Psychosis - NCO
A client with schizophrenia tells the nurse, "There are foreign agents conspiring against me; they're out to get me at every turn." How should the nurse respond? 1 "It must be scary to believe that people are out to trick you at every opportunity." 2 "Those people you call foreign agents are out to do you in. What else is happening?" 3 "What's happened to make you believe that these people you call foreign agents are after you?" 4 "I can understand how frightening your thoughts are to you, but there are not foreign agents out to get you."
"I can understand how frightening your thoughts are to you, but there are not foreign agents out to get you." Noting how frightening the client's thoughts must seem but also telling the client that the thoughts do not seem factual acknowledges the client's feelings and points out reality. Although "It must be scary to believe that people are out to trick you at every opportunity" is an empathic response, it does not point out reality; the word "trick" does not have the same connotation as "do me in." The response "Those people you call foreign agents are out to do you in. What else is happening?" reinforces the client's delusional system. The response "What's happened to make you believe these people you call foreign agents are after you?" does not focus on feelings and places the client on the defensive.
The registered nurse is teaching a nursing student regarding education a client who is on treatment with monoamine oxidase inhibitors (MAOIs). Which statement made by the nursing student indicates further teaching? 1 "I should encourage the client to take food high in tyramine." 2 "I should encourage the client to wear a medical alert necklace." 3 "I should advise the client to report any problem in vision." 4 "I should advise the client to report any symptoms of seizures."
1 "I should encourage the client to take food high in tyramine." Because of the potential for a dangerous hypertensive crisis, the nurse should tell the client to avoid foods high in tyramine when taking MAOIs. The nurse should encourage the client to wear a medical alert necklace. The nurse should advise the client to report any problem in vision. The nurse should advise the client to report any symptoms of seizures.
A client newly admitted to the psychiatric unit because of an acute psychotic episode is actively hallucinating. The admitting nurse has documented the content of the auditory hallucinations, which center on the theme of powerlessness. Later the primary nurse approaches the client, who appears to be listening to voices, and comments, "You seem to be listening to something. Tell me what you hear." The primary nurse requests feedback from the psychiatric clinical specialist regarding this nursing intervention. How should the clinical specialist respond? 1 By reminding the nurse that once the content is known, there is no need to focus on the hallucinations, because doing so reinforces them 2 By giving positive feedback for the nurse's attempt to explore the content of the client's hallucinations and reinforcing the need to continue this approach 3 By recognizing this as a positive intervention and helping the nurse develop a plan of care that calls for a contract to refrain from acting on command hallucinations 4 By suggesting that the nurse use an open-ended approach and asking the nurse to discuss the correlation between positive behaviors observed and prescribed antipsychotics
1 By reminding the nurse that once the content is known, there is no need to focus on the hallucinations, because doing so reinforces them Once the content of the hallucination is known and it is not a command to harm the self or others, focusing on the hallucinations is not therapeutic; recognizing feelings, pointing out reality, and learning to use strategies to push aside hallucinations are therapeutic. Giving positive feedback reinforces the nurse's inappropriate approach with the client; continuing this approach reinforces the value of the hallucinations for the client, which is undesirable. This is a negative, not a positive, intervention; also, no data support the fact that the client is experiencing command hallucinations. Clear, concise, direct communication is more desirable when clients are experiencing hallucinations, which are usually frightening; although positive behaviors are a response to antipsychotic medications, these should not be the primary focus of this supervisory session.
A client with depression was prescribed fluoxetine. After two days, the client arrives at the hospital and reports restlessness, confusion, and poor concentration. Upon assessment, the nurse finds an elevated body temperature. Which intervention by the healthcare provider would be beneficial to the client? 1 Withdrawing the drug 2 Administering isocarboxazid 3 Reducing the dose of the drug 4 Informing the client that these are expected side effects
1 - Withdrawing from the drug Restlessness, confusion, poor concentration, and fever are symptoms of serotonin syndrome. The only treatment for serotonin syndrome is discontinuation of the drug. Isocarboxazid is a monoamine oxidase inhibitor that should not be used in a client with serotonin syndrome because it may lead to life-threatening conditions. Reducing the drug dosage may not reverse the symptoms completely. Informing the client that these are expected adverse effects is important, but the drug should be discontinued immediately.
A nurse is preparing a teaching plan to educate a relative of a client with schizophrenia about the early signs of relapse. What signs should the nurse plan to include? Select all that apply. 1 Appearing disheveled 2 Socializing with peers 3 Staying alone in the house 4 Joining a local church singing group 5 Exhibiting indifference to family activities
1 Appearing disheveled 3 Staying alone in the house 5 Exhibiting indifference to family activities Appearing disheveled, a negative sign, may indicate schizophrenic relapse, because the individual does not have the interest or energy to complete the activities of daily living. Staying at home alone can be a sign of mental illness relapse, because the individual is becoming isolated and not socializing. Indifference to family activities may indicate mental illness relapse, because it may reflect feelings of apathy or a lack of emotional energy to become involved with others. Socializing with peers is a sign of mental health, because the individual is interacting with others; humans are highly social beings. Joining a church singing group indicates mental health, because the individual is interacting with others and is interested in an activity.
The nurse cares for a client diagnosed with bipolar disorder who was prescribed drug therapy. Laboratory reports reveal that the client's thyroxine levels are low. Which drug might have led to this condition? 1 Lithium 2 Fluoxetine 3 Risperidone 4 Carbamazepine
1 Lithium Lithium is used to treat bipolar disorder. Decreased levels of thyroxine and triiodothyronine may indicate hypothyroidism. Lithium may cause a goiter, which is associated with hypothyroidism. Fluoxetine is a serotonin reuptake inhibitor that may lead to hyponatremia. Risperidone is a second generation antipsychotic used to treat bipolar disorder that does not cause hypothyroidism. Carbamazepine is an antiepileptic drug used to treat bipolar disorder; this drug may cause leukopenia, anemia, and thrombocytopenia.
A client with schizophrenia has been experiencing hallucinations. During what client behaviors should the nurse expect the hallucinations to be more frequent? 1 Rest 2 Playing sports 3 Watching television 4 Interacting with others
1 Rest Hallucinations occur most often when sensory stimulation is diminished because there is less competition for attention. Sports, television-watching, and interacting with others compete for sensory attention, thereby diminishing hallucinations.
While caring for a client receiving medication therapy for acne, the nurse observes aggressive behaviors and suicidal ideations. Which medication may be responsible for the client's condition? 1 Celecoxib 2 Isotretinoin 3 Minocycline 4 Meclofenamate
2 Isotretinoin Isotretinoin a potent and effective oral agent that is used to treat severe cystic acne when other treatments do not respond. It causes many multiple side effects that include aggressive behaviors and suicidal ideations. Minocycline is a systemic antibiotic that is more expensive and causes fewer gastrointestinal side effects. Celecoxib and meclofenamate are nonsteroidal anti-inflammatory agents that cause nausea, vomiting, and indigestion as side effects.
A nurse who is working on a psychiatric unit notes that a client with schizophrenia is beginning to pace around the lounge while glaring at other clients. How should the nurse respond to this behavior? 1 By pointing out the behavior to the client 2 By walking with the client to a quiet area on the unit 3 By suggesting that the client go to the gym to work out 4 By arranging for an additional staff member to be present in the vicinity of the client
2 The client is demonstrating signs of agitation, and stimuli from the environment must be reduced. Pointing out the behavior is confrontational and may increase the client's agitation. The client should not be left unattended at this time; aggressive physical activity at this time may increase the agitation. Arranging for the presence of another staff member will not interrupt the client's behavior, which is the priority at this time.
3.Which drugs may lead to a prolongation of the QT interval in a client who is on drug therapy for schizophrenia? Select all that apply. 1 Loxapine 2 Haloperidol 3 Thiothixene 4 Thioridazine 5 Chlorpromazine
2- Haloperidol 4- Thioridazine 5- Chlorpromazine Prolongation of the QT interval indicates severe dysrhythmias. This is due to the use of haloperidol, thioridazine, and chlorpromazine, which are first generation antipsychotics. Loxapine and thiothixene do not cause prolongation of the QT interval.
What should a nurse do first when managing interpersonal relationships with a client who has schizophrenia? 1 Allow the client to be alone when desired but provide quiet activities. 2 Insist that the client join group meetings and activities with other clients. 3 Establish a one-on-one relationship and then bring the client into group activities. 4 Encourage dependence by the client initially but set limits on the extent of this behavior.
3 Establish a one-on-one relationship and then bring the client into group activities. To improve social function in clients with schizophrenia, the nurse must first work to develop a trusting one-on-one relationship. Clients with schizophrenia will build trust through one-on-one interactions. Clients need interaction to increase trust; they will not seek interactions without encouragement. If forced, these individuals will be too fearful of the group to function in it or benefit by it. Dependency is not encouraged for any capable clients.
A nurse is caring for a client who uses ritualistic behavior. What common antiobsessional medication does the nurse anticipate will be prescribed? 1 Benztropine 2 Amantadine 3 Fluvoxamine 4 Diphenhydramine
3 - Fluvoxamine Fluvoxamine blocks the uptake of serotonin, which leads to a decrease in obsessive-compulsive behaviors. Benztropine is an antiparkinsonian agent, not an antianxiety agent. Amantadine is an antiparkinsonian agent, not an antianxiety agent. Diphenhydramine is an antihistamine, not an antianxiety agent.
A client with schizophrenia is demonstrating waxy flexibility. Which intervention is the best way to manage the possible outcome of this behavior? 1 Providing thickened liquids to minimize the risk of aspiration 2 Documenting intake and output each shift to monitor hydration 3 Reinforcing appropriate social boundaries through staff role modeling 4 Performing passive range-of-motion exercises three times a day for effective joint health
4 - Performing passive range-of-motion exercises three times a day for effective joint health Waxy flexibility is an excessive and extended maintenance of posture that can lead to a variety of problems, including joint trauma. Passive range-of-motion exercises focus on the effective management of joint mechanics. Although aspiration precautions, documentation of intake and output, and staff role modeling may address issues experienced by a client with schizophrenia, passive range-of-motion exercises address waxy flexibility.
A client is found to have paranoid schizophrenia, and the healthcare provider prescribes a typical antipsychotic medication. The picture illustrates the client's physical status as observed by the nurse on the client's first visit to the community mental health clinic. What extrapyramidal side effect has developed? 1 Dystonia Correct 2 Akathisia 3 Tardive dyskinesia 4 Pseudoparkinsonism
Akathisia, an extrapyramidal side effect of typical antipsychotics, is motor restlessness. The client is unable to sit or stand still and feels the need to move, pace, rock, swing the legs, or tap the feet. The condition occurs within 5 to 90 days of the initiation of therapy. Dystonia is muscle spasms of the face, tongue, head, neck, jaw, or back, usually resulting in exaggerated posturing. This extrapyramidal side effect of typical antipsychotics occurs within 1 hour to 1 week of the initiation of therapy. Tardive dyskinesia is facial, ocular, oral/buccal, lingual/masticatory, and systemic movements. This extrapyramidal side effect of typical antipsychotics may occur 6 months or more after the initiation of therapy. Pseudoparkinsonism has characteristics similar to those of Parkinson disease (e.g., shuffling gait, tremors, rigidity, bradykinesia). This extrapyramidal side effect of typical antipsychotics may occur any time after the initiation of therapy.
The nurse finds that a child has inattention, hyperactivity, and impulsivity upon assessment. Which medication would be beneficial for the child? 1 Modafinil 2 Doxapram 3 Armodafinil 4 Atomoxetine
Atomoxetine Inattention, hyperactivity, and impulsivity in a child may indicate that the child has attention deficit hyperactivity disorder. Atomoxetine is a nonstimulant second-line drug used to treat attention deficit hyperactivity disorder (ADHD). Modafinil is a nonamphetamine stimulant used to treat shift-work sleep disorder (SWSD). Doxapram and armodafinil are nonamphetamine stimulants used to treat shift-work sleep disorder (SWSD).
A client experiencing hallucinations tells a nurse, "The voices are telling me that I am evil." The client asks whether the nurse hears the voices. What is the most appropriate response by the nurse? 1 "I don't hear the voices, but I believe that you can hear them." 2 "It is the voice of your conscience, and only you can control that." 3 "Those voices are coming from within you; only you can hear them." 4 "The voices are a symptom of your illness; don't pay attention to them.
Correct 1 "I don't hear the voices, but I believe that you can hear them." The nurse, demonstrating knowledge and understanding, accepts the client's perceptions even though they are hallucinatory by saying "I don't hear the voices, but I believe that you can hear them." Telling the client "It is the voice of your conscience, and only you can control that" may increase the client's guilt and fear. Saying "Those voices are coming from within you; only you can hear them" may increase the client's fear. The statement "The voices are a symptom of your illness; don't pay attention to them" presents reality but negates the client's feelings and asks for an unrealistic response.
A nurse greets a client who has been experiencing delusions of persecution and auditory hallucinations by saying, "Good evening. How are you?" The client, who has been referring to himself as "the man," answers, "The man is bad." Of what is this an example? 1 Dissociation 2 Transference 3 Displacement 4 Identification
Correct 1 Dissociation Speaking in the third person reflects poor ego boundaries and dissociation from the real self. Transference is the movement of emotional energy and feelings that one has for one person to another person. Displacement is an attempt to reduce anxiety by transferring the emotions associated with one object or person to another. Identification is an attempt to increase self-esteem by acquiring the attributes or characteristics of an admired individual.
A client is admitted to the acute care psychiatric unit with a diagnosis of panic disorder with agoraphobia. During the initial assessment phase, what should the nurse focus on? 1 Easing the client's anxiety so further interviewing may be done 2 Learning about the client's home life to facilitate the planning of future care 3 Suggesting that the client rest for a while before taking the health history 4 Helping the client identify the source of anxiety so the source may be avoided
Correct 1 Easing the client's anxiety so further interviewing may be done The client will be unable to concentrate or focus on the interview if anxiety is not reduced. Learning about the client's home life to facilitate the planning of care is not the priority at this time; anxiety must be reduced and the client's level of comfort increased. The client will not rest until anxiety is reduced. Helping the client identify the source of anxiety so the source can be avoided is not the priority at this time; anxiety must be reduced and the client's level of comfort increased.
A nurse is caring for a client who is experiencing auditory hallucinations. What is the most therapeutic response by the nurse? 1 "Those voices you hear aren't real." 2 "I don't hear the voices you're hearing." 3 "Try to focus your attention on other things." 4 "You won't hear the voices when you get better."
Correct 2 "I don't hear the voices you're hearing i don't hear the voices you're hearing" points out reality without being demeaning or arguing with the client. The voices are real to the client, and stating otherwise will not be believed. Trying to focus the client's attention on other things is probably impossible. The client will be unable to focus on the future when attempting to cope with the frightening experience of hearing voices in the present; also, it may be false reassurance.
A client with schizophrenia uses the word "worriation" when talking with the nurse. How should the nurse respond? 1 By correcting the pronunciation of the word 2 By asking for clarification of the word's meaning 3 By ignoring its use while interacting with the client 4 By telling the client to use words that everyone can understand
Correct 2 By asking for clarification of the word's meaning This is an example of a neologism, a self-coined word whose meaning is known only to the client. It is not a mispronunciation. The word's meaning must be explored. The use of a neologism should not be ignored, because the word usually has significance to the individual who is using it. Telling the client to use words everyone else can understand is a demeaning response that may cut off communication.
On admission a disturbed, unkempt client refuses to remove clothing. What should the nurse do first to best meet the client's needs? 1 Get assistance and remove the clothing to meet the client's basic hygiene needs. 2 Provide the client with two outfits to encourage the client to reach a simple decision. 3 Ask whether the client would like to change some item of clothing, such as socks or shirt. 4 Explain that the client will look more attractive in clean clothing in an effort to increase self-esteem.
Correct 3 Ask whether the client would like to change some item of clothing, such as socks or shirt. The nurse should ask whether the client would like to change some item of clothing, such as socks or shirt. Any other approach will be threatening, increase anxiety, and probably result in a physical confrontation. Getting assistance and removing the clothing to meet basic hygiene needs will increase anxiety, not foster decision-making. Providing the client with two outfits to encourage the client to reach a simple decision will increase the client's anxiety and probably result in a physical confrontation. Explaining that the client will look more attractive in clean clothing will increase anxiety, not self-esteem.
A nurse is educating a client who is taking clozapine for paranoid schizophrenia. What will the nurse emphasize about the side effects of clozapine? 1 Risk for falls 2 Inability to sit still 3 Increase in temperature 4 Dizziness upon standing
Correct 3 Increase in temperature Clozapine may cause agranulocytosis, which can result in the development of infection. Risk for falls is more common with typical antipsychotic medications, because they may cause orthostatic hypotension and extrapyramidal side effects. Inability to sit still (akathisia) and dizziness upon standing (orthostatic hypotension) are more common with typical antipsychotics, because they may cause extrapyramidal side effects.
A client with a diagnosis of bipolar I disorder, manic episode, is started on a regimen of an antipsychotic agent and lithium carbonate. The nurse explains to the client that the rationale behind this regimen is that the antipsychotic has which action? 1 Potentiates the action of lithium for more effective results 2 Interacts with lithium to prevent progression to the depressive phase 3 Helps decrease the risk of lithium toxicity in the first week of therapy 4 Acts to quiet the client while allowing time for the lithium to reach a therapeutic level
Correct 4 Acts to quiet the client while allowing time for the lithium to reach a therapeutic level Antipsychotics usually are prescribed to calm agitated clients during the 3-week period it takes for the lithium to become effective. Antipsychotic drugs have a different, not a potentiating, mechanism of action. The drugs are used to control symptoms of mania, not to prevent depression. The neuroleptic drug has no effect on lithium toxicity.
An older client with depression is prescribed a tricyclic antidepressant. What is the priority nursing intervention in this situation? 1 Providing psychotherapy to the client 2 Teaching strategies to overcome depression 3 Encouraging the client to walk for 30 minutes 4 Requesting that the physician change the drug 00:01:02 Question Answer Confidence Buttons
Correct 4 Requesting that the physician change the drug Tricyclic antidepressants have anticholinergic properties that can cause acute confusion, severe constipation, and urinary incontinence in older adults. Therefore the priority nursing care for an older client who is prescribed a tricyclic antidepressant is to request that the physician change the drug. Providing psychotherapy is an alternate treatment, which is of medium priority. Teaching strategies to overcome depression is of low priority. Encouraging the client to walk for 30 minutes overcomes the feelings of depression, but it is not the priority.
What is an important aspect of nursing care for a client exhibiting psychotic patterns of thinking and behavior? 1 Helping keep the client oriented to reality 2 Involving the client in activities throughout the day 3 Helping the client understand that it is harmful to withdraw from situations 4 Encouraging the client to discuss why interacting with other people is being avoided
Helping keep the client oriented to reality Keeping the withdrawn client oriented to reality prevents further withdrawal into a private world. A gradual involvement in selected activities is best. Helping the client understand that it is harmful to withdraw from situations is futile at this time. The psychotic client is unable to tell anyone the reason for avoiding interaction with others.
