Schizophrenia

Which statement regarding the pathophysiology and etiology of schizophrenia is correct? A. "Brain imaging shows that there is reduced blood flow to the thalamus, frontal lobe, and temporal lobes." B. "There's an increased number of nicotinic receptors in the hippocampus, which makes it harder to form new memories and interpret sensory stimuli." C. "Genetics doesn't seem to factor into the cause of the disease." D. "The ventricles and sulci of the brain are decreased in size."

A) "Brain imaging shows that there is reduced blood flow to the thalamus, frontal lobe, and temporal lobes." Rationale: There are many abnormalities of the central nervous system in a client with schizophrenia. Brain imaging studies of individuals with schizophrenia consistently reveal a pattern of structural abnormalities that include decreased volumes of gray matter in the prefrontal cortex, temporal lobes, hippocampus, and thalamus; enlarged ventricles and sulci; and decreased blood flow to the frontal lobe, thalamus, and temporal lobes. A decreased number of nicotinic receptors in the hippocampus makes it harder for the client with schizophrenia to form new memories and interpret sensory stimuli. Genetics seems to factor into the cause of the disease, as familial patterns of the disease are noted. In the client with schizophrenia, the ventricle and sulci of the brain are increased in size.

The nurse is running a group therapy session for clients diagnosed with schizophrenia. Which interventions address the cognitive deficits associated with this disorder? A. Have clients wear name tags B. Provide a highly stimulating environment C. Encourage open-ended activities D. Use humor

A) Have clients wear name tags Rationale: Facial agnosia is a cognitive alteration frequently associated with schizophrenia. Name tags assist clients to remember other group members' names and may foster social interaction. Decreased stimuli would address deficits in focus and attention. Structured activities and cues are required to address lack of spontaneity in speech. Individuals with schizophrenia may have concrete thinking and may not respond well to humor.

The nurse is caring for a client with schizophrenia whose symptoms of psychosis have resolved. The client's family complains that the client's hygiene remains poor and he lacks motivation and initiative. Which conclusion by the nurse is most appropriate? A. The client is experiencing negative symptoms. B. The client is experiencing disordered thinking. C. The client was misdiagnosed. D. The client is most likely hearing voices.

A) The client is experiencing negative symptoms Rationale: Negative symptoms are those that subtract from normal behavior. These symptoms include a lack of interest, motivation, responsiveness, pleasure in daily activities, or the ability to care for self. Positive symptoms include hallucinations, delusions, and a disorganized thought or speech pattern. There isn't any evidence to support that the client is hearing voices. There isn't any evidence to support that the client is very depressed.

The nurse is teaching techniques to improve communication skills to a family with a member with schizophrenia. Which techniques should be included? SATA A. Use active listening B. Make positive, specific requests for change C. Use "I" language to express feelings. D. Encourage client to communicate with only family E. Use "you" statements to point out negative behavior.

A, B, C Rationale: Increasing communication in a safe setting with family and friends helps to stimulate both self-confidence and the fostering of important relationships. Use "I" language to express positive feelings (e.g., "I am happy when you decide to sit down for dinner with us"). Engage in active listening (e.g., asking questions and nodding in agreement when another person speaks). Make positive, specific requests for change that are linked to emotions (e.g., "I would really like it if you could play a game with us tonight"). Express negative feelings with "I" rather than "you" language (e.g., saying "I'm worried that you may not be getting enough sleep" instead of "You never get enough sleep at night").

The nurse is caring for the client prescribed thorazine. Which assessment findings alert the nurse to the possibility that the client has developed tardive dyskinesia? SATA A. Wormlike motions of the tongue B. Lip smacking C. Unusual facial movements D. Muscle spasms of the neck E. Shuffling gait

A, B, C Rationale: Tardive dyskinesia is characterized by unusual tongue and face movements such as lip smacking and wormlike motions of the tongue. Severe muscle spasms of the back, neck, and tongue are known as acute dystonia, not tardive dyskinesia.

An adolescent client is admitted to the hospital for treatment of schizophrenia. The client's mother is confused and wants to know what she did to cause this to occur. Which responses by the nurse are appropriate? SATA A. "Schizophrenia is a biological disorder of the brain." B. "Research shows that schizophrenia is a genetic disorder." C. "Research indicates that a very stressful environment causes schizophrenia." D. "Schizophrenia is due to too much dopamine in certain parts of the brain." E. "Schizophrenia is linked to drinking alcohol during pregnancy."

A, B, D Rationale: Theories explaining the cause of schizophrenia include a genetic component, imbalances in neurotransmitters in specific areas of the brain, and overactive dopaminergic pathways in the basal nuclei. There is no evidence to support a link between schizophrenia and alcohol consumption during pregnancy. A stressful environment will exacerbate the symptoms of schizophrenia but does not cause the illness.

The nurse is providing education related to improving family dynamics for the the family of an adolescent diagnosed with schizophrenia. Which topics should be included in the teaching? SATA A. Establish boundaries B. Identify coping mechanisms C. Discuss childhood memories D. Prevent future episodes E. Improve Communication

A, B, E Rationale: The goal is to help clients and families cope, improve their communication and interpersonal skills, establish boundaries, and moderate family cohesion and flexibility. The family may not be able to prevent future psychologic episodes. Discussing childhood memories is irrelevant to treatment.

The client is receiving risperidone (Risperdal) for the treatment of schizophrenia. Which client statement indicates the medication is effectively treating the positive symptoms of schizophrenia? A. "I promise not to skip breakfast anymore." B. "I'm not hearing the voices anymore." C. "I'll start going to group therapy." D. "I feel better and I'm ready to go home."

B) "I'm not hearing voices anymore." Rationale: Among the therapeutic effects of risperidone (Risperdal) is the remission of a range of psychotic symptoms that include delusions, paranoia, auditory hallucinations, and irrational behavior. A client stating he feels better and is ready to go home, stating he will go to group therapy, or stating he will not skip breakfast does not indicate the remission of any psychotic symptoms.

A nurse working in a psych unit is caring for a client diagosed with schizophrenia who manifests positive symptoms of the disease. Based on this data, which manifestation does the nurse expect to identify when providing care? A. Social withdrawal B. Hallucinations C. Anhedonia D. Concrete thinking

B) Hallucinations Rationale: The major manifestations of schizophrenia are described as either positive symptoms or negative symptoms, depending on whether they involve the presence of unusual behaviors or the absence of typical behaviors. Hallucinations are a positive symptom; all other choices are negative symptoms.

The nurse is educating an adolescent client diagnosed with schizophrenia on predisposing risk factors. Which significant risk factor should the nurse include in the teaching? A. Summer birthdate B. Parents recently divorced C. Positive family history D. Lives in rural setting

C) Positive family history Rationale: The most significant risk factor for schizophrenia is a positive family history. There is evidence that individuals born in late winter may be at greater risk of developing the illness, possibly due to exposure to infection. Although stress can trigger the illness in certain susceptible individuals, it is not a risk factor itself. Living in a rural area is not a risk factor for schizophrenia.

The nurse is caring for a client who is experiencing auditory hallucinations. Which is the priority nursing diagnosis for this client? A. Disturbed thought process B. Individual ineffective coping C. Impaired verbal communication D. Risk for violence, Self-directed or Other-directed

D) Risk for Violence, Self-directed or Other directed Rationale: Maintaining a safe environment is the priority diagnosis. When hallucinating or interpreting others' actions and statements from the standpoint of delusions, the client may believe herself to be in danger, regardless of whether there is a factual basis for her fear. Under such circumstances, both the client and perceived aggressors may be at risk for injury. Although the client has impaired thought processes, this is not the priority diagnosis at this time. Individual Ineffective Coping and Impaired Verbal Communication are also correct diagnoses, but the key word here is "priority," and this client has a potential or risk for harm to self or others.

The healthcare provider prescribes aripiprazole (Abilify) for the client with schizoprhrenia. Which is the priority outcome for this client? A. The client will report a decrease in auditory hallucination B. The client will report symptoms of restlessness C. The client will consume adequate fluids and a high-fiber diet. D. The client will adhere to the medication regime

D) The client will adhere to the medication regime Rationale: Medication compliance is a priority for clients with schizophrenia. Relapse of symptoms will occur without the medications. The symptom of restlessness is known as akathisia. This would be important to report, but it is not the priority outcome. Adequate fluids and fiber will decrease the side effect of constipation, but this is not the priority outcome. A decrease in auditory hallucinations is an expected effect of aripiprazole (Abilify), but this is not the priority outcome.