for the client, the nurse would anticipate a problem with: A. auditory hallucinations. B. bizarre behaviors. C. ideas of reference. D. motivation for activities

D. motivation for activities Explanation: In a client demonstrating negative symptoms of schizophrenia, avolition, or the lack of motivation for activities, is a common problem. All of the other symptoms listed are the positive symptoms of schizophrenia.

True or False About one third of people with schizophrenia attempt suicide and about one in ten die from the act.

True Potential for suicide is a major concern among patients with schizophrenia.

True or False If a client is actively hallucinating, the nurse should intervene with one-on-one contact.

True: The nurse should ask the client directly about the hallucination and avoid reacting to the hallucination as if it were real. Decrease stimuli or move the client to another area and avoid indicating to the client that others are also experiencing the hallucination. Encourage expression of feelings, focus on reality-based topics, and respond verbally to anything real the client talks about. Avoid touching the client.

DEFINE: delusion of persecution

a set of delusional conditions in which the affected persons believe they are being persecuted. Specifically, they have been defined as containing two central elements: The individual thinks that harm is occurring, or is going to occur.

A patient diagnosed with schizophrenia states, "I am the Buddha!" Which type of psychotic symptom is the patient demonstrating? a. Delusion of grandeur b. Delusion of persecution c. Magical thinking d. Religiosity

a. Delusion of grandeur This patient is demonstrating a problem with content of thought. Although this patient is identifying with a religious figure, a patient demonstrating religiosity is obsessed with religious ideas and behavior. An individual who demonstrates a delusion of grandeur has an exaggerated feeling of importance, power, or identity.

The nurse is talking with a client. The client abruptly says to the nurse, "The moon is full. Astronauts walk on the moon. Walking is a good health habit." The client's behavior MOST likely indicates? a. Flight of ideas b. Neologisms c. Dissociation d. Word salad

a. Flight of ideas is the correct option. Defines nearly continuous flow of speech, jumping from one topic to another.

Select the correct term for the following definition: A severe mental condition in which there is disorganization of the personality, deterioration in social functioning, and loss of contact with or distortion of reality. There may be evidence of hallucinations and delusional thinking. With can occur with or without the presence of organic impairment. a. psychosis b. substance use disorder c. bipolar disorder d. depression

a. psychosis

The healthcare provider is caring for a patient in an inpatient mental health unit. The patient tells the healthcare provider, "Here come the monkeys. They are on the ceiling." Which of the following responses is most appropriate in this situation? a. "Really? How many monkeys do you see?" b. "The monkeys may appear very real to you, but I don't see any monkeys on the ceiling." c. "Did you say you see monkeys on the ceiling?" d. "Please tell me more about the monkeys."

b. "The monkeys may appear very real to you, but I don't see any monkeys on the ceiling." The healthcare provider will want to use a therapeutic communication technique that helps present reality to the patient. Delving deeper into a conversation by asking the patient to continue talking about the situation can be helpful in some situations, but it is not helpful when a patient is experiencing a misinterpretation of reality. The most appropriate response is to voice doubt by expressing uncertainty about the reality about the patient's perceptions.

Which nursing behavior will enhance the establishment of a trusting relationship with a client diagnosed with schizophrenia spectrum disorder? a. Establishing personal contact with family members b. Being reliable, honest, and consistent during interactions c. Sharing limited personal information d. Sitting close to the client to establish rapport

b. Being reliable, honest, and consistent during interactions The nurse can enhance the establishment of a trusting relationship with a client diagnosed with schizophrenia spectrum disorder by being reliable, honest, and consistent during interactions. The nurse should also convey acceptance of the clients needs and maintain a calm attitude when dealing with agitated behavior.

A nurse is caring for a client who is experiencing a flat affect, paranoid delusions, anhedonia, anergia, neologisms, and echolalia. Which statement correctly differentiates the clients positive and negative symptoms of schizophrenia? a. Paranoid delusions, anhedonia, and anergia are positive symptoms of schizophrenia. b. Paranoid delusions, neologisms, and echolalia are positive symptoms of schizophrenia. c. Paranoid delusions, anergia, and echolalia are negative symptoms of schizophrenia. d. Paranoid delusions, flat affect, and anhedonia are negative symptoms of schizophrenia.

b. Paranoid delusions, neologisms, and echolalia are positive symptoms of schizophrenia. The nurse should recognize that positive symptoms of schizophrenia include, but are not limited to, paranoid delusions, neologisms, and echolalia. The negative symptoms of schizophrenia include, but are not limited to, flat affect, anhedonia, and anergia. Positive symptoms reflect an excess or distortion of normal functions. Negative symptoms reflect a diminution or loss of normal functions.

The nurse is interviewing a client on the psychiatric unit. The client tilts his head to the side, stops talking in mid-sentence, and listens intently. The nurse recognizes these behaviors as a symptom of the client's illness. What is the most appropriate nursing intervention for this symptom? a. ask the client to describe his physical symptoms b. ask the client to describe what he is hearing c. administer a dose of benztropine d. call the HCP for additional orders

b. ask the client to describe what he is hearing

Early intervention usually takes place during which phase of schizophrenia? a. premorbid phase b. prodromal phase c. active psychosis d. residual phase

b. prodromal phase The prodromal phase begins with a change from premorbid functioning and extends until the onset of frank psychotic symptoms. The average length of prodromal phase is between 2-5 years, but varies as little as a few weeks or months. The individual will begin to show signs of significant deterioration in function. Many client report depressive symptoms, experience social withdrawal, have a decline in cognitive function, and some adolescents may have sudden onset obsessive-compulsive behaviors. Early intervention can improve long-term outcomes if behaviors associated with the prodromal phase are recognized.

schizoid or schizotypal personalities are characterized as: a. loud, disregard personal boundaries, hands-on learners b. quiet, passive, introverted c. jovial, cheerful, social d. drawn to substance abuse, moody, inappropriate for age

b. quiet, passive, introverted Premorbid history of schizophrenia may include schizoid or schizotypal personalities characterized as quiet, passive, and introverted. Pts may have had few friends as a child, avoided sports team,s and enjoy solitary activities rather than social activities.

The pattern of development of schizophrenia may be viewed in ______ phases: a. 2 phases: onset and deterioration b. 3 phases: early, progressive, and psychotic c. 4 phases: premorbid, prodromal, active psychotic, and residual d. 5 phases: antemorbid, progressive, static, active, psychotic

c. 4 phases: premorbid, prodromal, active psychotic, and residual

The healthcare provider is assessing a patient using the Global Assessment of Functioning (GAF) scale. Which of these patient characteristics will the GAF measure? a.Overall physical health status b. Performance of activities of daily living without pain c. Ability to have friends and keep a job d. Current nutritional and hydration status

c. Ability to have friends and keep a job The Global Assessment of Functioning, or GAF, scale is used to rate how serious a mental illness may be. It measures how much a person's symptoms affect his or her day-to-day life on a scale of 0 to 100. It's designed to help mental health providers understand how well the person can do everyday activities. The GAF allows the healthcare provider to evaluate the patient's psychological, social, and occupational functioning. A patient scoring high on the GAF scale will have superior functioning in a wide range of activities. A patient scoring low on the GAF scale may be in danger of hurting self or others. The GAF will give the healthcare provider information about factors such as the ability to have friends, keep a job, the patient's level of anxiety, and presence of hallucinations. It does not assess environmental or physical factors.

A paranoid client diagnosed with schizophrenia spectrum disorder states, "My psychiatrist is out to get me. I'm sad that the voice is telling me to stop him." What symptom is the client exhibiting, and what is the nurses legal responsibility related to this symptom? a. Magical thinking; administer an antipsychotic medication. b. Persecutory delusions; orient the client to reality. c. Command hallucinations; warn the psychiatrist. d. Altered thought processes; call an emergency treatment team meeting.

c. Command hallucinations; warn the psychiatrist. The nurse should determine that the client is exhibiting command hallucinations. The nurses legal responsibility is to warn the psychiatrist of the potential for harm. Clients demonstrating a risk for violence could potentially be physically, emotionally, and/or sexually harmful to others or to self.

When caring for a patient in an inpatient psychiatric setting, which of these will the healthcare provider establish as a priority goal for the patient? a. Improving communication skills b. Attending group therapy sessions c. Demonstrating decreased symptoms d. Demonstrating medication adherence

c. Demonstrating decreased symptoms All of these may be goals for a patient with mental healthcare needs, but one is the priority in this setting. Inpatient settings are necessary if a patient is experiencing an exacerbation of their illness and has a need for frequent monitoring in a controlled environment. Stabilization of symptoms must be accomplished before the patient can be expected to accomplish additional goals.

A patient is diagnosed with schizoid personality disorder. When interviewing the patient, the healthcare provider would most likely observe which of the following behaviors? a. Disregard for violating the rights of others b. Distrust or suspicion of others' motives c. Detachment from social relationships d. Excessive attention seeking

c. Detachment from social relationships Personality disorders involve traits in an individual's personality that are inflexible, maladaptive, and cause significant impairment of functioning. Patients who are diagnosed with schizoid personality disorder are unable to respond to others in a meaningful way. The patient diagnosed with schizoid personality disorder is introverted, will almost always choose solitary activities, and will be detached from social relationships.

A client is diagnosed with schizophrenia spectrum disorder. A physician orders haloperidol (Haldol) 50 mg bid, benztropine (Cogentin) 1 mg prn, and zolpidem (Ambien) 10 mg HS. Which client behavior would warrant the nurse to administer benztropine? a. Tactile hallucinations b. Tardive dyskinesia c. Restlessness and muscle rigidity d. Reports of hearing disturbing voices

c. Restlessness and muscle rigidity The symptom of tactile hallucinations and reports of hearing disturbing voices would be addressed by an antipsychotic medication such as haloperidol. Tardive dyskinesia, a potentially irreversible condition, would warrant the discontinuation of an antipsychotic medication such as haloperidol. An anticholinergic medication such as benztropine would be used to treat the extrapyramidal symptoms of restlessness and muscle rigidity.

A client diagnosed with schizophrenia spectrum disorder tells a nurse about voices commanding him to kill the president. Which is the priority nursing diagnosis for this client? a. Disturbed sensory perception b. Altered thought processes c. Risk for violence: directed toward others d. Risk for injury

c. Risk for violence: directed toward others The nurse should prioritize the diagnosis risk for violence: directed toward others. A client who hears voices commanding him to kill someone is at risk for other-directed violence. Other risk factors for violence include aggressive body language, verbal aggression, catatonic excitement, and rage reactions.

The nurse is caring for a client with schizophrenia. Orders from the HCP include 100 mg chlorpromazine IM STAT and then 50 mg PO bid, 2 mg benztropine PO bid PRN. Why is chlorpromazine ordered? a. to reduce extrapyramidal symptoms b. to prevent neuroleptic malignant syndrome c. to decrease psychotic symptoms d. to induce sleep

c. to decrease psychotic symptoms chlorpromazine: antiemetic, antipsychotic - phenothiazines Indications: second-line treatment for schizophrenia and psychoses after failure with atypical antipsychotics. Action: alters the effects of dopamine in the CNS. significant anticholinergic/alpha-adrenergic blocking activity Ther. Effects: diminished s/s of psychosis; relief of n/v and intractable hiccups; decreased symptoms of porphyria (porphyria: Disorders resulting from buildup of certain chemicals related to red blood cell proteins.)

Three specific delusions are classic positive symptoms of schizophrenia; these delusions are: a. action control, thought control, sleep deprivation b. speech alteration, feeling bugs, identifying as someone else c. hypersexuality, inappropriate speech, mimicing d. thought broadcasting, thought insertion, thought withdrawal

correct answer: d thought broadcasting: thinking one's thoughts are broadcasted so that everyone can hear thought insertion: thinking that others are inserting thoughts into the individual's head thought withdrawal: thinking that thoughts are being drawn out of the person's head by others

In phase 1 of schizophrenia, the premorbid phase, distinctive personality traits or behaviors may exist without clear evidence of illness. Premorbid personality traits and behaviors include: (select all that apply) a. being very shy and withdrawn b. hyperactivity and loud speaking voice c. having poor peer relationships d. doing poorly in school e. excelling in kinesthetic activities f. demonstrating antisocial behavior

correct answers: a. being very shy and withdrawn c. having poor peer relationships d. doing poorly in school f. demonstrating antisocial behavior

A patient is being observed for extrapyramidal symptoms. Which of these symptoms would alert the nurse to the possible onset of this condition? Select all answers that apply: A. Tremors at rest B. Blurred vision C. Facial grimacing D. Inability to concentrate E. Flaccid extremities F. Restlessness

correct answers: A. Tremors at rest C. Facial grimacing F. Restlessness The extrapyramidal system is a descending motor tract. The extrapyramidal system is involved in motor functions such as overall body coordination and posture. Extrapyramidal symptoms include motor restlessness (akathisia), tremors at rest (a symptom of parkinsonism), and facial grimacing (a symptom of dystonia).

Recent research on the RAISE approach to treatment of schizophrenia incorporates which of the following elements as important to improving outcomes? Select all that apply: a. early intervention at the first episode of psychosis b. support for employment and/or educational pursuits c. rapid, high-dose loading with antipsychotic medications d. court-ordered sanctions for treatment e. recovery-focused psychotherapy

correct answers: a, b, e a. early intervention at the first episode of psychosis b. support for employment and/or educational pursuits e. recovery-focused psychotherapy

Which nursing interventions are appropriate for a hospitalized client with mania who is exhibiting manipulative behavior? Select all that apply: a. communicate expected behaviors to the client b. ensure that the client knows that they are not in charge of the nursing unit c. assist the client in identifying ways of setting limit on personal behaviors d. follow through about the consequences of behavior in a nonpunitive manner e. enforce rules by informing the client that they will not be allowed to attend therapy groups f. have the client state the consequences for behaving in ways that are viewed as unacceptable

correct answers: a, c, d, f a. communicate expected behaviors to the client c. assist the client in identifying ways of setting limit on personal behaviors d. follow through about the consequences of behavior in a nonpunitive manner f. have the client state the consequences for behaving in ways that are viewed as unacceptable rationale: set clear, consistent, and enforceable limits on manipulative behavior. be clear about consequences and follow through.

Current treatment guidelines for the prodromal phase of schizophrenia suggest which of the following interventions: select all that apply a. immediate pharmacologic intervention with benzodiazepines b. cognitive therapies that minimize functional impairment c. family education to improve coping skills d. inpatient isolation and intensive psychotherapy e. involvement with schools to reduce the possibility of failure r/t manifestations of schizophrenia

correction answers: b. cognitive therapies that minimize functional impairment c. family education to improve coping skills e. involvement with schools to reduce the possibility of failure r/t manifestations of schizophrenia Interventions in the prodromal phase should include support with the patient's identified problems. Depending on the age of occurrence, involving the school is an appropriate intervention that helps support the individual through age-appropriate development. There is some controversy around the benefits of pharmaceutical use during the prodromal phase, however benzodiazepines are not the primary drugs used in this population, antipsychotics are commonly used.

Clint, a client on the psychiatric unit, has been diagnosed with Schizophrenia. He begins to tell the nurse about how the CIA is looking for him and will kill him if they find him. Which of the following is the most appropriate response by the nurse? a. "That's ridiculous, Clint. No one is going to hurt you." b. "The CIA isn't interested in people like you, Clint." c. "Why do you think the CIA wants to kill you?" d. "I know you believe that, Clint, but it's really hard for me to believe."

d. "I know you believe that, Clint, but it's really hard for me to believe."

When assessing a patient diagnosed with schizophrenia, which of the following will the healthcare provider identify as a negative symptom? a. Hallucinations b. Disorganized speech c. Delusions d. Anhedonia

d. Anhedonia Positive symptoms of schizophrenia are an exaggeration or distortion of normal functioning. Symptoms are classified as negative when they demonstrate a decrease of normal functioning such as flat affect (the inability to show emotion), anhedonia (the inability to experience pleasure), or asociality (an inability to maintain social contacts). Positive symptoms include hallucinations, delusions, or disorganized speech.

The nurse is caring for a client with schizophrenia. Orders from the HCP include 100 mg chlorpromazine IM STAT and then 50 mg PO bid, 2 mg benztropine PO bid PRN. Because Benztropine was ordered on a PRN basis, which of the following assessments by the nurse would convey a need for this medication? a. the client's levels of agitation increases b. the client complains of a sore throat c. the client's skin has a yellowish cast d. the client develops muscle spasms

d. the client develops muscle spasms Benztropine: antiparkinson agent - anticholinergic Indications: adjuctive Tx of all forms of Parkinson's disease, including drug-induced extrapyramidal effects and acute dystonic reactions Actions: blocks cholinergic activity in the CNS; stores the natural balance of neurotransmitters in the CNS Ther. effects: reduction of rigidity and tremors

DEFINE: echolalia

meaningless repetition of another person's spoken words as a symptom of psychiatric disorder.

Place the following items into the correct category of symptoms - either positive symptoms or negative symptoms: a. blunted affect -- f. disorganized speech b. apathy -- g. hallucinations c. delusions -- h. lack of speech or spontaneous movement d. flight of ideas e. lack of motivation

positive symptoms: c. delusions, d. flight of ideas, f. disorganized speech, g. hallucinations negative symptoms: a. blunted affect, b. apathy, e. lack of motivation, h. lack of speech or spontaneous movement

Define hallucinations

sense perception (occurs with 1 of the 5 senses) for which no external stimuli exist; can have an organic or functional cause.

DESCRIBE: benztropine

trade name: Congentin Ther. class: antiparkinson agents Pharm. class: anticholinergics Indications: tx of parkinson's disease, including drug-induced extrapyramidal effects and acute dystonic reactions Actions: blocks cholinergic activity in the CNS; stores the natural balance of neurotransmitters in the CNS Ther. effects: reduction of rigidity and tremors Common adv. effects: blurred vision, dry eyes, constipation, dry mouth, confusion, sedation Less common adv. effects: hallucinations, weakness, arrhythmias, hypotension, palpitations, tachycardia, ileus, nausea, urinary retention Assessment: those with mental illness are at risk of developing exaggerated symptoms during early therapy with this drug. Withhold and notify HCP if significant behavioral changes occur. - Monitor pulse and BP closely. Maintain bedrest for 1 hr after administration. Advise pt to change positions slowly to minimize orthostatic hypotension. Related nursing diagnoses: impaired physical mobiloty; risk for injury Implementation: PO give with food or immediately after meals to minimize GI upset/irritation. Evaluation/Desired Outcomes: decreased tremors and rigidity; improved gait and balance. Therapeutic effects can be seen 2-3 days after therapy was initiated.

TRUE or FALSE first-degree biological relatives of patients with schizophrenia have a 10 times greater risk for developing the disorder.

true there are strong genetic/hereditary links to schizophrenia. The exact cause is unclear. There is a genetic component to all forms of schizophrenia. Genetics lead to vulnerability, but the environment also exerts influence in the cause of schizophrenia.