Question 1

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?

Accepted Answer

Clients receiving antipsychotic therapy need to be alerted to the potential for complications, including neuroleptic malignant syndrome, a life-threatening condition that can occur with antipsychotic agents. This syndrome is manifested by severe muscle rigidity and elevated temperature that can rapidly accelerate. The nurse should instruct the client to seek immediate care if an elevated temperature develops. Tremor also should be reported, but this is not a life-threatening manifestation. Decreased blood pressure and weight gain can occur with antipsychotic agents, but these are not life threatening.

Question 2

A nurse is preparing an in-service program about schizophrenia for a group of psychiatric-mental health nurses. Which would the nurse include as a major reason for relapse?

Accepted Answer

Although a lack of family or social support, accessibility to community resources, and stigmatization are factors that can contribute to relapse, one of the major reasons for relapse is failure to follow the medication regimen.

Question 3

While being assessed, a client diagnosed 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?

Accepted Answer

Persecutory delusions involve the belief that one is being watched, ridiculed, harmed, or plotted against. Grandiose delusions involve the belief that one has exceptional powers, wealth, skill, influence, or destiny. Nihilistic delusions involve the belief that one is dead or a calamity is impending. Somatic delusions involve beliefs about abnormalities in bodily functions or structures.

Question 4

A nurse is interviewing a client diagnosed with schizophrenia when the client begins to say, "Kite, night, right, height, fright." The nurse documents this behavior using which term?

Accepted Answer

The client is manifesting clang association, which is the repetition of words or phrases that are similar in sound but are in no other way connected. Stilted language is the use of overly and inappropriate artificial formal language. Verbigeration is the purposeless repetition of words or phrases. Neologisms are words that are made up that have no common meaning and are not recognized.

Question 5

A nurse is providing care to a client 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 everywhere. Upon entering the client's room, the nurse sees numerous empty cups that had been filled with fluids on the bedside table and in the trash can. The room has an odor of urine. The nurse suspects which cause of this behavior?

Accepted Answer

Some persons with schizophrenia develop disturbed fluid and electrolyte balance. Nurses should observe for polydipsia (frequently drinking an excessive amount of fluids) or frequent incontinence. These individuals are obsessed with drinking water and compulsively consume fluids. Because of urgency and incontinence, especially at night, the client's clothing and room may smell of urine. Diabetes would be manifested by changes in glucose concentrations and possibly weight loss (as a result of polydipsia). Tardive dyskinesia would be indicated by involuntary movements; this condition is a late-appearing side effect of antipsychotic agents. Orthostatic hypotension would be suggested by changes in blood pressure, and dizziness upon position changes.

Question 6

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?

Accepted Answer

Although research is demonstrating that schizophrenia does not result from dysregulation of a single neurotransmitter or biogenic amine (such as serotonin, norepinephrine, or dopamine), positive symptoms of schizophrenia, specifically hallucinations and delusions, are thought to be caused by dopamine hyperactivity in the mesolimbic tract. Researchers are also hypothesizing a role for GABA but have yet to identify any specific information.

Question 7

After teaching a class on antipsychotic agents, the instructor determines that the education was successful when the class identifies which as an example of a second-generation antipsychotic agent?

Accepted Answer

Quetiapine is an example of a second-generation antipsychotic agent. Fluphenazine, thiothixene, and chlorpromazine are examples of first-generation antipsychotic agents.

Question 8

When educating a client with schizophrenia induced polydipsia, the nurse teaches the client to self-monitor urine specific gravity and which vital sign?

Accepted Answer

For persons with schizophrenia who demonstrate polydipsia, regulation of fluid intake is disturbed. This results in an abnormally low serum sodium level, which can lead to severe water intoxication, a medical emergency. Nursing interventions include teaching and assisting the client to develop self-monitoring skills. Fluid intake and weight gain should be monitored to control fluid intake and reduce the likelihood of developing water intoxication. None of the other options are directly related to polydipsia monitoring.

Question 9

A client diagnosed with schizophrenia tells the nurse, "I'm being watched constantly by the Federal Bureau of Investigation because of my job." Which response by the nurse would be most appropriate?

Accepted Answer

When interacting with a client who is experiencing delusions, the nurse must remember that these experiences are real for the client. Based on the client's statement, the nurse should focus on the feelings that are generated by the delusion, such as acknowledging how frightening it must be to feel constantly watched. The nurse should not focus on the delusion itself (such as by asking the client to tell the nurse more about being watched). Telling the client that the client is not being watched, that it is all in the client's mind, or that the client is experiencing a delusion would be inappropriate because these statements tell the person that his or her experiences are not real.

Question 10

A client diagnosed 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 agree with which statement?

Accepted Answer

Clozapine is associated with agranulocytosis, so clients taking clozapine should have regular blood tests. White blood cell and granulocyte counts should be measured before treatment is initiated, and at least weekly or twice weekly after treatment begins. Although cardiac dysrhythmias can occur, they are more likely to occur with ziprasidone. Cigarette smoking can reduce the concentration of clozapine, thus necessitating a higher dose of this medication. Clozapine is associated with weight gain, not weight loss.

Question 11

To promote recovery, what would be most important for a nurse to keep in mind when establishing a nurse-client relationship with a client who has schizophrenia?

Accepted Answer

Engaging a client with schizophrenia takes time, and short, time-limited interactions are best for a client who is experiencing psychosis. Consistency in interactions and follow-through helps to establish trust. Relationships should be built on the recovery paradigm that focuses on individualizing treatment and care that is person-centered and allows for self-direction. Clients with schizophrenia are often reluctant to engage in any relationship.

Question 12

A nurse is developing an education plan for a client diagnosed with schizophrenia. Which method would the nurse use to be most effective?

Accepted Answer

Evidence indicates that people with schizophrenia may learn best in an errorless learning environment in which they are directly given correct information and then encouraged to write it down. Asking questions that encourage guessing is not as effective in helping them retain information. Trial-and-error learning also is avoided. Visual aids can supplement verbal information, but these aids should have simple information stated in simple language. Overcrowding the visual material or incorporating images that draw attention away from important content should be avoided.

Question 13

Assessment of a client diagnosed with schizophrenia reveals that the client is hearing voices. The client feels watched and is experiencing illusions. When developing the plan of care for this client, which nursing diagnosis would be most appropriate?

Accepted Answer

The most appropriate nursing diagnosis would be disturbed sensory perception related to the client's hallucinations and illusions. The client's memory is not impaired. Risk for self-directed violence would be appropriate if the client verbalized that the voices were telling the client to harm the self. Although ineffective coping could apply, there is nothing to support this nursing diagnosis.

Question 14

A nursing instructor is preparing a class lecture about schizophrenia and appropriate outcomes focusing on recovery. Which would the instructor include as a major goal?

Accepted Answer

Outcome research has shown that schizophrenia can be successfully treated and managed. Continuity of care has been identified as a major goal of recovery for clients with schizophrenia because they are at risk for becoming lost to services if left alone after discharge. Although inpatient hospitalizations that are brief and focus on client stabilization, crisis management as key to emergency care, and decreased social isolation through social engagement are all important, they are not considered major goals for recovery.

Question 15

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?

Accepted Answer

When psychosis and mood disturbance occur at the same time, a diagnosis of schizoaffective disorder is made. Substance abuse, delirium, or anxiety are not involved with the diagnosis of schizoaffective disorder.

Question 16

A group of nursing students is reviewing information about other psychotic disorders. The students demonstrate a need for additional review when they identify what information about schizophreniform disorder?

Accepted Answer

The essential features of schizophreniform disorder are identical to those of criteria A for schizophrenia, with the exception of the duration of the illness, which can be less than 6 months. Symptoms must be present for at least 1 month to be classified as a schizophreniform disorder. About one third of individuals recover, with the other two-thirds developing schizophrenia.

Question 17

A client is receiving antipsychotic therapy as treatment for schizoaffective disorder. The nurse is reviewing the client's medical record. Which drug, if noted on the record, would cause the nurse to be concerned?

Accepted Answer

For the client using antipsychotic agents, lithium should be avoided. A few clients taking haloperidol and lithium have experienced fluid imbalance. Lithium may interact similarly with other antipsychotic agents. It may also prolong the effects of neuromuscular blocking agents. Use of nonsteroidal anti-inflammatory drugs (NSAIDs) may increase plasma lithium levels. Diuretics, such as furosemide and angiotensin-converting enzyme inhibitors (such as quinapril) should be prescribed cautiously with lithium, which is excreted through the kidneys.

Question 18

After assessing a client with schizophrenia, a nurse suspects that the client is experiencing an anticholinergic crisis. What would the nurse most likely have assessed? Select all that apply.

Accepted Answer

Anticholinergic crisis is associated with multiple neuropsychiatric and physical signs and symptoms. These include nonreactive dilated pupils, blurred vision, ataxia, incoherent speech; flushed skin, and confusion.

Question 19

A client diagnosed with schizoaffective disorder is working with the nurse on social skills training. What client behaviors would show that the training has been effective? Select all that apply.

Accepted Answer

Positive results include improved interpersonal competence and decreased symptom severity. Identifying feelings and developing realistic goals, along with supportive therapy, can integrate insight into the disease process. Education focusing on conflict resolution skills, promoting compromise, negotiation, and expression of negative feelings helps the client achieve positive social adjustment. Helping to develop coping skills is also essential.

Quiz 24: Schizophrenia and Related Disorders: Nursing Care of Persons With Thought Disorders