Podcast
Questions and Answers
A patient experiencing neuroleptic malignant syndrome (NMS) secondary to antipsychotic medication administration requires immediate intervention. Which of the following pharmacological interventions directly targets the underlying pathophysiology of NMS?
A patient experiencing neuroleptic malignant syndrome (NMS) secondary to antipsychotic medication administration requires immediate intervention. Which of the following pharmacological interventions directly targets the underlying pathophysiology of NMS?
- Administration of intravenous lorazepam to manage acute agitation and prevent potential self-harm.
- Immediate administration of dantrolene and bromocriptine to address muscle rigidity and dopaminergic blockade. (correct)
- Intramuscular injection of benztropine to counteract extrapyramidal symptoms and restore motor control.
- Concurrent administration of propranolol and clonazepam to manage tachycardia and anxiety associated with NMS.
A patient diagnosed with schizophrenia presents with persistent auditory hallucinations despite adherence to an antipsychotic regimen. Which advanced neuroimaging technique would be most useful in differentiating between treatment-resistant hallucinations and structural brain abnormalities?
A patient diagnosed with schizophrenia presents with persistent auditory hallucinations despite adherence to an antipsychotic regimen. Which advanced neuroimaging technique would be most useful in differentiating between treatment-resistant hallucinations and structural brain abnormalities?
- Positron emission tomography (PET) scan with glucose metabolic analysis to detect general areas of neural hypo- or hyper-activity.
- Computed tomography (CT) scan to rule out gross structural abnormalities affecting cerebral perfusion.
- Functional magnetic resonance imaging (fMRI) to assess real-time brain activity patterns associated with hallucination experiences. (correct)
- Electroencephalography (EEG) to identify abnormal cortical electrical activity indicative of seizure disorders.
A patient exhibiting catatonic behavior secondary to schizophrenia demonstrates waxy flexibility. Which advanced nursing intervention is most critical to prevent complications associated with prolonged immobility?
A patient exhibiting catatonic behavior secondary to schizophrenia demonstrates waxy flexibility. Which advanced nursing intervention is most critical to prevent complications associated with prolonged immobility?
- Initiating a bowel management program with regular stool softeners to prevent impaction from decreased peristalsis.
- Administering high-dose benzodiazepines to manage acute agitation and prevent potential self-injury.
- Implementing a strict fluid restriction to prevent potential hyponatremia from psychogenic polydipsia.
- Conducting passive range-of-motion exercises every two hours to prevent contractures and skin breakdown. (correct)
In a patient with schizophrenia experiencing medication-induced metabolic syndrome, which therapeutic approach is most effective for mitigating cardiovascular risk beyond standard dietary and exercise interventions?
In a patient with schizophrenia experiencing medication-induced metabolic syndrome, which therapeutic approach is most effective for mitigating cardiovascular risk beyond standard dietary and exercise interventions?
A patient with schizophrenia displays persistent negative symptoms, particularly avolition and anhedonia, despite optimal antipsychotic management. Which adjunctive pharmacological strategy has the most evidence for improving these specific symptoms?
A patient with schizophrenia displays persistent negative symptoms, particularly avolition and anhedonia, despite optimal antipsychotic management. Which adjunctive pharmacological strategy has the most evidence for improving these specific symptoms?
A patient with a long history of schizophrenia presents with tongue movements and lip smacking. Which intervention is most appropriate?
A patient with a long history of schizophrenia presents with tongue movements and lip smacking. Which intervention is most appropriate?
A patient with schizophrenia is prescribed clozapine. Which laboratory value requires ongoing monitoring due to the risk of a potentially life-threatening side effect?
A patient with schizophrenia is prescribed clozapine. Which laboratory value requires ongoing monitoring due to the risk of a potentially life-threatening side effect?
A patient in the acute phase of schizophrenia exhibits disorganized thinking and delusional beliefs. Which nursing intervention is most therapeutic?
A patient in the acute phase of schizophrenia exhibits disorganized thinking and delusional beliefs. Which nursing intervention is most therapeutic?
Which nursing intervention is most appropriate for a patient experiencing auditory hallucinations?
Which nursing intervention is most appropriate for a patient experiencing auditory hallucinations?
A patient diagnosed with schizophrenia is prescribed haloperidol. The nurse should monitor for which of the following side effects?
A patient diagnosed with schizophrenia is prescribed haloperidol. The nurse should monitor for which of the following side effects?
A patient with schizophrenia is being discharged. What is the most important topic to emphasize in patient and family education?
A patient with schizophrenia is being discharged. What is the most important topic to emphasize in patient and family education?
Which of the following is an example of a negative symptom of schizophrenia?
Which of the following is an example of a negative symptom of schizophrenia?
What is the primary mechanism of action of typical antipsychotic medications?
What is the primary mechanism of action of typical antipsychotic medications?
Which of the following best describes 'word salad' in the context of schizophrenia?
Which of the following best describes 'word salad' in the context of schizophrenia?
What is the typical age range for the onset of schizophrenia?
What is the typical age range for the onset of schizophrenia?
Which phase of schizophrenia is characterized by a gradual onset of symptoms over months to years?
Which phase of schizophrenia is characterized by a gradual onset of symptoms over months to years?
What does the term 'anhedonia' refer to?
What does the term 'anhedonia' refer to?
Which of the following is a key nursing consideration when administering antipsychotic medications?
Which of the following is a key nursing consideration when administering antipsychotic medications?
What is the most appropriate initial nursing intervention when a patient reports hearing voices?
What is the most appropriate initial nursing intervention when a patient reports hearing voices?
A patient is prescribed benztropine (Cogentin). Which side effect of antipsychotic medication is this drug used to treat?
A patient is prescribed benztropine (Cogentin). Which side effect of antipsychotic medication is this drug used to treat?
Which long acting injectable antipsychotic requires a 3 week overlap with oral antipsychotic?
Which long acting injectable antipsychotic requires a 3 week overlap with oral antipsychotic?
Which of the following is NOT a risk factor that is related to relapse in schizophrenia?
Which of the following is NOT a risk factor that is related to relapse in schizophrenia?
A newly admitted patient has a diagnosis of schizoaffective disorder. Which of the following best describes this?
A newly admitted patient has a diagnosis of schizoaffective disorder. Which of the following best describes this?
Which of the following statements best describes the difference between hallucinations and delusions?
Which of the following statements best describes the difference between hallucinations and delusions?
If a patient refuses medication, which of the following is the most appropriate initial nursing action?
If a patient refuses medication, which of the following is the most appropriate initial nursing action?
Which of the following is the priority nursing intervention to use when a patient begins to escalate?
Which of the following is the priority nursing intervention to use when a patient begins to escalate?
The nurse is caring for a client who takes an antipsychotic medication daily. The nurse assesses the client for symptoms of tardive dyskinesia, knowing that this side effect is characterized by which of the following?
The nurse is caring for a client who takes an antipsychotic medication daily. The nurse assesses the client for symptoms of tardive dyskinesia, knowing that this side effect is characterized by which of the following?
A patient with schizophrenia is exhibiting catatonic symptoms. Which assessment finding is most characteristic of catatonia?
A patient with schizophrenia is exhibiting catatonic symptoms. Which assessment finding is most characteristic of catatonia?
Which of the following interventions is the MOST appropriate to use when communicating with a client experiencing auditory hallucinations?
Which of the following interventions is the MOST appropriate to use when communicating with a client experiencing auditory hallucinations?
Which of the following is NOT typically included in patient and family teaching regarding antipsychotic medications?
Which of the following is NOT typically included in patient and family teaching regarding antipsychotic medications?
A client is taking clozapine 300mg PO TID. Which of the following assessment findings would be of MOST concern to the nurse?
A client is taking clozapine 300mg PO TID. Which of the following assessment findings would be of MOST concern to the nurse?
One principle of milieu therapy is that manipulation by clients must be addressed in which of the following ways?
One principle of milieu therapy is that manipulation by clients must be addressed in which of the following ways?
Of the following, what is the most common reason that clients with schizophrenia do not adhere to their medication regiment?
Of the following, what is the most common reason that clients with schizophrenia do not adhere to their medication regiment?
Which of the following defense mechanisms does a patient use when claiming that they are the president - despite not being the president?
Which of the following defense mechanisms does a patient use when claiming that they are the president - despite not being the president?
Which of the following is not an action that a nurse would implement for a patient who is experiencing command hallucinations?
Which of the following is not an action that a nurse would implement for a patient who is experiencing command hallucinations?
Which of the following statements would indicate that the patient has a good understanding of relapse prevention?
Which of the following statements would indicate that the patient has a good understanding of relapse prevention?
Flashcards
Schizophrenia Definition
Schizophrenia Definition
Derived from Greek words meaning "split mind," first identified by Dr. Bleuler in 1911.
Schizophrenia Epidemiology
Schizophrenia Epidemiology
Typically occurs between 15-25 years old, Affects 1% of the population, More common in men than women, High rates of unemployment, homelessness, incarceration, and suicide, Leading cause of disability among 15-44-year-olds.
Delusions
Delusions
False beliefs (paranoia, grandiosity, somatic)
Hallucinations
Hallucinations
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Disorganized Thinking
Disorganized Thinking
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Abnormal Motor Behavior
Abnormal Motor Behavior
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Affective Flattening
Affective Flattening
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Avolition
Avolition
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Anhedonia
Anhedonia
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Alogia
Alogia
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Social Withdrawal
Social Withdrawal
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Premorbid Schizophrenia Phase
Premorbid Schizophrenia Phase
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Prodromal Schizophrenia Phase
Prodromal Schizophrenia Phase
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Active Schizophrenia Phase
Active Schizophrenia Phase
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Residual Schizophrenia Phase
Residual Schizophrenia Phase
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Nursing: Hallucinations
Nursing: Hallucinations
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Nursing: Delusions
Nursing: Delusions
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Nursing: Communication
Nursing: Communication
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Nursing: Safety First
Nursing: Safety First
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Typical Antipsychotics Mechanism
Typical Antipsychotics Mechanism
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Typical Antipsychotics Side Effects
Typical Antipsychotics Side Effects
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Atypical Antipsychotics Mechanism
Atypical Antipsychotics Mechanism
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Atypical Antipsychotics Side Effects
Atypical Antipsychotics Side Effects
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Nursing: Medications
Nursing: Medications
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WBC Count significance
WBC Count significance
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Glucose (Fasting) significance
Glucose (Fasting) significance
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Lipid Panel significance
Lipid Panel significance
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Liver Function significance
Liver Function significance
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Electrolytes significance
Electrolytes significance
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Extrapyramidal Symptoms
Extrapyramidal Symptoms
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Neuroleptic Malignant Syndrome
Neuroleptic Malignant Syndrome
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Psychosocial Interventions
Psychosocial Interventions
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Study Notes
- Schizophrenia comes from Greek words that mean "split mind"
- Dr. Bleuler first identified Schizophrenia in 1911
Epidemiology & Characteristics
- Schizophrenia diagnoses typically occur between ages 15 and 25
- Schizophrenia affects 1% of the population
- Schizophrenia is more common in men than women
- Schizophrenia is correlated with high rates of unemployment, homelessness, incarceration, and suicide
- Schizophrenia is a leading cause of disability among 15-44 year olds
Signs and Symptoms
- Positive Symptoms are excesses or distortions of normal functions
- Delusions are false beliefs (paranoia, grandiosity, somatic)
- Hallucinations are sensory experiences without external stimuli (auditory, visual, tactile, gustatory, olfactory)
Disorganized Thinking examples
- Associative Looseness
- Neologisms (made-up words)
- Clang Associations (rhyming words)
- Word Salad (random words without meaning)
Disorganized/Abnormal Motor Behavior examples
- Catatonia
- Bizarre posturing
- Waxy flexibility
Negative Symptoms
- Negative Symptoms are the loss of normal function
- Affective Flattening is reduced emotional expression
- Avolition is lack of motivation
- Anhedonia is the inability to experience pleasure
- Alogia is reduced speech output
- Social Withdrawal is poor social functioning
Phases of Schizophrenia
- Premorbid Phase includes social withdrawal and poor relationships
- Prodromal Phase includes a gradual onset of symptoms over months or years
- Active Phase means psychotic symptoms dominate
- Residual Phase is when symptoms lessen but may persist
Nursing Interventions for Hallucinations
- Acknowledge hallucinations, but do not reinforce them
- Provide reality-based responses
- Minimize stimuli
- Encourage distraction techniques
Nursing interventions for Delusions
- Do not challenge beliefs
- Reinforce reality
- Establish trust and consistency
Nursing interventions for Communication
- Use simple, direct language
- Provide structure and routine
Nursing interventions for Safety Considerations
- Suicide precautions if necessary
- Monitor for self-harm or aggression
- Ensure medication adherence
Antipsychotic Medications
- Typical (First-Generation) antipsychotics block dopamine receptors (D2)
- Examples of Typical Antipsychotics: Haloperidol (Haldol), Chlorpromazine (Thorazine), and Fluphenazine (Prolixin)
- Side Effects of Typical Antipsychotics: Extrapyramidal Symptoms (EPS), Tardive Dyskinesia, and Neuroleptic Malignant Syndrome (NMS)
Atypical (Second-Generation) Antipsychotics
- Atypical (Second-Generation) antipsychotics block dopamine and serotonin receptors
- Examples of Atypical Antipsychotics: Clozapine (Clozaril), Risperidone (Risperdal), Olanzapine (Zyprexa), and Aripiprazole (Abilify)
- Clozapine (Clozaril) requires WBC monitoring for agranulocytosis
Side effects of Atypical Antipsychotics
- Weight gain and metabolic syndrome
- Hyperglycemia
- Less risk of EPS
Nursing Considerations for Medications
- Monitor vital signs (BP, HR)
- Assess for EPS (akathisia, dystonia, tardive dyskinesia)
- Monitor CBC & WBC (especially with Clozapine)
- Educate on medication adherence and potential side effects
Lab Values to Monitor
- WBC Count normal range: 4,500 - 11,000/mm³, monitor for agranulocytosis (Clozapine)
- Glucose (Fasting) normal range: 70 - 100 mg/dL, watch for Hyperglycemia risk with atypicals
- Lipid Panel normal range: LDL < 100, HDL > 40, Triglycerides < 150, monitor for metabolic syndrome
- Liver Function normal range: AST (10-40 U/L), ALT (7-56 U/L), monitor for hepatotoxicity
- Electrolytes normal range: Na+ (135-145), K+ (3.5-5.0), monitor for imbalances
Side Effects & Management
- EPS (Extrapyramidal Symptoms) include tremors, rigidity, akathisia, dystonia managed with Benztropine (Cogentin) or Diphenhydramine (Benadryl)
- Tardive Dyskinesia includes involuntary movements and lip smacking managed by discontinuing offending drug, switching to atypical antipsychotic
- Neuroleptic Malignant Syndrome (NMS) includes fever, rigidity, altered mental status managed by stopping the medication, administer Dantrolene & Bromocriptine
- Metabolic Syndrome includes weight gain, diabetes, dyslipidemia managed by diet, exercise, blood glucose levels
Psychosocial Interventions
- Cognitive Behavioral Therapy (CBT)
- Social Skills Training
- Family Education & Therapy
- Assertive Community Treatment (PACT)
- Milieu Therapy (Therapeutic Environment)
Patient & Family Education
- Importance of medication adherence
- Recognizing early signs of relapse
- Managing stress & coping skills
- Avoiding substance abuse which can trigger psychotic episodes
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