Ch. 24 Schizophrenia Flashcards
Which type of antipsychotic medication is most likely to produce extrapyramidal effects?
First-generation antipsychotic drugs.
The conventional, or first-generation, antipsychotic drugs are potent antagonists of dopamine receptors D2, D3, and D4. This makes them effective in treating target symptoms but also produces many extrapyramidal side effects because of the blocking of the D2 receptors.
Encephalopathic syndrome has occurred in a few clients when haloperidol is taken with which medication?
Lithium carbonate (Lithium)
A nurse is working with a client that has been diagnosed with delusional thoughts. Which is an initial short-term outcome appropriate for this client?
engage in reality oriented conversation
Delusions are not reality oriented; thus an appropriate outcome would be that the client will engage in reality-oriented conversation rather than discussing delusional beliefs. Delusions are fixed, false beliefs.
A client is diagnosed with schizoaffective disorder (SAD). The nurse understands that in addition to psychosis, the client must also exhibit:
SAD is characterized by periods of intense symptom exacerbation alternating with quiescent periods, during which psychosocial functioning is adequate. This disorder is at times marked by psychosis; at other times, by mood disturbance. When psychosis and mood disturbance occur at the same time, a diagnosis of schizoaffective disorder is made.
Which increases the risk for neuroleptic malignant syndrome (NMS)?
Dehydration, poor nutrition, and concurrent medical illness all increase the risk for NMS.
A client is admitted with the diagnosis of possible schizophrenia and to rule out (R/O) organic pathology. Based on this information, what treatment will the nurse expect for this client?
The CT will reveal structural changes in the brain that might be responsible for symptoms of psychosis (e.g., abscess, tumor).
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?
A persecutory delusion is a belief that one is being watched, ridiculed, harmed, or plotted against.
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, the ability to assume and maintain awkward or uncomfortable positions for long periods, is characteristic of catatonic schizophrenia. Clients commonly remain in these awkward positions until someone repositions them.
The client with schizophrenia makes the following statement, “I just don’t know how to count. The sky turned to fire. I have a ball in my head.” What term does the nurse use to document this statement?
Associative looseness is demonstrated through fragmented or poorly related thoughts and ideas. The series of disconnected thoughts best exemplifies this concept.
Which drug classification is the primary medication treatment for schizophrenia?
Antipsychotic drugs are the primary medical treatment for clients diagnosed with schizophrenia and are also used in psychotic episodes of acute mania, psychotic depression, and drug-induced psychosis.
A client was admitted to the psychiatric intensive care unit with schizophrenia. Among the client’s signs and symptoms, the client was experiencing nihilistic delusions. The nurse understands that these delusions involve a belief about what?
An impending calamity such as death
Delusions are erroneous, fixed beliefs that cannot be changed by reasonable argument. Nihilistic delusions involve the belief that one is dead or a calamity is impending; when these delusions involve bodily illness, they take hypochondriacal concerns to the utmost extreme.
A client with schizophrenia is prescribed a second-generation antipsychotic. The client’s parent asks, “About how long will it take until we see any changes in the symptoms?” Which response by the nurse would be most appropriate?
Generally, it takes about 1 to 2 weeks for antipsychotic drugs to effect a change in symptoms. During the stabilization period, the selected drug should be given an adequate trial, generally 6 to 12 weeks, before considering a change in the drug prescription. If treatment effects are not seen, another antipsychotic agent may be tried.
A client diagnosed with schizophrenia has been prescribed Clozapine (Clozaril). Which of the following is a potentially fatal side effect of this medication?
Agranulocytosis is manifested by a failure of the bone marrow to produce adequate white blood cells. 1-2% of patients
A client on the unit suddenly cries out in fear. The nurse notices that the client’s head is twisted to one side, the client’s back is arched, and the client’s eyes have rolled back in the sockets. The client has recently begun drug therapy with haloperidol. Based on this assessment, which would be the first action of the nurse?
Give a PRN dose of benztropine IM
The client is having an acute dystonic reaction; the treatment is anticholinergic medication.
How will the nurse be able to recognize and assess signs and symptoms of a psychotic disorder?
Reassure patient that they are safe. Acknowledge what they are hearing/seeing even though
recognize social withdrawal
positives: hallucinations
negatives
How can the nurse maintain a focused psychiatric assessment of the patient with a psychotic disorder?
Therapeutic communication
What can set off schizophrenia?
Traumatic events, but there is not one single thing, could be many other factors.
