Question 1

When a patient diagnosed with schizophrenia was discharged 6 months ago, haloperidol (Haldol) was prescribed. The patient 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 patient?

Accepted Answer

Haloperidol (Haldol) is a typical antipsychotic medication that commonly causes sedation and muscle stiffness, which can make the patient feel like a robot. Sweating, nausea, and diarrhea are less common side effects, while mild fever, sore throat, skin rash, headache, watery eyes, and runny nose are unlikely to be caused by this medication. As such, the nurse should validate with the patient if they experienced any sedation or muscle stiffness while taking haloperidol.

Question 2

A patient took trifluoperazine 30 mg po daily 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?

Accepted Answer

The patient is exhibiting signs of tardive dyskinesia, which is a potential side effect of long-term use of antipsychotic medications such as trifluoperazine. Agranulocytosis is a serious blood disorder that can be caused by some medications but would not present with the symptoms described. Tourette's syndrome is a neurological disorder characterized by repetitive, involuntary movements and vocalizations but typically starts in childhood, and the symptoms described are more indicative of tardive dyskinesia. Anticholinergic effects refer to a range of side effects such as dry mouth, constipation, and blurred vision, but do not typically cause the specific symptoms described.

Question 3

Which of the following is true for withdrawn patients diagnosed with schizophrenia?

Accepted Answer

Withdrawn patients with schizophrenia often avoid relationships due to anxiety and discomfort with emotional closeness, rather than hostility or violence.

Question 4

A person has had difficulty keeping a job because of arguing with co-workers and accusing them of conspiracy. Today the person shouts, "They're all plotting to destroy me. Isn't that true?" Select the nurse's most therapeutic response.

Accepted Answer

This response acknowledges the person's feelings and provides empathy, which is a therapeutic approach.

Question 5

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

Accepted Answer

Aripiprazole is less likely to cause weight gain and has a lower risk of metabolic side effects compared to other antipsychotics, making it a suitable choice for an overweight and hypertensive patient.

Question 6

A newly admitted patient 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.

Accepted Answer

Option C is the most helpful reply as it shows the nurse's empathy and willingness to support the patient. It also suggests a distraction technique to focus on something other than the voices, which can be helpful for patients experiencing auditory hallucinations. Option A is not ideal as it simply restates the patient's complaint without offering any support or interventions. Option B may not be appropriate as it implies that the patient should have a plan to deal with the voices, which may exacerbate their feelings of helplessness or anxiety. Option D is not helpful as it dismisses the patient's concerns and may be seen as insensitive.

Question 7

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.

Accepted Answer

The patient is likely laughing in response to inner stimuli,such as hallucinations or fantasy.Focus on the hallucinatory clue (the patient's laughter)and then elicit the patient'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 patient is probably not focusing on what the nurse said in the first place.

Question 8

A nurse observes a catatonic 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?

Accepted Answer

The phenomenon described is waxy flexibility, which is a condition associated with some psychotic disorders such as schizophrenia. Patients with waxy flexibility maintain a rigid posture which can be molded by others into different positions without any resistance.

Question 9

An acutely violent patient diagnosed with schizophrenia receives several doses of haloperidol (Haldol). Two hours later, the nurse notices the patient'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?

Accepted Answer

The patient is experiencing an acute dystonic reaction, a side effect of haloperidol. Diphenhydramine (Benadryl) is an antihistamine with anticholinergic properties that can quickly relieve these symptoms.

Question 10

Which of the following patient statements implies a hallucination that requires the nurse to implement safety measures?

Accepted Answer

This statement implies a command hallucination with potential harm, as the patient believes voices are saying everyone is trying to kill them, which may lead to defensive or harmful actions.

Question 11

A community mental health nurse wants to establish a relationship with a very withdrawn patient diagnosed with schizophrenia. The patient lives at home with a supportive family. Select the nurse's best plan.

Accepted Answer

The best plan is to take a slow and gentle approach, allowing the patient time to become comfortable with the nurse. Regular visits are important to establish trust, but the visits should be kept short initially to avoid overwhelming the patient. Accepting silence and not pushing for conversation allows the patient to feel respected and in control. It is also important to let the patient know when the nurse will return, so that they have something to look forward to and can build anticipation for the next visit. Option B focuses too much on questioning and may be overwhelming for the patient, while option C is potentially invasive and may be uncomfortable for the patient. Option D does not prioritize building a relationship with the patient, instead focusing on the nurse's own tasks.

Question 12

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 behaviour as which of the following?

Accepted Answer

The patient's belief that doctors are plotting to kill them is an idea of reference, where they interpret unrelated events as having personal significance or threat.

Question 13

A patient diagnosed with schizophrenia demonstrates little spontaneous movement and has waxy flexibility. The patient's activities of daily living are severely compromised. An appropriate outcome would be which of the following?

Accepted Answer

The answer of A patient diagnosed with schizophrenia demonstrates little...

Question 14

A patient diagnosed with schizophrenia tells the nurse, "I eat skiller. Tend to end. Easter. It blows away. Get it?" Select the nurse's best response.

Accepted Answer

This response validates the patient's experience ("I am having difficulty understanding") while still conveying that their communication is not easily comprehensible. It also opens the door for the patient to try to clarify or rephrase their statement.

Question 15

A patient diagnosed with schizophrenia has taken fluphenazine (Modecate) 5 mg po bid for 3 weeks. The nurse now observes a shuffling propulsive gait, a masklike face, and drooling. Which term applies to these symptoms?

Accepted Answer

These symptoms are indicative of pseudoparkinsonism, a side effect of antipsychotic medications like fluphenazine, characterized by symptoms similar to Parkinson's disease, such as a shuffling gait, masklike face, and drooling.

Question 16

A patient diagnosed with schizophrenia exhibits little spontaneous movement and demonstrates waxy flexibility. Which patient needs are of priority importance?

Accepted Answer

In this situation, the patient's physiological needs are of priority importance. Waxy flexibility is a symptom of catatonia, which can lead to severe physical complications if not properly managed, such as dehydration, malnutrition, and contractures. While psychosocial and self-esteem needs are important, they can be addressed after the patient's physiological needs are met. Self-actualization, while also important, is typically not a focus in the acute phase of schizophrenia treatment.

Question 17

A patient is experiencing delusions of persecution about being poisoned. The patient has refused all hospital meals for 3 days. Which intervention is most likely to be acceptable to the patient?

Accepted Answer

The patient who is delusional about food being poisoned is likely to believe restaurant food might still be poisoned and to say that the staff member tasting the food has taken an antidote to the poison before tasting.Attempts to tube feed or give nutrition intravenously are seen as aggressive and usually promote violence.Patients perceive foods in sealed containers,packages,or natural shells as being safer.

Question 18

A patient's care plan includes monitoring for auditory hallucinations. Which assessment findings suggest the patient may be hallucinating?

Accepted Answer

Darting eyes, tilted head, and mumbling to oneself are common signs of auditory hallucinations. Detachment and overconfidence may suggest a different issue, while euphoric mood, hyperactivity, and distractibility can indicate mania or hyperactivity, but not necessarily auditory hallucinations. Foot tapping and repeatedly writing the same phrase may suggest compulsive behavior rather than auditory hallucinations.

Question 19

A patient diagnosed with schizophrenia is very disturbed and violent. After several doses of haloperidol (Haldol), 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 thrust forward, and drooling. Which problem is most likely?

Accepted Answer

The patient is experiencing an acute dystonic reaction, which is a side effect of haloperidol that can occur within hours to days of starting the medication or after increasing the dose. It is characterized by sudden and involuntary muscle contractions, often in the head and neck, causing abnormal posturing and facial grimacing. It can also involve drooling and difficulty speaking or swallowing. Treatment involves stopping the medication and administering an anticholinergic or antihistamine medication.

Question 20

A patient diagnosed with schizophrenia says, "My co-workers are out to get me. I also saw two doctors plotting to kill me." How does this patient perceive the environment?

Accepted Answer

The patient's perception of their environment is dangerous, as they believe that others are plotting to harm them. This is a common symptom of paranoid schizophrenia. The other answer choices do not accurately reflect the patient's perception.

Quiz 15: Schizophrenia Spectrum and Other Psychotic Disorders