Schizophrenia

To deal with a client's hallucinations therapeutically, which nursing intervention should be implemented? A. reinforce the perceptual distortions until the client develops new defenses. B. Provide an unstructured environment C. avoid making connections between anxiety-producing situations and hallucinations D. use empathic listening and redirect the client's attention to reality-based interaction

D. use empathic listening and redirect the client's attention to reality-based interaction The nurse should first empathize with the client by focusing on feelings generarted by the hallucination, present objective reality, and then redirect the client to reality-based activites

Gender differences in schizophrenia

Earlier diagnosis and poorer prognosis in men

Negative symptoms of schizophrenia

Emotions and behaviors that should be present but are diminished Avolition, ambivalence, flat affect - inappropriate affect: emotions are incongruent with the circumstances - bland affect: weak emotional tone - flat affect: appears to be void of emotional tone - apathy: disinterest in the environment - avolition: inability to initiate goal-directed activity

Positive symptoms of schizophrenia

Excessive or distorted thoughts and perceptions Delusions(thoughts) and hallucinations(sensory) - loose associations: shift of ideas from one unrelated topic to another - neologisms: made up words that have meaning only to the person who invents them - clang associations: choice of words is governed by sound - word salad: group of words put together in a random fashion - circumstantiality: delay in reaching the point of a communication because of unnecessary and tedious details - tangentiality: inability to get to the point of communication due to introduction of many new topics - perservation: persistent repetition of the same word or idea in response to different questions - echolalia: repeating words or phrases spoken by another Thinking: echolalia, circumstantiality, loose associations, tangentiality, flight of ideas, word salad, neologisms, paranoias, referential thinking, autistic thinking, concrete thinking, clang association, stilted language, pressured speech Behaviors: aggression, agitation, Catatonia, catatonic excitement, Echopraxia, regressed behavior, hyper vigilance, waxy flexibility

Delusional disorder

Existence of prominent, nonbizarre delusions -erotomanic type, grandiose type, jealous type, persecutory type, somatic type, mixed type

Familial differences in schizophrenia

First-degree biologic relatives with greater risk

Predisposing factors of schizophrenia

Genetics Biochemical: excess dopamine Physiological: viral infection, anatomical abnormalities - anatomical abnormalities: larger lateral and third ventricles, smaller total brain volume Environmental: poverty, stressful life events Theoretical integration and transaction model: biological based disease of which the onset is influenced by internal and external environment

Factors associated with positive prognosis of schizophrenia

Good premorbid functioning Later age onset Female gender Abrupt onset precipitated by stressful event Associated mood disturbance Brief duration of active phase symptoms Minimal residual symptoms A sense of structural brain abnormalities Normal neurological functioning No family history of mood disorder No family history of schizophrenia

Social domain nursing diagnosis for schizophrenia

Impaired social interaction Ineffective role performance Dysfunction family process Interrupted family process

Neurocognitive impairment in schizophrenia

Memory, vigilance or sustained attention, verbal fluency or the ability to generate new words, executive function(volition, planning, purposeful actions self monitoring behavior) Disorganized thinking

Catatonic disorder due to another medical condition

Metabolic disorders, neurological conditions

A patient on antipsychotic medication reports to the nurse that her muscles feel very stiff, and she appears diaphoretic. Her temperature is 105 degrees. Her symptoms are indicative of the potentially fatal adverse reaction to antipsychotic medication known as ________________________

Neuroleptic Malignant Syndrome Although neuroleptic malignant syndrome is rare, its rapid progression and potential to cause death make it a priority to assess for regularly and to intervene aggressively when symptoms are apparent. Antipsychotic medication should be immediately discontinued

Psychotic disorder associated with another medical condition

Prominent hallucinations and delusions are directly attributable to a general medical condition

Schizophreniform disorder

Same symptoms as schizophrenia with the exception that the duration of the disorder has been at least 1 month but less than 6 months

Schizoaffective disorder

Schizophrenic symptoms accompanied by a strong element of symptomatology associated with the mood disorders, either mania or depression

Biological domain nursing diagnosis for schizophrenia

Self neglect Disturbed sleep pattern Imbalanced nutrition less than Excess fluid volume Sexual dysfunction

Brief psychotic disorder

Sudden onset of symptoms, may or may not be preceded by severe psychosocial stressor, lasts less than 1 month

Priority care issues of schizophrenia

Suicide assessment Aggression and safety of patient, staff, others Antipsychotic medication

Substance induced psychotic disorder

The presence of prominent hallucinations and delusions that are judged to be directly attributable to substance intoxication or withdrawal

Clozapine (clozaril)

Used when second generation antipsychotics aren't effective Decreases WBC

Age of onset of schizophrenia

late adolescence and early adulthood

Clinical course of schizophrenia

1) prodromal phase - social maladjustment, antagonistic thoughts and behavior, shy and withdrawn, poor peer relationships, doing poorly in school, antisocial behavior 2) acute illness - perceptual abnormalities, ideas of reference, suspiciousness herald onset of psychosis, deterioration in role functioning, social withdrawal, functional impairment, sleep disturbance, anxiety, irritability, depressed mood, poor concentration 3) stabilization period - chronic illness characterized by acute episodes in which symptoms are more pronounced(delusions, hallucinations, impairment in work/social relations/self care) 4) recovery - symptoms are similar to those in the prodromal phase, flat affect and impairment in role functioning are prominent 5) relapses

A client is experiencing extrapyramidal symptoms secondary to neuroleptic drug therapy. The physician ordered biperiden (Akineton), 2mg tid IV. If a 5mg/mL vial is used, what is the total amount, in mL per day, that the nurse will administer?

1.2

The family of a patient who has been prescribed antipsychotic medication tells the nurse they understand there are potentially fatal side effects with these medications. They ask the nurse for information about what they should look for that could signal potentially dangerous or fatal side effects. Which of the following responses by the nurse are accurate with regard to the family's question? (Select all that apply) A. "If the patient has acute muscle spasms or the patient's eyes appear to be rolling back, emergency intervention should be sought." B. "if the patient has an unusually high fever and complains of muscle rigidity, any further antipsychotic medication should be discontinued and immediate emergency intervention should be sought." C. "If the patient complains of sore throat, fever, and malaise, the doctor should be contacted to evaluate for a possible dangerous side effect of the mediation." D. "if the male patient begins to show signs of breast enlargement or the female patient experiences amenorrhea, take the patient immediately to the ER." E. "If the patient's psychotic symptoms appear to be absent, call the doctor immediately."

A. "If the patient has acute muscle spasms or the patient's eyes appear to be rolling back, emergency intervention should be sought." B. "if the patient has an unusually high fever and complains of muscle rigidity, any further antipsychotic medication should be discontinued and immediate emergency intervention should be sought." C. "If the patient complains of sore throat, fever, and malaise, the doctor should be contacted to evaluate for a possible dangerous side effect of the mediation." Feedback 1: These symptoms are indicative of an acute dystonia, which can progress to laryngospasm if not treated. Emergency intervention with an anticholinergic such as Cogentin is needed to reverse this side effect. Feedback 2: These symptoms are indicative of neuroleptic malignant syndrome, which can progress rapidly and be fatal. Immediate discontinuation of antipsychotic medication and emergency intervention are critical needs. Feedback 3: These symptoms may be indicative of agranulocytosis, which can be fatal is not treated. Further bloodwork is needed.

A client diagnosed with schizophrenia states, "My roommate is plotting to have others kill me." Which is the appropriate nursing response? A. "i know you believe that to be true, but i find that hard to believe." B. "What would make you think such a thing?" C. "I know your roommate. He would do no such thing." D. "I can see why you feel that way."

A. "i know you believe that to be true, but i find that hard to believe." This client is experiencing a persecutory delusion. this nursing response is an example o voicing doubt, which expresses uncertainty as to the reality of the client's perceptions. this is an appropriate therapeutic communication technique in dealing with clients experiencing delusional thinking.

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: A. Delusion of persecution B. Delusion of reference C. Delusion of control or influence D. Delusion of grandeur

A. Delusion of persecution

A client diagnosed with schizophrenia experiences identity confusion and communicates with the nurse using echolalia. What is the client attempting to do by using this form of speech? A. Identify with the person speaking B. Imitate the nurse's movements C. Alleviate alogia D. Alleviate avolition

A. Identify with the person speaking Echolalia is a parrot-like repetition of overheard words or fragments of speech. It is an attempt by the client to identify with the person who is speaking.

A client who is experiencing command hallucinations is hospitalized after jumping from a bridge. The client's parents insist that their son feel rather than jumped. Which of the following likely explain the parents' response? (Select all that apply) A. The parents are in denial about the reality of their son's mental illness B. The parents are grieving over the loss of their expectations for their child C. The parents do not understand the extent or seriousness of mental illness D. The parents reject the idea of their son having a mental illness E. The parents are showing support for their son.

A. The parents are in denial about the reality of their son's mental illness B. The parents are grieving over the loss of their expectations for their child C. The parents do not understand the extent or seriousness of mental illness D. The parents reject the idea of their son having a mental illness Feedback 1: by stating the jump was a fall, the parents are expressing denial and minimizing the problem Feedback 2: The child's attempted suicide could generate a loss of hope that their child will meet parental expectations. This can occur any time a child is physically or mentally different. Feedback 3: The parents may have a knowledge deficit and truly may not understand the implications of their child's mental illness Feedback 4: By claiming that their son feel rather than jumped from the bridge, the parents are embracing an accidental cause and rejecting the possibility of mental illness.

The family of a client diagnosed with schizophrenia tells the nurse that they were at a NAMI meeting and heard that the recovery model for intervention with people with schizophrenia is gaining recognition as a desirable approach. They ask the nurse to describe this model. Which of these responses by the nurse are accurate statements about the recovery model? (Select all that apply) A. This model supports that recovery is an obtainable objective for people with schizophrenia B. This approach engages the client in an Alcoholics Anonymous (AA) - like 12-step program for recovery C. the recovery model actively engages the client in determining the goals for the treatment plan. D. The recovery model should not be confused with providing a "cure" for schizophrenia E. The recovery model is controversial because it stigmatizes the person with schizophrenia

A. This model supports that recovery is an obtainable objective for people with schizophrenia C. the recovery model actively engages the client in determining the goals for the treatment plan. D. The recovery model should not be confused with providing a "cure" for schizophrenia Feedback 1: Conventional models for treatment in schizophrenia have been criticized for potentially inhibiting a client's ability to recognize his or her potential because they focus too heavily on the disease as one in which recovery is not obtainable. The recovery model shifts the focus toward recovery as an attainable goal. Feedback 3: Central to the recovery model in intervention with people with schizophrenia is a patient-centered approach in which the clinician and the client work together to develop a treatment plan that is in alignment with goals set forth by the client Feedback 4: It is important in educating clients and families that the recovery model is not to be confused with promising a remission or a cure for this illness. Instead, it focuses on potential to function more autonomously rather than a primary focus on managing an intractable illness.

A patient admitted to the psychiatric unit and diagnosed with schizophrenia reports to the nurse that there are people playing drums in his chest. Which of these would be appropriate interventions by the nurse? (Select all that apply) A. check the patient's vital signs B. tell the patient that these are tactile hallucinations and that he need not be concerned C. Ask the patient to describe more completely what he is feeling D. Give the patient PRN Cogentin as ordered E. Encourage the patient to discuss this with the music therapist.

A. check the patient's vital signs C. Ask the patient to describe more completely what he is feeling Feedback 1: This intervention is a priority to ensure that the patient's symptoms are not secondary to a medical emergency such as heart attack. Feedback 3: This is an appropriate intervention since further assessment is needed to ensure that the patient's physiological needs are being met.

A client diagnosed with schizophrenia experiences identify confusion and communicates with the nurse using echolalia. What is the client attempting to do by using this form of speech? A. identify with the person speaking B. imitate the nurse's movements C. alleviate alogia D. alleviate avolition

A. identify with the person speaking Echolalia is a parrot-like repetition of overheard words or fragments of speech. it is an attempt by the client to identify with the person who is speaking.

A withdrawn client, newly diagnosed with schizophrenia, is experiencing delusional thinking. Which nursing intervention is most appropriate? A. present objective reality B. use self-disclosure C. use physical touch for reassurance D. provide an in-depth explanation of unit rules and regulations

A. present objective reality When communicating with a client diagnosed with schizophrenia, the nurse should reinforce and focus on reality by talking about real events and real people. Discussions that focus on false ideas reinforce the client's delusions.

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

ANS: A 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.

After taking chlorpromazine (Thorazine) for 1 month, a client presents to an emergency department (ED) with severe muscle rigidity, tachycardia, and a temperature of 105oF (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)

ANS: A The nurse should expect that an ED physician would diagnose the client with neuroleptic malignant syndrome and treat the client by discontinuing chlorpromazine (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.

A 16-year-old client diagnosed with schizophrenia experiences command hallucinations to harm others. The clients parents ask a nurse, Where do the voices come from? Which is the appropriate nursing reply? A. Your child has a chemical imbalance of the brain, which leads to altered thoughts. 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.

ANS: A The nurse should explain that a chemical imbalance of the brain leads to altered thought processes. Hallucinations, or false sensory perceptions, may occur in all five senses. The client who hears voices is experiencing an auditory hallucination.

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

ANS: A The nurse should intervene immediately if the client experiences a sore throat, fever, and malaise when taking the atypical antipsychotic drug clozapine (Clozaril). 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.

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."

ANS: A 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.

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

ANS: 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.

Which of the following components should a nurse recognize as an integral part of a rehabilitative program when planning care for clients diagnosed with schizophrenia? (Select all that apply.) A. Group therapy B. Medication management C. Deterrent therapy D. Supportive family therapy E. Social skills training

ANS: A, B, D, E The nurse should recognize that group therapy, medication management, supportive family therapy, and social skills training all play an integral part in rehabilitative programs for clients diagnosed with schizophrenia. Schizophrenia results from various combinations of genetic predispositions, biochemical dysfunctions, physiological factors, and psychological stress. Effective treatment requires a comprehensive, multidisciplinary effort.

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

ANS: 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.

Which nursing behavior will enhance the establishment of a trusting relationship with a client diagnosed with schizophrenia? 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.

ANS: B The nurse can enhance the establishment of a trusting relationship with a client diagnosed with schizophrenia 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.

During an admission assessment, a nurse asks a client diagnosed with schizophrenia, "Have you ever felt that certain objects or persons have control over your behavior?" The nurse is assessing for which type of thought disruption? A. Delusions of persecution B. Delusions of influence C. Delusions of reference D. Delusions of grandeur

ANS: B The nurse is assessing the client for delusions of influence when asking if the client has ever felt that objects or persons have control of the client's behavior. Delusions of control or influence are manifested when the client believes that his or her behavior is being influenced. An example would be if a client believes that a hearing aid receives transmissions that control personal thoughts and behaviors.

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 clients statement? A. The client is experiencing command hallucinations. B. The client is expressing a neologism. C. The client is experiencing a paranoia. D. The client is verbalizing a word salad.

ANS: B The nurse should describe the clients 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.

A client has been recently admitted to an inpatient psychiatric unit. Which intervention should the nurse plan to use to reduce the clients 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

ANS: B The nurse should focus on the clients feelings rather than attempt to change the clients 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.

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 noncompliance B. Note escalating behaviors and intervene immediately C. Interpret attempts at communication D. Assess triggers for bizarre, inappropriate behaviors

ANS: 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.

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 client's 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.

ANS: B The nurse should recognize that positive symptoms of schizophrenia include paranoid delusions, neologisms, and echolalia. The negative symptoms of schizophrenia include flat affect, anhedonia, and anergia. Positive symptoms reflect an excess or distortion of normal functions. Negative symptoms reflect a decrease or loss of normal functions.

A college student has quit attending classes, isolates self because of 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

ANS: B The nursing diagnosis that must be prioritized in this situation is risk for other-directed violence R/T yelling accusations. Hearing voices and yelling accusations indicate a potential for violence, and this potential safety issue should be prioritized.

A newly admitted client has taken thioridazine (Mellaril) for 2 years, with good symptom control. Symptoms exhibited on admission included paranoia 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.

ANS: C Altered thinking can affect a clients 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 clients personality structure.

ANS: C 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 states, Cant you hear him? Its the devil. Hes telling me Im going to hell. Which is the most appropriate nursing reply? A. Did you take your medicine this morning? B. You are not going to hell. You are a good person. C. Im sure the voices sound scary. I dont hear any voices speaking. D. The devil only talks to people who are receptive to his influence.

ANS: C The most appropriate reply by the nurse is to reassure the client with an accepting attitude while not reinforcing the hallucination.

Parents ask a nurse how they should reply when their child, diagnosed with paranoid schizophrenia, tells them that voices command him to harm others. Which is the appropriate nursing reply? 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."

ANS: C 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 maintain an attitude of acceptance to encourage communication but should not reinforce the hallucinations by exploring details of content. It is inappropriate to present logical arguments to persuade the client to accept the hallucinations as not real.

An elderly client diagnosed with schizophrenia takes an antipsychotic and a beta-adrenergic blocking agent (propranolol) for hypertension. Understanding the combined side effects of these drugs, the nurse would most appropriately make which statement? 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.

ANS: C The most appropriate statement by the nurse is to instruct the client to rise slowly when changing positions. 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.

A client diagnosed with schizophrenia states, My psychiatrist is out to get me. Im 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

ANS: C 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. A client who is demonstrating a risk for violence could potentially become physically, emotionally, and/or sexually harmful to others or to self.

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

ANS: C 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).

A client diagnosed with schizoaffective disorder is admitted for social skills training. Which information should be taught by the nurse? 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

ANS: C 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 in communicating needs and maintaining connectedness.

A client diagnosed with brief psychotic disorder tells a nurse about voices telling him to kill the president. Which nursing diagnosis should the nurse prioritize for this client? A. Disturbed sensory perception B. Altered thought processes C. Risk for violence: directed toward others D. Risk for injury

ANS: C The nurse should prioritize the diagnosis risk for violence: directed toward others. A client who hears voices telling him to kill someone is at risk for responding and reacting to the command hallucination. Other risk factors for violence include aggressive body language, verbal aggression, catatonic excitement, and rage reactions.

A client is diagnosed with schizophrenia. 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

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

ANS: C 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.

Which nursing intervention would be most appropriate when caring for an acutely agitated client with paranoia? 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.

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

ANS: D The nurse is assessing for the potential symptom of delusions of reference. A client who believes that he or she receives messages through the radio is experiencing delusions of reference. When a client experiences these delusions, he or she interprets all events within the environment as personal references.

A client diagnosed with chronic schizophrenia presents in an emergency department (ED) with uncontrollable tongue movements, stiff neck, and difficulty swallowing. The nurse would expect the physician to recognize which condition and implement which treatment? A. Neuroleptic malignant syndrome and treat by discontinuing antipsychotic medications B. Agranulocytosis and treat by administration of clozapine (Clozaril) C. Extrapyramidal symptoms and treat by administration of benztropine (Cogentin) D. Tardive dyskinesia and treat by discontinuing antipsychotic medications

ANS: D The nurse should expect that an ED physician would diagnose the client with tardive dyskinesia and discontinue antipsychotic medications. Tardive dyskinesia is a condition of abnormal involuntary movements of the mouth, tongue, trunk, and extremities that can be an irreversible side effect of typical antipsychotic medications.

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

ANS: D The nurse should know that thioridazine (Mellaril) would be contraindicated because of cross-sensitivity among phenothiazines. Prochlorperazine (Compazine) and thioridazine are both classified as phenothiazines.

Psychological domain nursing disgnosis for schizophrenia

Acute confusion Disturbed thought process Chronic low self esteem Ineffective coping Knowledge deficit

Some patients with schizophrenia express lack of insight or awareness that there is anything wrong or that any disorder is present. This symptom is referred to as _____________.

Anosognosia This symptom is often apparent when a client is asked what prompted admission to the hospital. A response such as "for some reason, the police just came over and told me I had to go to the hospital," is evidence of anosognosia. It is considered a symptom of the illness rather than a defense mechanism. A comparable symptom occurs following brain damage.

The family of a patient with schizophrenia requests information about Assertive Community Treatment (ACT). Which of the following responses by the nurse are consistent with this treatment model? (Select all that apply) A. "this model of treatment is based in the hospital and provides group education about how to assert oneself in the community." B. "this is a program of case management that takes a team approach in providing comprehensive community-based psychiatric services." C. This model is designed to meet the needs of people with conditions ranging from mild depression to severe and persistent illnesses such as schizophrenia." D. "One of the primary goals of ACT is to lessen the family's burden of providing care."

B. "this is a program of case management that takes a team approach in providing comprehensive community-based psychiatric services." D. "One of the primary goals of ACT is to lessen the family's burden of providing care." Feedback 1: This response demonstrates a lack of understanding of ACT. ACT is a community-based treatment model that focuses on comprehensive management of needs for patients with severe and persistent mental illnesses like schizophrenia. Feedback 4: NAMI (2012) identifies primary goals for ACT, one of which is to lessen the family's burden for providing care. ACT recognizes that patients with severe, persistent mental illness require many services beyond what one resource or the family can provide exclusively

The nurse is interviewing a client on the psychiatric unit. The client tilts his head to the side, stops talking in midsentence, and listens intently. the nurse recognizes these behaviors as a symptom of the client's illness. The most appropriate nursing intervention for this symptom is to: A. Ask the client to describe his physical symptoms B. Ask the client to describe what he is hearing C. Administer a dose of benzotropine D. Call the physician for additional orders

B. Ask the client to describe what he is hearing

The primary goal in working with an actively psychotic, suspicious client would be to: A. Promote interaction with others B. Decrease his anxiety and increase trust C. Improve this relationship with his parents D. Encourage participation in therapy activities

B. Decrease his anxiety and increase trust

A client diagnosed with schizophrenia manifests the symptom of mutism. Which nursing intervention would assist the client in communicating with others? A. Providing assistance with self-care needs B. Using clear, concrete statements C. Conveying acceptance of the client's need for false beliefs D. attempting to decode incomprehensible communication patterns.

B. Using clear, concrete statements The use of clear, concrete statement shows the client what is expected. Because clients diagnosed with schizophrenia experience concrete thinking, explanations must be provided at the client's concrete level of comprehension

A client diagnosed with schizophrenia hears another patient say, "You'll be tied up for another hour." and becomes agitated because he interprets that to mean he will literally be tied up. Which cognitive symptom of schizophrenia is this client manifesting? A. nihilistic delusions B. concrete thinking C. circumstantiality D. perseveration

B. concrete thinking Concrete thinking is manifested by literal interpretation of abstract or figurative ideas. This symptom may be present in schizophrenia and is believed to represent regression to an earlier level of cognitive development

Several types of delusions may occur in an individual with schizophrenia. Which of the following types of delusion places the patient at greatest risk for agitation or aggression? A. delusions of grandeur B. delusions of persecution C. delusions of reference D. nihilistic delusions

B. delusions of persecution In delusions of persecution an individual falsely believes he or she is being threatened or persecuted in some way. This carries a high risk for increasing the individual's agitation and possibly aggression in protective efforts.

In planning care to reinforce reality for a client diagnosed with schizophrenia, the nurse should include which interventions? A. explore the client's expressions of distorted thinking B. discuss perceptions and thinking that are in touch with reality C. Encourage the client to share delusional thinking in group discussions. D. ask the client why distorted thinking and bizarre behavior have occurred.

B. discuss perceptions and thinking that are in touch with reality Discussing reality=based perceptions and thinking will assist the client to maintain orientation and will promote organized thinking.

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. 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 nursing home resident who has been taking antipsychotic medications for several months complains to the nurse of a stiff neck and difficulty swallowing. These symptoms are indicative of which condition? A. dysphonia B. tardive dyskinesia C. akathisia D. echolalia

B. tardive dyskinesia Tardive dyskinesia is a syndrome characterized by abnormal, involuntary movements, including bizarre facial and tongue movements, a stiff neck, and/or difficulty swallowing. This condition may occur as an adverse effect of long-term therapy with antipsychotic medications

Antipsychotics

Blockage of dopamine transmission Used to decrease agitation and psychotic symptoms of schizophrenia and other psychotic disorders Second generation(atypical) effective in treating negative and positive symptoms Monitoring and admission: 1-2 weeks to effect a change in symptoms, trial of 6-12 weeks before med change Clozapine used when no other second generation agent effective Side effects: orthostatic hypotenstion, weight gain, reduced seizure threshold, decreased WBC, extrapyramidal symptoms, tar dive dyskinesia, neuroleptic malignant syndrome - extrapyramidal symptoms(EPS): psudeoparkinsonism, akinesia, akathisia, dystonia, oculogyric crisis = antiparkinsonian agents to be prescribed, anticholinergics, benzotropine(anticholinergic that blocks cholinergic activity in CNS responsible for EPS) - neuroleptic malignant syndrome: severe muscle rigidity, elevated temperature with rapidly accelerating cascade of symptoms = withhold med, dopamine agonist(bromocriptine), muscle relaxants(dantrolene or benzodiazepine) - anticholingeric crisis: hot, blind, mad, dry = discontinue med, physostigmine, gastric lavage/charcoal/catharsis for intentional overdoses

A client is admitted with a diagnosis of schizoaffective disorder. Which symptoms are characteristic of this diagnosis? A. strong ego boundaries and abstract thinking B. acute dystonias and tardive dyskinesia C. Altered mood and thought disturbances D. substance abuse and cachexia

C. Altered mood and thought disturbances The characteristic symptoms of schizoaffective disorder are a combination of alterations in mood (mania or depression) and thought

A client who has been taking chlorpromazine (Thorazine) for several months presents in the ED with extrapyramidal symptoms (EPS) of restlessness, drooling and tremors. What medication will the nurse expect the physician to order? A. Paroxetine (Paxil) B. Carbamazepine (Tegretol) C. Benztropine (Cogentin) D. Lorazepam (Ativan)

C. Benztropine (Cogentin) Benztropine is an anticholinergic medication that blocks cholinergic activity in the CNS, which is responsible for EPS. Anticholinergics are the drugs of choice to treat extrapyramidal symptoms associated with antipsychotic mediations

A client who has been taking chlorpromazine (Thorazine) for several months presents in the ED with extrapyramidal symptoms of restlessness, drooling, and tremors. What medication will the nurse expect the physician to order? A. Paroxetine (Paxil) B. Carbamazepine (Tegretol) C. Benztropine (Cogentin) D. Lorazepam (Ativan)

C. Benztropine (Cogentin) Cogentin is an anticholinergic medication that blocks cholinergic activity in the central nervous system, which is responsible for extrapyramidal symptoms. This is the drug of choice to treat extrapyramidal symptoms associated with antipsychotic medications.

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.

A client is admitted with a diagnosis of brief psychotic disorder with catatonic features. Which symptoms are associated with the catatonic specifier? A. Strong ego boundaries and abstract thinking B. Ataxia and akinesia C. Stupor, muscle rigidity, and negativism D. substance abuse and cachexia

C. Stupor, muscle rigidity, and negativism Symptoms associated with the catatonic specifier include stupor and muscle rigidity or excessive, purposeless motor activity. Waxy flexibility, negativism, echolalia, and echopraxia are also common behaviors

The nurse is caring for a client with schizophrenia. Orders from the physician 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

The nurse is interviewing a client on the psychiatric unit. The client tilts is head to the side, stops talking in midsentence, and listens intently. The nurse recognizes from these signs that the client is likely experiencing: A. somatic delusions B. catatonic stupor C. auditory hallucinations D. pseudoparkinsonism

C. auditory hallucinations

A client is experiencing paranoia and states, "the FBI and phone company are plotting against me." Which charting entry best describes this client's symptom? A. experiencing delusions of grandeur B. experiencing erotomanic delusions C. experiencing delusions of persecution D. experiencing somatic delusions

C. experiencing delusions of persecution Individuals experiencing delusions of persecution feel that they are being threatened and believe that others have harmful intentions. The client in the question believes that the FBI and the phone company are plotting harm.

The client hears the word "match". the client replies, "A match. I like matches. They are the light of the world. God will light the world. Let your light so shine." Which communication pattern does the nurse identify? A. word salad B. clang association C. Loose association D. ideas of reference

C. loose association Loose association is characterized by communication in which ideas shift from one unrelated topic to another. The situation in the question represents this communication pattern.

The client hears the word "match". The client says, "A match. Tomorrow is the end of the world. Nothing is better than hot coffee." Which communication pattern does the nurse identify? A. word salad B. clang association C. loose association D. ideas of reference

C. loose association Loose association is characterized by communication in which ideas shit from one unrelated topic to another. The situation in the question clearly represents this communication pattern

The nurse is providing care for an emaciated client experiencing an acute phase of catatonic stupor. Which nursing intervention would take priority when meeting this client's needs? A. minimize attempts to communicate with the client B. assist the client to ambulate C. provide nutrient-dense foods and beverages D. place the patient is seclusion for safety

C. provide nutrient-dense foods and beverages Nutrition is an essential consideration for a client with catatonic stupor. The emaciated client in the question is suffering from malnutrition. The nurse must prioritize this basic physical need.

A client has been admitted to the inpatient psychiatric unit and is manifesting mutism. His diagnosis is schizophrenia with catotonia. What would the nurse expect to observe? A. frenzied and purposeless movements B. exaggerated suspiciousness C. stuporous withdrawal D. sexual preoccupation

C. stuporous withdrawal The client's mutism indicates catatonic stupor. This client would be noted to have extreme psychomotor retardation, and efforts to move the individual may be met with bodily resistence

A client diagnosed with schizophrenia is experiencing disorganized thinking. Which technique should the nurse use to promote communication? A. giving broad openings B. probing C. verbalizing the implied D. using open-ended questions

C. verbalizing the implied When working with clients who have greatly impaired communication ability, the nurse can use the technique of verbalizing the implied. By putting into words what the client may be experiencing, the nurse helps the client to organize his or her thinking.

To deal with a client's hallucinations therapeutically, which nursing intervention should be implemented? a) reinforce the perceptual distortions until the client develops new defenses b) provide an unstructured environment c) avoid making connections between anxiety-producing situations and hallucinations d) distract the client's attention

Correct answer: D The nurse should first empathize with the client by focusing on feelings generated by the hallucination, present objective reality, and then distract or redirect the client to reality-based activities.

A client is being discharged on haloperidol (Haldol). Which teaching should the nurse include about the medication? A. "If you forget to take your morning dose of Haldol, double the dose at bedtime." B. "Limit your alcohol intake to no more than 3 ounces per day. " C. "When you go home, sit outside and enjoy the sunshine." D. "Do not stop taking Haldol abruptly."

D. "Do not stop taking Haldol abruptly." The client should be taught not to stop taking Haldol abruptly after long-term use. To do so might produce withdrawal symptoms, such as N/V, dizziness, gastritis, headache, tachycardia, insomnia and/or tremulousness

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. The most appropriate response by the nurse is: 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."

Which medication does the nurse determine will give the client the most immediate relief from neuroleptic-induced extrapyramidal side effects? A. lorazepam (Ativan), 1 mg PO B. Diazepam (Valium), 5 mg PO C. Haloperidol (Haldol), 2 mg IM D. Benztropine (Cogentin), 2 mg PO

D. Benztropine (Cogentin), 2 mg PO The symptoms of neuroleptic-induced extrapyramidal side effects include tremors, chorea, dystonia, akinesia, and akahesia. Congentin, 1-4 mg given once or twice daily, is the drug of choice to treat these symptoms.

The nurse is caring for a client with schizophrenia. Orders from the physician 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 level of agitation increases B. The client complains of a sore throat C. The client's skin has a yellowish cast. D. The client develops tremors and a shuffling gait.

D. The client develops tremors and a shuffling gait.

The primary focus of family therapy for clients with schizophrenia and their families is: A. to discuss concrete problem solving and adaptive behaviors for coping with stress B. To introduce the family to others with the same problem 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

To deal with a client's hallucinations therapeutically, which nursing intervention should be implemented? A. Reinforce the perceptual distortions until the client develops new defenses B. Provide an unstructured environment C. Avoid making connections between anxiety-producing situations and hallucinations D. distract the client's attention

D. distract the client's attention The nurse should first empathize with the client by focusing on feelings generated by the hallucination, present objective reality, and then distract or redirect the client to reality-based activities.