Question 1

A patient with schizophrenia tells the nurse as they sit in the day room,"I hear voices telling me bad things." The most therapeutic response the nurse can make is:

Accepted Answer

By voicing his or her own reality related to the voices,the nurse does not deny the patient's experiences but helps the patient distinguish actual voices from those resulting from internal stimulation.Discussing what the voices are saying serves only to validate the reality of the voices.Challenging the voices will cause the patient to defend his perceptions and thereby reinforce the importance of the hallucination.Asking to move validates the reality of the voices and is not a helpful action since the voices go where the patient goes.

Question 2

Which interventions will the nurse implement to preserve milieu safety when a patient becomes agitated? Select all that apply.

Accepted Answer

The correct options demonstrate that the staff is in control without unnecessarily challenging the patient.Asking 'why' is often interpreted as being challenging and often serves to future agitate the patient.Eight feet is considered to be the therapeutic distance between patient and staff in this type of situation.

Question 3

A patient admitted with the diagnosis of schizophreniform disorder R/O organic pathology.Based on this information,the nurse can expect that the patient will:

Accepted Answer

The MRI will reveal structural changes in the brain that might be responsible for symptoms of psychosis (e.g.,abscess,tumor).Psychologic testing may be performed but will be less definitive in ruling out organic pathology.Immunologic studies are not indicated.The DST is related to depression.

Question 4

During a treatment team meeting,the point is made that a patient with schizophrenia has recovered from the acute psychosis but continues to demonstrate apathy,avolition,and blunted affect.The nurse who relates these symptoms to serotonin (5HT?)excess will suggest that the patient receive:

Accepted Answer

Olanzapine is an atypical antipsychotic.Atypical antipsychotic medications are more effective than typical antipsychotics in blocking serotonin receptors and reducing the negative symptoms of schizophrenia.Haloperidol (Haldol)and chlorpromazine (Thorazine)are typical antipsychotic medications while phenelzine (Nardil)is an MAOI antidepressant.

Question 5

What response would be anticipated when a patient who received chlorpromazine (Thorazine)for 15 years to treat schizophrenia is switched to Seroquel (quetiapine)?

Accepted Answer

Atypical antipsychotics have been noted to block oral dyskinesia and improve tardive dyskinesia as well as improve both positive and negative symptoms of schizophrenia.Pseudoparkinsonism and dystonic reactions are associated with typical antipsychotic medication.Anticholinergic symptoms are not intense with the use of atypical antipsychotic medication.

Question 6

A patient tells the nurse,When I'm in the day room,I hear people whispering about me,and that makes me want to punch them." What direction will the nurse provide the staff regarding interacting with this patient?

Accepted Answer

This approach is important when providing care for a patient who is misinterpreting reality and is suspicious of the motives of others.Ostracizing the patient is non-therapeutic.Patients often misinterpret touch as threatening.This might promote loss of control.Using nonverbal communication techniques would be nontherapeutic as it would increase patient anxiety and promote loss of control.

Question 7

A patient experiences intrusive,insulting auditory hallucinations.Which independent behavioral technique can the nurse teach the patient to employ when the voices are troublesome?

Accepted Answer

This action provides an alternative to listening to the voices and gives the patient a sense of control.The patient should not adjust medication independently.Reading will not be particularly effective,because the voices are uncontested in a quiet atmosphere.Positive talk is generally used to positively affect self-esteem.

Question 8

A patient is exhibiting auditory hallucinations in addition to being forgetful and easily confused.Which diagnosis does the nurse base this patient's interventions on?

Accepted Answer

Schizophrenia may alter cognitive functioning,including memory,retention,attention,and the processing of incoming information.Altered cognition accounts for many of the symptoms mentioned in the scenario.Knowing that cognition is altered,the nurse can adjust plans to take the deficits into account.The patient is not exhibiting symptoms that would warrant any of the other options.

Question 9

Prior to discharge,the nurse plans to teach the patient and family about relapse.Which items will the nurse include in the teaching?

Accepted Answer

The patient and family must be aware of signs of impending relapse.These signs are usually similar to those that the patient experienced prior to hospitalization and will be patient-specific.The nurse should be notified ASAP,rather than waiting two weeks.Patients should never adjust medication dosage.Street drug use often precipitates relapse since many street drugs are dopaminergic.

Question 10

Which interventions will the nurse implement to assure effective staff crises management skills? Select all that apply.

Accepted Answer

The correct options empower the staff while improving/maintaining their crises management skills.The failures of the process should be identified without blaming staff for ineffective crises management.

Question 11

The wife of a patient newly diagnosed with paranoid schizophrenia is concerned that her husband "will be this sick for the rest of his life." What information can the nurse provide to the wife?

Accepted Answer

The prognosis for paranoid schizophrenia is good with appropriate treatment and effective follow-up.The remaining options are not correct when considering this type of schizophrenia

Question 12

A patient with catatonic schizophrenia has been standing with his left arm upraised and his right foot off the floor for the majority of the last 20 hours,eating only when allowed to eat standing up.Which nursing intervention has priority for this patient?

Accepted Answer

Patients who maintain one position for long periods of time should be assessed for dependent edema.In this case,the nurse would look for edema of the lower extremities and would be concerned about the pressure exerted by standing on one foot for long periods of time.Such encouragement would probably be met with resistance by the patient.High-calorie drinks would be necessary if the patient failed to eat at meals.The patient probably would not be able to cognitively process what is required to participate in activities.

Question 13

Which nursing action best addresses the needs of a paranoid patient who believes the food is poisoned?

Accepted Answer

Patients who think hospital food is being poisoned will sometimes eat wrapped foods that have not been opened,and occasionally,they may eat food brought from the outside by a trusted person.Delusions are fixed,false beliefs that cannot be refuted by logic.The patient will probably state that the others have been given the antidote to the poison.Encouraging discussion about the delusion is not therapeutic.Although it is wise to minimize the amount of discussion about delusions,refusing to allow the patient to speak about the delusions will not foster a therapeutic alliance.

Question 14

A patient with schizophrenia is medication compliant and has well-controlled symptoms.He has,however,never been successful in holding a job because of poor social skills and lack of understanding of basic job skills.The nurse case manager should consider referring the patient:

Accepted Answer

Psychosocial rehabilitation helps patients readjust to community living by promoting development of necessary skills.Social skills training and job skills training programs are usually available.The patient does not need the more intensive services found in a day hospital.Cognitive therapy will not offer the needed community living skills training.Assertiveness training is only a small portion of the community living skills the patient needs.

Question 15

A patient prescribed an antipsychotic medication develops a high fever,unstable blood pressure,and muscle rigidity.Her next dose of medication is due.The nurse should:

Accepted Answer

These symptoms could be related to a possibly fatal disorder called neuroleptic malignant syndrome (NMS),and the nurse should hold the medication and contact the doctor immediately.The other options are inappropriate in light of the seriousness of the situation.

Question 16

In planning aftercare for a patient with schizophrenia and whose insurance benefits have been exhausted,the nurse who is concerned about overcoming negative symptoms will make provisions for the patient to have stimulation,structure,socialization,and support.Which option would best incorporate these factors?

Accepted Answer

A psychosocial club is organized to provide the 4 S's and is not costly to patients.Day hospitalization would not be possible because of the lack of insurance benefits.Living with his mother might fall short of stimulation and support.Spending time in the mall lacks structure,socialization,and support.

Question 17

Because of the cognitive disturbances associated with schizophrenia,which technique will be useful as the nurse teaches a patient about self-management?

Accepted Answer

Patients with cognitive disturbances should be taught small blocks of information at a time and given frequent reinforcement.Both verbal and visual materials should be used since processing of verbal stimuli may be more impaired.Teaching should be scheduled when the patient is most alert.A large number of choices may be confusing for the person,but a few simple choices may be included.

Quiz 13: Schizophrenia and Other Psychotic Disorders