SCHIZOPHRENIA

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Patrice believes that although she is speaking and is aware of herself, she is really dead. She is not able to explain how she continues to exist even though she is deceased, but she maintains this belief even in the face of tremendous evidence that she is wrong. Patrice is experiencing ________ syndrome.

Cotard's

A client diagnosed with schizophrenia states to the nurse, "My, oh my. My mother is brother. Anytime now it can happen to my mother." Your best response would be: A "You are having problems with your speech. You need to try harder to be clear." B "You are confused. I will take you to your room to rest a while." C "I will get you a prn medication for agitation." D "I'm sorry, I didn't understand that. Do you want to talk more about your mother as we did yesterday?"

A client has reached the stable plateau phase of schizophrenia. What is the appropriate clinical planning focus for this client? A Safety and crisis intervention B Acute symptom stabilization C Stress and vulnerability assessment D Social, vocational, and self-care skills

Schizophrenia is best characterized as presenting which personality trait? A Split B Multiple C Ambivalent D Deteriorating

Tara and Aaron are twins who are both diagnosed with schizophrenia. Aaron was diagnosed at 23 years old and Tara at 31 years old. Based on your knowledge of early and late onset of schizophrenia, which of the following is true? A Tara and Aaron have the same expectation of a poor long-term prognosis. B Tara will experience more positive signs of schizophrenia such as hallucinations. C Aaron will be more likely to hold a job and live a productive life. D Tara has a better chance for positive outcomes because of later onset.

When a client diagnosed with paranoid schizophrenia tells the nurse, "I have to get away. The volmers are coming to execute me," an appropriate response for the nurse would be: A "You are safe here. This is a locked unit, and no one can get in." B "I do not believe I understand the word volmers. Tell me more about them." C "Why do you think someone or something is going to harm you?" D "It must be frightening to think something is going to harm you."

Which side effect of antipsychotic medication is generally nonreversible? A Anticholinergic effects B Pseudoparkinsonism C Dystonic reaction D Tardive dyskinesia

D Tardive dyskinesia Tardive dyskinesia is not always reversible with discontinuation of the medication and has no proven cure. The side effects in A, B, and C often appear early in therapy and can be minimized with treatment.

The type of altered perception most commonly experienced by clients with schizophrenia is A delusions. B illusions. C tactile hallucinations. D auditory hallucinations.

D auditory hallucinations. Hallucinations, especially auditory hallucinations, are the major example of alterations of perception in schizophrenia. They are experienced by as many as 90% of individuals with schizophrenia.

Schizophrenia is best characterized as A split personality. B multiple personalities. C ambivalent personality. D deteriorating personality.

D deteriorating personality. The course of schizophrenia is marked by recurrent acute exacerbations. With each relapse of psychosis, an increase in residual dysfunction and deterioration occurs.

17. When assessing a client for possible disordered water balance, the nurse checks the client's urine specific gravity. Which result would lead the nurse to suspect that the client is experiencing severe disordered water balance? A) 1.020 B) 1.011 C) 1.005 D) 1.002

D) 1.002

3. A client has been diagnosed with schizophrenia. Assessment reveals that the client lives alone. His clothing is disheveled, his hair is uncombed and matted, and his body has a strange odor. During an interview, the client's family voices a desire for the client to live with them when he is discharged. Based on the assessment findings, which nursing diagnosis would be the priority? A) Ineffective Role Performance related to symptoms of schizophrenia. B) Social Isolation related to auditory hallucinations. C) Dysfunctional Family Processes related to psychosis. D) Bathing Self-Care Deficit related to symptoms of schizophrenia.

D) Bathing Self-Care Deficit related to symptoms of schizophrenia.

34. The nurse is preparing to document information obtained from a client diagnosed with a delusional disorder who is experiencing somatic delusions. Which of the following would the nurse most likely document? A) Disorientation B) Reduced attention span C) Above average intelligence D) Body complaints

D) Body complaints

30. The nurse is caring for a client who was just admitted with a diagnosis of schizoaffective disorder with depression. Which agent would the nurse anticipate as being prescribed for this client? A) Lithium B) Haloperidol C) Chlorpromazine D) Clozapine

D) Clozapine

8. A client hospitalized for treatment of schizophrenia has been receiving olanzapine (Zyprexa) for the past 2 months. The nurse would be especially alert for which of the following? A) Weight loss B) Hypertension C) Diarrhea D) Diabetes

D) Diabetes

1. The nurse is caring for a client in an inpatient mental health setting. The nurse notices that when the client is conversing with other clients, he repeats what they are saying word for word. The nurse interprets this finding and documents it as which of the following? A) Echopraxia B) Neologisms C) Tangentiality D) Echolalia

D) Echolalia

32. The nurse is caring for a client diagnosed with a delusional disorder. While assessing this client, which of the following would the nurse expect to find? A) History of chronic major depression B) Consistently disrupting behavior patterns C) Verbalization of bizarre delusions D) Living with one or more delusions for a period of time

D) Living with one or more delusions for a period of time

26. A client who has a major depressive episode tells the nurse that for the past 2 weeks, he has been hearing voices and at times thinks that someone is following him. History reveals that he had these alternating symptoms before along with times when he has experienced neither of these symptoms and has been able to function adequately. The nurse interprets these findings as suggesting which of the following? A) Paranoid schizophrenia B) Undifferentiated schizophrenia C) Brief psychotic disorder D) Schizoaffective disorder

D) Schizoaffective disorder

41. When obtaining a client's history, the nurse determines that the client has been experiencing delusions and hallucinations for the past 3 months, which has caused some problems in his ability to function on a daily basis at work. He also is exhibiting catatonic excitement, echopraxia, loose associations, and pressured speech. The nurse suspects which of the following? A) Schizophrenia B) Schizoaffective disorder C) Brief Psychotic disorder D) Schizophreniform disorder

D) Schizophreniform disorder

7. The nurse is caring for a client who has been receiving treatment for schizophrenia with chlorpromazine for the past year. It would be essential for the nurse to monitor the client for which of the following? A) Weight loss B) Torticollis C) Hypoglycemia D) Tardive dyskinesia

D) Tardive dyskinesia

Negative symptoms

Deficits in normal thought, emotions, or behaviors 1) pathological deficits 2) poverty of speech (alogia) - reduction of the quantity of speech or speech content - may also say quite a bit but convey little meaning 3) restricted affect - show less emotion than most people - avoidance of eye contact - an immobile, expressionless face --> blunted affect --> flat affect 4) loss of volition (motivation or directness) - feeling drained of entry and interest in normal goals - an inability to start or follow through on a course of action - ambivalence: conflicted feelings about most things - social withdrawal

Assessment of a client with schizophrenia reveals that the client is hearing voices that tell the client that people are staring at the client and that the client is seeing illusions. When developing the plan of care for this client, which nursing diagnosis would be most appropriate?

Disturbed sensory perception

The nurse is developing a care plan for a client with somatic delusions. Which would be an appropriate nursing diagnosis for this client?

Disturbed thought process

A group of nursing students is reviewing the various theories related to the etiology of schizophrenia. The students demonstrate understanding of the information when they identify which neurotransmitter as being responsible for hallucinations and delusions?

Dopamine

psychotherapy

Early psychotherapist treatment was rare before antipsychotic drugs emerged Today psychotherapy is more successful in schizophrenia treatment • Cognitive-behavioural therapies • Sociocultural interventions: Family therapy and social therapy

Which of the following symptoms of schizophrenia involves mimicking another person's speech?

Echolalia

An integrative treatment approach to schizophrenia would include all but which of the following? a. Integrated dual-disorders treatment. b. Emergency hospitalization protocols c. Illness management and recovery. d. Supportive employment

Emergency hospitalization protocols

Which of the following individuals coined the term dementia praecox, which meant "premature loss of mind"?

Emil Kraepelin

2nd gen antipsychotic drugs

"Atypical": Biological operation differs from that of conventional antipsychotics • Appear more effective than conventional antipsychotic drugs, especially for negative symptoms • Cause few extrapyramidal side effects and seem less likely to cause tardive dyskinesia • Carry a risk of a life-threatening drop in white blood cells (agranulocytosis) • May cause weight gain, dizziness, and significant elevations in blood sugar

The nurse is working with a client with schizophrenia who has cognitive deficits. It is time for the client to get up and eat breakfast. Which statement by the nurse would be most effective in helping the client prepare for breakfast?

"First, wash your face and brush your teeth. Then put your clothes on." The client needs clear direction, with tasks broken into small steps, to begin to participate in the client's own self-care. The client, not the nurse, should perform the steps.

Which statement made by a client would indicate that the client has delusions of grandeur?

"I am a magician, and my magic powers are good when the moon is full."

A patient diagnosed with paranoid schizophrenia refuses food, stating the voices are saying the food is contaminated and deadly. A therapeutic response for the nurse would be

"I understand that the voices are very real to you, but I do not hear them."

Which statement by a person with paranoid schizophrenia most clearly indicates that the antipsychotic medication is effective?

"I used to hear scary voices but now I don't hear them anymore."

In working with the individual and family, which is the most accurate statement the nurse can make in order to teach the client and family about schizophrenia?

"Individuals with schizophrenia do have differences in brain structure and function that cause a variety of symptoms such as lack of motivation and hearing voices." Excessive amount of the neurotransmitter dopamine allows nerve impulses to bombard the mesolimbic pathway, the part of the brain normally involved in arousal and motivation. Normal cell communications are disrupted, resulting in the development of hallucinations and delusions. Abnormalities in brain shape and brain circuitry are being researched.

A client tells the nurse that the client has bugs in the client's brain and asks the nurse if the nurse can see them. Which response by the nurse is most therapeutic?

"No, I don't see any bugs. That sounds scary for you."

The nurse is teaching a client with schizoaffective disorders (SAD) about the client's prescribed medication therapy. The nurse determines that additional education is needed when the client states what?

"One day, I won't have to worry about taking any medication."

The nurse working with a client who is newly diagnosed with schizophrenia would include which in the client's education?

"Schizophrenia is an illness that involves neurotransmitters, more specifically dopamine."

A young adult is hospitalized with schizophrenia. The parents are distraught and filled with guilt. What would be an appropriate nursing response?

"There are many theories about the cause of schizophrenia, but this illness is not your fault."

A client with schizophrenia is prescribed clozapine because other prescribed medications have been ineffective. After educating the client and family about the drug, the nurse determines that the education was successful when they state:

"We'll need to make sure that the client has the client's blood count checked at least weekly."

A patient with schizophrenia tells the nurse he or she has discontinued the pharmacological treatment plan because the symptoms are cured. Which is the best response by the nurse?

"You are experiencing something called anosognosia, which means it is difficult to realize you need to continue with treatment."

2nd gen antipsychotics include:

- clozaril - risperdal - abilify

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

-Ask the client about any previous problems with psychotropic medications.

Nurse Winona educates the family about symptom management for when the schizophrenic client becomes upset or anxious. Which of the following would Nurse Winona state is helpful? -Call the therapist to request a medication change. -Encourage the use of learned relaxation techniques. -Request that the client be hospitalized until the crisis is over. -Wait before the anxiety worsens before intervening

-Encourage the use of learned relaxation techniques.

Ramsay is diagnosed with schizophrenia paranoid type and is admitted in the psychiatric unit of Nurseslabs Medical Center. Which of the following nursing interventions would be most appropriate? -Establishing a non demanding relationship -Encouraging involvement in group activities -Spending more time with Ramsay -Waiting until Ramsay initiates interaction

-Establishing a non demanding relationship

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

-Extreme social withdrawal, odd mannerisms and behavior

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

-Frequent angry outburst noted toward peers and staff

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

-Frequent reassessment is needed and is based on the client's response to treatment.

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? -Conclusive evidence indicates a specific gene transmits the disorder. -Incidence of this disorder is variable in all families. -There is a little evidence that genes play a role in transmission. -Genetic factors can increase the vulnerability for this disorder.

-Genetic factors can increase the vulnerability for this disorder.

Upon Sam's admission for acute psychiatric hospitalization, Nurse Jona documents the following: Client refuses to bathe or dress, remains in room most of the day, speaks infrequently to peers or staff. Which nursing diagnosis would be the priority at this time? -Anxiety -Decisional conflict -Self-care deficit -Social isolation

-Social isolation

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

-Teach Drogo to use thought stopping techniques.

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? -Confront the delusional material directly by telling Gio that this simply is not so. -Tell Gio that this must seem frightening to him but that you believe he is safe here. -Tell Gio to wait and talk about these beliefs in his one-on-one counselling sessions. -Isolate Gio when he begins to talk about these beliefs.

-Tell Gio that this must seem frightening to him but that you believe he is safe here.

Jaime has a diagnosis of schizophrenia with negative symptoms. In planning care for the client, Nurse Brienne would anticipate a problem with: -auditory hallucinations. -bizarre behaviors. -ideas of reference. -motivation for activities.

-motivation for activities.

In regard to the family interactions among schizophrenic patients, the word "double bind," was first proposed to describe

. a communication style that presented conflicting messages.

Which symptom seen in a patient with schizophrenia can be categorized as a positive symptom? 1 Delusions 2 Dysphoria 3 Loss of motivation 4 Impaired judgment

1 Delusions

When teaching a class of nursing students about brief psychotic disorder, the instructor explains that the episode lasts for at least 1 day but less than which time frame?

1 month

features of effective community care

1) coordinated services • Community mental health centers provide medications, psychotherapy, and inpatient emergency care • Coordination of services is especially important for mentally ill chemical abusers (MICAs) 2) short term hospitalization • If treatment on an outpatient basis is unsuccessful, patients may be transferred to short-term hospital programs • After being hospitalized for up to a few weeks, patients are released to aftercare programs for follow-up in the community 3) partial hospitalization If the patient needs fall between full hospitalization and outpatient care, day center programs may be effective Programs provide daily supervised activities and programs to improve social skills 4) supervised residences Halfway houses (or group homes) provide shelter and supervision for those patients who are unable to live alone or with their families, but who do not require hospitalization 5) occupational training and support - Paid employment provides income, independence, self-respect, and the stimulation of working with others - Many people recovering from schizophrenia receive occupational training in a sheltered workshop

According to the text, more than _____ percent of the people who take conventional drugs for an extended time develop tardive dyskinesia to some degree

15%

In 2017, approximately _____ billion dollars in public funding was devoted each year to people with mental disorders.

152 billion dollars

institutional care for schizophrenia in 1793 and 1955

1793: move from asylums toward large mental hospitals • Moral treatment with sympathy and kindness • Public mental hospitals (state hospitals) for patients who could not afford private care 1955: Overcrowding and understaffing created dramatic changes • Shift to earlier treatment using restraints, isolation, and punishment • Back wards, straitjackets, and handcuffs; lobotomy • Most common pattern of decline was social breakdown syndrome

Which statement is FALSE regarding institutionalization in the past? 1. The primary goal of institutionalization was to restrain, provide food, shelter, and clothing. 2. Institutions provided access to appropriate therapy. 3. Because of funding issues, institutions were often overcrowded. 4. Many people placed in institutions were neglected.

2 (institutions provided access to appropriate therapy)

The average age of schizophrenia onset for men is _____ years, compared to _____ years for women.

23 years for men 28 years for women

_____ antipsychotic drugs are LESS likely to produce tardive dyskinesia than other types of drugs that are used to treat schizophrenia.

2nd generation

where do people with schizophrenia live?

34% unsupervised living 25% living with a family member 18% supervised living (halfway houses) 8% nursing homes 6% jails and prisons 5% hospitals 5% homeless

Approximately _____ people with severe mental disorders end up in prisons because their disorders have led them to break the law.

440,000

Studies have suggested that various cognitive-behavioral techniques have been helpful to clients with schizophrenia; in one study, hospitalization decreased by about _____ among people treated with cognitive-behavioral techniques.

50%

A client diagnosed with schizophreniform disorder must have symptoms present for at least 1 month but with a duration of less than how long?

6 months

In the United States in 2017, about _____ percent of people with severe mental disorders entered an alternative institution such as a nursing home or rest home

In the United States in 2017, about _____ percent of people with severe mental disorders entered an alternative institution such as a nursing home or rest home.

A client diagnosed with paranoid schizophrenia tells the nurse, "I have to get away. The volmers are coming to execute me." The term "volmers" can be assessed as A a neologism. B clang association. C blocking. D a delusion.

Currently what is understood to be the causation of schizophrenia? A A combination of inherited and nongenetic factors B Deficient amounts of the neurotransmitter dopamine C Excessive amounts of the neurotransmitter serotonin D Stress related and ineffective stress management skills

The most common course of schizophrenia is an initial episode followed by what course of events? A Recurrent acute exacerbations and deterioration B Recurrent acute exacerbations C Continuous deterioration C Complete recovery

Which of the following would be assessed as a negative symptom of schizophrenia? A Anhedonia B Hostility C Agitation D Hallucinations

Which client exhibits the characteristics that are typical of the prodromal phase of schizophrenia?

A 20-year-old is experiencing a gradual decrease in the ability to concentrate, be productive, and sleep restfully.

Which of the following would be assessed as a negative symptom of schizophrenia? A Anhedonia B Hostility C Agitation D Hallucinations

A Anhedonia Negative symptoms refer to deficits that characterize schizophrenia. They include the crippling symptoms of affective blunting (lack of facial expression), anergia (lack of energy), anhedonia (inability to experience happiness), avolition (lack of motivation), poverty of content of speech, poverty of speech, and thought blocking.

In which of the following situations would the risk of developing schizophrenia be the HIGHEST for a child? a. A child's non-schizophrenic parent has a schizophrenic identical twin b. A child's schizophrenic parent has a non-schizophrenic fraternal twin c. A child's schizophrenic parent has a schizophrenic identical twin d. A child's non-schizophrenic parent has a schizophrenic fraternal twin

A child's schizophrenic parent has a non-schizophrenic fraternal twin

The causation of schizophrenia currently is understood to be

A combination of inherited and nongenetic factors

During an admission assessment with a psychiatric-mental health nurse, a client states that the client hears the voice of God in the client's head and the voice is telling the client that the client is worthless. How should the nurse document this symptom?

A hallucination

When a client diagnosed with schizophrenia hears voices saying that he is a horrible human being, the nurse can correctly assume that the hallucination A is a projection of the client's own feelings. B derives from neuronal impulse misfiring. C is a retained memory fragment. D may signal seizure onset.

A is a projection of the client's own feelings. One theory about derogatory hallucinations is that the content is a projection of the individual's feelings about himself or herself. The derogatory hallucinations are an extension of the strong feelings of rejection and lack of self-respect experienced by the individual during the prodromal period.

A patient diagnosed with paranoid schizophrenia tells the nurse, "I have to get away. The volmers are coming to execute me." The term "volmers" can be assessed as

A neologism is a newly coined word that has meaning only for the patient. Clang association is choosing a word with similar sound like "click, clack, clutch." Blocking is related to thoughts and a stop or reduction in thoughts often related to interruptions caused by hallucinations. Delusions are false beliefs.

The most common course of schizophrenia is an initial episode followed by A recurrent acute exacerbations and deterioration. B recurrent acute exacerbations. C continuous deterioration. D complete recovery.

A recurrent acute exacerbations and deterioration. Causation is a complicated matter. Schizophrenia most likely occurs as a result of a combination of inherited genetic factors and extreme non-genetic factors (e.g., viral infection, birth injuries, nutritional factors) that can affect the genes governing the brain or directly injure the brain.

9. The nurse is caring for a client who has been taking clozapine (Clozaril) for 2 weeks. The client tells the nurse, My throat is sore, and I feel weak. The nurse assesses the client's vital signs and finds that the client has a fever. The nurse notifies the physician, expecting an order to obtain which laboratory test? A) A white blood cell count B) Liver function studies C) Serum potassium level D) Serum sodium level

A) A white blood cell count

4. The nurse is caring for an elderly client who has been taking an antipsychotic medication for 1 week. The nurse notifies the physician when he observes that the client has muscle rigidity that resembles Parkinson's disease. Which agent would the nurse expect the physician to prescribe? A) Anticholinergic B) Anxiolytic C) Benzodiazepine D) Beta-blocker

A) Anticholinergic

13. The nurse is interviewing a client with schizophrenia when the client begins to say, Kite, night, right, height, fright. The nurse documents this as which of the following? A) Clang association B) Stilted language C) Verbigeration D) Neologisms

A) Clang association

24. A nursing instructor is preparing a class lecture about schizophrenia and outcomes focusing on recovery. Which of the following would the instructor include as a major goal? A) Continuity of care B) Shorter in-patient stays C) Immediate crisis stabilization D) Social engagement

A) Continuity of care

6. A hospitalized client with schizophrenia is receiving antipsychotic medications. While assessing the client, the nurse identifies signs and symptoms of a dystonic reaction. Which agent would the nurse expect to administer? A) Diphenhydramine (Benadryl) B) Propranolol (Inderal) C) Risperidone (Risperdal) D) Aripiprazole (Abilify)

A) Diphenhydramine (Benadryl)

15. A group of nursing students is reviewing the various theories related to the etiology of schizophrenia. The students demonstrate understanding of the information when they identify which neurotransmitter as being responsible for hallucinations and delusions? A) Dopamine B) Serotonin C) Norepinephrine D) Gamma-amino butyric acid (GABA)

A) Dopamine

10. A client is being released from the inpatient psychiatric unit with a diagnosis of schizophrenia and treatment with antipsychotic medications. After teaching the client and family about managing the disorder, the nurse determines that the teaching was effective when they state which of the following should be reported immediately? A) Elevated temperature B) Tremor C) Decreased blood pressure D) Weight gain

A) Elevated temperature

39. As part of an interdisciplinary team, a nurse is assisting in developing the plan of care for a client with a delusional disorder. Which of the following would the team be least likely to include in the plan? A) Insight-oriented therapy B) Psychoeducation C) Cognitive therapy D) Support therapy

A) Insight-oriented therapy

27. A nursing instructor is developing a class lecture that compares and contrasts schizoaffective disorder with schizophrenia. When describing one of the differences between these two diagnoses, which of the following would the instructor include as reflecting schizoaffective disorder? A) It is episodic in nature. B) It involves difficulties with self-care. C) It has less severe hallucinations. D) It is associated with a lower suicide risk.

A) It is episodic in nature.

28. The nurse is caring for a client who was diagnosed with schizoaffective disorder. Based on the nurse's understanding of this disorder, the nurse develops a plan of care to address which issue as the top priority? A) Suicide B) Aggression C) Substance abuse D) Eating disorder

A) Suicide

29. A patient diagnosed with schizophrenia begins to talks about "macnabs" hiding in the warehouse at work. The term "macnabs" should be documented as: a. a neologism. c. thought insertion. b. concrete thinking. d. an idea of reference.

ANS: A A neologism is a newly coined word having special meaning to the patient. "Macnabs" is not a known common word. Concrete thinking refers to the inability to think abstractly. Thought insertion refers to thoughts of others are implanted in one's mind. Ideas of reference are a type of delusion in which trivial events are given personal significance. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 205-206 TOP: Nursing Process: Assessment

27. The family of a patient diagnosed with schizophrenia is unfamiliar with the illness and family's role in recovery. Which type of therapy should the nurse recommend? a. Psychoeducational c. Transactional b. Psychoanalytic d. Family

ANS: A A psychoeducational group explores the causes of schizophrenia, the role of medication, the importance of medication compliance, support for the ill member, and hints for living with a person with schizophrenia. Such a group can be of immeasurable practical assistance to the family. The other types of therapy do not focus on psychoeducation. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 214 (Box 12-5) | Page 221 TOP: Nursing Process: Implementation

17. A patient diagnosed with schizophrenia is very disturbed and violent. After several doses of haloperidol (Haldol), the patient is calm. Two hours later the nurse sees the patient's head rotated to one side in a stiff position, the lower jaw thrust forward, and drooling. Which problem is most likely? a. An acute dystonic reaction c. Waxy flexibility b. Tardive dyskinesia d. Akathisia

ANS: A Acute dystonic reactions involve painful contractions of the tongue, face, neck, and back. Opisthotonos and oculogyric crisis may be observed. Dystonic reactions are considered emergencies requiring immediate intervention. Tardive dyskinesia involves involuntary spasmodic muscular contractions that involve the tongue, fingers, toes, neck, trunk, or pelvis. It appears after prolonged treatment. Waxy flexibility is a symptom seen in catatonic schizophrenia. Internal and external restlessness, pacing, and fidgeting are characteristics of akathisia. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Page 215-216 (Table 12-4) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

33. A nurse asks a patient diagnosed with schizophrenia, "What is meant by the old saying 'You can't judge a book by looking at the cover.'?" Which response by the patient indicates concrete thinking? a. "The table of contents tells what a book is about." b. "You can't judge a book by looking at the cover." c. "Things are not always as they first appear." d. "Why are you asking me about books?"

ANS: A Concrete thinking refers to an impaired ability to think abstractly. Concreteness is often assessed through the patient's interpretation of proverbs. Concreteness reduces one's ability to understand and address abstract concepts such as love or the passage of time. The incorrect options illustrate echolalia, an unrelated question, and abstract thinking. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 205-206 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

18. An acutely violent patient diagnosed with schizophrenia receives several doses of haloperidol (Haldol). Two hours later the nurse notices the patient's head rotated to one side in a stiffly fixed position, the lower jaw thrust forward, and drooling. Which intervention by the nurse is indicated? a. Administer diphenhydramine (Benadryl) 50 mg IM from the PRN medication administration record. b. Reassure the patient that the symptoms will subside. Practice relaxation exercises with the patient. c. Give trihexyphenidyl (Artane) 5 mg orally at the next regularly scheduled medication administration time. d. Administer atropine sulfate 2 mg subcut from the PRN medication administration record.

ANS: A Diphenhydramine, trihexyphenidyl, benztropine, and other anticholinergic medications may be used to treat dystonias. Swallowing will be difficult or impossible; therefore, oral medication is not an option. Medication should be administered immediately, so the intramuscular route is best. In this case, the best option given is diphenhydramine. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Page 215-216 (Table 12-4) TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity

13. A community mental health nurse wants to establish a relationship with a very withdrawn patient diagnosed with schizophrenia. The patient lives at home with a supportive family. Select the nurse's best plan. a. Visit daily for 4 days, then every other day for 1 week; stay with patient for 20 minutes, accept silence; state when the nurse will return. b. Arrange to spend 1 hour each day with the patient; focus on asking questions about what the patient is thinking or experiencing; avoid silences. c. Visit twice daily; sit beside the patient with a hand on the patient's arm; leave if the patient does not respond within 10 minutes. d. Visit every other day; remind the patient of the nurse's identity; encourage the patient to talk while the nurse works on reports.

ANS: A Severe constraints on the community mental health nurse's time will probably not allow more time than what is mentioned in the correct option; yet, important principles can be used. A severely withdrawn patient should be met "at the patient's own level," with silence accepted. Short periods of contact are helpful to minimize both the patient's and the nurse's anxiety. Predictability in returning as stated will help build trust. An hour may be too long to sustain a home visit with a withdrawn patient, especially if the nurse persists in leveling a barrage of questions at the patient. Twice-daily visits are probably not possible, and leaving after 10 minutes would be premature. Touch may be threatening. Working on reports suggests the nurse is not interested in the patient. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Page 210-211 | Page 215 (Box 12-6) | Page 222 (Case study and Nursing Care Plan 12-1) TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity

12. A patient is experiencing delusions of persecution about being poisoned. The patient has refused all hospital meals for 3 days. Which intervention is most likely to be acceptable to the patient? a. Allowing the patient supervised access to food vending machines b. Allowing the patient to phone a local restaurant to deliver meals c. Offering to taste each portion on the tray for the patient d. Providing tube feedings or total parenteral nutrition

ANS: A The patient who is delusional about food being poisoned is likely to believe restaurant food might still be poisoned and to say that the staff member tasting the food has taken an antidote to the poison before tasting. Attempts to tube feed or give nutrition intravenously are seen as aggressive and usually promote violence. Patients perceive foods in sealed containers, packages, or natural shells as being safer. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 205-206 (Table 12-1) TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity

4. When a patient diagnosed with schizophrenia was discharged 6 months ago, haloperidol (Haldol) was prescribed. The patient now says, "I stopped taking those pills. They made me feel like a robot." What are common side effects the nurse should validate with the patient? a. Sedation and muscle stiffness b. Sweating, nausea, and diarrhea c. Mild fever, sore throat, and skin rash d. Headache, watery eyes, and runny nose

ANS: A Typical antipsychotic drugs often produce sedation and extrapyramidal side effects such as stiffness and gait disturbance, effects the patient might describe as making him or her feel like a "robot." The side effects mentioned in the other options are usually not associated with typical antipsychotic therapy or would not have the effect described by the patient. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 215-216 (Table 12-4) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

22. What assessment findings mark the prodromal stage of schizophrenia? a. Withdrawal, misinterpreting, poor concentration, and preoccupation with religion b. Auditory hallucinations, ideas of reference, thought insertion, and broadcasting c. Stereotyped behavior, echopraxia, echolalia, and waxy flexibility d. Loose associations, concrete thinking, and echolalia neologisms

ANS: A Withdrawal, misinterpreting, poor concentration, and preoccupation with religion are prodromal symptoms, the symptoms that are present before the development of florid symptoms. The incorrect options each list the positive symptoms of schizophrenia that might be apparent during the acute stage of the illness. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 201-202 | Page 204-205 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

38. A newly hospitalized patient experiencing psychosis says, "Red chair out town board." Which term should the nurse use to document this finding? a. Word salad c. Anhedonia b. Neologism d. Echolalia

ANS: A Word salad (schizophasia) is a jumble of words that is meaningless to the listener and perhaps to the speaker as well, because of an extreme level of disorganization. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 205-206 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

20 The nursing diagnosis most likely to be applicable for a person who has schizophrenia, paranoid type, is: a. social isolation related to impaired ability to trust. b. impaired mobility related to fear of losing control of hostile impulses. c. fear of being alone related to lack of confidence in significant others. d. impaired memory related to poor information processing associated with brain deficits.

ANS: A Individuals with paranoid schizophrenia are usually distrustful of others and socially withdrawn. They often have delusions of persecution and auditory hallucinations that further serve to isolate them from others. DIF: Cognitive Level: Application REF: Text Pages: 360-361 TOP: Nursing Process: Diagnosis|Nursing Process: Analysis MSC: NCLEX: Psychosocial Integrity

20 A patient displays positive symptoms of schizophrenia as evidenced by psychotic disorders of thinking. The nurse can expect the patient to evidence: a. delusions and hallucinations. b. grimacing and mannerisms. c. echopraxia and echolalia. d. avolition and anhedonia.

ANS: A Positive symptoms of schizophrenia represent an excess or distortion of normal function. Delusions and hallucinations are considered psychotic disorders of thinking. The other symptoms listed are noted in schizophrenia, but they are not considered thought disorders. DIF: Cognitive Level: Application REF: Text Page: 347 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

20 A patient admitted in a semistuporous catatonic state has neither left the apartment nor attended to personal hygiene for several weeks. The patient's last 48 hours have been spent lying in bed, mute and motionless. The priority nursing diagnosis is: a. self-care deficit. b. situational low self-esteem. c. disturbed thought processes. d. impaired verbal communication.

ANS: A The patient evidences self-care deficit in the areas of bathing/hygiene, dressing/grooming, feeding, and toileting. These deficits pose the greatest risk to the patient and are therefore the priority. DIF: Cognitive Level: Analysis REF: Text Pages: 353-354 TOP: Nursing Process: Diagnosis|Nursing Process: Analysis MSC: NCLEX: Psychosocial Integrity

20 A patient with schizophrenia repeatedly asks for directions and the time of day. The nurse should: a. repeat the information in a kind, matter-of-fact manner. b. write out the information so the patient can easily refer to it. c. share that the habit of frequent questioning is annoying and should be avoided. d. initially provide the facts and then remind the patient that the question was already asked.

ANS: A The person with schizophrenia has brain malfunction resulting in poor memory and attention. The information should be repeated as often as necessary in a kind, matter-of-fact manner. DIF: Cognitive Level: Application REF: Text Page: 348 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

20 A patient diagnosed with schizophrenia reveals to the nurse that voices have warned of danger and adds, "They're so loud they frighten me. Do you hear them?" The nurse's best initial response would be: a. "I know these voices are very real to you, but I don't hear them." b. "Don't worry. You're safe in the hospital. I won't let anything happen to you." c. "Tell me more about the voices. Are they men or women? How many are there?" d. "What do you do in order to keep yourself occupied so you don't hear the voices?"

ANS: A When asked, the nurse should point out that he or she is not experiencing the same stimuli but should accept the reality of the hallucinations for the patient. Being able to communicate with the nurse at the time the hallucinations are occurring is helpful to the patient. Interactive discussion of hallucinations is a vital element in the development of reality-testing skills. DIF: Cognitive Level: Application REF: Text Page: 366 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

1. A nurse at the mental health clinic plans a series of psychoeducational groups for persons newly diagnosed with schizophrenia. Which two topics take priority? a. "The importance of taking your medication correctly" b. "How to complete an application for employment" c. "How to dress when attending community events" d. "How to give and receive compliments" e. "Ways to quit smoking"

ANS: A, E Stabilization is maximized by adherence to the antipsychotic medication regimen. Because so many persons with schizophrenia smoke cigarettes, this topic relates directly to the patients' physiological well-being. The other topics are also important but are not priority topics. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Page 204 | Page 211-212 | Page 215 (Box 12-6) | Page 224 TOP: Nursing Process: Planning/Outcomes Identification MSC: Client Needs: Health Promotion and Maintenance

6. A patient's care plan includes monitoring for auditory hallucinations. Which assessment findings suggest the patient may be hallucinating? a. Detachment and overconfidence b. Darting eyes, tilted head, mumbling to self c. Euphoric mood, hyperactivity, distractibility d. Foot tapping and repeatedly writing the same phrase

ANS: B Clues to hallucinations include eyes looking around the room as though to find the speaker, tilting the head to one side as though listening intently, and grimacing, mumbling, or talking aloud as though responding conversationally to someone. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 206-207 | Page 212-213 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

. A newly admitted patient diagnosed with schizophrenia is hypervigilant and constantly scans the environment. The patient states, "I saw two doctors talking in the hall. They were plotting to kill me." The nurse may correctly assess this behavior as: a. echolalia. c. a delusion of infidelity. b. an idea of reference. d. an auditory hallucination.

ANS: B Ideas of reference are misinterpretations of the verbalizations or actions of others that give special personal meanings to these behaviors; for example, when seeing two people talking, the individual assumes they are talking about him or her. The other terms do not correspond with the scenario. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 206 (Table 12-1) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

24. A patient diagnosed with schizophrenia begins a new prescription for lurasidone HCL (Latuda). The patient is 5'6" and currently weighs 204 lbs. Which topic is most important for the nurse to include in the teaching plan related to this medication? a. How to recognize tardive dyskinesia c. Ways to manage constipation b. Weight management strategies d. Sleep hygiene measures

ANS: B Lurasidone HCL (Latuda) is a second-generation antipsychotic medication. The incidence of weight gain, diabetes, and high cholesterol is high with this medication. The patient is overweight now, so weight management will be especially important. The incidence of tardive dyskinesia is low with second-generation antipsychotic medications. Constipation may occur, but it is less important than weight management. This drug usually produces drowsiness. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 218-219 (Table 12-5) TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity

37. A patient insistently states, "I can decipher codes of DNA just by looking at someone." Which problem is evident? a. Visual hallucinations c. Idea of reference b. Magical thinking d. Thought insertion

ANS: B Magical thinking is evident in the patient's appraisal of his own abilities. There is no evidence of the distracters. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 205-206 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

26. A patient diagnosed with schizophrenia has taken a conventional antipsychotic medication for a year. Hallucinations are less intrusive, but the patient continues to have apathy, poverty of thought, and social isolation. The nurse would expect a change to which medication? a. Haloperidol (Haldol) c. Chlorpromazine (Thorazine) b. Olanzapine (Zyprexa) d. Diphenhydramine (Benadryl)

ANS: B Olanzapine is a second-generation atypical antipsychotic that targets both positive and negative symptoms of schizophrenia. Haloperidol and chlorpromazine are conventional antipsychotics that target only positive symptoms. Diphenhydramine is an antihistamine. See relationship to audience response question. PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

10. A patient diagnosed with schizophrenia demonstrates little spontaneous movement and has waxy flexibility. The patient's activities of daily living are severely compromised. An appropriate outcome would be that the patient will: a. demonstrate increased interest in the environment by the end of week 1. b. perform self-care activities with coaching by the end of day 3. c. gradually take the initiative for self-care by the end of week 2. d. accept tube feeding without objection by day 2.

ANS: B Outcomes related to self-care deficit nursing diagnoses should deal with increasing ability to perform self-care tasks independently, such as feeding, bathing, dressing, and toileting. Performing the tasks with coaching by nursing staff denotes improvement over the complete inability to perform the tasks. The incorrect options are not directly related to self-care activities, difficult to measure, and unrelated to maintenance of nutrition. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 209-210 TOP: Nursing Process: Outcomes Identification MSC: Client Needs: Physiological Integrity

1. A person has had difficulty keeping a job because of arguing with co-workers and accusing them of conspiracy. Today the person shouts, "They're all plotting to destroy me. Isn't that true?" Select the nurse's most therapeutic response. a. "Everyone here is trying to help you. No one wants to harm you." b. "Feeling that people want to destroy you must be very frightening." c. "That is not true. People here are trying to help you if you will let them." d. "Staff members are health care professionals who are qualified to help you."

ANS: B Resist focusing on content; instead, focus on the feelings the patient is expressing. This strategy prevents arguing about the reality of delusional beliefs. Such arguments increase patient anxiety and the tenacity with which the patient holds to the delusion. The other options focus on content and provide opportunity for argument. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 205-206 | Page 213-215 (Box 12-4)

19. A patient took trifluoperazine 30 mg po daily for 3 years. The clinic nurse notes that the patient grimaces and constantly smacks both lips. The patient's neck and shoulders twist in a slow, snakelike motion. Which problem would the nurse suspect? a. Agranulocytosis c. Tourette's syndrome b. Tardive dyskinesia d. Anticholinergic effects

ANS: B Tardive dyskinesia is a neuroleptic-induced condition involving the face, trunk, and limbs. Involuntary movements, such as tongue thrusting; licking; blowing; irregular movements of the arms, neck, and shoulders; rocking; hip jerks; and pelvic thrusts, are seen. These symptoms are frequently not reversible even when the drug is discontinued. The scenario does not present evidence consistent with the other disorders mentioned. Agranulocytosis is a blood disorder. Tourette's syndrome is a condition in which tics are present. Anticholinergic effects include dry mouth, blurred vision, flushing, constipation, and dry eyes. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Page 215-216 (Table 12-4) TOP: Nursing Process: Evaluation MSC: Client Needs: Physiological Integrity

5. Which hallucination necessitates the nurse to implement safety measures? The patient says, a. "I hear angels playing harps." b. "The voices say everyone is trying to kill me." c. "My dead father tells me I am a good person." d. "The voices talk only at night when I'm trying to sleep."

ANS: B The correct response indicates the patient is experiencing paranoia. Paranoia often leads to fearfulness, and the patient may attempt to strike out at others to protect self. The distracters are comforting hallucinations or do not indicate paranoia. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Page 207 | Page 212-213 TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity

35. A client says, "Facebook has a new tracking capacity. If I use the Internet, Homeland Security will detain me as a terrorist." Select the nurse's best initial action. a. Tell the client, "Facebook is a safe website. You don't need to worry about Homeland Security." b. Tell the client, "You are in a safe place where you will be helped." c. Administer a prn dose of an antipsychotic medication. d. Tell the client, "You don't need to worry about that."

ANS: B The patient is experiencing paranoia and delusional thinking, which leads to fear. Explaining that the patient is in a safe place will help relieve the fear. It is not therapeutic to disagree or give advice. Medication will not relieve the immediate concern. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Page 205-206 (Table 12-1) | Page 213-215 (Box 12-4)

3. A patient diagnosed with schizophrenia says, "My co-workers are out to get me. I also saw two doctors plotting to kill me." How does this patient perceive the environment? a. Disorganized c. Supportive b. Dangerous d. Bizarre

ANS: B The patient sees the world as hostile and dangerous. This assessment is important because the nurse can be more effective by using empathy to respond to the patient. Data are not present to support any of the other options. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 210 (Table 12-3) | Page 213 (Box 12-4)

11. A nurse observes a catatonic patient standing immobile, facing the wall with one arm extended in a salute. The patient remains immobile in this position for 15 minutes, moving only when the nurse gently lowers the arm. What is the name of this phenomenon? a. Echolalia c. Depersonalization b. Waxy flexibility d. Thought withdrawal

ANS: B Waxy flexibility is the ability to hold distorted postures for extended periods of time, as though the patient were molded in wax. Echolalia is a speech pattern. Depersonalization refers to a feeling state. Thought withdrawal refers to an alteration in thinking. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 207-208 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

20 Which teaching point will have the most positive effect on patients diagnosed with schizophrenia and their families concerning the risk of relapses? a. Patients who take their medications will not relapse. b. Caffeine and nicotine can reduce the effectiveness of antipsychotic drugs. c. With support, education, and adherence to treatment, patients will not relapse. d. Schizophrenia is a chronic disorder that is characterized by repeated relapses.

ANS: B Caffeine intake greater than 250 mg daily or smoking 10 to 20 cigarettes daily dramatically reduces the effectiveness of antipsychotic and antianxiety drugs and lithium. The need to limit the use of these substances is an important teaching point. DIF: Cognitive Level: Analysis REF: Text Page: 374 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

20 A patient who has been hospitalized for 2 days remains anxious and continues to be preoccupied with paranoid delusions. What intervention will best help the patient focus less on the delusions? a. Schedule time for the patient to read and listen to music. b. Plan activities that require physical skills and constructive use of time. c. Begin planning for discharge by engaging the patient in psychoeducation. d. Discuss personal goals related to improved socialization with the patient.

ANS: B Engaging the patient in physical activity will help distract the patient and keep the patient from focusing solely on the delusions. The patient would still be able to focus on the delusions while appearing to be reading or listening to music. The latter two activities are better addressed later in the course of treatment. DIF: Cognitive Level: Analysis REF: Text Page: 367 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

20 A patient diagnosed with schizophrenia is standing naked after showering and appears dazed and indecisive. The nursing intervention that will be most helpful to promote dressing would be: a. saying, "These are your clothes. Please get dressed." b. saying, "These are your underpants. I'll help you put them on." c. asking, "Which of these two outfits would you like to wear now?" d. asking, "Is something the matter with your clothes that makes you not want to dress?"

ANS: B When cognitive functioning is disrupted, a self-care deficit may be severe. The nurse may need to dress the patient. Each step of the process of dressing should be undertaken singly, and a simple explanation as to what is expected should be given. DIF: Cognitive Level: Application REF: Text Page: 348 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

21. The nurse assesses a patient diagnosed with schizophrenia. Which assessment finding would the nurse regard as a negative symptom of schizophrenia? a. Auditory hallucinations c. Poor personal hygiene b. Delusions of grandeur d. Psychomotor agitation

ANS: C Negative symptoms include apathy, anhedonia, poor social functioning, and poverty of thought. Poor personal hygiene is an example of poor social functioning. The distracters are positive symptoms of schizophrenia. See relationship to audience response question. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 207-208 (Table 12-2) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

36. Which finding constitutes a negative symptom associated with schizophrenia? a. Hostility c. Poverty of thought b. Bizarre behavior d. Auditory hallucinations

9. A patient diagnosed with schizophrenia exhibits little spontaneous movement and demonstrates waxy flexibility. Which patient needs are of priority importance? a. Self-esteem c. Physiological b. Psychosocial d. Self-actualization

ANS: C Physiological needs must be met to preserve life. A patient with waxy flexibility must be fed by hand or tube, toileted, given range-of-motion exercises, and so forth to preserve physiological integrity. Higher level needs are of lesser concern. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 207 | Page 209-210 TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity

16. A patient diagnosed with schizophrenia has taken fluphenazine (Prolixin) 5 mg po bid for 3 weeks. The nurse now observes a shuffling propulsive gait, a mask-like face, and drooling. Which term applies to these symptoms? a. Neuroleptic malignant syndrome c. Pseudoparkinsonism b. Hepatocellular effects d. Akathisia

ANS: C Pseudoparkinsonism induced by antipsychotic medication mimics the symptoms of Parkinson's disease. It frequently appears within the first month of treatment and is more common with first-generation antipsychotic drugs. Hepatocellular effects would produce abnormal liver test results. Neuroleptic malignant syndrome is characterized by autonomic instability. Akathisia produces motor restlessness. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 215-216 (Table 12-4) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

15. A newly admitted patient diagnosed with schizophrenia says, "The voices are bothering me. They yell and tell me I am bad. I have got to get away from them." Select the nurse's most helpful reply. a. "Do you hear the voices often?" b. "Do you have a plan for getting away from the voices?" c. "I'll stay with you. Focus on what we are talking about, not the voices. " d. "Forget the voices and ask some other patients to play cards with you."

ANS: C Staying with a distraught patient who is hearing voices serves several purposes: ongoing observation, the opportunity to provide reality orientation, a means of helping dismiss the voices, the opportunity of forestalling an action that would result in self-injury, and general support to reduce anxiety. Asking if the patient hears voices is not particularly relevant at this point. Asking if the patient plans to "get away from the voices" is relevant for assessment purposes but is less helpful than offering to stay with the patient while encouraging a focus on their discussion. Suggesting playing cards with other patients shifts responsibility for intervention from the nurse to the patient and other patients. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 206-207 | Page 212-213 (Box 12-3) TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

20 A patient reports, "The government has implanted a device in my head." What outcome would the nurse identify as being appropriate for the patient to achieve within 1 week of admission? a. Taking antipsychotic medication as prescribed without objection b. Giving coherent data to support beliefs that a device has been implanted c. Interpreting reality correctly by stating that no implantation has occurred d. Reporting feeling less anxious about having the government listening to interior thoughts

ANS: C An appropriate outcome for a delusional patient is that the patient will interpret reality correctly. DIF: Cognitive Level: Analysis REF: Text Pages: 361-362 TOP: Nursing Process: Outcome Identification MSC: NCLEX: Psychosocial Integrity

20 A patient tells the nurse, "I can't go to any unit meetings because everyone can hear my thoughts." The nurse can correctly assess this symptom as: a. concrete thinking. b. loose associations. c. thought broadcasting. d. auditory hallucinations.

ANS: C Believing that others can hear one's unexpressed thoughts is called thought broadcasting. DIF: Cognitive Level: Comprehension REF: Text Page: 351 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

20 A novice nurse asks the assigned mentor, "Why should I avoid telling the patient that his ideas are bizarre and simply not logical?" The mentor responds, "If you do that: a. it will give the patient the basis for beginning to self-reflect on the delusions." b. the patient will probably incorporate you into the delusions as a persecutor." c. it will be difficult to use empathy and calmness to foster the patient's trust." d. you will have little chance of gaining the patient's cooperation."

ANS: C Developing trust is fundamental to working with a delusional patient. Much assessment data must be gathered before questioning the facts and their meaning and discussing the consequences of the delusion. DIF: Cognitive Level: Application REF: Text Page: 367 TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

20 A nurse observes a patient who is sitting alone in a room muttering, "You don't know what you're talking about! Leave me alone." The nurse attempts to validate whether the patient is: a. seeking the attention of staff. b. inappropriately expressing emotion. c. experiencing auditory hallucinations. d. displaying negative symptoms of schizophrenia.

ANS: C Impulsive activity, talking to people who are not present, and covering the ears are behaviors that may indicate the patient is responding to auditory hallucinations. DIF: Cognitive Level: Application REF: Text Page: 351 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

20 A patient reports, "My brain is controlled by government agents who can trace my whereabouts and listen to my thoughts." An appropriate nursing response to this information would be: a. "Your story is very strange and too bizarre for me to believe." b. "Tell me why you think your brain is being controlled by the government." c. "Were you experiencing any stress just before you began to think your brain was being controlled?" d. "Are you feeling frightened or angry about the government violating your body and controlling your brain?"

ANS: C It is appropriate for the nurse to help the patient place the delusion in a time frame and to identify triggers that may be related to stress or anxiety. DIF: Cognitive Level: Application REF: Text Page: 367 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

20 A patient diagnosed with schizophrenia approaches the nurse and says, "I'm cold. Ice cream is cold. Freezers keep ice cream cold." This speech pattern can be assessed as: a. hyperverbosity. b. circumstantiality. c. loose associations. d. expressing delusions.

ANS: C Loose associations reflect a disturbance in thinking in which speech shifts from topic to topic in a random, seemingly unrelated manner. When severe, it results in incoherence. DIF: Cognitive Level: Comprehension REF: Text Page: 349 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

20 A patient is delusional and has auditory hallucinations. The best statement to make when approaching the patient with an oral electronic thermometer would be: a. "I need your vital signs. Put this in your mouth. This will not hurt. " b. "I hope I can count on you to hold still while I take your temperature." c. "Please sit here while I put the thermometer under your tongue for a little while." d. "This probe is only a thermometer that will tell us whether you have a fever. It will be all over in just a few seconds."

ANS: C Psychotic patients often are preoccupied with internal stimuli and find it difficult to comprehend the words and actions of others. They may misinterpret both words and actions. To gain cooperation, use simple, explicit, concrete explanations and directions. DIF: Cognitive Level: Application REF: Text Page: 349 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

20 A most useful strategy for helping a patient with schizophrenia prevent a potential relapse is to: a. have the patient attend group therapy. b. educate the patient on the need to take prescribed medication daily. c. teach the patient and family about behaviors that indicate impending relapse. d. schedule appointments for blood tests to determine serum medication levels.

ANS: C When the patient or family members are aware of the symptoms of an impending relapse, they can use symptom management strategies to prevent the relapse. While medication is a critical part of this condition's management, relapse can occur even when the client is medication-compliant. DIF: Cognitive Level: Application REF: Text Page: 371 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

7. A health care provider considers which antipsychotic medication to prescribe for a patient diagnosed with schizophrenia who has auditory hallucinations and poor social function. The patient is also overweight and hypertensive. Which drug should the nurse advocate? a. Clozapine (Clozaril) c. Olanzapine (Zyprexa) b. Ziprasidone (Geodon) d. Aripiprazole (Abilify)

ANS: D Aripiprazole is a third-generation atypical antipsychotic effective against both positive and negative symptoms of schizophrenia. It causes little or no weight gain and no increase in glucose, high- or low-density lipoprotein cholesterol, or triglycerides, making it a reasonable choice for a patient with obesity or heart disease. Clozapine may produce agranulocytosis, making it a poor choice as a first-line agent. Ziprasidone may prolong the QT interval, making it a poor choice for a patient with cardiac disease. Olanzapine fosters weight gain. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Page 215-219 (Table 12-5) TOP: Nursing Process: Planning

34. The nurse is developing a plan for psychoeducational sessions for several adults diagnosed with schizophrenia. Which goal is best for this group? Members will: a. gain insight into unconscious factors that contribute to their illness. b. explore situations that trigger hostility and anger. c. learn to manage delusional thinking. d. demonstrate improved social skills.

ANS: D Improved social skills help patients maintain relationships with others. These relationships are important to management of the disorder. Most patients with schizophrenia think concretely, so insight development is unlikely. Not all patients with schizophrenia experience delusions. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Page 211-215 (Box 12-6) TOP: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

31. A patient diagnosed with schizophrenia and auditory hallucinations anxiously tells the nurse, "The voice is telling me to do things." Select the nurse's priority assessment question. a. "How long has the voice been directing your behavior?" b. "Does what the voice tell you to do frighten you?" c. "Do you recognize the voice speaking to you?' d. "What is the voice telling you to do?"

ANS: D Learning what a command hallucination is telling the patient to do is important because the command often places the patient or others at risk for harm. Command hallucinations can be terrifying and may pose a psychiatric emergency. The incorrect questions are of lesser importance than identifying the command. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 207-209 TOP: Nursing Process: Assessment MSC: Client Needs: Safe, Effective Care Environment

25. A patient diagnosed with schizophrenia says, "It's beat. Time to eat. No room for the cat." What type of verbalization is evident? a. Neologism c. Thought broadcasting b. Idea of reference d. Associative looseness

ANS: D Looseness of association refers to jumbled thoughts incoherently expressed to the listener. Neologisms are newly coined words. Ideas of reference are a type of delusion. Thought broadcasting is the belief that others can hear one's thoughts. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 205 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

28. A patient diagnosed with schizophrenia has been stable for a year; however, the family now reports the patient is tense, sleeps 3 to 4 hours per night, and has difficulty concentrating. The patient says, "My computer is sending out infected radiation beams." The nurse can correctly assess this information as an indication of: a. the need for psychoeducation. c. chronic deterioration. b. medication noncompliance. d. relapse.

ANS: D Signs of potential relapse include feeling tense, difficulty concentrating, trouble sleeping, increased withdrawal, and increased bizarre or magical thinking. Medication noncompliance may not be implicated. Relapse can occur even when the patient is taking medication regularly. Psychoeducation is more effective when the patient's symptoms are stable. Chronic deterioration is not the best explanation. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Page 213-215 (Box 12-6) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

30. A patient diagnosed with schizophrenia anxiously says, "I can see the left side of my body merging with the wall, then my face appears and disappears in the mirror." While listening, the nurse should: a. sit close to the patient. b. place an arm protectively around the patient's shoulders. c. place a hand on the patient's arm and exert light pressure. d. maintain a normal social interaction distance from the patient.

ANS: D The patient is describing phenomena that indicate personal boundary difficulties and depersonalization. The nurse should maintain appropriate social distance and not touch the patient because the patient is anxious about the inability to maintain ego boundaries and merging or being swallowed by the environment. Physical closeness or touch could precipitate panic. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 204 | Page 212-213 TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

20. A nurse sits with a patient diagnosed with schizophrenia. The patient starts to laugh uncontrollably, although the nurse has not said anything funny. Select the nurse's best response. a. "Why are you laughing?" b. "Please share the joke with me." c. "I don't think I said anything funny." d. "You're laughing. Tell me what's happening."

ANS: D The patient is likely laughing in response to inner stimuli, such as hallucinations or fantasy. Focus on the hallucinatory clue (the patient's laughter) and then elicit the patient's observation. The incorrect options are less useful in eliciting a response: no joke may be involved, "why" questions are difficult to answer, and the patient is probably not focusing on what the nurse said in the first place. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 206-207 | Page 212-213 (Box 12-3)

23. A patient diagnosed with schizophrenia says, "Contagious bacteria are everywhere. When they get in your body, you will be locked up with other infected people." Which problem is evident? a. Poverty of content c. Neologisms b. Concrete thinking d. Paranoia

ANS: D The patient's unrealistic fear of harm indicates paranoia. Neologisms are invented words. Concrete thinking involves literal interpretation. Poverty of content refers to an inadequate fund of information. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 205-206 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

8. A patient diagnosed with schizophrenia tells the nurse, "I eat skiller. Tend to end. Easter. It blows away. Get it?" Select the nurse's best response. a. "Nothing you are saying is clear." b. "Your thoughts are very disconnected." c. "Try to organize your thoughts and then tell me again." d. "I am having difficulty understanding what you are saying."

ANS: D When a patient's speech is loosely associated, confused, and disorganized, pretending to understand is useless. The nurse should tell the patient that he or she is having difficulty understanding what the patient is saying. If a theme is discernible, ask the patient to talk about the theme. The incorrect options tend to place blame for the poor communication with the patient. The correct response places the difficulty with the nurse rather than being accusatory. See relationship to audience response question. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 205 | Page 213-214 TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

14. Withdrawn patients diagnosed with schizophrenia: a. are usually violent toward caregivers. b. universally fear sexual involvement with therapists. c. exhibit a high degree of hostility as evidenced by rejecting behavior. d. avoid relationships because they become anxious with emotional closeness.

ANS: D When an individual is suspicious and distrustful and perceives the world and the people in it as potentially dangerous, withdrawal into an inner world can be a defense against uncomfortable levels of anxiety. When someone attempts to establish a relationship with such a patient, the patient's anxiety rises until trust is established. There is no evidence that withdrawn patients with schizophrenia universally fear sexual involvement with therapists. In most cases, it is untrue that withdrawn patients with schizophrenia are commonly violent or exhibit a high degree of hostility by demonstrating rejecting behavior. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 211 TOP: Nursing Process: Evaluation MSC: Client Needs: Psychosocial Integrity

20 A severely withdrawn patient diagnosed with schizophrenia will spend time in the dayroom but will not speak to staff or other patients. The most therapeutic nursing intervention in response to this behavior would be to: a. seat the patient with a group of patients who are talking to each other. b. ignore the silence and talk about superficial topics such as the weather. c. point out that the patient makes others uncomfortable by refusing to speak. d. plan time for staff members to sit with the patient even though the patient does not talk with them.

ANS: D Developing trust is fundamental to developing a nurse-patient relationship. The nurse must demonstrate consistent and genuine caring. Initially schedule brief (5- to 10-minute), frequent contacts. Increase time gradually based on patient agreement. DIF: Cognitive Level: Application REF: Text Page: 360 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

20 A patient diagnosed with schizophrenia was rehospitalized after a relapse. A priority intervention in designing a discharge plan to prevent relapses will be: a. helping the patient's family develop tolerance for the cognitive symptoms. b. mobilizing the family to provide structure to reduce social dysfunction. c. working on self-concept to reduce avolition, anhedonia, and dysphoria. d. early identification of signs of impending relapse and coping strategies.

ANS: D Early identification of signs of impending relapse provides time for intervention with symptom-management techniques and support systems. Symptom self-management promotes personal empowerment. DIF: Cognitive Level: Application REF: Text Page: 362 TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

20 An appropriate short-term goal for a withdrawn, isolated patient diagnosed with schizophrenia is, "The patient will: a. participate in all therapeutic activities." b. define major barriers to communication." c. talk about feelings of withdrawal in group." d. consistently interact with an assigned nurse."

ANS: D Interacting with at least one person is desirable to reduce complete withdrawal and isolation. Such interaction provides the basis for formation of trust and the development of a nurse-patient relationship. DIF: Cognitive Level: Application REF: Text Page: 362 TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

20 During occupational therapy a patient diagnosed with schizophrenia sits staring at a piece of paper. Which response is most therapeutic at this time? a. "If you prefer to sit and stare for a time, it is acceptable for you to leave." b. "You seem immobilized by anxiety. Is there anything I can do to help?" c. "Are you having trouble deciding where you want to glue that piece?" d. "Rub the glue stick on the back of the paper."

ANS: D Patients with disrupted cognitive functioning have difficulty focusing on an activity in a sustained, concentrated fashion. They may need direction. Because multistage commands are often not understood, simple directions should be given one step at a time. DIF: Cognitive Level: Analysis REF: Text Pages: 348-349 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

20 Which neurological deficits would the nurse be most likely to encounter when assessing a patient diagnosed with schizophrenia? a. Weakness and loss of function b. Paralysis and diminished reflexes c. Droopy eyelids and reddened cornea d. Increased blinking and impaired fine motor skills

ANS: D Patients with schizophrenia are considered to have neurobiological problems. "Soft signs" are neurological deficits consistent with brain dysfunction of the frontal or parietal lobes. Soft signs include astereognosis, agraphesthesia, dysdiadochokinesia, impaired fine motor skills, increased eye blinking, abnormal smooth pursuit eye movements, and muscle twitches. By contrast, hard signs include loss of function, weakness, diminished reflexes, and paralysis. DIF: Cognitive Level: Application REF: Text Page: 352 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

20 The medical record of a patient diagnosed with schizophrenia states that the patient has cognitive dysfunction. From this statement, the nurse can expect to see evidence of: a. anxiety, fear, and agitation. b. aggression, anger, hostility, or violence. c. blunted or flat affect or inappropriate affective responses. d. impaired memory and attention as well as formal thought disorder.

ANS: D Problems in cognitive functioning include impaired short-term and long-term memory, distractibility and poor concentration, loose associations, tangentiality, incoherence, illogical speech, concrete thinking, indecisiveness, impaired judgment, and delusions. DIF: Cognitive Level: Comprehension REF: Text Page: 348 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

20 A patient diagnosed with schizophrenia has difficulty completing tasks and seems forgetful and disinterested in activities. A nurse can best select successful strategies by understanding that these behaviors are due to: a. a lack of self-esteem. b. manipulative tendencies. c. shyness and embarrassment. d. problems in cognitive functioning.

ANS: D The information processing of individuals with schizophrenia may be altered by brain deficits affecting memory and attention that then affect retention, ability to focus, and ability to make decisions. DIF: Cognitive Level: Comprehension REF: Text Page: 348 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

20 Which data gathered from the assessment of a family with a member diagnosed with schizophrenia would be of greatest importance in discharge planning for the patient? a. The patient is the middle sibling. b. The patient's mother is a talented artist. c. The patient's paternal grandfather was eccentric. d. The patient becomes anxious when family members are critical of one another.

ANS: D The patient and family should be made aware of symptom triggers to which the patient is particularly reactive. Triggers may precipitate relapse. Teaching the family to modify this behavior is ideal, but if it is impossible, the patient can be taught to contact a mental health provider. DIF: Cognitive Level: Analysis REF: Text Page: 359 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

20 What part of the brain is dysfunctional in persons with schizophrenia? Research has implicated the: a. medulla and cortex. b. cerebellum and cerebrum. c. hypothalamus and medulla. d. prefrontal and limbic cortices.

ANS: D The two most consistent neurobiological research findings in schizophrenia are imaging studies that show reduced brain volume and abnormal function, and neurochemical studies that show alterations of neurotransmitter systems affecting the prefrontal cortex and the limbic system. DIF: Cognitive Level: Comprehension REF: Text Page: 355 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation

social (personal) therapy for schizophrenia

Addresses social and personal difficulties in clients' lives • Practical advice, problem solving, decision making, social skills training, medication management, employment counseling, financial assistance, and housing Research shows that this approach reduces rehospitalization

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

Age of onset is typical for schizophrenia.

A client diagnosed with schizophrenia has been prescribed clozapine. Which is a potentially fatal side effect of this medication?

Agranulocytosis

A mental health client has been prescribed clozapine for the treatment of schizophrenia. The nurse should be alert to which potentially life-threatening adverse effects of this medication?

Agranulocytosis Agranulocytosis is a life-threatening adverse effect of clozapine. White blood cell counts should be monitored frequently due to extremely low levels of white blood cells.

A patient with schizophrenia was changed to clozapine 3 weeks ago. The patient calls the clinic nurse complaining of sore throat, fever, and malaise. Which laboratory test would be most helpful in determining the cause of these findings?

Agranulocytosis is the reduction of white blood cells (WBCs) and is a possible adverse effect of antipsychotic drugs, particularly clozapine. Chief complaints are flulike symptoms. A complete blood cell count would show the reduction in WBCs. Serum lithium level, liver panel, and urinalysis are not necessary.

A nurse monitoring client medication needs to recognize side effects quickly and intervene promptly for which reason?

Alleviate the side effects and help client maintain adherence

Which of the following is NOT one of the ways in which medications can affect the neurotransmitter activity in a person with schizophrenia?

Antagonist drugs can prevent neurotransmitters from leaking from synaptic vesicles.

developmental psychopathology views on schizophrenia

Applies an integrative and developmental framework • Individual's genetic predisposition is implemented by a dysfunctional brain circuit • May eventually lead to schizophrenia if, over the course of the person's development, he or she experiences significant life stressors, difficult family interactions, and/or other negative environmental factors

A patient who has been receiving antipsychotic medication for 6 weeks tells the nurse that the hallucinations are nearly gone and that concentration has improved. When the patient reports flulike symptoms, including a fever and a very sore throat, the nurse should

Arrange for the patient to have blood drawn for a white blood cell count Antipsychotic medications may cause agranulocytosis, the first manifestation of which may be a sore throat and flulike symptoms. Agranulocytosis with infection could be life threatening, so recommending rest does not address the underlying problem.

When assuming the management of the care of a delusional client, which should be the nurse's priority intervention?

Assure the client that he or she is safe in this milieu

The type of altered perception most commonly experienced by patients with schizophrenia is

Auditory hallucinations

The negative schizophrenic symptom that involves an inability to initiate and persist in activities is called

Avolition.

Nico, a 22-year-old patient, is diagnosed with schizophrenia. Which of the following symptoms would alert a provider to a possible diagnosis of schizophrenia in a 22-year-old male client? A Excessive sleeping with disturbing dreams B Hearing voices telling him to hurt his roommate C Withdrawal from college because of failing grades D Chaotic and dysfunctional relationships with his family and peers

The purpose of the Abnormal Involuntary Movement Scale (AIMS) assessment on a persistently mentally ill client who has been diagnosed with schizophrenia is early detection of A acute dystonia. B tardive dyskinesia. C cholestatic jaundice. D pseudoparkinsonism.

Which nursing intervention is designed to help a schizophrenic client minimize the occurrence of a relapse? A Schedule the client to attend group therapy that includes those who have relapsed. B Teach the client and family about behaviors associated with relapse. C Remind the client of the need to return for periodic blood draws to minimize the risk for Relapse. D Help the client and family adapt to the stigma of chronic mental illness and periodic relapses.

37. A client with schizoaffective disorder is having difficulty adhering to the medication regimen that requires the use of several agents. The client also is experiencing several side effects contributing to this nonadherence. The physician plans to change the client's medication. Which agent would the nurse anticipate that the physician would prescribe? A) Lithium B) Aripiprazole C) Clozapine D) Olanzapine

B) Aripiprazole

14. A nurse is providing care to a client just recently diagnosed with schizophrenia during an inpatient hospital stay. Throughout the day, the nurse observes the client drinking from the water fountain quite frequently as well as carrying cans of soda and bottles of water with him wherever he goes. Upon entering the client's room, the nurse sees numerous empty cups that had been filled with fluids on his table and in the trash can. The room has an odor of urine. The nurse suspects which of the following? A) Diabetes mellitus B) Disordered water balance C) Tardive dyskinesia D) Orthostatic hypotension

B) Disordered water balance

22. A nurse is developing a teaching plan for a client with schizophrenia. Which method would the nurse use to be most effective? A) Engaging the client the trial and error learning B) Having the client write down information after directly being given the correct information C) Asking the client questions that encourage the client to guess at the correct answer D) Using visual aids that are very colorful and full of descriptive graphic images

B) Having the client write down information after directly being given the correct information

36. After teaching a group of students about the epidemiology of schizoaffective disorder, the instructor determines that the teaching was successful when the students state which of the following? A) The disorder occurs often in children. B) It is more likely to occur in women. C) Most persons are African Americans. D) The disorder is rare in family relatives.

B) It is more likely to occur in women.

18. A client with schizophrenia tells the nurse, I'm being watched constantly by the FBI because of my job. Which response by the nurse would be most appropriate? A) Tell me more about how you are being watched. B) It must be frightening to feel like you're always been watched. C) You're not being watched; it's all in your mind. D) You are experiencing a delusion because of your illness.

B) It must be frightening to feel like you're always been watched.

33. The nurse is preparing to interview a client who has a delusional disorder. Which of the following would the nurse expect? A) Cognitive impairment B) Normal behavior C) Labile affect D) Evidence of motor symptoms

B) Normal behavior

5. The nurse is caring for a hospitalized client who has schizophrenia. The client has been taking antipsychotic medications for 1 week when the nurse observes that the client's eyes are fixed on the ceiling. The nurse interprets this finding as which of the following? A) Akathisia B) Oculogyric crisis C) Retrocollis D) Tardive dyskinesia

B) Oculogyric crisis

29. A family member of a client diagnosed with schizoaffective disorder asks a nurse what causes the disorder. Which response by the nurse would be most appropriate? A) Dysfunctional family dynamics has been identified as a strong link. B) Research has suggested that the cause is predominately genetic. C) Dopamine, a substance in the brain, appears to be underactive. D) Studies have indicated that birth order is strongly associated with this disorder.

B) Research has suggested that the cause is predominately genetic.

20. A client with schizophrenia is prescribed clozapine because other prescribed medications have been ineffective. After teaching the client and family about the drug, the nurse determines that the teaching was successful when they state which of the following? A) He needs to have an electrocardiogram periodically when taking this drug. B) We'll need to make sure that he has his blood count checked at least weekly. C) He might develop toxic levels of the drug if he smokes cigarettes. D) We need to watch to make sure that he doesn't lose too much weight.

B) We'll need to make sure that he has his blood count checked at least weekly.

Which statement is true about delusional disorder?

Behavior is relatively normal except when focused on the delusion.

Which would a nurse expect to administer to a client with schizophrenia who is experiencing a dystonic reaction?

Benztropine

A nurse is preparing to document information obtained from a client diagnosed with a delusional disorder who is experiencing somatic delusions. Which would the nurse most likely document?

Body complaints

A client diagnosed with disorganized schizophrenia would have greatest difficulty with the nursing intervention? A Interacting with a neutral attitude B Using concrete language C Giving multistep directions D Providing nutritional supplements

A client diagnosed with paranoid schizophrenia refuses food, stating the voices are saying the food is contaminated and deadly. Which response should the nurse provide to this client statement? A "You are safe here in the hospital; nothing bad will happen to you." B "The voices are wrong about the hospital food. It is not contaminated." C "I understand that the voices are very real to you, but I do not hear them." D "Other people are eating the food, and nothing is happening to them."

A client, who has been prescribed clozapine 6 weeks ago, reports flulike symptoms including a fever and a very sore throat, the nurse should initiate which nursing intervention? A Suggest that the client take something for the fever and get extra rest. B Advise the physician that the client should be admitted to the hospital. C Arrange for the client to have blood drawn for a white blood cell count. D Consider recommending a change of antipsychotic medication.

A teenaged client is being discharged from the psychiatric unit with a prescription for risperidone. The nurse providing medication teaching to the client's mother should provide which response when asked about the risk her son faces for extrapyramidal side effects (EPSs)? A All antipsychotic medications have an equal chance of producing EPSs. B Newer antipsychotic medications have a higher risk for EPSs. C Risperidone is a newer antipsychotic medication and has a lower risk of EPSs than older antipsychotics. D eAdvise the mother to ask the provider to change the medication to clozapine instead of risperidone.

The nurse is planning long-term goals for a 17-year-old male client recently diagnosed with schizophrenia. Which statement should serve as the basis for the goal-setting process? A If treated quickly following diagnosis, schizophrenia can be cured. B Schizophrenia can be managed by receiving treatment only at the time of acute exacerbations. C Patients with schizophrenia often do not fully respond to treatment and have residual symptoms and varying degrees of disability. D If patients with schizophrenia stay on their drug regimen, they usually lead fully productive lives with no further symptoms.

Which symptom would NOT be assessed as a positive symptom of schizophrenia? A Delusion of persecution B Auditory hallucinations C Affective flattening D Idea of reference

C Affective flattening Positive symptoms are those symptoms that should not be present, but are. They include hallucinations, delusions, bizarre behavior, and paranoia and are referred to as florid symptoms. Affective flattening is one of the negative symptoms that contribute to rendering the person inert and unmotivated.

23. Assessment of a client with schizophrenia reveals that he is hearing voices that tell him that people are staring at him and illusions. When developing the plan of care for this client, which nursing diagnosis would be most appropriate? A) Disturbed thought processes B) Risk for self-directed violence C) Disturbed sensory perception D) Ineffective coping

C) Disturbed sensory perception

35. A client with schizoaffective disorder is prescribed clozapine to treat her symptoms. Which of the following instructions would the nurse provide? A) Keep a record of how often and how long you experience the side effect of dry mouth. B) Monitor your urinary output and notify your doctor if your urine changes color. C) Keep an eye on your weight, and if you gain weight rapidly, notify your doctor. D) If you experience any drowsiness, discontinue taking this medication.

C) Keep an eye on your weight, and if you gain weight rapidly, notify your doctor.

19. A nurse is working with a group of clients diagnosed with schizophrenia in a community setting. Which of the following would least likely be a priority? A) Improving the quality of life B) Instilling hope C) Managing psychosis D) Preventing relapse

C) Managing psychosis

11. A nurse is preparing an in-service program for a group of psychiatric mental health nurses about schizophrenia. Which of the following would the nurse include as a major reason for relapse? A) Lack of family support B) Accessibility to community resources C) Non-adherence to prescribed medications D) Stigmatization of mental illness

C) Non-adherence to prescribed medications

12. While assessing a client with schizophrenia, the client states, Everywhere I turn, the government is watching me because I know too much. They are afraid that I might go public with the information about all those conspiracies. The nurse interprets this statement as indicating which type of delusion? A) Grandiose B) Nihilistic C) Persecutory D) Somatic

C) Persecutory

16. After teaching a class on antipsychotic agents, the instructor determines that the teaching was successful when the class identifies which of the following as an example of a second-generation antipsychotic agent? A) Fluphenazine (Prolixin) B) Thiothixene (Navane) C) Quetiapine (Seroquel) D) Chlorpromazine (Thorazine)

C) Quetiapine (Seroquel)

2. While caring for a hospitalized client with schizophrenia, the nurse observes that the client is listening to the radio. The client tells the nurse that the radio commentator is speaking directly to him. The nurse interprets this finding as which of the following? A) Autistic thinking B) Concrete thinking C) Referential thinking D) Illusional thinking

C) Referential thinking

42. A group of nursing students is reviewing information about other psychotic disorders. The students demonstrate understanding of this information when they identify which disorder as involving an inducer? A) Brief psychotic disorder B) Schizophreniform disorder C) Shared psychotic disorder D) Psychotic disorder attributable to a substance

C) Shared psychotic disorder

21. Which of the following would be most important for the nurse to keep in mind when establishing the nurse patient relationship with a client with schizophrenia to promote recovery? A) The relationship typically develops over a short period of time. B) Decisions about care are the responsibility of interdisciplinary team. C) Short, time-limited interactions are best for the client experiencing psychosis. D) Typically, clients with schizophrenia readily engage in a therapeutic relationship.

C) Short, time-limited interactions are best for the client experiencing psychosis.

38. While interviewing a client diagnosed with a delusional disorder, the client states, I have this really strange odor coming out of my mouth. I stop to brush my teeth almost every hour and then rinse with mouthwash every half hour to get rid of this smell. I've seen so many doctors, and they can't tell me what's wrong. The nurse interprets the client's statement as reflecting which type of delusion? A) Erotomanic B) Grandiose C) Somatic D) Jealous

C) Somatic

31. The nurse is assessing a newly admitted client diagnosed with schizoaffective disorder. The nurse assesses the client's level of anxiety and reactions to stressful situations, obtaining this information for which reason? A) To help determine the client's outcomes after treatment B) To help identify whether or not the client's mental competency is intact C) To act as a predictor of the client's risk for a suicide attempt D) To provide a basis for evaluating the client's social skills

C) To act as a predictor of the client's risk for a suicide attempt

The client has been diagnosed with schizophrenia and is showing the following symptoms: immobility, rigidity, and stupor. These symptoms can be further classified as which characteristic symptoms of schizophrenia?

Catatonic Catatonic clients show motoric immobility or stupor, rigidity, excessive motor activity, extreme negativism, stupor, and peculiarities of movement, such as posturing, echolalia and echopraxia, mutism, and waxy flexibility.

A nurse understands that antipsychotic drugs may sometimes have toxic effects. The nurse suggests to the patient's guardians to give the patient foods rich in carbohydrates and protein and to ensure that the patient undergoes a liver function test every 6 months. Which of these toxic effects was the nurse thinking about when making such a suggestion?

Cholestatic jaundice

A client with schizoaffective disorder is engaging in an extremely long conversation about a current affairs in the world. The client goes on to provide the nurse with minute details. The nurse interprets this as suggesting what?

Circumstantiality

Which speech pattern is exhibited by the client stating, "I will take a pill if I go up the hill but not if my name is Jill, I don't want to kill?"

Clang association

A client diagnosed with schizoaffective disorder and severe depression is being treated with antipsychotic medications. The client tells the nurse about difficulty with self-care activities. With which intervention should the nurse respond?

Establish a routine and set goals.

How often must clients receiving clozapine get white blood cell counts drawn?

Every week for the first 6 months

A client is diagnosed with schizoaffective disorder. Which would the nurse identify as supporting this diagnosis?

Evidence of hallucinations and delusions accompanied by major depression For the diagnosis of schizoaffective disorder, the client must have an uninterrupted period of illness when there is a major depressive, manic, or mixed episode along with two of the following symptoms of schizophrenia: delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, or negative symptoms. In addition, the positive symptoms must be present without the mood symptoms at some time during this period for at least 2 weeks. The ability to maintain functioning would not be possible. Disorganized speech is only one of the symptoms that may be present. It also may be present with schizophrenia. A smaller thalamus and hippocampus are associated with schizophrenia.

Positive symptoms

Excesses of or bizarre additions to normal thoughts, emotions, or behaviours 1) delusions: single or many - delusions of persecution - delusions of reference - delusions of grandeur - delusions of control 2) disorganized thinking and speech: - loose associations or derailment - neologisms - perseveration - clang or rhymes 3) inappropriate affect - situationally unsuitable - may sometimes be an emotional response to other disorder features 4) heightened perceptions and hallucinations - problems of perception and attention - perceptions in the absence of external stimuli (auditory, tactile, visual, gustatory) may occur together

A client has been taking haloperidol for 5 years when the client is admitted to the inpatient unit for relapse of symptoms of schizophrenia. Upon assessment, the client demonstrates akathisia, dystonia, a stiff gait, and rigid posture. The nurse correctly identifies these symptoms are indicative of what?

Extrapyramidal side effects

A client broke down in tears when speaking with the nurse, stating, "You have no idea what it's like to be responsible for finding terrorist leaders. Every day I have to stay one step ahead of the operatives that have been sent after me." In light of the client's statement, which nursing diagnosis should the nurse prioritize?

Fear related to persecutory delusions

failures of community care

Fewer than half of all people who need them receive appropriate community mental health services Two contributing factors 1) Poor coordination of services - Failure of communication between and within community mental health agencies - Poor communication between state hospitals and community mental health centers - solutions: community therapists as case managers 2) Shortage of services • An inadequate number of community programs are available to people with schizophrenia - Often a failure to provide adequate services for people with severe disorders in available community programs • Economic reasons for services shortage - Less funding for people with severe disorders - Program funding often falls to local governments and nonprofit organizations Consequences?

Gynecomastia, amenorrhea, and galactorrhea are side effects most often associated with which medications?

First-generation antipsychotic medications commonly have side effects that relate to sexual dysfunction. These side effects include gynecomastia (enlarged breast tissue), amenorrhea (absence of menstruation), and galactorrhea (discharge from nipples).

psychodynamic explanation of schizophrenia

Fromm-Reichmann: Schizophrenogenic mothers • Little research support Self theorists: Biological deficiencies cause the development of a fragmented self

A patient with schizophrenia who is experiencing symptoms of disorganized thinking would have the greatest difficulty when the nurse

Gives multistep directions

A client with delusional disorder tells the nurse that the client has discovered how to jump to the moon. The nurse would document this belief as what?

Grandiose delusion

A client with schizophrenia is hearing voices that tell the client to kill the self. What term is used to identify this type of false sensory perception?

Hallucination

During an admission assessment, a client with schizoaffective disorder states that the client hears the voice of God in the client's head and the voice is telling the client that the client is worthless. What would the nurse document this symptom as?

Hallucination

Clients diagnosed with schizophrenia may experience disordered water balance that may lead to water intoxication. Which may occur as a result of water intoxication?

Hyponatremia

A client with delusions presents with strong defensiveness, even when watching the news or listening to the radio. The nurse would document this finding in the health history as what?

Ideas of reference Ideas of reference occur when a client has self-centered thoughts and falsely believes ideas are centered on something the client is doing, thinking, or feeling. Looseness of association is the inability to think logically. Ambivalence refers to contradictory or opposing emotions, attitudes, ideas, or desires for the same person or things or toward the environment. Echolalia is a pathological parrot-like response of a word or phrase.

Herman, a man who has been hospitalized with schizophrenia, has a very unusual set of behaviors. He tends to cry when he sees a very funny television show or is told a joke, and laughs out loud when his doctors discuss his illness with him. Which of the following symptoms is Herman demonstrating?

Inappropriate affect

Positive symptoms seen in schizophrenia are believed to be a result of which type of neurological dysfunction?

Increased amount of dopamine

In regard to cultural differences in "expressed emotion," which is thought to be positively correlated with schizophrenia, research has found that ________ families have the lowest percentage of expressed emotion.

Indian

biological views of schizophrenia

Inheritance and brain activity play key roles in the development of schizophrenia Genetic factors (diathesis-stress perspective) have research support • Relatives of people with schizophrenia • Twins with schizophrenia • People with schizophrenia who are adopted • Direct genetic research and molecular biology Dopamine hypothesis: • Certain neurons using dopamine fire too often, producing symptoms of schizophrenia • Messages traveling from dopamine-sending neurons to dopamine receptors on other neurons, particularly to the D-2 receptors, may be transmitted too easily or too often • This theory is based on the effectiveness of antipsychotic medications (schizophrenia may be related to abnormal activity or interactions of both dopamine and other neurotransmitters, rather than to abnormal dopamine activity alone) Dysfunctional brain structures and circuitry • Brain circuit structures function and interconnect in problematic ways that are collectively unique to this disorder • Newer research suggests the schizophrenia-related circuit may be two distinct subcircuits whose various structures sometimes overlap • Abnormal neurotransmitter activity is now seen as part of a broader circuit dysfunction that can propel people toward schizophrenia Studies suggest that a dysfunctional brain circuit may lead to schizophrenia - this circuit includes the prefrontal cortex, hippocampus, amygdala, thalamus, striatum, and substantia nigra, among other structures Viral problems • Exposure to viruses before birth triggers a passed-on immune response that interrupts fetal brain development • Evidence = (1) Animal model investigations (2) Links involving late winter births and mother influenza exposure involvement of the immune system

The nurse is providing teaching to a client diagnosed with schizoaffective disorder. The nurse should explain to the client that which is true about this disorder?

It is a mix of psychotic and mood symptoms.

A student nurse has been assigned to provide care for an inpatient psychiatric-mental health client who has a diagnosis of schizophrenia. The student nurse is apprehensive about interacting with the client. The client's detailed explanations of the client's delusions accompanied by unpredictable movements have prompted fear in the student. How should this nursing student interpret such feelings?

It is natural to feel fear when a client exhibits unpredictable behavior, and this can cause the student to be reasonably cautious.

Which of the following drugs causes schizophrenic symptoms?

Ketamine

Which of the following statements regarding schizophrenia is accurate? a. The lifetime prevalence rate of schizophrenia worldwide is 3%. b. Women with schizophrenia have a poorer prognosis than men with schizophrenia. c. Life expectancy is less than average due to suicides and accidents. d. The frequency of early life schizophrenia is higher for women, while the frequency of later life onset of symptoms is higher for men.

Life expectancy is less than average due to suicides and accidents

A patient's dose of haloperidol was increased earlier today. The patient now is experiencing laryngeal dystonia. What is the nurse's priority action?

Maintain a patent airway

family therapy for schizophrenia

Many persons recovering from schizophrenia and other severe disorders live with family members • This creates significant family stress • Those who live with relatives who display high levels of expressed emotion are at greater risk for relapse than those who live with more positive or supportive families

The nurse is assigned to a client with catatonic schizophrenia. Which intervention should the nurse include in the client's care plan?

Meeting all of the client's physical needs

in the 1950's, what two GOOD institutional approaches emerged?

Milieu therapy (Maxwell Jones): • Institutions cannot help patients unless they create a social climate that promotes productive activity, self-respect, and individual responsibility • Residents live in a therapeutic community of respect, support, and openness, which resembles daily life outside the hospital • Many leave the hospital at higher rates than patients receiving custodial care; some need sheltered aftercare • Often combined with other community programs Token economy: • Systematic use of operant conditioning techniques used in hospital wards to change patient behaviors • Patients are rewarded with tokens for acceptable behavior; not rewarded for unacceptable behavior • Token economies reduce psychotic and related behaviors • Limitations - Uncontrolled studies - Some ethical and legal concerns about controlling rewards related to basic needs - Some question whether the change involves thoughts or perceptions or just imitation of normal behavior - Transfer to real-world rewards may be difficult

A nursing instructor is developing an education plan for a group of students about schizophrenia and schizoaffective disorders. The instructor identifies that in addition to psychosis, what other condition must be present at the same time for a diagnosis of schizoaffective disorder?

Mood disturbance

sociocultural views of schizophrenia

Multicultural factors • Racial and ethnic group differences in rates of schizophrenia • African Americans are more likely than non-Hispanic white Americans to receive this diagnosis (more prone to disorder; biased diagnoses; misread cultural differences; economic hardship effects) • Key country-to-country differences • Stable prevalence • Varied course and outcomes • Genetic differences among populations • Psychosocial environments Social labeling • Features of schizophrenia are influenced by the diagnosis (self-fulfilling prophecy) • Rosenhan study Family dysfunction • Schizophrenia is linked to family stress • High expressed emotion is tied to relapse • People with schizophrenia are often difficult to live with

A comprehensive nursing assessment for neuroleptic malignant syndrome (NMS) should include checking for which in a client taking an antipsychotic medication?

Muscular rigidity, tremors, and difficulty swallowing NMS is characterized by muscular rigidity, tremors, difficulty swallowing, fever, hypertension, and diaphoresis.

32. A patient receiving risperidone (Risperdal) reports severe muscle stiffness at 1030. By 1200, the patient has difficulty swallowing and is drooling. By 1600, vital signs are 102.8° F; pulse 110; respirations 26; 150/90. The patient is diaphoretic. Select the nurse's best analysis and action. a. Agranulocytosis; institute reverse isolation. b. Tardive dyskinesia; withhold the next dose of medication. c. Cholestatic jaundice; begin a high-protein, high-cholesterol diet. d. Neuroleptic malignant syndrome; notify health care provider stat.

NS: D Taking an antipsychotic medication coupled with the presence of extrapyramidal symptoms, such as severe muscle stiffness and difficulty swallowing, hyperpyrexia, and autonomic symptoms (pulse elevation), suggest neuroleptic malignant syndrome, a medical emergency. The symptoms given in the scenario are not consistent with the medical problems listed in the incorrect options. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Page 210 (Table 12-3) | Page 219-220 TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity

The nurse must be aware that individuals from diverse ethnic groups might describe troubling experiences in terms of physical problems or specific culture-bound syndromes. The syndrome of ghost sickness is exhibited by which culture?

Native American

Which has not been proposed as a potential mechanism for the etiology of thought disorders?

Neglect in childhood Many studies strongly suggest that genetics plays a part in the development of schizophrenia. Neuroanatomical imaging and study may link schizophrenia to certain patterns of hemispheric brain dysfunction. The most recent research into the etiology of schizophrenia has focused on brain imaging and neurochemical and neuropathologic changes in the brains of clients with the disorder.

A client with a diagnosis of schizophrenia has been brought to the emergency department by a worker from the group home where the client resides. The worker states that the client has stopped taking medications and drank 2 to 3 gallons of water over the past several hours. What assessments should the nurse who is caring for this client prioritize?

Neurological assessment and monitoring of electrolyte levels

A nurse provides care to a client with schizoaffective disorder during hospitalization for acute psychosis. Nursing interventions to help the client to establish trust with the health care team is best accomplished by what?

Offering reassurance in a soft, nonthreatening voice

What is the generic name of the antipsychotic medication Zyprexa?

Olanzapine

cognitive-behavioural view of schizophrenia

Operant conditioning: Circumstantial support; more recently viewed as a partial explanation Misinterpreting unusual sensations: No direct research support

A nursing student is preparing to care for a client diagnosed with schizophrenia. When interacting with the client, the student notices that the client is highly suspicious and guarded, stating, "They're out to get me." The student identifies this as what?

Paranoia

An adult with a 6-year history of schizophrenia begins a community rehabilitation program. Select the most appropriate initial outcome for this patient. The patient will

Participation in scheduled activities of the program should occur first. After the patient is accustomed to the program, he or she might lead a group or apply for employment. Hallucinations commonly continue to occur in patients diagnosed with schizophrenia.

A nurse is caring for a patient with schizophrenia. Upon the nurse's report, the primary health care provider prescribed 25 mg of diphenhydramine hydrochloride to the patient. What had the nurse reported to the primary health care provider about the patient?

Patients with schizophrenia are generally prescribed antipsychotic drugs. These drugs cause extrapyramidal side effects, like tremors, and abnormal involuntary movements, like tardive dyskinesia. Diphenhydramine hydrochloride 25 mg by the intramuscular or intravenous route is prescribed to such patients to treat extrapyramidal side effects

A 44-year-old client has been experiencing intense job stress. In recent weeks, the client has confided in the client's spouse that the client believes the client's firm monitors every aspect of the client's personal performance and that the firm is engaged in deception and cover-up of its "true purpose." A nurse would recognize that the primary theme of the client's delusional disorder is what?

Persecutory

A client with schizophrenia believes that the cook at the psychiatric hospital is trying to poison the client. The nurse would record this type of delusion as what?

Persecutory

While being assessed, a client with schizophrenia states, "Everywhere I turn, the government is watching me because I know too much. They are afraid that I might go public with the information about all those conspiracies." The nurse interprets this statement as indicating which type of delusion?

Persecutory

Which type of delusion refers to a situation whereby a person or someone close to person is being malevolently treated in some way?

Persecutory type

A client with a diagnosis of schizophrenia has a history of auditory and visual hallucinations. Which intervention is most likely to minimize the client's hallucinations?

Provide frequent contact and communication with the client

A client is being seen in the health clinic. The nurse observes a shuffling gait, drooling, and slowness of movement. The client is currently taking an antipsychotic for treatment of schizophrenia. The nurse knows that which side effect is occurring?

Pseudoparkinsonism

Which extrapyramidal side effect is noted by a client who has bradykinesia and a shuffling gait?

Pseudoparkinsonism

A distinguishing factor of psychosis is that it

Psychosis is disintegrative and involves a significant distortion of reality. Psychosis emerges with the panic level of anxiety. Delusional thinking may not be demonstrated by all psychotic individuals. Cognitive function is not a predisposing factor for the development of psychosis.

schizophrenia

Psychotic disorder in which personal, social, and occupational functioning deteriorate as a result of unusual perceptions, odd thoughts, disturbed emotions, and motor abnormalities

A client is brought to the emergency department stating, "I'm scared because the Federal Bureau of Investigation is now tapping my home phone, and I can hear them talking between my two telephones during the night." The client's eyes dart around the room while the nurse is trying to interview the client, and the client is tapping the client's fingers on the table. The nursing priority with this client is what?

Reassure the client that the client is in a safe place where the client will be helped.

A client has been prescribed clozapine for schizoaffective disorder (SCA) with depression. The nurse should explain to the client that one advantage of clozapine is that it can provide what?

Reduction of hospitalizations and risk for suicide

Which statement is accurate regarding the relationship between depression and schizophrenia?

Regular assessments should occur for both depression and suicide risk in patients diagnosed with schizophrenia.

A client begins to exhibit hallucinations and delusions along with disorganized speech after forgetting to take antipsychotic medication. The nurse suspects that the client is at which point in the clinical course of the disorder?

Relapse

A 24-year-old with schizophrenia and paranoid delusions is admitted to the hospital. The student nurse asks the charge nurse about what approach to take with the client, who has been exhibiting hostility and isolation. Which approach would be the most appropriate direction from the charge nurse?

Respect the client's need for personal space and avoid physical contact. A newly admitted client with paranoid schizophrenia needs a sense of trust before the nurse attempts to touch the client. Using emphatic tones and veiled threats will only increase the client's anxiety and lead to increased potential for hostility and anger.

A nurse is caring for a client diagnosed with schizophreniform disorder. The nurse demonstrates understanding of this disorder when identifying that the client is at risk for developing what?

Schizophrenia

Some research has suggested that schizophreniform disorder may be an early manifestation of which other mental health condition?

Schizophrenia

A 20-year-old son of a client who was diagnosed with schizophrenia at the age of 25 is concerned that he may also develop the disorder. Which statement regarding schizophrenia and genetics is true?

Schizophrenia has shown a strong genetic contribution.

course of schizophrenia

Schizophrenia usually first appears between the late teens and mid-thirties Three phases • Prodromal: Beginning of deterioration; mild symptoms • Active: Symptoms become apparent • Residual: Return to prodromal-like levels Each phase of the disorder may last for days or years A fuller recovery from the disorder is more likely in people: • With good premorbid functioning • Whose disorder was triggered by stress • With abrupt onset • With later onset (during middle age) • Who receive early treatment

When obtaining a client's history, a nurse determines that the client has been experiencing delusions and hallucinations for the past 3 months, which has caused some problems in the client's ability to function at work. The client also is exhibiting catatonic excitement, echopraxia, loose associations, and pressured speech. The nurse suspects which condition?

Schizophreniform disorder

A group of nursing students is reviewing information about other psychotic disorders. The students demonstrate understanding of this information when they identify which disorder as involving an inducer?

Shared psychotic disorder

A client with a long history of schizophrenia has managed well on fluphenazine. The client reports smacking of the lips and sticking out the tongue. Based on this report, what does the nurse suspect is occurring with the client?

Signs of tardive dyskinesia (TD) associated with neuroleptic medication

Psychomotor symptoms

Slow, awkward movements, repeated grimaces, and odd gestures that have a private purpose; catatonia 1) awkward movements, repeated grimaces, and odd gestured - movements seem to have a magical quality 2) symptoms may take extreme forms, collectively called catatonia - includes stupor, rigidity, posturing, and excitement - experienced by about 10% of people with schizophrenia

A nurse is assessing a client who is reporting the sensation of "bugs crawling under the skin" and intense itching and burning. The client states, "I know bugs have invaded my body." There is no evidence to support the client's report. The nurse interprets this as which type of delusion?

Somatic

The nurse should consider which during a psychiatric assessment of a newly immigrated client who is being evaluated for possible religious delusions?

Some cultures hold religious beliefs that might be confused with delusional thought

When developing the plan of care for a client with schizophrenia who is in the acute phase of illness, the nurse understands that the client is at high risk for what?

Suicide

A 55-year-old client was admitted to the psychiatric unit after an incident in a department store in which the client accused a sales clerk of following the client around the store and stealing the client's keys. The client was subdued by the police after destroying a window display because voices had told the client that it was evil. As the nurse approached the client, the client says, "You're all out to get me, and you're one of them. They're Rostoputians and grog babies here." This demonstrates what?

Suspiciousness and neologisms

Tara and Aaron are twins who are both diagnosed with schizophrenia. Aaron was diagnosed at 23 years and Tara at 31 years. Based on knowledge of early- and late-onset schizophrenia, which statement is true?

Tara has a better chance for positive outcomes because of later onset.

A client has been taking neuroleptic medications for many years as a treatment for schizophrenia. The client is exhibiting tongue protrusion, facial grimacing, and excessive blinking. These manifestations are characteristic of which extrapyramidal side effects (EPS)?

Tardive dyskinesia

The purpose of the Abnormal Involuntary Movement Scale (AIMS) assessment on a persistently mentally ill patient who has been diagnosed with schizophrenia is early detection of

Tardive dyskinesia

Which of the following side-effects of antipsychotic medications involves involuntary chewing, puffing of the cheeks, and a protruding tongue?

Tardive dyskinesia

Which assessment findings in a client who is suspected of having a delusional disorder would be suggestive of a diagnosis of schizophrenia?

The client experiences frequent and sustained hallucinations.

The client's diagnosis of schizoaffective disorder is supported when the nurse documents what?

The client reports "hearing voices" for the last 3 months

A client with a delusional disorder has been undergoing individual psychotherapy. The therapy would be deemed ultimately successful when the client meets which outcome?

The client will differentiate between reality and fantasy.

Research related to the development of schizophrenia has shown what?

The disorder is thought to arise from the interaction of a biological predisposition and environmental stressors.

Which is NOT true about the research and discovery of the first antipsychotic drug?

The first phenothiazine tested on patients with psychotic symptoms by Jean Delay and Pierre Deniker in 1952 was fluphenazine.

A nurse plans a series of psychoeducational groups for persons with schizophrenia. Which topic would take priority?

The importance of taking medication correctly

A patient is on conventional antipsychotics. On clinical observation, the nurse finds that the patient has hyponatremia, increased confusion, and delirium. Which is the most likely cause of the patient's condition?

The patient has potentially fatal water intoxication.

A client with schizophrenia is prescribed an antipsychotic medication. Which immediate side effects would the nurse include in the education plan for this medication?

The potential for sedation Sedation with antipsychotic medication will likely happen immediately after initiating the medication. The nurse should be sure to inform the client they he or she will experience this side effect readily. The other options are examples of side effects that are possible with longer term treatment using antipsychotic medications. Weight gain is commonly associated with many antipsychotic medications. The potential for weight loss with antipsychotic medication is not typically discussed with clients.

Which data support a nursing diagnosis of impaired verbal communication?

The presence of neologism, echolalia, and clanging

A client states, "My boss keeps putting thoughts into my head. Yesterday my boss made me copy 25 reports and then told me I had wasted company time and money!" The nurse knows the client is experiencing which perceptual disturbance?

Thought insertion

Which drug would a nurse anticipate being given with chlorpromazine to reduce extrapyramidal side effects?

Trihexyphenidyl: Chlorpromazine is a first-generation antipsychotic drug. It can cause extrapyramidal side effects, like akathisia, tremor, impaired gait, and so on, as a result of the blockage of dopamine receptors. These side effects can be treated by administering antiparkinson drugs like trihexyphenidyl. Trihexyphenidyl is an antimuscarinic class of drug. Montelukast is a leukotriene receptor antagonist used to treat asthma. Lamivudine is a nucleoside reverse transcriptase used to treat HIV/AIDS; it cannot be used to reduce the extrapyramidal side effects of chlorpromazine. Valacyclovir is an antiviral drug used to treat viral infections.

A client is diagnosed with a delusional disorder. While providing care to the client, the nurse assesses the client's delusions. Which would be least appropriate for the nurse to do?

Try to change the client's delusional belief

Which statements characterizes the major difference between the typical and atypical antipsychotic medications?

Typical antipsychotics most often relieve positive symptoms but do not have a significant impact on negative symptoms.

side effects of antipsychotic drugs used for schizophrenia

Unwanted effects of 1st gen antipsychotic drugs • Extrapyramidal effects - Parkinsonian and related symptoms: Result of medication-induced reductions of dopamine activity in striatum - Neuroleptic malignant syndrome: Potentially fatal reaction, particularly in the elderly - Tardive dyskinesia: Symptoms similar to psychotic symptoms and often overlooked; difficult to eliminate (clinicians are now more careful in their prescription practices) - prescribe the lowest dose - gradually reduce or stop the medication weeks or months after the patient begins functioning normally

A client diagnosed with schizophrenia states, "I want to go home, go home, go home." This is an example of which speech pattern?

Verbigeration

Who developed the transorbital lobotomy as a surgical treatment for a variety of mental illnesses?

Walter Freeman

A client is admitted to the psychiatric hospital with a diagnosis of schizophrenia. During the physical examination, the client's arm remains outstretched after the nurse obtains the pulse and blood pressure, and the nurse must reposition the arm. The nurse interprets this as what?

Waxy flexibility

A patient with undifferentiated schizophrenia lives in a community care home and takes olanzapine daily with supervision. During the patient's monthly outpatient visits with a psychiatric nurse, which assessment parameter takes priority?

Weight

Assessment of genetic predisposition supports asking a client who is exhibiting symptoms of a delusional disorder what?

Whether any family members have been diagnosed with schizophrenia

A patient diagnosed with schizophrenia says, "Cheese dog run fast." How should the nurse document this comment?

Word salad

Jenny has been diagnosed with Bipolar I. She needs to have her medication monitored and receive some help for readjusting socially to life outside of the hospital. Jenny has been attending _____, in which she participates in social therapy and has her medication monitored. She is at the facility for five hours a day and then returns home in the afternoon.

a day center

A strange or false belief that is held firmly despite evidence to the contrary is known as:

a delusion

Marcel has been diagnosed with schizoaffective disorder. This means that in addition to schizophrenic symptoms, he also has symptoms of

a mood disorder.

Iris has been taking Thorazine for several years. She has never really responded well to it, so she still struggles with her symptoms. Her doctor is MOST likely to try _____ instead of Thorazine.

a second-generation antipsychotic

Claire makes her bed on a daily basis and bathes and dresses herself without assistance. All of these behaviors are rewarded. For each behavior she completes, she is given a gold marker. Once she has collected a certain number of gold markers, she will be allowed to purchase amenities from the local store such as food. Claire is participating in:

a token economy

A nurse at the mental health clinic plans a series of psychoeducational groups for persons newly diagnosed with schizophrenia. Which two topics take priority? a. "The importance of taking your medication correctly" b. "How to complete an application for employment" c. "How to dress when attending community events" d. "How to give and receive compliments" e. "Ways to quit smoking"

a. "The importance of taking your medication correctly" e. "Ways to quit smoking" Stabilization is maximized by adherence to the antipsychotic medication regimen. Because so many persons with schizophrenia smoke cigarettes, this topic relates directly to the patients' physiological well-being. The other topics are also important but are not priority topics.

A nurse asks a patient diagnosed with schizophrenia, "What is meant by the old saying 'You can't judge a book by looking at the cover.'?" Which response by the patient indicates concrete thinking? a. "The table of contents tells what a book is about." b. "You can't judge a book by looking at the cover." c. "Things are not always as they first appear." d. "Why are you asking me about books?"

a. "The table of contents tells what a book is about." Concrete thinking refers to an impaired ability to think abstractly. Concreteness is often assessed through the patient's interpretation of proverbs. Concreteness reduces one's ability to understand and address abstract concepts such as love or the passage of time. The incorrect options illustrate echolalia, an unrelated question, and abstract thinking.

An acutely violent patient diagnosed with schizophrenia receives several doses of haloperidol (Haldol). Two hours later the nurse notices the patient's head rotated to one side in a stiffly fixed position, the lower jaw thrust forward, and drooling. Which intervention by the nurse is indicated? a. Administer diphenhydramine (Benadryl) 50 mg IM from the PRN medication administration record. b. Reassure the patient that the symptoms will subside. Practice relaxation exercises with the patient. c. Give trihexyphenidyl (Artane) 5 mg orally at the next regularly scheduled medication administration time. d. Administer atropine sulfate 2 mg subcut from the PRN medication administration record.

a. Administer diphenhydramine (Benadryl) 50 mg IM from the PRN medication administration record. Diphenhydramine, trihexyphenidyl, benztropine, and other anticholinergic medications may be used to treat dystonias. Swallowing will be difficult or impossible; therefore, oral medication is not an option. Medication should be administered immediately, so the intramuscular route is best. In this case, the best option given is diphenhydramine.

A patient is experiencing delusions of persecution about being poisoned. The patient has refused all hospital meals for 3 days. Which intervention is most likely to be acceptable to the patient? a. Allowing the patient supervised access to food vending machines b. Allowing the patient to phone a local restaurant to deliver meals c. Offering to taste each portion on the tray for the patient d. Providing tube feedings or total parenteral nutrition

a. Allowing the patient supervised access to food vending machines

1. Which characteristic in an adolescent female is sometimes associated with the prodromal phase of schizophrenia? a. Always afraid another student will steal her belongings. b. An unusual interest in numbers and specific topics. c. Demonstrates no interest in athletics or organized sports. d. Appears more comfortable among males.

a. Always afraid another student will steal her belongings.

A patient diagnosed with schizophrenia is very disturbed and violent. After several doses of haloperidol (Haldol), the patient is calm. Two hours later the nurse sees the patient's head rotated to one side in a stiff position, the lower jaw thrust forward, and drooling. Which problem is most likely? a. An acute dystonic reaction b. Tardive dyskinesia c. Waxy flexibility d. Akathisia

a. An acute dystonic reaction Acute dystonic reactions involve painful contractions of the tongue, face, neck, and back. Opisthotonos and oculogyric crisis may be observed. Dystonic reactions are considered emergencies requiring immediate intervention. Tardive dyskinesia involves involuntary spasmodic muscular contractions that involve the tongue, fingers, toes, neck, trunk, or pelvis. It appears after prolonged treatment. Waxy flexibility is a symptom seen in catatonic schizophrenia. Internal and external restlessness, pacing, and fidgeting are characteristics of akathisia.

The family of a patient diagnosed with schizophrenia is unfamiliar with the illness and family's role in recovery. Which type of therapy should the nurse recommend? a. Psychoeducational b. Psychoanalytic c. Transactional d. Family

a. Psychoeducational A psychoeducational group explores the causes of schizophrenia, the role of medication, the importance of medication compliance, support for the ill member, and hints for living with a person with schizophrenia. Such a group can be of immeasurable practical assistance to the family. The other types of therapy do not focus on psychoeducation.

2. Which nursing intervention is particularly well chosen for addressing a population at high risk for developing schizophrenia? a. Screening a group of males between the ages of 15 and 25 for early symptoms. b. Forming a support group for females aged 25 to 35 who are diagnosed with substance use issues. c. Providing a group for patients between the ages of 45 and 55 with information on coping skills that have proven to be effective. d. Educating the parents of a group of developmentally delayed 5- to 6-year-olds on the importance of early intervention.

a. Screening a group of males between the ages of 15 and 25 for early symptoms.

When a patient diagnosed with schizophrenia was discharged 6 months ago, haloperidol (Haldol) was prescribed. The patient now says, "I stopped taking those pills. They made me feel like a robot." What are common side effects the nurse should validate with the patient? a. Sedation and muscle stiffness b. Sweating, nausea, and diarrhea c. Mild fever, sore throat, and skin rash d. Headache, watery eyes, and runny nose

a. Sedation and muscle stiffness Typical antipsychotic drugs often produce sedation and extrapyramidal side effects such as stiffness and gait disturbance, effects the patient might describe as making him or her feel like a "robot." The side effects mentioned in the other options are usually not associated with typical antipsychotic therapy or would not have the effect described by the patient.

A community mental health nurse wants to establish a relationship with a very withdrawn patient diagnosed with schizophrenia. The patient lives at home with a supportive family. Select the nurse's best plan. a. Visit daily for 4 days, then every other day for 1 week; stay with patient for 20 minutes, accept silence; state when the nurse will return. b. Arrange to spend 1 hour each day with the patient; focus on asking questions about what the patient is thinking or experiencing; avoid silences. c. Visit twice daily; sit beside the patient with a hand on the patient's arm; leave if the patient does not respond within 10 minutes. d. Visit every other day; remind the patient of the nurse's identity; encourage the patient to talk while the nurse works on reports.

a. Visit daily for 4 days, then every other day for 1 week; stay with patient for 20 minutes, accept silence; state when the nurse will return.

What assessment findings mark the prodromal stage of schizophrenia? a. Withdrawal, misinterpreting, poor concentration, and preoccupation with religion b. Auditory hallucinations, ideas of reference, thought insertion, and broadcasting c. Stereotyped behavior, echopraxia, echolalia, and waxy flexibility d. Loose associations, concrete thinking, and echolalia neologisms

a. Withdrawal, misinterpreting, poor concentration, and preoccupation with religion Withdrawal, misinterpreting, poor concentration, and preoccupation with religion are prodromal symptoms, the symptoms that are present before the development of florid symptoms. The incorrect options each list the positive symptoms of schizophrenia that might be apparent during the acute stage of the illness.

A newly hospitalized patient experiencing psychosis says, "Red chair out town board." Which term should the nurse use to document this finding? a. Word salad b. Neologism c. Anhedonia d. Echolalia

a. Word salad Word salad is a jumble of words that is meaningless to the listener and perhaps to the speaker as well, because of an extreme level of disorganization.

A patient diagnosed with schizophrenia begins to talks about "macnabs" hiding in the warehouse at work. The term "macnabs" should be documented as: a. a neologism. b. concrete thinking. c. thought insertion. d. an idea of reference.

a. a neologism. A neologism is a newly coined word having special meaning to the patient. "Macnabs" is not a known common word. Concrete thinking refers to the inability to think abstractly. Thought insertion refers to thoughts of others are implanted in one's mind. Ideas of reference are a type of delusion in which trivial events are given personal significance.

Larry was a self-sufficient, good student prior to his first episode of schizophrenia, which occurred suddenly when he was 19 years old. Similarly, Kahn was well-liked, performed well in school, and was self-sufficient before he developed schizophrenia when he was 18 years old. However, unlike Larry, Kahn's disorder appeared gradually. Both teens received early treatment. According to statistics, Larry is MORE likely to have a fuller recovery than Kahn because Larry had:

an abrupt onset

One advantage of second-generation antipsychotics compared to conventional antipsychotics is that second-generation antipsychotics:

are less likely to produce tardive dyskinesia.

Bleuler described the underlying behaviors of schizophrenia as the destruction of the forces that connect one function to the next. He called this underlying foundation of the disorder

associative splitting.

Catatonic posturing is a form of catatonia in which a person:

assumes awkward, bizarre positions for long periods of time

Andrea Yates showed symptoms of postpartum psychosis and drowned her five children in 2001. Assuming that she was suffering from postpartum psychosis, her actions were:

atypical; less than 4 percent of women with postpartum psychosis harm or attempt to harm their offspring.

The Rosenhan study (1973) indicated that the staff at mental hospitals tend to be _____ and that patients tend to feel ______.

authoritarian, powerless

Arjun sits at home on most days, watches television, smokes cigarettes, and sits on the couch. He does not feel like cooking, cleaning, or doing much of anything. This can MOST likely be described as:

avolition

A person has had difficulty keeping a job because of arguing with co-workers and accusing them of conspiracy. Today the person shouts, "They're all plotting to destroy me. Isn't that true?" Select the nurse's most therapeutic response. a. "Everyone here is trying to help you. No one wants to harm you." b. "Feeling that people want to destroy you must be very frightening." c. "That is not true. People here are trying to help you if you will let them." d. "Staff members are health care professionals who are qualified to help you."

b. "Feeling that people want to destroy you must be very frightening." Resist focusing on content; instead, focus on the feelings the patient is expressing. This strategy prevents arguing about the reality of delusional beliefs. Such arguments increase patient anxiety and the tenacity with which the patient holds to the delusion. The other options focus on content and provide opportunity for argument

Which hallucination necessitates the nurse to implement safety measures? The patient says, a. "I hear angels playing harps." b. "The voices say everyone is trying to kill me." c. "My dead father tells me I am a good person." d. "The voices talk only at night when I'm trying to sleep."

b. "The voices say everyone is trying to kill me." The correct response indicates the patient is experiencing paranoia. Paranoia often leads to fearfulness, and the patient may attempt to strike out at others to protect self. The distracters are comforting hallucinations or do not indicate paranoia.

A patient diagnosed with schizophrenia says, "My co-workers are out to get me. I also saw two doctors plotting to kill me." How does this patient perceive the environment? a. Disorganized b. Dangerous c. Supportive d. Bizarre

b. Dangerous The patient sees the world as hostile and dangerous. This assessment is important because the nurse can be more effective by using empathy to respond to the patient. Data are not present to support any of the other options.

A patient's care plan includes monitoring for auditory hallucinations. Which assessment findings suggest the patient may be hallucinating? a. Detachment and overconfidence b. Darting eyes, tilted head, mumbling to self c. Euphoric mood, hyperactivity, distractibility d. Foot tapping and repeatedly writing the same phrase

b. Darting eyes, tilted head, mumbling to self Clues to hallucinations include eyes looking around the room as though to find the speaker, tilting the head to one side as though listening intently, and grimacing, mumbling, or talking aloud as though responding conversationally to someone.

A patient insistently states, "I can decipher codes of DNA just by looking at someone." Which problem is evident? a. Visual hallucinations b. Magical thinking c. Idea of reference d. Thought insertion

b. Magical thinking Magical thinking is evident in the patient's appraisal of his own abilities. There is no evidence of the distracters.

A patient diagnosed with schizophrenia has taken a conventional antipsychotic medication for a year. Hallucinations are less intrusive, but the patient continues to have apathy, poverty of thought, and social isolation. The nurse would expect a change to which medication? a. Haloperidol (Haldol) b. Olanzapine (Zyprexa) c. Chlorpromazine (Thorazine) d. Diphenhydramine (Benadryl)

b. Olanzapine (Zyprexa) Olanzapine is a second-generation atypical antipsychotic that targets both positive and negative symptoms of schizophrenia. Haloperidol and chlorpromazine are conventional antipsychotics that target only positive symptoms. Diphenhydramine is an antihistamine. See relationship to audience response question.

A patient took trifluoperazine 30 mg po daily for 3 years. The clinic nurse notes that the patient grimaces and constantly smacks both lips. The patient's neck and shoulders twist in a slow, snakelike motion. Which problem would the nurse suspect? a. Agranulocytosis b. Tardive dyskinesia c. Tourette's syndrome d. Anticholinergic effects

b. Tardive dyskinesia Fluphenazine decanoate is a first-generation antipsychotic medication. Tardive dyskinesia is a condition involving the face, trunk, and limbs that occurs more frequently with first-generation antipsychotics than second or third generation. Involuntary movements, such as tongue thrusting; licking; blowing; irregular movements of the arms, neck, and shoulders; rocking; hip jerks; and pelvic thrusts, are seen. These symptoms are frequently not reversible even when the drug is discontinued. The scenario does not present evidence consistent with the other disorders mentioned. Agranulocytosis is a blood disorder. Tourette's syndrome is a condition in which tics are present. Anticholinergic effects include dry mouth, blurred vision, flushing, constipation, and dry eyes.

A client says, "Facebook has a new tracking capacity. If I use the Internet, Homeland Security will detain me as a terrorist." Select the nurse's best initial action. a. Tell the client, "Facebook is a safe website. You don't need to worry about Homeland Security." b. Tell the client, "You are in a safe place where you will be helped." c. Administer a prn dose of an antipsychotic medication. d. Tell the client, "You don't need to worry about that."

b. Tell the client, "You are in a safe place where you will be helped." The patient is experiencing paranoia and delusional thinking, which leads to fear. Explaining that the patient is in a safe place will help relieve the fear. It is not therapeutic to disagree or give advice. Medication will not relieve the immediate concern.

A nurse observes a catatonic patient standing immobile, facing the wall with one arm extended in a salute. The patient remains immobile in this position for 15 minutes, moving only when the nurse gently lowers the arm. What is the name of this phenomenon? a. Echolalia b. Waxy flexibility c. Depersonalization d. Thought withdrawal

b. Waxy flexibility Waxy flexibility is the ability to hold distorted postures for extended periods of time, as though the patient were molded in wax. Echolalia is a speech pattern. Depersonalization refers to a feeling state. Thought withdrawal refers to an alteration in thinking.

A patient diagnosed with schizophrenia begins a new prescription for lurasidone HCL (Latuda). The patient is 5'6" and currently weighs 204 lbs. Which topic is most important for the nurse to include in the teaching plan related to this medication? a. How to recognize tar dive dyskinesia b. Weight management strategies c. Ways to manage constipation d. Sleep hygiene measures

b. Weight management strategies

A newly admitted patient diagnosed with schizophrenia is hypervigilant and constantly scans the environment. The patient states, "I saw two doctors talking in the hall. They were plotting to kill me." The nurse may correctly assess this behavior as: a. echolalia. b. an idea of reference. c. a delusion of infidelity. d. an auditory hallucination.

b. an idea of reference. Ideas of reference are misinterpretations of the verbalizations or actions of others that give special personal meanings to these behaviors; for example, when seeing two people talking, the individual assumes they are talking about him or her. The other terms do not correspond with the scenario.

A patient diagnosed with schizophrenia demonstrates little spontaneous movement and has waxy flexibility. The patient's activities of daily living are severely compromised. An appropriate outcome would be that the patient will: a. demonstrate increased interest in the environment by the end of week 1. b. perform self-care activities with coaching by the end of day 3. c. gradually take the initiative for self-care by the end of week 2. d. accept tube feeding without objection by day 2.

b. perform self-care activities with coaching by the end of day 3. Outcomes related to self-care deficit nursing diagnoses should deal with increasing ability to perform self-care tasks independently, such as feeding, bathing, dressing, and toileting. Performing the tasks with coaching by nursing staff denotes improvement over the complete inability to perform the tasks. The incorrect options are not directly related to self-care activities, difficult to measure, and unrelated to maintenance of nutrition.

annual prevalence of schizophrenia based on annual income

below $20,000 - 1.9% $20,000-$40,000 - 0.7% $40,000-$70,000 - 0.4% above $70,000 - 0.3% Significant financial and emotional costs • 25 percent attempt suicide; 5 percent die • Increased risk of physical illness More frequently found in lower-SES groups • Downward drift theory

Elsie has been hallucinating and suffering from delusions. In addition to schizophrenia, she MOST likely would be diagnosed with:

bipolar disorder

A newly admitted patient diagnosed with schizophrenia says, "The voices are bothering me. They yell and tell me I am bad. I have got to get away from them." Select the nurse's most helpful reply. a. "Do you hear the voices often?" b. "Do you have a plan for getting away from the voices?" c. "I'll stay with you. Focus on what we are talking about, not the voices. " d. "Forget the voices and ask some other patients to play cards with you."

c. "I'll stay with you. Focus on what we are talking about, not the voices. " Staying with a distraught patient who is hearing voices serves several purposes: ongoing observation, the opportunity to provide reality orientation, a means of helping dismiss the voices, the opportunity of forestalling an action that would result in self-injury, and general support to reduce anxiety. Asking if the patient hears voices is not particularly relevant at this point. Asking if the patient plans to "get away from the voices" is relevant for assessment purposes but is less helpful than offering to stay with the patient while encouraging a focus on their discussion. Suggesting playing cards with other patients shifts responsibility for intervention from the nurse to the patient and other patients.

7. Which therapeutic communication statement might a psychiatric-mental health registered nurse use when a patient's nursing diagnosis is altered thought processes? a. "I know you say you hear voices, but I cannot hear them." b. "Stop listening to the voices, they are NOT real." c. "You say you hear voices, what are they telling you?" d. "Please tell the voices to leave you alone for now."

c. "You say you hear voices, what are they telling you?"

10. Tomas is a 21-year-old male with a recent diagnosis of schizophrenia. Tomas's nurse recognizes that self-medicating with excessive alcohol is common in this disease and can co-occur along with: a. Generally good health despite the mental illness. b. An aversion to drinking fluids. c. Anxiety and depression. d. The ability to express his needs.

c. Anxiety and depression.

A patient diagnosed with schizophrenia exhibits little spontaneous movement and demonstrates waxy flexibility. Which patient needs are of priority importance? a. Self-esteem b. Psychosocial c. Physiological d. Self-actualization

c. Physiological Physiological needs must be met to preserve life. A patient with waxy flexibility must be fed by hand or tube, toileted, given range-of-motion exercises, and so forth to preserve physiological integrity. Waxy flexibility may also precipitate a risk for falls; therefore, safety is a concern. Higher level needs are of lesser concern.

The nurse assesses a patient diagnosed with schizophrenia. Which assessment finding would the nurse regard as a negative symptom of schizophrenia? a. Auditory hallucinations b. Delusions of grandeur c. Poor personal hygiene d. Psychomotor agitation

c. Poor personal hygiene Negative symptoms include apathy, anhedonia, poor social functioning, and poverty of thought. Poor personal hygiene is an example of poor social functioning. The distracters are positive symptoms of schizophrenia. See relationship to audience response question.

Which finding constitutes a negative symptom associated with schizophrenia? a. Hostility b. Bizarre behavior c. Poverty of thought d. Auditory hallucinations

c. Poverty of thought Negative symptoms include apathy, anhedonia, poor social functioning, and poverty of thought. Poor personal hygiene is an example of poor social functioning. The distracters are positive symptoms of schizophrenia. See relationship to audience response question.

A patient diagnosed with schizophrenia has taken fluphenazine (Prolixin) 5 mg po bid for 3 weeks. The nurse now observes a shuffling propulsive gait, a mask-like face, and drooling. Which term applies to these symptoms? a. Neuroleptic malignant syndrome b. Hepatocellular effects c. Pseudoparkinsonism d. Akathisia

c. Pseudoparkinsonism Pseudoparkinsonism induced by antipsychotic medication mimics the symptoms of Parkinson's disease. It frequently appears within the first month of treatment and is more common with first-generation antipsychotic drugs. Hepatocellular effects would produce abnormal liver test results. Neuroleptic malignant syndrome is characterized by autonomic instability. Akathisia produces motor restlessness.

A _____ is a community therapist who offers a full range of services for people with schizophrenia or other severe disorders, including therapy, advice, medication, guidance, and protection of patients' rights.

case manager

In 1954, ____ was approved for sale in the US

chlorpromazine

When Charlie's therapist asked him how his day was going, Charlie responded, "Here's the deal, I ate a meal, I wanted veal, do not break the seal." This is an example of:

clang

A nurse is interviewing a client with schizophrenia when the client begins to say, "Kite, night, right, height, fright." The nurse documents this as:

clang association.

cognitive-behavioural therapies for the treatment of schizophrenia

cognitive remediation: • Focuses on difficulties in attention, planning, and memory • Provides increasingly more complex computer tasks until planning and social awareness tasks are reached • Provides for modest improvement - Improvements in attention, planning, memory, and problem-solving surpass those with other interventions - Extend to everyday client life and social relationships hallucination reinterpretation and acceptance: • Therapists help change how clients view and react to their hallucinations combination of behavioural and cognitive techniques: • Education about biological causes of hallucinations • Identification of events and triggers of hallucinations • Challenge of inaccurate ideas of hallucination power • Reattribution and more accurate interpretation of hallucinations • Education for unpleasant sensation coping New wave CBT: 1) Posit that hallucinations should be accepted rather than misinterpreted or overreacted to 2) Help clients accept their streams of problematic thoughts 3) Help patients gain a greater sense of control, become more functional, and move forward in life 4) Often produce helpful results

Shontelle accuses her mother of stealing her thoughts and replacing them with someone else's thoughts. Shontelle has a delusion of:

control

A patient diagnosed with schizophrenia tells the nurse, "I eat skiller. Tend to end. Easter. It blows away. Get it?" Select the nurse's best response. a. "Nothing you are saying is clear." b. "Your thoughts are very disconnected." c. "Try to organize your thoughts and then tell me again." d. "I am having difficulty understanding what you are saying."

d. "I am having difficulty understanding what you are saying." When a patient's speech is loosely associated, confused, and disorganized, pretending to understand is useless. The nurse should tell the patient that he or she is having difficulty understanding what the patient is saying. If a theme is discernible, ask the patient to talk about the theme. The incorrect options tend to place blame for the poor communication with the patient. The correct response places the difficulty with the nurse rather than being accusatory.

A patient diagnosed with schizophrenia and auditory hallucinations anxiously tells the nurse, "The voice is telling me to do things." Select the nurse's priority assessment question. a. "How long has the voice been directing your behavior?" b. "Does what the voice tell you to do frighten you?" c. "Do you recognize the voice speaking to you?' d. "What is the voice telling you to do?"

d. "What is the voice telling you to do?" Learning what a command hallucination is telling the patient to do is important because the command often places the patient or others at risk for harm. Command hallucinations can be terrifying and may pose a psychiatric emergency. The incorrect questions are of lesser importance than identifying the command.

A nurse sits with a patient diagnosed with schizophrenia. The patient starts to laugh uncontrollably, although the nurse has not said anything funny. Select the nurse's best response. a. "Why are you laughing?" b. "Please share the joke with me." c. "I don't think I said anything funny." d. "You're laughing. Tell me what's happening."

d. "You're laughing. Tell me what's happening." The patient is likely laughing in response to inner stimuli, such as hallucinations or fantasy. Focus on the hallucinatory clue (the patient's laughter) and then elicit the patient's observation. The incorrect options are less useful in eliciting a response: no joke may be involved, "why" questions are difficult to answer, and the patient is probably not focusing on what the nurse said in the first place.

A health care provider considers which antipsychotic medication to prescribe for a patient diagnosed with schizophrenia who has auditory hallucinations and poor social function. The patient is also overweight and hypertensive. Which drug should the nurse advocate? a. Clozapine (Clozaril) b. Ziprasidone (Geodon) c. Olanzapine (Zyprexa) d. Aripiprazole (Abilify)

d. Aripiprazole (Abilify) Aripiprazole is a third-generation atypical antipsychotic effective against both positive and negative symptoms of schizophrenia. It causes little or no weight gain and no increase in glucose, high- or low-density lipoprotein cholesterol, or triglycerides, making it a reasonable choice for a patient with obesity or heart disease. Clozapine may produce agranulocytosis, making it a poor choice as a first-line agent. Ziprasidone may prolong the QT interval, making it a poor choice for a patient with cardiac disease. Olanzapine fosters weight gain.

A patient diagnosed with schizophrenia says, "It's beat. Time to eat. No room for the cat." What type of verbalization is evident? a. Neologism b. Idea of reference c. Thought broadcasting d. Associative looseness

d. Associative looseness Looseness of association refers to jumbled thoughts incoherently expressed to the listener. Neologisms are newly coined words. Ideas of reference are a type of delusion. Thought broadcasting is the belief that others can hear one's thoughts.

A patient receiving risperidone (Risperdal) reports severe muscle stiffness at 1030. By 1200, the patient has difficulty swallowing and is drooling. By 1600, vital signs are 102.8° F; pulse 110; respirations 26; 150/90. The patient is diaphoretic. Select the nurse's best analysis and action. a. Agranulocytosis; institute reverse isolation. b. Tardive dyskinesia; withhold the next dose of medication. c. Cholestatic jaundice; begin a high-protein, high-cholesterol diet. d. Neuroleptic malignant syndrome; notify health care provider stat.

d. Neuroleptic malignant syndrome; notify health care provider stat. Taking an antipsychotic medication coupled with the presence of extrapyramidal symptoms, such as severe muscle stiffness and difficulty swallowing, hyperpyrexia, and autonomic symptoms (pulse elevation), suggest neuroleptic malignant syndrome, a medical emergency. The symptoms given in the scenario are not consistent with the medical problems listed in the incorrect options.

5. Which characteristic presents the greatest risk for injury to others by the patient diagnosed with schizophrenia? a. Depersonalization b. Pressured speech c. Negative symptoms d. Paranoia

d. Paranoia

A patient diagnosed with schizophrenia says, "Contagious bacteria are everywhere. When they get in your body, you will be locked up with other infected people." Which problem is evident? a. Poverty of content b. Concrete thinking c. Neologisms d. Paranoia

d. Paranoia The patient's unrealistic fear of harm indicates paranoia. Neologisms are invented words. Concrete thinking involves literal interpretation. Poverty of content refers to an inadequate fund of information.

4. A female patient diagnosed with schizophrenia has been prescribed a first-generation antipsychotic medication. What information should the nurse provide to the patient regarding her signs and symptoms? a. Her memory problems will likely decrease. b. Depressive episodes should be less severe. c. She will probably enjoy social interactions more. d. She should experience a reduction in hallucinations.

d. She should experience a reduction in hallucinations.

8. When patients diagnosed with schizophrenia suffer from anosognosia, they often refuse medication, believing that: a. Medications provided are ineffective. b. Nurses are trying to control their minds. c. The medications will make them sick. d. They are not actually ill.

d. They are not actually ill.

6. Gilbert, age 19, is described by his parents as a "moody child" with an onset of odd behavior about at age 14, which caused Gilbert to suffer academically and socially. Gilbert has lost the ability to complete household chores, is reluctant to leave the house, and is obsessed with the locks on the windows and doors. Due to Gilbert's early and slow onset of what is now recognized as schizophrenia, his prognosis is considered: a. Favorable with medication b. In the relapse stage c. Improvable with psychosocial interventions d. To have a less positive outcome

d. To have a less positive outcome

Withdrawn patients diagnosed with schizophrenia: a. are usually violent toward caregivers. b. universally fear sexual involvement with therapists. c. exhibit a high degree of hostility as evidenced by rejecting behavior. d. avoid relationships because they become anxious with emotional closeness.

d. avoid relationships because they become anxious with emotional closeness.

The nurse is developing a plan for psychoeducational sessions for several adults diagnosed with schizophrenia. Which goal is best for this group? Members will: a. gain insight into unconscious factors that contribute to their illness. b. explore situations that trigger hostility and anger. c. learn to manage delusional thinking. d. demonstrate improved social skills.

d. demonstrate improved social skills. Improved social skills help patients maintain relationships with others. These relationships are important to management of the disorder. Most patients with schizophrenia think concretely, so insight development is unlikely. Not all patients with schizophrenia experience delusions.

A patient diagnosed with schizophrenia anxiously says, "I can see the left side of my body merging with the wall, then my face appears and disappears in the mirror." While listening, the nurse should: a. sit close to the patient. b. place an arm protectively around the patient's shoulders. c. place a hand on the patient's arm and exert light pressure. d. maintain a normal social interaction distance from the patient.

d. maintain a normal social interaction distance from the patient. The patient is describing phenomena that indicate personal boundary difficulties and depersonalization. The nurse should maintain appropriate social distance and not touch the patient because the patient is anxious about the inability to maintain ego boundaries and merging or being swallowed by the environment. Physical closeness or touch could precipitate panic.

A patient diagnosed with schizophrenia has been stable for a year; however, the family now reports the patient is tense, sleeps 3 to 4 hours per night, and has difficulty concentrating. The patient says, "My computer is sending out infected radiation beams." The nurse can correctly assess this information as an indication of: a. the need for psychoeducation. b. medication noncompliance. c. chronic deterioration. d. relapse

d. relapse Signs of potential relapse include feeling tense, difficulty concentrating, trouble sleeping, increased withdrawal, and increased bizarre or magical thinking. Medication nonadherence may not be implicated. Relapse can occur even when the patient is taking medication regularly. Psychoeducation is more effective when the patient's symptoms are stable. Chronic deterioration is not the best explanation.

Sarah exhibits early symptoms of schizophrenia, such as hearing voices. Family members decide to discuss the voices with Sarah to try to understand what is going on and prevent her from misinterpreting her sensory problems. This action by family members should MOST likely:

decrease the likelihood of future symptoms, according to the cognitive viewpoint only

Your textbook suggests that the policies of ________ have often been poorly planned because they resulted in many former patients becoming homeless.

deinstitutionalization

Mia was recently diagnosed with schizophrenia. Her doctors performed PET scans and MRIs of her brain, and a research scientist discussed the scans with her, identifying inflammation in her brain. The researcher also discussed the possibility that her hypothalamic-pituitary-adrenal (HPA) stress pathway was overactive. He then asked Mia and her parents some questions about her childhood and the time before the symptoms manifested. Judging from this information, the researcher is MOST likely a _____ theorist.

developmental psychopathology

which symptom is MOST likely to occur during the active phase of schizophrenia? vague speech disorganized speech blunted emotion social withdrawal

disorganized speech

Biological researchers have been fairly successful in their investigations into the causes of schizophrenia. Which of the following is NOT considered a biological cause of schizophrenia?

drug and alcohol abuse

A nurse is caring for a client in an inpatient mental health setting. The nurse notices that when the client is conversing with other clients, the client repeats what they are saying word for word. The nurse interprets this finding and documents it as:

echolalia.

A client is being released from the inpatient psychiatric unit with a diagnosis of schizophrenia and treatment with antipsychotic medications. After teaching the client and family about managing the disorder, the nurse determines that the education was effective when they state that which should be reported immediately?

elevated temperature

Which assessment finding supports the belief that the patient is demonstrating a positive symptom of schizophrenia?

he patient refuses to sleep because "I'll be abducted by the aliens."

Developmental psychopathology theorists believe that a diathesis-stress relationship is at work in the development of schizophrenia. In particular, they believe that a dysfunctional brain circuit may adversely affect the functioning of people who later develop schizophrenia through the circuit's impact on the operation of the _____ pathway.

hypothalamic-pituitary-adrenal

risk of developing schizophrenia based on family relation

identical twin - 48% offspring of two schizophrenic parents - 46% fraternal twin - 17% offspring of one schizophrenic parent - 13% sibling - 9% parent - 6% half-sibling - 6% grandchild - 5% nephew/niece - 4%

When describing the difference between schizoaffective disorder (SAD) and schizophrenia, the nurse would address which as associated with SAD?

increased mood responses

Annie has been experiencing growing suspicions that her partner, Lisa, is cheating on her. She has no evidence of the infidelity, but her belief in this issue is growing stronger and stronger by the day. Annie may be experiencing the ________ type of delusional disorder.

jealous

Hector is hospitalized to treat chronic schizophrenia. When he entered a facility, he was referred to as a resident, treated with respect, and viewed as a person capable of making decisions. He was told that he would have input into his daily schedule and would be part of a therapeutic community. This therapeutic approach is called _____ therapy.

milieu

Angelina is currently hospitalized. As part of her program, she participates with staff members in defining the roles of residents and to determine sanctions. The staff and residents create an atmosphere of mutual respect, support, and openness. Angelina is MOST likely participating in:

milieu therapy

Tanuja sits at home on most days, watches television, and smokes cigarettes. She does not feel like cooking, cleaning, or doing much of anything. She has difficulty recognizing other people's needs and emotions, and she has a limited display of emotion. Tanuja's symptoms are:

negative

Symptoms of schizophrenia fall under three main categories. _____ symptoms include loss of volition, blunted and flat affect, poverty of speech, and social withdrawal. _____ symptoms are collectively called catatonia, where people may move relatively slowly or make awkward and repetitive movements. _____ symptoms include hallucinations, disorganized thinking and speech, inappropriate affect, and delusions.

negative psychomotor positive

This class of conventional antipsychotic drugs, known as _____, often produces undesired effects similar to the symptoms of neurological disorders.

neuroleptic drugs

A nurse is caring for a hospitalized client who has schizophrenia. The client has been taking antipsychotic medications for 1 week when the nurse observes that the client's eyes are fixed on the ceiling. The nurse interprets this finding as:

oculogyric crisis. The nurse should contact the client's physician because the client is exhibiting a dystonic reaction termed oculogyric crisis in which the muscles that control eye movements tense and pull the eyeball so that the client is looking toward the ceiling. Akathisia is manifested by restlessness, with clients often reporting that they feel driven to keep moving. Retrocollis involves the neck muscle, causing the head to be pulled back. Tardive dyskinesia involves abnormal, involuntary movements that are constant.

A woman diagnosed with a psychotic disorder announces that the local police precinct has been conspiring to catch her in an illegal act. Although she states that she obeys the law, she is convinced that the "dirty cops" are going to frame her so that they can, "toss her in jail and throw away the key." Her thinking is indicative of a delusion of ________.

persecution

A client diagnosed with schizophrenia is having delusions that the client is being plotted against by the government. This would be documented as which type of delusion?

persecutory

In general, the closer people are genetically related to someone with schizophrenia, the MORE likely they are to be diagnosed with schizophrenia as well. This is evidence of _____ correlation between a schizophrenia diagnosis and closeness of relationship.

positive

_____ symptoms of schizophrenia seem to be excesses of, or bizarre additions to, normal thoughts, emotions, or behaviors.

positive

Which factor is associated with increased risk for schizophrenia? Alcoholism Adolescent pregnancy Overcrowded schools Poverty

poverty

While caring for a hospitalized client with schizophrenia, a nurse observes that the client is listening to the radio. The client tells the nurse that the radio commentator is speaking directly to the client. The nurse interprets this finding as:

referential thinking.

______ are MORE likely during times of life stress

relapses

The genetic view of schizophrenia has been supported by studies of the _____ of people with schizophrenia.

relatives

Part of milieu therapy involves referring to people with mental illness as:

residents

According to developmental psychopathologists, _____ exercises can help prevent, or at least delay, the onset of schizophrenia.

resilience and coping skills

Nicholas has moved through the active phase of schizophrenia and appears to be improving. In the residual phase of schizophrenia, he can be expected to:

return to his prodromal-like functioning

Partially because of the lack of actual quality of community mental health care, many mentally ill patients experience the "_____" syndrome, in which patients are readmitted and released several times from hospitals.

revolving door syndrome

During a postmortem analysis on a sample of brain tissue from a person who committed suicide, a coroner finds enlarged ventricles. This may be evidence that the person suffered from:

schizophrenia

key features, duration and lifetime prevalence for various schizophrenia spectrum disorders

schizophrenia 1) key features - various psychotic symptoms, such as delusions, hallucinations, disorganized speech, restricted or inappropriate affect, and catatonia 2) duration - 6 months or more 3) lifetime prevalence - 1% brief psychotic disorder 1) key features - Various psychotic symptoms, such as delusions, hallucinations, disorganized speech, restricted or inappropriate affect, and catatonia 2) duration - less than one month 3) lifetime prevalence - unknown schizophreniform disorder 1) key features - Various psychotic symptoms, such as delusions, hallucinations, disorganized speech, restricted or inappropriate affect, and catatonia 2) duration - 1-6 months 3) lifetime prevalence - 0.2% schizoaffective disorder 1) key features - Marked symptoms of both schizophrenia and a major depressive episode or a manic episode 2) duration - 6 months or more 3) lifetime prevalence - unknown delusional disorder 1) key features - Persistent delusions that are not bizarre and not due to schizophrenia; persecutory, jealous, grandiose, and somatic delusions are common 2) duration - 1 month or more 3) lifetime prevalence - 0.1% psychotic disorder due to another medical condition 1) key features - Hallucinations, delusions, or disorganized speech caused by a medical illness or brain damage 2) duration - no minimum length 3) lifetime prevalence - unknown substance/medication-induced psychotic disorder 1) key features - Hallucinations, delusions, or disorganized speech caused directly by a substance, such as an abused drug 2) duration - no minimum length 3) lifetime prevalence - unknown

A _____ is a supervised workplace for people who are not yet ready for competitive jobs.

sheltered workplace

Developmental psychopathology researchers have found that people with schizophrenia tend to be all of the following throughout early development EXCEPT: prone to motor difficulties disobedient socially outspoken disagreeable

socially outspoken

Dr. Ho believes that clinicians from majority groups misread cultural differences as symptoms of schizophrenia and, therefore, misdiagnose schizophrenia in African Americans. Dr. Ho is MOST likely a _____ theorist.

sociocultural

A client diagnosed with delusional disorder who uses excessive health care resources most likely has which type of delusions?

somatic Persons who have somatic delusions believe they have a physical ailment. Clients with somatic delusions use excessive health care resources.

psychosis

state in which a person loses contact with reality in key ways - most commonly appears as schizophrenia

A form of catatonia in which a person stops responding to his or her environment and remains motionless and silent for long stretches of time is called catatonic:

stupor

A nurse is caring for a patient with schizophrenia. The nurse observes that the patient does opposite of any given instruction unintentionally and the patient often runs in the corridor. What is the probable diagnosis by the nurse from such behavior?

symptoms of negativism, in which patients tend toward resistance and to do the opposite of what they are told. These patients also have motor agitation, in which they run or pace rapidly in response to stimuli and show unintended excessive movements. The patient's behavior is unlikely to be due to hearing problem, restlessness, or dislike toward the nurse.

The belief that one can feel bugs tingling under one's skin would be an example of a(n) _____ hallucination.

tactile

A nurse is caring for a client who has been receiving treatment for schizophrenia with chlorpromazine for the past year. It would be essential for the nurse to monitor the client for:

tardive dyskinesia.

Outpatient therapy, inpatient treatment, emergency care, preventive care, and aftercare are all part of:

the community approach

Which BEST differentiates brief psychotic disorder from schizophrenia?

the duration of brief psychotic disorder is significantly shorter than that of schizophrenia

In addition to a shortage of services, _____ also contributes to a lack of treatment among people with schizophrenia and other mental health disorders.

the poor coordination of services

One feature of assertive community treatment is:

to offer a broad variety of services, from drug treatments and psychotherapy to vocational training and counseling.

In the 1970s, Gordon Paul and Robert Lentz set up a(n) ________ system at a mental health center in Illinois. It was used to reward patients for appropriate behaviors and fine patients for disruptive or inappropriate actions. It was among the first to demonstrate that patients with schizophrenia could learn appropriate skills needed to live independently.

token economy

You are watching a film of Walter Freeman performing a surgery on a patient who is diagnosed with schizophrenia. The surgeon inserts what looks like an ice pick into the eye socket. Dr. Freeman then takes a hammer and hits this instrument through the bone, moves it until he breaks the bone, then proceeds to move the instrument into the brain, and rotates it in a circular motion. The procedure you were observing is a:

transorbital lobotomy

Hiro was born during February, and his physician attributes that fact to the development of his schizophrenia. Hiro's doctor is espousing the _____ theory of schizophrenia.

viral

A client has been prescribed clozapine for treatment of schizophrenia. The client must be taught to monitor which blood concentrations weekly while taking this drug?

white blood cells

prevalence of schizophrenia

• 1 of 100 experience schizophrenia during lifetime • 21 million worldwide; 3.6 million in the United States • Equally distributed between men and women • Average age at onset: 23 for men; 28 for women

schizophrenia checklist

• For 1 month, individual displays two or more of the following symptoms much of the time: - Delusions - Hallucinations - Disorganized speech - Very abnormal motor activity, including catatonia - Negative symptoms • At least one of the individual's symptoms must be delusions, hallucinations, or disorganized speech • Individual functions much more poorly in various life spheres than was the case prior to the symptoms • Beyond this 1 month of intense symptomology, individual continues to display some degree of impaired functioning for at least 5 additional months

institutional alternatives

• Many people who would have been placed in psychiatric institutions in the past now reside in other settings, such as nursing homes and prisons • Mental health care is typically minimal in these settings

effective community treatment

• Research indicates that clients in effective community programs make more improvements than those in other kinds of treatments or poor community programs • Worldwide, well-coordinated community treatment is seen as a crucial solution to the problem of severe mental dysfunction

antipsychotic drugs for schizophrenia (discovered in the 1950s)

• Researchers developed antihistamine drugs for allergies • Antihistamines (phenothiazines) used to calm patients about to undergo surgery • Chlorpromazine tested on patients with psychosis and sharp symptom reduction observed • In 1954, chlorpromazine (Thorazine) was approved for sale in the United States as an antipsychotic drug • Other antipsychotic drugs were later discovered - First-generation antipsychotic drugs (neuroleptic drugs) - Second-generation antipsychotic drugs

effectiveness of antipsychotic drugs

• Symptoms reduce in about 70 percent of patients diagnosed with schizophrenia • More effective than any other approach used alone • In most cases, the drugs produce the maximum level of improvement within the first six months of treatment • Positive symptoms of schizophrenia are reduced more completely, or at least more quickly, than negative symptoms

treatment of schizophrenia

• Today's treatment picture varies dramatically for patients, families, caregivers, and communities • The treatment outlook is superior to that of past years • Severe mental disorders are still very difficult to treat; only 40- 60% of people with schizophrenia receive adequate care • This chapter presents treatments from a historical perspective

SCHIZOPHRENIA

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