Schizophrenia: Positive Symptoms

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Questions and Answers

A patient with schizophrenia is exhibiting a flat affect, social withdrawal, and a lack of motivation. Which category of symptoms do these behaviors fall under?

  • Negative symptoms (correct)
  • Positive symptoms
  • Cognitive symptoms
  • Disorganized symptoms

A client with schizophrenia is prescribed haloperidol. What potential side effect is most important for the nurse to monitor?

  • Weight gain
  • Photosensitivity
  • Excessive movement (correct)
  • Agranulocytosis

When communicating with a client experiencing delusions, which intervention is most therapeutic?

  • Encouraging detailed descriptions of delusional experiences
  • Shifting the focus to reality-based topics (correct)
  • Presenting logical explanations to disprove the delusions
  • Arguing against the delusional beliefs

A client with schizophrenia is non-adherent to their medication regimen. Which pharmacological intervention might be considered to improve adherence and outcomes?

<p>Long-acting injectable antipsychotics (A)</p> Signup and view all the answers

A client experiencing catatonia is exhibiting rigid posture, is unresponsive to stimuli, and is refusing to eat or drink. What is the priority nursing intervention?

<p>Providing fluid and nutrition (B)</p> Signup and view all the answers

A client with schizophrenia states, "The TV is sending messages directly to my brain." Which type of delusion is the client experiencing?

<p>Delusion of control (D)</p> Signup and view all the answers

A client with schizophrenia is exhibiting disorganized speech, including inventing new words that have no meaning. This is an example of what?

<p>Neologism (A)</p> Signup and view all the answers

Which nursing intervention is most likely to promote trust with a newly admitted client with schizophrenia?

<p>Avoiding physical contact without informing the client (D)</p> Signup and view all the answers

A client with schizophrenia is prescribed risperidone. What potential side effect is most important for the nurse to monitor?

<p>Weight gain (B)</p> Signup and view all the answers

A client with schizophrenia is experiencing auditory hallucinations. Which nursing intervention is most appropriate?

<p>Providing distraction (e.g., music with headphones) (D)</p> Signup and view all the answers

A client with schizophrenia is pacing and agitated. What is the first nursing action?

<p>Monitoring for worsening anxiety and agitation (A)</p> Signup and view all the answers

A client diagnosed with schizophrenia is speaking incoherently. They are jumping from one unrelated topic to another. Which term describes this?

<p>Tangentiality (C)</p> Signup and view all the answers

Which of the following principles should guide the nurse's approach when caring for a client experiencing delusions?

<p>Validating underlying feelings without reinforcing delusions (D)</p> Signup and view all the answers

A client with schizophrenia displays minimal emotional expression. The client's face appears immobile, and his voice lacks inflection. How should the nurse document this?

<p>Affective flattening (A)</p> Signup and view all the answers

A client’s chart indicates treatment with a first-generation antipsychotic medication. Which side effect is more commonly associated with first-generation antipsychotics compared to second-generation?

<p>Extrapyramidal symptoms (D)</p> Signup and view all the answers

Which of the following outcomes indicates effective social skills training for a client diagnosed with schizophrenia and negative symptoms?

<p>The client initiates and maintains brief conversations with peers (B)</p> Signup and view all the answers

A client with schizophrenia refuses to eat or drink, stating, “The food is poisoned.” What is the most appropriate intervention?

<p>Offer prepackaged foods and drinks, opening them in front of the client (B)</p> Signup and view all the answers

During an assessment, a client with schizophrenia reports tactile hallucinations. Which question is most appropriate?

<p>“Are you experiencing any strange sensations on your skin?” (C)</p> Signup and view all the answers

Which statement reflects the current understanding of the etiology of schizophrenia?

<p>It involves a combination of genetic, environmental, and neurochemical factors (A)</p> Signup and view all the answers

A client says 'The bread is buttered, I need a ladder to go to the moon after noon!" Which of the following does this symptom represent?

<p>Word salad (C)</p> Signup and view all the answers

A client states, "I am the president of the United States, and I have the power to control the world." Which type of delusion is the client experiencing?

<p>Grandiose delusion (D)</p> Signup and view all the answers

Which of the following interventions demonstrates appropriate nursing care for a client diagnosed with schizophrenia exhibiting disorganized behavior?

<p>Assisting the client with hygiene and grooming as needed (B)</p> Signup and view all the answers

A client states says a new word that they made up, such as "flurries" which of the following terms describes this?

<p>Neologism (A)</p> Signup and view all the answers

What would be the priority nursing intervention for a client with schizophrenia experiencing command hallucinations?

<p>Initiating one-on-one supervision (B)</p> Signup and view all the answers

A client taking a first-generation antipsychotic begins to display facial grimacing and repetitive movements. Which medication should the nurse prepare to administer?

<p>Benztropine (Cogentin) (C)</p> Signup and view all the answers

Which of the following distinguishes schizophrenia from other psychotic disorders?

<p>Significant impairment in social and occupational functioning (C)</p> Signup and view all the answers

A client receiving antipsychotic medication develops muscle rigidity, fever, and altered mental status. Which of the following should the nurse suspect?

<p>Neuroleptic malignant syndrome (C)</p> Signup and view all the answers

Why is it important to use canned foods?

<p>The patient may be afraid of being poisoned so they may feel safer with canned food. (D)</p> Signup and view all the answers

A client diagnosed with schizophrenia is prescribed clozapine. Which potential adverse effect requires regular monitoring?

<p>Agranulocytosis (B)</p> Signup and view all the answers

During a home visit, the nurse observes that a client with schizophrenia is withdrawn, neglects personal hygiene, and reports feeling empty. Which aspects of care should the nurse prioritize?

<p>Assessing for suicidal ideation and providing support (C)</p> Signup and view all the answers

A client with schizophrenia states, "I can’t take medications because the government is tracking me with the pills." How should the nurse respond?

<p>“I understand that you’re concerned; can you tell me more about what you mean?” (A)</p> Signup and view all the answers

A client who has been on antipsychotic medications for several years begins exhibiting involuntary, repetitive movements of the tongue and face. What is the appropriate term for this?

<p>Tardive dyskinesia (B)</p> Signup and view all the answers

A client reports that they are unable to feel pleasure from activities that they used to enjoy, such as hobbies and spending time with loved ones. Which symptom is the client experiencing?

<p>Anhedonia (C)</p> Signup and view all the answers

A client recently diagnosed with schizophrenia is overwhelmed and asks their nurse, "What caused this disease?". Which is the best response?

<p>&quot;It sounds like you are concerned about your diagnosis and how it happened.&quot; (A)</p> Signup and view all the answers

What is meant by balance neutral?

<p>Maintain a neutral approach (not overly warm) (B)</p> Signup and view all the answers

Which of the following is true?

<p>In schizophrenia there is too little dopamine leading to negative symptoms (B)</p> Signup and view all the answers

Which of the following is NOT a nursing intervention that can be utilized for hallucinations?

<p>Encourage the client to focus on the voices (A)</p> Signup and view all the answers

Flashcards

Schizophrenia

Complex psychiatric disorder affecting interpretation of reality.

Hallucinations

False sensory experiences (tactile, visual, auditory, olfactory)

Delusions

Irrational beliefs

Neologism

New made-up words

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Tangentiality

Diverging from the main topic.

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Word Salad

Jumbling words with no meaning

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Echolalia

Client repeats phrases or words.

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Catatonia

Immobile, peculiar postures, and unresponsive.

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Apathy

Lack of interest

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Avolition

Lack of motivation.

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Asociality

Social withdrawal and preference for being alone.

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Affective Flattening

Empty flattening/monotone speech

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Anhedonia

Inability to experience pleasure

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Alogia

Lack of speech

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Treatment for Schizophrenia

Antipsychotics to manage positive symptoms.

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Side effect of 1st Generation Antipsychotics

Excessive Movement

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Side effect of 2nd Generation Antipsychotics

Weight gain

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Study Notes

  • Schizophrenia is a complex psychiatric disorder where the client is unable to interpret and interact with reality.
  • Schizophrenia can arise from a combination of genetics, the environment, and brain chemistry.
  • Dopamine plays a significant role in schizophrenia.
  • Too much dopamine can lead to positive symptoms in the limbic part of the brain.
  • Too little dopamine can lead to negative emotions in the prefrontal cortex.

Clinical Features - Positive Symptoms

  • Hallucinations involve false senses, including tactile, visual, auditory, and olfactory.
  • Delusions are irrational beliefs, such as grandiose delusions, delusions of reference, and delusions of control.
  • Disorganized thoughts/incoherent speech lack a logical flow and can manifest as:
    • Neologisms: made-up words.
    • Tangentiality: diverging from the main topic.
    • Word Salad: jumbling words without meaning.
    • Echolalia: repeating phrases or words.
  • Disorganized/Agitated behavior e.g. catatonia, which includes immobile, peculiar postures and unresponsiveness.
  • Psychomotor slowing or agitation can be present.

Clinical Features - Negative Symptoms

  • Apathy is a lack of interest, such as poor hygiene or poor eating habits.
  • Avolition is a lack of motivation.
  • Asociality is social withdrawal, where the person is comfortable when alone.
  • Affective Flattening involves empty, monotone speech.
  • Anhedonia is the inability to experience pleasure.
  • Alogia is a lack of speech.

Treatment

  • Antipsychotics can manage positive symptoms.
  • 1st Generation/Typical antipsychotics (e.g., haloperidol) can cause excessive movement as a side effect.
  • 2nd Generation/Atypical antipsychotics (e.g., risperidone, olanzapine, aripiprazole) can cause weight gain as a side effect.
  • Long-acting injectables improve adherence and outcomes.

Nursing Interventions

  • Priority: Establish trust by being honest and consistent.
  • Use frequent and short interaction times.
  • Sit calmly in the client's room if needed.
  • Avoid touching the client without informing them.
  • Maintain a balanced, neutral approach, avoiding being overly warm.
  • Explain procedures step by step.
  • Initiate activities on a one-on-one basis, progressing to small groups.

Nursing Interventions - Hallucinations:

  • Monitor cues.
  • Ask directly about the content of the hallucination.
  • Monitor for worsening anxiety and agitation.
  • Decrease stimuli or assist the client to another area.
  • Provide distraction, such as music with headphones.
  • Explain what is real and unreal verbally.
  • Check for suicidal/homicidal ideation.

Nursing Interventions - Delusions:

  • Use therapeutic communication.
  • Refrain from arguing or trying to convince the client.
  • Shift the conversation to reality-based topics rather than focusing on the delusion.
  • Use canned or prepackaged foods.
  • Open medication in front of the client.
  • Check the mouth and palms after medication administration.
  • Use positive reinforcement.

Nursing Interventions - Negative Symptoms:

  • Use social skills training.
  • Measure the client's readiness to engage with others.
  • If the client is in a catatonic state, prioritize fluid and nutrition.

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