Schizophrenia

Question 1

How does age affect the prognosis of schizophrenia?

Answer 1

Adolescence or early adulthood (about 23 years) earlier the onset, the worse the outcome

Question 2

What are the manifestations of Schizotypal Personality Disorder?

Answer 2

bizarre speech and behavior, eccentric, magical thinking, visual disturbances

Question 3

How long does Delusional Disorder Last?

Answer 3

Delusional thinking lasts for 1 month

Question 4

What scenarios could Delusional Disorder entail?

Answer 4

Situations that could occur in real life, such as being followed, loved by another, or having a disease.

Question 5

A patient believes that their nurse is trying to poison them. What kind of delusion is this patient experiencing?

Answer 5

Persecution: he/she is being spied on, tricked, tormented. Singled out for harm (paranoia

Question 6

A patient claims that their nurse is “cheating” on them with another patient. What kind of delusion is this patient experiencing?

Answer 6

Jealous: believing SO is sexually involved with another. Can be directed towards their nurse or others on the unit

Question 7

A patient is continually preaching very specific passages from the Holy Bible with complete accuracy. What kind of delusion is this patient experiencing?

Answer 7

Religiosity: obsessed with religious beliefs

Question 8

A patient is walking around the floor poking people wearing what they claim to be an “invisible cloak.” What kind of delusion is this patient experiencing?

Answer 8

Magical Thinking: believes that thoughts/actions can control others/situations… wearing a hat makes them invisible.

Question 9

A patient is claiming that they are receiving someone else’s thoughts somehow. What delusion is this patient experiencing?

Answer 9

Thought Insertion: others’ thoughts are being inserted into their minds

Question 10

A patient is wearing a tinfoil hat so that the government does not steal his thoughts. The patient is expressing what kind of delusion?

Answer 10

Thought withdrawal: thoughts removed by an outside energy

Question 11

A patient is becoming paranoid that people around him can hear what he’s thinking about. What delusion is this patient exhibiting?

Answer 11

thought broadcasting: thoughts are heard by others

Question 12

A patient states that “when I get out of here, Bradd Pitt and I are finally going to get married!” What delusion is this patient exhibiting?

Answer 12

Erotomania: belief that another person romantically desires him/her

Question 13

A patient claims that they did not mean to harm another patient. They state that the government took control of their body. What kind of delusion is the patient experiencing?

Answer 13

Being Controlled: force outside their body is controlling them

Question 14

What kind of therapy do nurses practice when treating those with delusions?

Answer 14

Milieu therapy - structured and safe environment to decrease anxiety and to distract the client from hallucinations

Question 15

How should a nurse interact with a patient having hallucinations?

Answer 15

Be direct about hallucinations. DO NOT ARGUE or AGREE with the hallucination; ASK DIRECTLY WHAT THE VOICES ARE TELLING THEM

Question 16

How should a nurse provide distractions for a patient experiencing hallucinations?

Answer 16

Focus on reality-based subjects, music, attend activities, walking, physical activities, talking to a trusted person, and telling hallucinations to “stop” or “go away”

Question 17

A patient is asking about why their antipsychotic medication isn’t taking effect, How should the nurse respond?

Answer 17

All antipsychotics usually take effect 2 to 6 weeks after the regimen is started, and all may require significant dosage adjustment in order to obtain a balance between effectiveness and side effects

Question 18

What low potency antipsychotics are typically used in the hospital?

Answer 18

Chlorpromazine, Thioridazine, and Mesoridazine

Question 19

What SE indicate that a nurse needs to intervene in a patient taking low potency first generation antipsychotic medication?

Answer 19

Anticholinergic SE: dry mouth, constipation, blurry vision, urinary retention, confusion, and hypotension

Question 20

What are some indications of anticholinergic toxicity?

Answer 20

nonreactive pupils, hot, dry red skin, agitation w, unstable vital signs

Question 21

What is the nursing intervention for a patient experiencing the EPS SE of akathasia from a high-dosage antipsychotic?

Answer 21

Usually, it subsides when the antipsychotic is discontinued. Propanolol (Inderal), lorazepam (ativan), or diazepam (valium) may be used.

Question 22

Where can involuntary movement be seen in a patient experiencing tardive dyskinesia?

Answer 22

abnormal involuntary movements, mainly of the face and trunk

Question 23

What medications would a nurse plan to administer to a patient experiencing extrapyramidal symptoms?

Answer 23

IM Artane (trihexyphenidyl), Benadryl (diphenhydramine), or Cogentin (benztropine)

Question 24

What is a potentially dangerous response to antipsychotics that nurses would be aware of?

Answer 24

Neuroleptic malignant syndrome (NMS)

Question 25

What are the symptoms to look out for that indicate Neuroleptic malignant syndrome?

Answer 25

FARM: Fever- tachycardia, diaphoresis, elevated BP and pulse, dilation of pupils/Autonomic- increased vitals, low LOC, diaphoreses, dilated pupils/Renal- failure, dark cola-colored urine (rhabdomyolysis)/Muscle Rigidity- dysphagia

Question 26

What should a nurse do if they witness a patient undergoing NMS?

Answer 26

Stop the drugs and call MD

Question 27

What would be administered to a patient if they are experiencing NMS

Answer 27

Dantrolene

Question 28

What unique SE does clozapine have that makes it so dangerous to take?

Answer 28

Agranulocytosis

Question 29

What second-generation antipsychotic meds are also available in sublingual form?

Answer 29

Zyprexa, Risperidone, and Clozapine

Question 30

When should Clozapine not be administered?

Answer 30

HOLD TX IF WBC BELOW 3000 mm3 and ANC BELOW 1500

Question 31

What is the normal reference range for WBC count?

Answer 31

Normal WBC 4500 to 11000

Question 32

What is the normal reference range for ANC?

Answer 32

AND 2500 and 6000

Question 33

A patient experiencing anticholinergic effects tends to go out into the sun frequently. What nursing intervention needs to be applied here?

Answer 33

The patient needs to wear long sleeves, sunscreen, and sunglasses because they may experience photosensitivity

Question 34

A 21-year-old client, being treated for asthma with a steroid medication, has been experiencing delusions of persecution and disorganized thinking for the past 6 months. Which factor may rule out a diagnosis of schizophrenia?

Answer 34

The client is receiving a medication that could lead to thought disturbances

Question 35

A client has been prescribed ziprasidone 40mg BID. Which of the following interventions are important related to this medication?

Answer 35

Obtain a baseline EKG initially and periodically throughout treatment., teach the client to take medication with meals, monitor the client’s pulse because of the possibility of palpitations

Question 36

A nurse is completing an admission assessment for a client who has schizophrenia. Which of the following findings should the nurse document as positive symptoms?

Answer 36

Auditory hallucinations, use of clang associations, delusions of persecution, constantly waving

Question 37

A patient with schizophrenia states, “the devil keeps telling me I am going to burn in hell.” what is the appropriate nursing response?

Answer 37

The voices must be scary for you. What you hear is part of your illness; it is not real.”

Question 38

The nurse documents that a client diagnosed with schizophrenia is experiencing anticholinergic side effects from long-term use of thioridazine. Which symptoms has the nurse noted?

Answer 38

Dry mouth, constipation, and urinary retention

Question 39

A nurse is caring for a client in an acute mental health unit. The client reports hearing voices that are telling her to “kill your doctor.” Which of the following actions should the nurse take first?

Answer 39

Initiate 1:1 observation of the client

Question 40

For the past year, a client has received haloperidol. The nurse administering the client’s next dose notes a twitch on the right side of the client’s face and tongue movements. Which nursing intervention takes priority?

Answer 40

HOLD the haloperidol and call the physician - TD - hold the med to avoid permanent damage - call doc!!!!

Question 41

A client has a history of schizophrenia, controlled by haloperidol. During an assessment, the nurse notes continuous restlessness. Which medication would the nurse expect the physician to prescribe for this client?

Answer 41

Benztropine

Question 42

A charge nurse is discussing manifestations of schizophrenia with a newly licensed nurse. Which of the following manifestations should the charge nurse identify as being effectively treated by first-generation antipsychotics?

Answer 42

Auditory hallucinations, delusions of grandeur, severe agitation

Question 43

Which atypical antipsychotic medication has the highest potential for a client to experience serious side effects?

Answer 43

Clozapine

Question 44

A paranoid client presents with bizarre behaviors, neologisms, and thought insertion. Which nursing action should be prioritized to maintain this client’s safety?

Answer 44

Note escalating behaviors and intervene immediately

Question 45

A nurse is speaking with a client who has schizophrenia when he suddenly seems to stop focusing on the nurse’s questions and begins looking at the ceiling and talking to himself. Which of the following actions should the nurse take?

Answer 45

Ask the client, “Are you seeing something on the ceiling?”

Question 46

When assessing a newly admitted patient with schizophrenia, which assessment data will the nurse document as negative symptoms?

Answer 46

Asociality, blunted affect, poor motivation

Question 47

A patient with schizophrenia who began taking haloperidol 1 week ago reports signs of tardive dyskinesia. What assessment finding does the nurse anticipate?

Answer 47

Lip puckering

Question 48

A client on an inpatient psychiatric unit refuses to take medications because “The pill has a special code written on it that will make it poisonous.” What kind of delusion is this client experiencing?

Answer 48

A persecutory delusion

Question 49

A client recently prescribed fluphenazine (prolixin) complained to the nurse of severe muscle spasms. On one examination, HR is 100, BP 160/92 mm Hg, and temp is 102F. Which nursing intervention takes priority?

Answer 49

Hold the next dose of fluphenazine and call the MD