Week 3 - Schizophrenia Flashcards by Sasha K.

Which side effect of antipsychotic medication is generally nonreversible?

Dystonic reaction

Tardive dyskinesia

Pseudoparkinsonism

Anticholinergic effects

Tardive dyskinesia

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Which potential side effect of antipsychotic medications does the Abnormal Involuntary Movement Scale (AIMS) assessment detect?

Acute dystonia

Tardive dyskinesia

Cholestatic jaundice

Pseudoparkinsonism

Tardive dyskinesia

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Which type of hallucination is a patient diagnosed with schizophrenia most likely to experience?

Visual

Tactile

Auditory

Olfactory

Auditory

Patients diagnosed with schizophrenia may experience hallucinations arising out of any of the senses; however, auditory hallucinations are experienced by 60% of people with schizophrenia at some time during their lives. Visual hallucinations more commonly are associated with substance abuse and withdrawal. Tactile and olfactory hallucinations are rare.

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Which symptom in a patient with schizophrenia can be categorized as a positive symptom?

Delusions

Dysphoria

Loss of motivation

Impaired judgment

Delusions

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Which term is correct to use when documenting that a patient with schizophrenia stated, “Cheese dog run fast”?

Neologism

Word salad

Circumstantiality

Magical thinking

Word salad

A word salad is a jumble of words that is meaningless to the listener and results from an extreme level of disorganization. A neologism is an invented word. Circumstantiality refers to verbal expression with excessive detail. Magical thinking means believing that one’s thoughts or actions can affect others.

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

Visual hallucinations

Illusions

Tactile hallucinations

Auditory hallucinations

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Which cause of schizophrenia is currently understood?

A combination of inherited and nongenetic factors

Deficient amounts of the neurotransmitter dopamine

Excessive amounts of the neurotransmitter serotonin

Stress-related and ineffective stress management skills

A combination of inherited and nongenetic factors

Causation is a complicated matter. Schizophrenia is most likely caused by a combination of inherited genetic factors and extreme nongenetic factors (e.g., viral infection, birth injuries, and nutritional factors) that can affect the genes governing the brain or directly injure the brain. Changes in dopamine and serotonin are signs of schizophrenia but are not thought to be the cause of the disease. Stress and ineffective stress management are risk factors but are not thought to cause schizophrenia.

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Which medication classification is most often associated with the side effects gynecomastia, amenorrhea, and galactorrhea?

Anticholinergic medications

Third-generation antipsychotics

Second-generation (atypical) antipsychotics

First-generation (conventional) antipsychotics

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). The incidence of these side effects is much less in second- and third-generation antipsychotic medications. Anticholinergic medications have side effects of constipation and blurred vision.

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Which cue will the nurse anticipate when reviewing the care plan for a patient with schizophrenia and a nursing diagnosis of impaired ability to perform hygiene?

Paranoia

Anosognosia

Lack of energy

Internalized stigma

Lack of energy

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Which electrolyte imbalance can occur in patients with schizophrenia who are experiencing polydipsia?

Hypokalemia

Hypocalcemia

Hyponatremia

Hypercalcemia

Hyponatremia

In patients with schizophrenia, polydipsia occurs because of dry mouth. Patients experience excessive thirst because of antipsychotic drugs and drink a lot of water. Polydipsia is characterized by hyponatremia, confusion, and severe symptoms of schizophrenia and is caused by the inability of the kidneys to filter excess fluids. Hypokalemia is a condition that produces reduced levels of potassium, which can be caused by antibiotics. Hypocalcemia refers to increased levels of calcium resulting from vitamin D deficiency or defective absorption. Hypocalcemia can also result from impaired metabolism of vitamin D in the body. Hypercalcemia is an increase in levels of calcium seen during hyperparathyroidism.

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Which condition would prompt the primary healthcare provider to prescribe 25 mg of diphenhydramine hydrochloride?

Peptic ulcer and asthma

Mydriasis and photosensitivity

Tremors and tardive dyskinesia

Excessively dry mucous membranes

Tremors and tardive dyskinesia

Patients with schizophrenia are generally prescribed antipsychotic drugs. These drugs cause extrapyramidal side effects, such as tremors, and abnormal involuntary movements, such as tardive dyskinesia. Diphenhydramine hydrochloride 25 mg (intramuscular or intravenous route) is prescribed to such patients to treat extrapyramidal side effects. Diphenhydramine hydrochloride is contraindicated in patients with peptic ulcer and asthma because it causes stomach distress (e.g., nausea, vomiting, and diarrhea). Physostigmine and benzodiazepines are administered to control these symptoms. Photosensitivity and mydriasis are symptoms of anticholinergic toxicity. Dry mucous membranes can be a symptom of anticholinergic toxicity but are not a major concern with the administration of diphenhydramine hydrochloride.

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Which is the most likely cause of hyponatremia, increased confusion, and delirium in a patient on conventional antipsychotics?

Dehydration

Medication withdrawal

Lack of response to the medication

Water intoxication

Antipsychotics are usually prescribed in combination with anticholinergics because they cause dry mouth. The patient can feel excessive thirst and may drink lots of water, which results in water intoxication, as indicated by hyponatremia, confusion, and worsening of the psychotic symptoms. If the patient has stopped taking medication or is not responding to them, it would lead the psychotic conditions to worsen as well. It would not produce hyponatremia. In addition, mental stress would not cause hyponatremia. Fatal water intoxication occurs because of excessive water intake. The signs do not indicate that the patient is dehydrated.

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Which laboratory test would be most helpful in determining the cause of sore throat, fever, and malaise in a patient who started taking clozapine 3 weeks ago?

Urinalysis

Liver panel

Serum lithium level

Complete blood cell count

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.

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Which belief voiced by a patient with schizophrenia correlates with exhibiting grandiose delusions?

“My brain is rotting.”

“I am President of the United States.”

“The food in the hospital is being poisoned.”

“The nurse has romantic feelings for me.”

“I am President of the United States.”

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Which information identifies a distinguishing factor of psychosis?

Is caused by moderate to severe anxiety

Incorporates delusions into an individual’s reality

Results in a significant misrepresentation of what is real

Is dependent on an individual’s baseline cognitive function

Results in a significant misrepresentation of what is real

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Which nursing intervention is an appropriate response to anosognosia in a patient with schizophrenia experiencing psychosis?

Establish trust and rapport.

Convey empathy and support.

Reduce excessive stimulation.

Explain the diagnosis in a confident manner.

Establish trust and rapport.

Anosognosia is common in patients with severe mental illness and is not denial or resistance to accepting the diagnosis. The patient cannot recognize they have an illness. It is important for the nurse to establish trust and rapport with the patient, because this will allow the nurse to provide treatment and implement interventions to help the patient remain safe and gain awareness of their illness. Empathy and support are not helpful if the patient does not recognize that they are ill. Reducing excessive stimulation is an intervention for a patient who is restless or agitated. Explaining the diagnosis in a confident manner will not promote the patient’s awareness of their illness.

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Which information about comorbidity would be included when educating the parents of an adolescent diagnosed with schizophrenia?

“Watch your child for signs of substance abuse.”

“Make sure your child does not become dehydrated.”

“With schizophrenia, your child will not experience any depression.”

“Contact the healthcare provider immediately if your child has anxiety.”

“Watch your child for signs of substance abuse.”

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Which nursing intervention is appropriate if a patient with schizophrenia on the unit begins giving away possessions to the other patients and saying goodbye?

Place the patient in isolation.

Implement patient rounds every 15 minutes.

Place the patient in a room by the nurse’s station.

Teach and guide the patient to practice coping skills.

Place the patient in a room by the nurse’s station.

The patient is demonstrating behaviors associated with self-harm or suicide. The patient requires close monitoring; therefore, placing them in a room by the nurse’s station allows for closer monitoring. Placing the patient in isolation is inappropriate and will provide the space and time to possibly harm themselves. Implementing patient rounds every 15 minutes is predictable and allows the patients time to harm themselves. Teaching and guiding the patient to practice coping skills is not an intervention to prevent them from harming themselves.

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Which statement is true regarding schizophrenia, treatment, and outcomes?

If treated quickly after diagnosis, schizophrenia can be cured.

Schizophrenia can be managed by receiving treatment only at the time of acute exacerbations.

If patients with schizophrenia stay on their drug regimen, they usually lead fully productive lives with no further symptoms.

Patients with schizophrenia often do not fully respond to treatment and have residual symptoms and varying degrees of disability.

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Which condition is most likely present when a patient diagnosed with schizophrenia who has been taking perphenazine for 12 weeks is instructed to go on bed rest and follow a diet rich in proteins and carbohydrates?

Agranulocytosis

Cholestatic jaundice

Postural hypotension

Autonomic dysfunction

Cholestatic jaundice

Patients with schizophrenia who are taking perphenazine, a first-generation antipsychotic drug, may experience toxic effects from long-term therapy. The nurse should identify the signs and symptoms of the toxic effects, like cholestatic jaundice, which results from collection of bile juice in the gallbladder. The patient should be instructed to go on bed rest and consume a diet rich in proteins and carbohydrates. Agranulocytosis is characterized by dangerously low levels of white blood cells; this condition is not related to bed rest and diet changes. Postural hypotension is characterized by a drop in blood pressure with a change in position and cannot be managed by a protein-rich diet. The autonomic nervous system controls involuntary actions of the body, and autonomic dysfunction is not treated by bed rest and diet changes.

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Which phase of schizophrenia is a patient in when they report diminishing symptoms and the ability to “remember things clearly again”?

Acute

Prodromal

Stabilization

Maintenance

Stabilization

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Which topic would take priority when planning a series of psychoeducational groups for people diagnosed with schizophrenia?

How to give and receive compliments

The importance of taking medication correctly

How to complete an application for employment

Ways to dress and behave when attending community events

The importance of taking medication correctly

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Which symptom would alert a healthcare provider to a possible diagnosis of schizophrenia in a young adult patient?

Excessive sleeping with disturbing dreams

Command hallucinations to hurt roommate

Withdrawal from college because of failing grades

Chaotic and dysfunctional relationships with family and peers

Command hallucinations to hurt roommate

Which patient action indicates a negative symptom of schizophrenia?

Refusing to eat anything that is not tasted by the staff first

Having difficulty focusing on any task for more than a few minutes

Communicating using a pattern of speech identified as “word salad”

Reporting hearing voices telling the patient that the world will end soon

Having difficulty focusing on any task for more than a few minutes

Attention impairment is considered a negative symptom because it represents a diminution or loss of normal brain function. Paranoia, hallucinations, and distorted speech are considered positive symptoms because they are an exaggeration or distortion of normal brain function.

Which assessment parameter takes priority when assessing a patient taking olanzapine daily? Height Weight Pupillary response to light Integrity of mucous membranes

Weight An important part of the nurse’s role in the community is monitoring the patient’s response to medications, compliance, and potential side or adverse effects. Key side effects of sexual dysfunction and weight gain are particularly important to monitor in patients taking antipsychotic medications. Olanzapine is an atypical antipsychotic drug that can cause significant weight gain, which results in diabetes for many patients. Neither height, pupil response, nor mucous membrane integrity takes priority over weight.

Which drug can be used to treat alogia, avolition, and anhedonia in patients with schizophrenia? Molindone Olanzapine Thiothixene Thioridazine

Olanzapine

Which toxic effect of antipsychotic medication can be avoided by ingesting foods rich in carbohydrates and protein? Weight gain Hyperpyrexia Agranulocytosis Cholestatic jaundice

Cholestatic jaundice

A nurse educates a client about the antipsychotic medication regime. Afterward, which comment by the client indicates the teaching was effective? “If I run out or stop taking my medication, I will experience withdrawal symptoms.” “I need to store my medication in a cool dark place, such as the refrigerator.” “Taking this medication regularly will reduce the severity of my symptoms.” “I will need higher and higher doses of my medication as time goes on.”

“Taking this medication regularly will reduce the severity of my symptoms.”

A newly admitted client diagnosed with schizophrenia is hypervigilant and constantly scans the environment. The client states, “I saw two doctors talking in the hall. They were plotting to kill me.” The nurse may correctly assess this behavior using which term? echolalia. an auditory hallucination. paranoia. a delusion of infidelity.

paranoia

A nurse leads a psychoeducational group about first-generation antipsychotic medications with six adult men diagnosed with schizophrenia. The nurse will monitor for concerns regarding body image with respect to which potential side effect of these medications? Visual changes Photosensitivity Constipation Gynecomastia

Gynecomastia

A client diagnosed with schizophrenia exhibits little spontaneous movement and demonstrates catatonia. Which client needs are of priority importance? Physiological Psychosocial Self-actualization Self-esteem

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

An acutely violent client diagnosed with schizophrenia received several doses of haloperidol. Two hours later the nurse notices the client’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? Give trihexyphenidyl 5 mg orally at the next regularly scheduled medication administration time. Administer atropine sulfate 2 mg subcut from the prn medication administration record. Reassure the client that the symptoms will subside. Practice relaxation exercises with the client. Administer diphenhydramine 50 mg IM from the prn medication administration record.

Administer diphenhydramine 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 nurse sits with a client diagnosed with schizophrenia. The client starts to laugh uncontrollably, although the nurse has not said anything funny. What is the nurse’s most therapeutic response? “I don’t think I said anything funny.” “Please share the joke with me.” “You’re laughing. Tell me what’s happening.” “Why are you laughing?”

“You’re laughing. Tell me what’s happening.” The client is likely laughing in response to inner stimuli, such as hallucinations or fantasy. Focus on the hallucinatory clue (the client’s laughter) and then elicit the client’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 client is probably not focusing on what the nurse said in the first place.

A client 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? Neologisms Poverty of content Concrete thinking Paranoia

Paranoia The client’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.

A health care provider considers which antipsychotic medication to prescribe for a client diagnosed with schizophrenia who has auditory hallucinations and poor social function. The client is also overweight and hypertensive. Which drug should the nurse advocate? Clozapine Aripiprazole Olanzapine Ziprasidone

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 client 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 client with cardiac disease. Olanzapine fosters weight gain.

A client diagnosed with schizophrenia says, “It’s beat. Time to eat. No room for the cat.” What type of verbalization is evident? Thought broadcasting Associative looseness Neologism Idea of reference

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 client diagnosed with schizophrenia has received fluphenazine decanoate twice a month for 3 years. The clinic nurse notes that the client grimaces and constantly smacks both lips. The client’s neck and shoulders twist in a slow, snakelike motion. Which problem would the nurse suspect? Anticholinergic effects Tourette’s syndrome Agranulocytosis Tardive dyskinesia

Tardive dyskinesia

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

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 distractors are positive symptoms of schizophrenia. See relationship to audience response question.

A newly admitted client 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. “Do you hear the voices often?” “Forget the voices and ask some other clients to play cards with you.” “Do you have a plan for getting away from the voices?” “I’ll stay with you. Focus on what we are talking about, not the voices.”

Staying with a distraught client 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 client hears voices is not particularly relevant at this point. Asking if the client plans to “get away from the voices” is relevant for assessment purposes but is less helpful than offering to stay with the client while encouraging a focus on their discussion. Suggesting playing cards with other clients shifts responsibility for intervention from the nurse to the client and other clients.

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

Darting eyes, tilted head, mumbling to self

A client diagnosed with schizophrenia has taken fluphenazine 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? Neuroleptic malignant syndrome Hepatocellular effects Pseudoparkinsonism Akathisia

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 client diagnosed with schizophrenia demonstrates little spontaneous movement and has catatonia. The client’s activities of daily living are severely compromised. What will be an appropriate outcome for this client? accepts tube feeding without objection by day 2. gradually takes the initiative for self-care by the end of week 2. performs self-care activities with coaching by the end of day 3. demonstrates increased interest in the environment by the end of week

performs self-care activities with coaching by the end of day 3.

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

“Feeling that people want to destroy you must be very frightening.”

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

Catatonia

A client diagnosed with schizophrenia begins a new prescription for ziprasidone. The client is 5'6'' and currently weighs 204 lbs. The client has dry flaky skin, headaches about twice a month, and a family history of colon cancer. Which intervention has the highest priority for the nurse to include in the client’s plan of care? Scheduling a colonoscopy Skin care techniques Teaching to limit caffeine intake Weight management strategies

Weight management strategies Ziprasidone is a second-generation antipsychotic medication. The incidence of weight gain, diabetes, and high cholesterol is high with second-generation antipsychotic medications. The client is overweight now, so weight management will be especially important. The other interventions may occur in time, but do not have the priority of weight management.

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

Withdrawal, misinterpreting, poor concentration, and preoccupation with religion

When a client diagnosed with schizophrenia was discharged 6 months ago, haloperidol was prescribed. The client 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 client? Sweating, nausea, and diarrhea Mild fever, sore throat, and skin rash Sedation and muscle stiffness Headache, watery eyes, and runny nose

Sedation and muscle stiffness

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

Psychoeducational

A client diagnosed with schizophrenia anxiously tells the nurse, “The voice is telling me to do things.” What is the nurse’s priority assessment question? “Does what the voice tell you to do frighten you?” “Do you recognize the voice speaking to you?” “How long has the voice been directing your behavior?” “What is the voice telling you to do?”

“What is the voice telling you to do?” Learning what a command hallucination is telling the client to do is important because the command often places the client 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 client receiving risperidone reports severe muscle stiffness at 1030. By 1200, the client has difficulty swallowing and is drooling. By 1600, vital signs are 102.8° F; pulse 110; respirations 26; 150/90. The client is diaphoretic. What is the nurse’s best analysis and action? Cholestatic jaundice; begin a high-protein, high-cholesterol diet. Agranulocytosis; institute reverse isolation. Tardive dyskinesia; withhold the next dose of medication. Neuroleptic malignant syndrome; notify health care provider stat.

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.

The nurse is developing a plan for psychoeducational sessions for a small group of adults diagnosed with schizophrenia. Which goal is best for this group’s members? explore situations that trigger hostility and anger. demonstrate improved social skills. gain insight into unconscious factors that contribute to their illness. learn to manage delusional thinking.

demonstrate improved social skills.

A client insistently states, “I can decipher codes of DNA just by looking at someone.” Which problem is evident? Idea of reference Visual hallucinations Magical thinking Thought insertion

Magical thinking Magical thinking is evident in the client’s appraisal of his own abilities. There is no evidence of the distractors.

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

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

relapse.

A client diagnosed with schizophrenia begins to talks about “macnabs” hiding in the warehouse at work. The client’s use of “macnabs” should be documented using what term? a neologism. an idea of reference. thought insertion. concrete thinking.

neologism A neologism is a newly coined word having special meaning to the client. “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.