Chapter 01 Psychiatric-Mental Health Nursing and Evidence-Based Practice, Exams of Advanced Education

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TEST BANK Chapter 17 Schizophrenia

Spectrum Disorders and Other Psychotic

Disorders Varcarolis Essentials of

Psychiatric Mental Health Nursing A

Communication Approach to Evidence-

Based Care

A person diagnosed with schizophrenia has had difficulty keeping a job because of severe paranoia. Today the person shouts, "They're all plotting to destroy me." 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 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." 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 as what classic behavior? a. Echolalia b. An idea of reference c. A delusion of infidelity d. An auditory hallucination b. An idea of reference A patient diagnosed with schizophrenia says, "My coworkers are out to get me. I also saw two doctors plotting to overdose me." What term identifies how this patient is perceiving the environment? a. Disorganized b. Unpredictable c. Dangerous d. Bizarre c. Dangerous When a patient diagnosed with schizophrenia was discharged 6 months ago, haloperidol was prescribed. The patient now says, "I stopped taking those pills. I didn't like how it made me feel." What likely side effects did the patient experience? 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 We have an expert-written solution to this problem! A nurse works with a patient diagnosed with schizophrenia regarding the importance of medication management. The patient repeatedly says, "I don't like taking pills." Which treatment strategy should the nurse discuss with the patient and health care provider? a. Use of long-acting antipsychotic injections b. Addition of a benzodiazepine, such as lorazepam c. Adjunctive use of an antidepressant, such as amitriptyline d. Inpatient hospitalization because of the high risk for exacerbation of symptoms a. Use of long-acting antipsychotic injections patient's care plan includes monitoring for auditory hallucinations. Which assessment findings suggest the patient may be hallucinating? a. Aloofness, haughtiness, suspicion b. Darting eyes, tilted head, mumbling to self c. Elevated mood, hyperactivity, distractibility d. Performing rituals, avoiding open places b. Darting eyes, tilted head, mumbling to self A health care provider considers which antipsychotic medication to prescribe for a patient diagnosed with schizophrenia who has auditory hallucinations and poor social functioning. The patient is also overweight. Which drug should the nurse advocate? a. Clozapine b. Ziprasidone c. Olanzapine d. Aripiprazole d. Aripiprazole Aripiprazole is an atypical antipsychotic medication that is 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 levels, 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 is demonstration catatonia. The patient has little spontaneous movement and waxy flexibility. Which patient needs are of priority importance? a. Psychosocial b. Physiological c. Self-actualization d. Safety and security b. Physiological Physiological needs must be met to preserve life. A patient who is catatonic may need to be fed by hand or tube, toileted, and given range-of-motion exercises to preserve physiological integrity. The assessment findings do not suggest safety concerns. Higher-level needs (psychosocial and self-actualization) are of lesser concern. A nurse observes a 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 We have an expert-written solution to this problem! A patient presenting with delusions of persecution about being poisoned has refused all hospital meals for 3 days. Which intervention is most likely to be acceptable to the patient? a. Allow the patient to have supervised access to food vending machines. b. Allow the patient to telephone a local restaurant to deliver meals. c. Offer to taste each portion on the tray for the patient. d. Begin tube feedings or total parenteral nutrition. a. Allow the patient to have supervised access to food vending machines. Patients diagnosed with schizophrenia who are suspicious and withdrawn generally present with what additional characteristic? a. Universally fear sexual involvement with therapists. b. Are socially disabled by the positive symptoms of schizophrenia. 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.

A newly admitted patient diagnosed with schizophrenia says, "The voices are bothering me. They yell and tell me I'm 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 will stay with you. Focus on what we are talking about, not the voices." d. "Forget about the voices. Ask some other patients to sit and talk with you." c. "I will stay with you. Focus on what we are talking about, not the voices." A patient diagnosed with schizophrenia has taken fluphenazine 5 mg orally twice daily for 3 weeks. The nurse now assesses a shuffling, propulsive gait; a masklike face; and drooling. Which term applies to these symptoms? a. Neuroleptic malignant syndrome b. Hepatocellular effects c. Pseudoparkinsonism c. Pseudoparkinsonism A patient diagnosed with schizophrenia is acutely disturbed and violent. After several doses of haloperidol, 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 is thrust forward, and the patient is drooling. Which effect is the patient demonstrating? a. Acute dystonic reaction b. Tardive dyskinesia c. Waxy flexibility d. Akathisia a. 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 that require 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 observed in catatonic schizophrenia. Akathisia is evidenced by internal and external restlessness, pacing, and fidgeting. We have an expert-written solution to this problem! An acutely violent patient diagnosed with schizophrenia receives several doses of haloperidol. Two hours later the nurse notices the patient's head rotated to one side in a stiffly fixed position; the lower jaw is thrust forward, and the patient is drooling. Which intervention by the nurse is indicated?

a. Administer diphenhydramine 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 5 mg orally at the next regularly scheduled medication administration time. d. Administer atropine sulfate 2 mg subcutaneously from the PRN medication administration record. a. 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; therefore, the intramuscular route is best. In this case, the best option given is diphenhydramine. We have an expert-written solution to this problem! A patient has taken trifluoperazine 30 mg/day orally 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 syndrome d. Anticholinergic effectS b. Tardive dyskinesia 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 observed. 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 syndrome is a condition in which tics are present. Anticholinergic effects include dry mouth, blurred vision, flushing, constipation, and dry eyes. 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 are laughing. Tell me what's happening."

d. "You are laughing. Tell me what's happening." We have an expert-written solution to this problem! Which symptoms are expected for a patient diagnosed with schizophrenia who has disorganization? a. Extremes of motor activity, from excitement to stupor b. Socially withdrawal and ineffective communication c. Severe anxiety with ritualistic behavior d. Highly suspicious, delusional behavior b. Socially withdrawal and ineffective communication What assessment findings mark the prodromal stage of schizophrenia? a. Withdrawal, magical thinking, poor concentration, and perceptual disturbances 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, magical thinking, poor concentration, and perceptual disturbances We have an expert-written solution to this problem! A patient diagnosed with schizophrenia says, "High heat. Last time here. Did you get a coat?" What type of verbalization is evident? a. Neologism b. Idea of reference c. Thought broadcasting d. Associative looseness d. Associative looseness A patient diagnosed with schizophrenia has taken a first-generation antipsychotic medication for a year. Hallucinations are less intrusive, but the patient continues to have apathy, poverty of thought, and social isolation. The nurse expects a change to which medication? a. Haloperidol b. Olanzapine c. Chlorpromazine d. Diphenhydramine b. Olanzapine Olanzapine is an atypical antipsychotic medication that targets both positive and negative symptoms of schizophrenia. Haloperidol and chlorpromazine are first-generation

(conventional) antipsychotic agents that target only positive symptoms. Diphenhydramine is an antihistamine. The family of a patient diagnosed with schizophrenia is unfamiliar with the illness and their role in recovery. Which type of therapy should the nurse recommend? a. Psychoeducational b. Psychoanalytic c. Transactional d. Family a. Psychoeducational We have an expert-written solution to this problem! 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, "Demons are in the basement and they can come through the floor." The nurse can correctly assess this information as what? a. Need for psychoeducation b. Medication nonadherence 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 noncompliance may not be implicated. Relapse can occur even when the patient is regularly taking his or her medication. Psychoeducation is more effective when the patient's symptoms are stable. Chronic deterioration is not the best explanation. A patient diagnosed with schizophrenia begins to talk about "cracklomers" in the local shopping mall. The term "cracklomers" should be documented using what term? a. Neologism b. Concrete thinking c. Thought insertion d. An idea of reference a. Neologism 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." What phenomena is the patient describing? a. Derealization b. Concrete thinking

c. Abstract thinking d. Depersonalization d. Depersonalization A patient receiving risperidone reports severe muscle stiffness at 10:30 am. By noon, the patient is diaphoretic, drooling, and has difficulty swallowing. By 4:00 pm, vital signs are body temperature, 102.8° F; pulse, 110 beats/min; respirations, 26 breaths per minute; and blood pressure, 150/90 mm Hg. 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, low-fat diet. d. Neuroleptic malignant syndrome. Immediately notify the health care provider. d. Neuroleptic malignant syndrome. Immediately notify the health care provider. A patient diagnosed with schizophrenia begins a new prescription for lurasidone HCl. The patient is 5 feet 6 inches tall and currently weighs 204 pounds. Which topic is most important for the nurse to include in the teaching plan related to this medication? a. How to recognize tardive dyskinesia? b. Weight management strategies. c. Ways to manage constipation. d. Sleep hygiene measures. b. Weight management strategies. Lurasidone HCl (Latuda) is an atypical antipsychotic medication. The incidence of weight gain, diabetes, and high cholesterol is high with this medication. The patient is overweight now, so weight management is especially important. The incidence of tardive dyskinesia is low with atypical antipsychotic medications. Constipation may occur, but it is less important than weight management. This drug usually produces drowsiness A patient diagnosed with schizophrenia has auditory hallucinations, delusions of grandeur, poor personal hygiene, and motor agitation. 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. Motor agitation c. Poor personal hygiene

1. The family members of a patient newly diagnosed with schizophrenia state that they do not understand what has caused the illness. The nurse's response should be based on which models? (Select all that apply.) a. Neurobiological b. Environmental

c. Family theory d. Genetic a. Neurobiological d. Genetic Compelling evidence exists that schizophrenia is a neurological disorder probably related to neurochemical abnormalities, neuroanatomical disruption of brain circuits, and genetic vulnerability. Stress and family disruption may contribute but are not considered etiological factors. Environmental factors are not recognized as causative variables in schizophrenia. A patient diagnosed with schizophrenia is hospitalized after arguing with coworkers and threatening to harm them. The patient is aloof and suspicious and says, "Two staff members I saw talking were plotting to assault me." Based on data gathered at this point, which nursing diagnoses relate? (Select all that apply.) a. Risk for other-directed violence b. Disturbed thought processes c. Risk for loneliness d. Spiritual distress e. Social isolation a. Risk for other-directed violence b. Disturbed thought processes We have an expert-written solution to this problem! A client demonstrating delusional behavior is escalating as a result of increasing anxiety regarding his or her safety. Which action demonstrates that the client has an understanding of actions to de-escalate his personal anxiety? a. The client retreats to his or her room accompanied by staff. b. The client asks to be allowed to voluntary seclude. c. The client engages in a group therapy session led by nursing staff. d. The client expresses the understanding that his or her safety is the primary nursing goal. b. The client asks to be allowed to voluntary seclude. Which nursing intervention is generally included in the plan of care for any hospitalized client experiencing a severe psychotic episode associated with schizophrenia to address safety issues? a. Identifying theme of any identified hallucinations b. Implementing institution's suicide precautions c. Setting boundaries to manage aggressiveness d. Assessing for the presence of feelings of guilt b. Implementing institution's suicide precautions

Which statement made by the client demonstrates an understanding of the benefit of clozapine? a. "I'm at a risk for developing infections." b. "It will help keep me from developing type 2 diabetes." c. "It will provide me with some protection against a heart attack." d. "This medication cost less than the first-generation antipsychotic types." a. "I'm at a risk for developing infections." Clozapine is an example of a second-generation antipsychotic (SGA) atypical medication. Unfortunately, the incidence of neutropenia (neutrophil count (ANC) less than 1500/μL) among clozapine-treated patients is 2% and agranulocytosis (white blood cell count (WBCs) below 3,500 WBCs per microliter of blood (mcL). 0.8%. These abnormalities can lead to serious infection or death. However, the SGAs in general have a higher risk for metabolic syndrome (weight gain, diabetes, and dyslipidemia) than the first-generation antipsychotics. As well, the SGAs lead to more cardiovascular events and premature deaths than the first-generation antipsychotics. The SGAs are also considerably more expensive than the more traditional FGAs. We have an expert-written solution to this problem! Which interventions should be considered appropriate for a patient in the withdrawn phase of catatonia? (Select all that apply.) a. Perform passive range of motion once each shift. c. Reposition every 2 hours. During catatonia’s withdrawn phase, the person may not move or eat, thus becoming vulnerable to pressure ulcers, contractures, malnutrition, and circulatory issues. The patient would be incapable of autonomous care or group interaction. A client has been prescribed an antipsychotic medication for the management of symptoms associated with schizophrenia. Which behaviors will show improvement as a result of adhering to the medication therapy? (Select all that apply.) a. Fears being abducted by alien creatures. b. Acknowledges regularly hearing voices. The negative symptoms (poor social adjustment, lack of motivation, withdrawal) are more debilitating and do not respond as well to antipsychotic drug therapy. The remaining symptoms are positive symptoms and are more florid (hallucinations, delusions, looseness of associations) and respond to antipsychotic drug therapy. Drug that's a FGA trx for Schizophrenia, low-potency FGA, most sedating agent and has fewer exrapyramidal symptoms(EPS), cause hypotention in large doses

Chlorpromazine (Thorazine) Drug thats a FGA trx for Scizophrenia, high potency FGA, least sedating, used in large doses to decrease assaultive behavior, increase incidence of EPS, effective in trx aggressive bhaviors because it controls problematic symptoms w/ decrease incidence of hypotention Haloperidol (Haldol) More common in SGA's, increase weight gain, increase insulin resistance potentially leading to type 2 diabetes, may cause hypercholesterolemia and dyslipidemia-increasing risk of cardiovascular disease and stroke, can cause hypertension metabolic syndrome One of the first SGA's made in the early 1990's for trx of negative symptoms of schizophrenia. Can cause neutropenia and agranulocytosis which can cause serious infection and even death. Prescribers must order CBC to verify WBC and ANC have been measured and are in normal limits, before next prescription. Increases risk of seizures and myocarditis. Only for pts not responding to other trx. Clozapine (clozaril) Extrapyramidal symptom: Masklike facies, stiff and stooped posture, shuffling gait, drooling, tremor, "pill-rolling" phenomenon. Onset 5-30days, Nurse will Alert medical staff then administer Anticholinergic agent: trihexyphenidyl(Artane) OR benztropine(Cogentin) OR Dopamine agonist: amantadine (symmetrel) a. pseudoparkinsonism b. Acute dystonic reactions c. akathisia d. Tardive dyskinesia a. pseudoparkinsonism Extrapyramidal symptom: Acute spasms of tongue, face, neck and back (tongue and jaw first) including Opisthotonos: tetanic heightening of entire body, head and belly up and Oculogyric crisis: eyes locked upward. Onset a few hours to 5 days. Nurse will administer diphenhydramine hydrochloride (Benadryl) IM/IV OR benztropine IM/IV. Relief occurs in minutes. Experience is very frightening. Nurse should take patient to quiet area and stay until relief of symptoms. a. pseudoparkinsonism b. Acute dystonic reactions c. akathisia d. Tardive dyskinesia b. Acute dystonic reactions Extrapyramidal symptom: Distressing motor inner-driven restlessness (e.g., tapping foot incessantly, rocking forward and backward in chair, shifting weight from side to side) Onset 2 hours to 60 days. Nurse needs to reduce dosage, switch to a low-potency antipsychotic, or trial an atypical antipsychotic.

Treat with anticholinergic, benzodiazepine or beta-blockers. Symptoms sometimes mistaken for psychotic agitation. a. pseudoparkinsonism b. Acute dystonic reactions c. akathisia d. Tardive dyskinesia c. akathisia Extrapyramidal symptom: Facial: protruding and rolling tongue, blowing, smacking, licking, spastic facial distortion. Limbs: Choreic- rapid, purposeless, and irregular movements Athetoid- slow, complex and serpentine movements. Trunk: neck and shoulder movements, dramatic hip jerks and rocking, twisting pelvic thrusts.(Snake-like movements) Onset months to years. Nurse will stop drug and switch to newer antipsychotic agent may help for beginning symptoms. Discontinuing drug does not always relieve symptoms. Ingrezza (valbenazine) used to treat. a. pseudoparkinsonism b. Acute dystonic reactions c. akathisia d. Tardive dyskinesia d. Tardive dyskinesia F-Fever, E-Elevated CPK/WBC, V-Vital sign instability(fluctuating BP, pallor, tachycardia, excessive sweating, salivation, tremors, incontinence) E-Encephalopathy (confustion, agitation, altered level of consciousness), R-Rigidity in muscle. Somewhat rare but potentially fatal Neuroleptic Malignant Syndrome Risk Factors for this are: Use of more than one psychotropic medication, Higher in those under age 40 and male, Presence of a mood disorder (40%), Higher dosage, rapid titration, use of long-acting (depot) drugs. Neuroleptic Malignant Syndrome type of side effects that include blurry vision, dry mouth, constipation, urinary hesitancy/retention, sexual dysfunction, and tachycardia anticholinergic side effects These antipsychotic agents are better tolerated, have mood-stabilizing properties, first line trx for early signs of schizophrenia, increased risk for metabolic syndrome, inhibits serotinin (5-HT) receptors, better for treating negative symptoms, fewer extrapyramidal effects and fewer anticholinergic effects. But like the other antipsychotic agents can cause weight gain. Second Generation Antipsychotics (SGA) These antipsychotics are a potent antagonists/ blockers of D2. Long term blocking of D2 can cause an increase response to stimulus which may lead to extrapyramidal side effects (tardive dyskinesia).

First Generation Antipsychotics (FGA) Agranulocytosis but serious side effect of this line of antipsychotics as well as Drug-induced liver problems First Generation Antipsychotics (FGA) Symptoms of this caused by FGA's are intense itchiness, dark urine, light colored feces, and yellowing of the skin or whites of the eyes. Nurses need to be aware of the prodromal signs and symptoms of these rare but life-threatening side effects. Report these symptoms to the psychiatric provider immediately Drug-induced liver problems This happens when drugs are stopped abruptly symptoms include nausea, vomiting, headache, tremulousness, and insomnia discontinuation syndrome Pseudoparkinsonism, Acute dystonic reactions, Akathisia, and Tardive dyskinesia are motor symptoms associated with the use of antipsychotic drugs. These symptoms are referred to as Extrapyramidal symptoms