Question 1

A client who has a major depressive episode has been hearing voices and feeling followed by someone. A history reveals that the client has had these alternating symptoms before. The client also has experienced time free from these symptoms and has been able to function adequately. The nurse interprets these findings as suggesting which disorder?

Accepted Answer

Schizoaffective disorder is characterized by intervals of intense symptoms between quiescent periods. At times, there are symptoms of schizophrenia, and at other times, there seems to be a mood disorder. Because the symptoms alternate with quiet periods, schizophrenia, either paranoid or undifferentiated, would not apply. A brief psychotic episode involves symptoms of at least 1 day but less than 1 month, and the onset is sudden. The client generally experiences emotional turmoil or overwhelming confusion and rapid intense shifts of affect.

Question 2

A nurse is caring for a client who was diagnosed with schizoaffective disorder. Based on an understanding of this disorder, the nurse develops a plan of care to address which issue as the top priority?

Accepted Answer

One of the characteristics that distinguishes schizoaffective disorder from schizophrenia is that clients with schizoaffective disorder are extremely susceptible to suicide. Schizoaffective disorder may be associated with substance abuse, but this would not be the priority. Aggression and eating disorder are not commonly associated with schizoaffective disorder.

Question 3

A family member of a client diagnosed with schizophrenia disorder asks a nurse what causes the disorder. The nurse integrates understanding of schizophrenia and related disorders such as schizoaffective disorder when responding to the family member. Which response by the nurse would be most appropriate?

Accepted Answer

Although the exact etiology is unresolved, there is a strong belief that the etiology is primarily genetic. Family dynamics do not appear to affect the development of this disorder. Before 1999, the prevailing belief was that the disorder was caused by overactivity of dopamine. Birth order does not appear to affect the development of this disorder.

Question 4

The nurse is caring for a client who was just admitted with a diagnosis of schizoaffective disorder with depression. Which agent would the nurse anticipate as being prescribed for this client?

Accepted Answer

Atypical antipsychotic agents are generally prescribed because of their efficacy and safe side effect profile. These agents have a mood-stabilizing, as well as antipsychotic, effect. Clozapine has been reported to be effective for this disorder. Lithium might be an alternative for clients experiencing mood states associated with the bipolar type. Haloperidol and chlorpromazine are typical antipsychotic agents.

Question 5

The nurse is assessing a newly admitted client diagnosed with schizoaffective disorder. The nurse assesses the client's level of anxiety and reactions to stressful situations, obtaining this information for which reason?

Accepted Answer

It is important for the nurse to assess the client's level of anxiety and reactions to stressful situations, because the combination of these symptoms with psychosis increases the client's risk for suicide. Additional information is needed to help determine the client's outcomes, identify whether the client's mental competency is intact, and evaluate the client's social skills.

Question 6

A nurse is caring for a client diagnosed with a delusional disorder. While assessing this client, which would a nurse expect to find?

Accepted Answer

Clients usually live with delusions for years, rarely receiving psychiatric treatment unless their delusion relates to their health or they act on the basis of their delusion and violate the law or social rules. The person often behaves in a normal manner except when focusing on the delusion. A person with delusional disorder does not have other psychiatric disorders. If mood episodes occur with this disorder, the duration of the mood episode is relatively brief in comparison. Behavior is remarkably normal except when the client focuses on the delusion. Delusional disorder involves the presence of nonbizarre delusions.

Question 7

A nurse is preparing to interview a client who has a delusional disorder. Which assessment would the nurse expect?

Accepted Answer

The nurse plans for the interview and expects that the client will act in a normal manner. Generally, clients diagnosed with a delusional disorder have psychosocial functioning that is not markedly impaired. They show few, if any, psychological deficits, and those that do occur are generally related directly to the delusion. General behavior and emotional responses are not odd or bizarre. Cognition is not impaired, and motor symptoms are not evident.

Question 8

A client diagnosed with schizoaffective disorder is prescribed clozapine to treat symptoms. Which instructions would the nurse provide?

Accepted Answer

The client should be cautioned to notify the health-care provider if the client has rapid weight gain because this may be indicative of excessive fluid retention. Dry mouth and sedation, common side effects of any antipsychotic agent, do not require the client to notify the physician. Urinary changes are not associated with clozapine use. Although clozapine is associated with an increased risk of infection, it would be important to notify the physician if the client's urine odor becomes foul, possibly suggesting an urinary tract infection.

Question 9

After teaching a group of students about the epidemiology of schizoaffective disorder (SAD), the instructor determines that the education was successful when the students agree with what statement?

Accepted Answer

The long-term outcome of SAD is generally better than that of schizophrenia but worse than that of mood disorder. Although the disorder can affect all age groups, it is rare in children and often indistinguishable from schizophrenia. Most clients are white. Relatives of clients diagnosed with schizoaffective disorder appear to be at increased risk for this disorder.

Question 10

While being interviewed, a client diagnosed with a delusional disorder states, "I have this really strange odor coming out of my mouth. I stop to brush my teeth almost every hour and then rinse with mouthwash every half hour to get rid of this smell. I've seen so many doctors, and they can't tell me what's wrong." The nurse interprets the client's statement as reflecting which type of delusion?

Accepted Answer

The client's statements reflect a somatic delusion, which involves bodily functions or sensations. Those with somatic delusions use excessive health care resources and often go through elaborate rituals to cleanse themselves or their surroundings. Erotomanic delusions focus on the belief that the client is loved intensely by a "loved object," who is usually married, of a higher economic status, or otherwise unattainable. With grandiose delusions, the client is convinced that he or she has a great unrecognized talent or has made an important discovery. Jealous delusions focus on the unfaithfulness or infidelity of a spouse or lover.

Question 11

When obtaining a client's history, a nurse determines that the client has been experiencing delusions and hallucinations for the past 3 months, which has caused some problems in the client's ability to function at work. The client also is exhibiting catatonic excitement, echopraxia, loose associations, and pressured speech. The nurse suspects which condition?

Accepted Answer

The essential features of schizophreniform disorder are identical to those of criteria A for schizophrenia (delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms), with the exception of the duration of the illness, which can be less than 6 months but with symptoms present for at least 1 month. Schizophrenia would be as described, but the symptoms must persist for at least 6 months. In brief psychotic disorder, the length of the episode is at least 1 day but less than 1 month. With schizoaffective disorder, the client must have an uninterrupted period of illness when there is a major depressive, manic, or mixed episode along with two of the following symptoms of schizophrenia: delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, or negative symptoms.

Question 12

A nurse is caring for a client in an inpatient mental health setting. The nurse notices that when the client is conversing with other clients, the client repeats what they are saying word for word. The nurse interprets this finding and documents it using which term?

Accepted Answer

The nurse should document the client's speech pattern as echolalia, or parrot-like and inappropriate repetition of another's words. Echopraxia refers to an involuntary imitation of another person's movements or gestures. Neologisms are made-up words that have no common meaning and are not recognized. Tangentiality is a disorganized thinking pattern in which the topic of conversation changes to an entirely different topic; the change is a logical progression but causes a permanent detour from the original focus.

Question 13

While caring for a hospitalized client diagnosed with schizophrenia, a nurse observes that the client is listening to the radio. The client tells the nurse that the radio commentator is speaking directly to the client. The nurse interprets this finding as which type of thinking?

Accepted Answer

The client is exhibiting referential thinking, that is, the belief that neutral stimuli, such as the radio, have special meaning to that person, such that the radio commentator is talking directly to him. Autistic thinking involves restriction of thinking to the literal and immediate so that the individual has private rules of logic and reasoning that make no sense to anyone else. Concrete thinking reflects a lack of abstraction in thinking with the inability to understand punch lines, metaphors, and analogies. Illusional thinking occurs when a person misperceives or exaggerates stimuli that actually exist in the external environment.

Question 14

A client has been diagnosed with schizophrenia. Assessment reveals that the client lives alone. The client's clothing is disheveled, the client's hair is uncombed and matted, and the client's body has a strange odor. During an interview, the client's family members voice a desire for the client to live with them when the client is discharged. Based on the assessment findings, which nursing diagnosis would be the priority?

Accepted Answer

The negative symptom of this condition may be so profound that simple activities of daily living, such as dressing, bathing, or combing hair, may not get done. Therefore, a priority nursing diagnosis for the client is [bathing] self-care deficit related to the symptoms of schizophrenia. The family's desire to care for the client does not support a nursing diagnosis of dysfunctional family processes. There is no evidence of ineffective role performance or social isolation at this time.

Question 15

A nurse is caring for an older adult client who has been taking an antipsychotic medication for 1 week. The nurse notifies the primary care provider that the client has muscle rigidity that resembles Parkinson's disease. Which agent would the nurse expect the primary health-care provider to prescribe?

Accepted Answer

Unless the client develops akathisia, the primary care provider will likely order an anticholinergic medication such as benztropine to increase the acetylcholine. An anxiolytic, anticholinergic, or beta-blocker would not be used.

Question 16

A nurse is caring for a hospitalized client who has been diagnosed with schizophrenia. The client has been taking antipsychotic medications for 1 week when the nurse observes that the client's eyes are fixed on the ceiling. The nurse documents this finding using which term?

Accepted Answer

The nurse should contact the client's physician because the client is exhibiting a dystonic reaction termed oculogyric crisis in which the muscles that control eye movements tense and pull the eyeball so that the client is looking toward the ceiling. Akathisia is manifested by restlessness, with clients often reporting that they feel driven to keep moving. Retrocollis involves the neck muscle, causing the head to be pulled back. Tardive dyskinesia involves abnormal, involuntary movements that are constant.

Question 17

A hospitalized client diagnosed with schizophrenia is receiving antipsychotic medications. While assessing the client, a nurse identifies signs and symptoms of a dystonic reaction. Which agent would the nurse expect to administer?

Accepted Answer

For dystonic reactions, the drug of choice is benztropine mesylate or diphenhydramine. Propranolol could be used to treat akathisia. Risperidone and aripiprazole are antipsychotic agents used to treat schizophrenia.

Question 18

A nurse is caring for a client who has been treated for schizophrenia with a first-generation antipsychotic medication for the past year. It would be essential for the nurse to monitor the client for which side effect?

Accepted Answer

Tardive dyskinesia is late-appearing, abnormal involuntary movements. Therefore, it is essential that the nurse monitor the client for tardive dyskinesia at this time. Weight gain (not weight loss) and new onset of diabetes (hyperglycemia) are possible side effects of an antipsychotic. Torticollis, a dystonic reaction, would occur early in antipsychotic drug treatment.

Question 19

A client hospitalized for treatment of schizophrenia has been receiving olanzapine for the past 2 months. A nurse should be especially alert for which side effect?

Accepted Answer

The nurse should monitor the client for symptoms of diabetes, which has been associated with second-generation antipsychotics, such olanzapine and clozapine. Weight gain and hypotension are common side effects. Constipation is more common with antipsychotic therapy because of the anticholinergic effects.

Question 20

A nurse is caring for a client who has been taking clozapine for 2 weeks. The client tells the nurse, "My throat is sore, and I feel weak." The nurse assesses the client's vital signs and finds that the client has a fever. The nurse notifies the physician, expecting an order to obtain which laboratory test?

Accepted Answer

Clients who are taking clozapine are at risk for developing agranulocytosis; therefore, they should have their white blood cells and granulocytes monitored while taking this medication. An immediate evaluation of blood cell status is necessary when symptoms of infection are present. Liver function studies and serum potassium and sodium concentration would not be necessary based on the assessment findings.

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