Podcast
Questions and Answers
Which two topics take priority for persons newly diagnosed with schizophrenia? (Select all that apply)
Which two topics take priority for persons newly diagnosed with schizophrenia? (Select all that apply)
Which nursing diagnoses relate to a client diagnosed with schizophrenia who feels threatened by staff members? (Select all that apply)
Which nursing diagnoses relate to a client diagnosed with schizophrenia who feels threatened by staff members? (Select all that apply)
What is Echolalia?
What is Echolalia?
Repeating words or phrases heard from others.
Word salad is a coherent and structured use of language.
Word salad is a coherent and structured use of language.
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A client has had difficulty keeping a job because of arguing with co-workers and accusing them of conspiracy. Today this client shouts, 'They're all plotting to destroy me. Isn't that true?' What is the nurse's most therapeutic response?
A client has had difficulty keeping a job because of arguing with co-workers and accusing them of conspiracy. Today this client shouts, 'They're all plotting to destroy me. Isn't that true?' What is the nurse's most therapeutic response?
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A newly admitted client diagnosed with schizophrenia is hypervigilant and constantly scans the environment. The client states, 'I saw two doctors talking in the hall. They were plotting to kill me.' The nurse may correctly assess this behavior using which term?
A newly admitted client diagnosed with schizophrenia is hypervigilant and constantly scans the environment. The client states, 'I saw two doctors talking in the hall. They were plotting to kill me.' The nurse may correctly assess this behavior using which term?
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A client diagnosed with schizophrenia says, 'My co-workers are out to get me. I also saw two doctors plotting to kill me.' How does this client perceive the environment?
A client diagnosed with schizophrenia says, 'My co-workers are out to get me. I also saw two doctors plotting to kill me.' How does this client perceive the environment?
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When a client diagnosed with schizophrenia was discharged 6 months ago, haloperidol was prescribed. The client 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 client?
When a client diagnosed with schizophrenia was discharged 6 months ago, haloperidol was prescribed. The client 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 client?
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Which hallucination expressed by a client necessitates the nurse to implement safety measures?
Which hallucination expressed by a client necessitates the nurse to implement safety measures?
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A client's care plan includes monitoring for auditory hallucinations. Which assessment findings suggest the client may be hallucinating?
A client's care plan includes monitoring for auditory hallucinations. Which assessment findings suggest the client may be hallucinating?
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A health care provider considers which antipsychotic medication to prescribe for a client diagnosed with schizophrenia who has auditory hallucinations and poor social function. The client is also overweight and hypertensive. Which drug should the nurse advocate?
A health care provider considers which antipsychotic medication to prescribe for a client diagnosed with schizophrenia who has auditory hallucinations and poor social function. The client is also overweight and hypertensive. Which drug should the nurse advocate?
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A client diagnosed with schizophrenia tells the nurse, 'I eat skiller. Tend to end. Easter. It blows away. Get it?' What is the nurse's most therapeutic response?
A client diagnosed with schizophrenia tells the nurse, 'I eat skiller. Tend to end. Easter. It blows away. Get it?' What is the nurse's most therapeutic response?
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A client diagnosed with schizophrenia exhibits little spontaneous movement and demonstrates catatonia. Which client needs are of priority importance?
A client diagnosed with schizophrenia exhibits little spontaneous movement and demonstrates catatonia. Which client needs are of priority importance?
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A client diagnosed with schizophrenia demonstrates little spontaneous movement and has catatonia. The client's activities of daily living are severely compromised. What will be an appropriate outcome for this client?
A client diagnosed with schizophrenia demonstrates little spontaneous movement and has catatonia. The client's activities of daily living are severely compromised. What will be an appropriate outcome for this client?
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A nurse observes a catatonic client standing immobile, facing the wall with one arm extended in a salute. The client remains immobile in this position for 15 minutes. What is the name of this phenomenon?
A nurse observes a catatonic client standing immobile, facing the wall with one arm extended in a salute. The client remains immobile in this position for 15 minutes. What is the name of this phenomenon?
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A nurse leads a psychoeducational group about first-generation antipsychotic medications with six adult men diagnosed with schizophrenia. The nurse will monitor for concerns regarding body image with respect to which potential side effect of these medications?
A nurse leads a psychoeducational group about first-generation antipsychotic medications with six adult men diagnosed with schizophrenia. The nurse will monitor for concerns regarding body image with respect to which potential side effect of these medications?
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A nurse leads a psychoeducational group about problem solving with six adults diagnosed with schizophrenia. Which teaching strategy is likely to be most effective?
A nurse leads a psychoeducational group about problem solving with six adults diagnosed with schizophrenia. Which teaching strategy is likely to be most effective?
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A nurse educates a client about the antipsychotic medication regime. Afterward, which comment by the client indicates the teaching was effective?
A nurse educates a client about the antipsychotic medication regime. Afterward, which comment by the client indicates the teaching was effective?
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A newly admitted client 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.
A newly admitted client 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.
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A client diagnosed with schizophrenia has taken fluphenazine 5 mg po bid for 3 weeks. The nurse now observes a shuffling propulsive gait, a mask-like face, and drooling. Which term applies to these symptoms?
A client diagnosed with schizophrenia has taken fluphenazine 5 mg po bid for 3 weeks. The nurse now observes a shuffling propulsive gait, a mask-like face, and drooling. Which term applies to these symptoms?
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A client diagnosed with schizophrenia is very disturbed and violent. After several doses of haloperidol, the client is calm. Two hours later the nurse sees the client's head rotated to one side in a stiff position, the lower jaw thrust forward, and drooling. Which problem is most likely?
A client diagnosed with schizophrenia is very disturbed and violent. After several doses of haloperidol, the client is calm. Two hours later the nurse sees the client's head rotated to one side in a stiff position, the lower jaw thrust forward, and drooling. Which problem is most likely?
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Which medication should be administered to treat dystonias when oral medication is not an option?
Which medication should be administered to treat dystonias when oral medication is not an option?
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What condition is indicated by grimacing and lip-smacking after receiving fluphenazine decanoate?
What condition is indicated by grimacing and lip-smacking after receiving fluphenazine decanoate?
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What should the nurse say as a therapeutic response when a client laughs uncontrollably?
What should the nurse say as a therapeutic response when a client laughs uncontrollably?
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Which assessment finding would be regarded as a negative symptom of schizophrenia?
Which assessment finding would be regarded as a negative symptom of schizophrenia?
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What assessment findings mark the prodromal stage of schizophrenia?
What assessment findings mark the prodromal stage of schizophrenia?
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What does the client’s statement about 'contagious bacteria' indicate?
What does the client’s statement about 'contagious bacteria' indicate?
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Which intervention has the highest priority for a client starting ziprasidone?
Which intervention has the highest priority for a client starting ziprasidone?
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What type of verbalization is evident when a client with schizophrenia says, 'It's beat. Time to eat. No room for the cat.'?
What type of verbalization is evident when a client with schizophrenia says, 'It's beat. Time to eat. No room for the cat.'?
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A client with schizophrenia continues to show symptoms of apathy and poverty of thought despite treatment. Which medication change would be expected?
A client with schizophrenia continues to show symptoms of apathy and poverty of thought despite treatment. Which medication change would be expected?
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What type of therapy should the nurse recommend for a family unfamiliar with schizophrenia?
What type of therapy should the nurse recommend for a family unfamiliar with schizophrenia?
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What assessment indicates a potential relapse in a client with schizophrenia?
What assessment indicates a potential relapse in a client with schizophrenia?
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How should a nurse document the client's use of the term 'macnabs'?
How should a nurse document the client's use of the term 'macnabs'?
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What does the client’s statement about seeing their body merging with the wall suggest?
What does the client’s statement about seeing their body merging with the wall suggest?
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What is the nurse's priority assessment question when a client hears a voice directing their actions?
What is the nurse's priority assessment question when a client hears a voice directing their actions?
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What condition is indicated by severe muscle stiffness, difficulty swallowing, and elevated vital signs after taking risperidone?
What condition is indicated by severe muscle stiffness, difficulty swallowing, and elevated vital signs after taking risperidone?
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What response indicates concrete thinking when asked about the saying 'You can't judge a book by its cover'?
What response indicates concrete thinking when asked about the saying 'You can't judge a book by its cover'?
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What is the best goal for a psychoeducational group for clients diagnosed with schizophrenia?
What is the best goal for a psychoeducational group for clients diagnosed with schizophrenia?
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What is the nurse's best initial action regarding the client's fear of international authorities due to Facebook's tracking capacity?
What is the nurse's best initial action regarding the client's fear of international authorities due to Facebook's tracking capacity?
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Which finding constitutes a negative symptom associated with schizophrenia?
Which finding constitutes a negative symptom associated with schizophrenia?
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What does the client's ability to 'decipher codes of DNA just by looking at someone' suggest?
What does the client's ability to 'decipher codes of DNA just by looking at someone' suggest?
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What term should the nurse use to document a client's disorganized speech, such as, 'Red chair out town board'?
What term should the nurse use to document a client's disorganized speech, such as, 'Red chair out town board'?
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Study Notes
Schizophrenia Spectrum Disorders
- A client with schizophrenia may have difficulty keeping a job due to arguing with co-workers and accusing them of conspiracy.
- Paranoia is an irrational fear, ranging from mild suspicion to profound belief that someone intends to harm them.
- Clients with schizophrenia perceive the environment as hostile and dangerous.
- Typical antipsychotic drugs can cause sedation and extrapyramidal side effects like stiffness and gait disturbance.
- Hallucinations that indicate a need for safety measures are those that suggest danger to the client or others, such as hearing voices telling the client to harm themselves.
- Clients with schizophrenia may exhibit catatonia, which is a state of immobility and lack of spontaneous movement.
- Physiological needs are the priority for catatonic clients, as they may require assistance with basic activities of daily living like feeding and toileting.
- First-generation antipsychotic medications can cause gynecomastia (enlargement of the breasts), which can affect body image.
- Clients with schizophrenia may benefit from concrete teaching strategies, such as role-playing or problem-solving exercises that use everyday situations.
- Antipsychotic medications are not addictive, but should be discontinued gradually to minimize discontinuation syndrome.
- A client experiencing auditory hallucinations may benefit from reassurance and redirection.
- Pseudoparkinsonism, a side effect of antipsychotic medication, mimics the symptoms of Parkinson's disease.
- Acute dystonic reactions are painful contractions of the tongue, face, neck, and back. They are considered emergencies requiring immediate intervention.
- Tardive dyskinesia is a condition involving involuntary movements of the face, trunk, and limbs and can occur with long-term use of antipsychotic medications.
- Diphenhydramine, trihexyphenidyl, and benztropine are medications used to treat dystonias.
- When a client is experiencing an acute dystonic reaction, administering an anticholinergic medication such as diphenhydramine IM is the most urgent intervention.
- Clients taking long-term antipsychotics may develop tardive dyskinesia, characterized by involuntary movements of the face, tongue, and limbs.
Anticholinergic Effects
- Anticholinergic effects are common side effects of medications.
- They cause dry mouth, blurred vision, flushing, constipation, and dry eyes.
Schizophrenia
- Schizophrenia is a mental illness characterized by disturbances in thought, perception, and behavior.
- Symptoms can be positive (e.g., hallucinations, delusions) or negative (e.g., apathy, social withdrawal).
Assessment
- Negative Symptoms: Poor personal hygiene is a negative symptom of schizophrenia.
- Prodromal Stage: Symptoms of the prodromal stage of schizophrenia include withdrawal, misinterpretation, poor concentration, and preoccupation with religion.
- Paranoia: A client who is fearful about "contagious bacteria" is exhibiting paranoia.
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Verbalizations
- Neologisms: Newly invented words or phrases used by a client, such as "macnabs."
- Associative Looseness: Jumbled thoughts expressed incoherently. Example: "It's beat. Time to eat. No room for the cat."
- Word Salad: Meaningless jumble of words, example: "Red chair out town board."
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Hallucinations: Hallucinations can be auditory, visual, or tactile.
- Command Hallucinations: Auditory hallucinations that tell the client to do something. The priority assessment should be to determine what the command is to ensure patient and others' safety.
- Concrete Thinking: Inability to think abstractly, often assessed through proverbs. Example: "The table of contents tells what a book is about."
- Magical Thinking: The belief that one's thoughts or actions can influence events. Example: "I can decipher codes of DNA just by looking at someone."
Medications
- Second-Generation Antipsychotics: These medications target both positive and negative symptoms of schizophrenia. Examples include olanzapine, ziprasidone.
- Conventional Antipsychotics: These medications target primarily positive symptoms. Examples include haloperidol, chlorpromazine.
- Weight Management: A priority intervention for clients taking second-generation antipsychotics is weight management as these medications often cause weight gain.
- Neuroleptic Malignant Syndrome: A potentially life-threatening condition characterized by muscle rigidity, high fever, altered mental status, autonomic instability (e.g., tachycardia, hypertension). It's a medical emergency that can be caused by antipsychotic medications.
Nursing Interventions
- Psychoeducation: Psychoeducational groups for clients with schizophrenia should focus on topics like medication management, coping skills, and social skills.
- Relapse: Signs of potential relapse include feeling tense, difficulty concentrating, trouble sleeping, increased withdrawal, and increased bizarre or magical thinking.
- Social Isolation: Clients with schizophrenia may benefit from social skills training to improve interpersonal relationships.
- Risk for Other-directed Violence: Clients with schizophrenia who are experiencing delusions of persecution may be at risk for violence.
- Safe Environment: Provide a calm and safe environment for clients experiencing psychosis. Maintain a normal social distance and avoid touching them to avoid triggering panic.
Important Considerations
- Medication Adherence: Adherence to antipsychotic medications is critical for symptom management and maintaining stability.
- Smoking Cessation: Encourage cessation of smoking as it negatively impacts overall health and is often a risk factor in clients with schizophrenia.
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Description
Test your knowledge on schizophrenia spectrum disorders, including symptoms, treatments, and behaviors associated with clients suffering from the condition. This quiz covers various aspects such as paranoia, hallucinations, and the effects of antipsychotic medications.
