Videbeck Ch.16 Schizophrenia - Textbook

Videbeck Ch.16 NCLEX-Style Chapter Review Questions

1. The nurse documents that the client is exhibiting negative symptoms of schizophrenia when observing the client doing what? Select all that apply.

a. Repeatedly turning down invitations to join in unit activities

b. Threatening to "slap anyone that bothers my stuff."

c. Talking very quietly

d. Walking in circles around the unit exhausted

e. Being unable to explain the phrase, "raining like cats and dogs."

a,e

Repeatedly turning down invitations to join in unit activities, Being unable to explain the phrase, "raining like cats and dogs."

Emotional isolation and a lack of abstract thinking are negative symptoms since they represents a lack of a normal function.

Videbeck Ch.16 NCLEX-Style Chapter Review Questions

2. A client is watching the news and tells the nurse that the newscaster is sending a message to him. What term is used to identify this symptom?

a. flight of idea

b. hallucination

c. idea of reference

d. delusion

c

idea of reference

Ideas of reference refers to the mistaken belief that external events have special meaning to the individual, such as the television newscaster sending a message directly to the individual. A delusion is a false belief. A hallucination is a sensory perception, such as hearing voices and seeing objects, that only the client experiences. Flight of ideas is a speech pattern in which the client skips from one unrelated subject to another.

Videbeck Ch.16 NCLEX-Style Chapter Review Questions

3. A client has been taking neuroleptic medications for many years as a treatment for schizophrenia. The client is exhibiting tongue protrusion, facial grimacing, and excessive blinking. These manifestations are characteristic of which extrapyramidal side effects (EPS).

a. Neuroleptic malignant syndrome

b. Dystonia

c. Tardive Dyskinesia

d. Akathisia

c

Tardive Dyskinesia

Unusual movements of the tongue, neck, and arms suggest tardive dyskinesia, an adverse reaction to neuroleptic medication. Dystonia is characterized by cramps and rigidity of the tongue, face, neck, and back muscles. Neuroleptic malignant syndrome causes rigidity, fever, hypertension, and diaphoresis. Akathisia causes restlessness, anxiety, and jitteriness.

Videbeck Ch.16 NCLEX-Style Chapter Review Questions

4. A client with schizophrenia is hearing voices that tell him to kill himself. What term is used to identify this type of false sensory perception?

a. Flight of ideas

b. Hallucination

c. Delusion

d. Ideas of reference

b

Hallucination

A hallucination is a sensory perception, such as hearing voices and seeing objects, that only the client experiences. A delusion is a false belief. Flight of ideas refers to the mistaken belief that someone or something outside the client is controlling the client's ideas or behavior.

Videbeck Ch.16 NCLEX-Style Chapter Review Questions

5. A client diagnosed with schizophrenia has been prescribed clozapine (Clozaril). Which of the following is a potentially fatal side effect of this medication?

a. Dystonia

b. Tardive dyskinesia

c. Neuroleptic malignant syndrome

d. Agranulocytosis

d

Agranulocytosis

Agranulocytosis is manifested by a failure of the bone marrow to produce adequate white blood cells. Neuroleptic malignant syndrome is a life-threatening reaction to neuroleptic medication that requires immediate treatment. Tardive dyskinesia causes involuntary movements of the tongue, mouth, facial muscles, and arm and leg muscles. Dystonia is characterized by cramps and rigidity of the tongue, face, neck, and back muscles.

Videbeck Ch.16 NCLEX-Style Chapter Review Questions

6. Cients receiving clozapine (Clozaril) must get white blood cell counts drawn every..

a. Year

b. 3 months

c. 6 months

d. Week for the first 6 months

d

Week for the first 6 months

Clients taking this antipsychotic must have weekly white blood cell counts for the first 6 months of clozapine therapy and every 2 weeks thereafter.

Videbeck Ch.16 NCLEX-Style Chapter Review Questions

7. Which of the following is a nonneurologic side effect of antipsychotic medications?

a. Seizures

b. Weight Gain

c. Akathisia

d. Dystonia

b

Weight Gain

Weight gain is a nonneurologic side effect of antipsychotic medications.

Videbeck Ch.16 NCLEX-Style Chapter Review Questions

8. Which medication classification has been most effective in treating akathisia?

a. Antimanics

b. Antianxiety

c. Beta-Blockers

d. Sedatives

c

Beta-Blockers

Beta-Blockers, such as propranolol,, have been most effective in treating akathisia.

Videbeck Ch.16 NCLEX-Style Chapter Review Questions

9. A client diagnosed with schizophrenia states, "I want to go home, go home, go home." This is an example of which of the following speech patterns?

a. Neologisms

b. Verbigeration

c. Clang association

d. Word salad

b

Verbigeration

A verbigeration is the stereotyped repetition of words or phrases that may or may not have meaning to the listener. Clang associations are ideas that are related to one another based on sound or rhyming rather than meaning. Neologisms are words invented by the client. A word salad is a combination of jumbled words and phrases that are disconnected or incoherent and make no sense to the listener.

Videbeck Ch.16 NCLEX-Style Chapter Review Questions

10. The nurse is assigned to a client with catatonic schizophrenia. Which intervention should the nurse include in the client's care plan?

a. Giving the client an opportunity to express concerns

b. Meeting all of the client's physical needs

c. Providing a quiet environment where the client can be alone

d. Administering lithium carbonate (Lithonate) as prescribed.

b

Meeting all of the client's physical needs

Meeting all of the client's physiologic needs is most important because clients with catatonic schizophrenia cannot meet their own needs by themselves. Clients with catatonic schizophrenia are unable to express their concerns. Lithium is used for the manic phase of bipolar disorder. The nurse needs to give support to the client and be present for him or her as reassurance.

Videbeck Ch.16 NCLEX-Style Chapter Review Questions

11. A client diagnosed with schizophrenia states to the nurse, "My intestines are being eaten by snakes." This statement represents which type of delusion?

a. Grandiose delusion

b. Referential delusion

c. Somatic delusion

d. Persecutory delusion

c

Somatic delusion

Somatic delusions are generally vague and unrealistic beliefs about the client's health or bodily functions. Persecutory delusions involve the client's belief that "others" are planning to harm the client or are spying, following, or belittling the client in some way. Grandiose delusions are characterized by the client's claim to associated with famous people or celebrities or the client's belief that he or she is famous or capable of great feats. Referential delusions or ideas of reference involve the client's belief that television broadcasts, music, or newspaper articles have special meaning fro him or her.

Videbeck Ch.16 NCLEX-Style Chapter Review Questions

12. Which of the following medications is used to control the extrapyramidal effects associated with antipsychotic medications?

a. Thioridazine (Mellaril)

b. Benzotropine (Cogentin)

c. Haloperidol (Haldol)

d. Chlopromazine (Thorazine)

b

Benzotropine (Cogentin)

Cogentin is an anticholinergic drug used to relieve drug-induced extrapyramidal adverse effects, such as muscle weakness, involuntary muscle movement, pseudoparkinsonism, and tardive dyskinesia.

Videbeck Ch.16 NCLEX-Style Chapter Review Questions

13. A client is being seen in the health clinic. The nurse observes a shuffling gait, drooling, and slowness of movement. The client is currently taking an antipsychotic for treatment of schizophrenia. The nurse knows that which of the following side effects is occurring?

a. Dystonic movements

b. Akathisia

c. Pseudoparkinsonism

d. Neuroleptic malignant syndrome

c

Pseudoparkinsonism

Pseudoparkinsonism is exhibited by a shuffling gait, drooling, and slowness of movement. Dystonia is characterized by cramps and rigidity of the tongue, face, neck, and back muscles. Akathisia causes restlessness, anxiety, and jitteriness. Neuroleptic malignant syndrome causes rigidity, fever, hypertension, and diaphoresis.

Videbeck Ch.16 NCLEX-Style Chapter Review Questions

14. A client diagnosed with schizophrenia tells the nurse, "I hear the voice of Elvis." Which of the following is the most therapeutic response by the nurse?

a. "I don't hear the voice, but I know you hear what sounds like a voice."

b. "You shouldn't focus on Elvis' voice."

c. "You know that Elvis has been dead for years."

d. "Don't worry about the voice as long as it doesn't belong to anyone real."

a

"I don't hear the voice, but I know you hear what sounds like a voice."

Acknowledging that the client hears what sounds like a voice states reality about the client's hallucination. The other options are judgmental and demeaning.

Videbeck Ch.16 NCLEX-Style Chapter Review Questions

15. Which of the following speech pattern is exhibited by the client stating, "I will take a pill if I go up the hill but not if my name is Jill, I don't want to kill?"

a. Clang association

b. Verbigeration

c. Neologism

d. Word salad

a

Clang association

Clang associations are ideas that are related to one another based on sound or rhyming rather than meaning. Neologisms are words invented by the client. A verbigeration is the stereotyped repetition of words or phrases that may or may not have meaning to the listener. A word salad is a combination of jumbled words and phrases that are disconnected or incoherent and make no sense to the listener.

Videbeck Ch.16 NCLEX-Style Chapter Review Questions

16. What term is used to describe the speech pattern being used when the client imitates or repeats what the nurse is saying?

a. Word salad

b. Echolalia

c. Neologisms

d. Clang associations

b

Echoliallia

Echolalia is the client's imitation or repetition of what the nurse says. Neologisms are words invented by the client. Clang associations are ideas that are related to one another based on sound or rhyming rather than meaning. A word salad is a combination of jumbled words and phrases that are disconnected or incoherent and make no sense to the listener.

Videbeck Ch.16 NCLEX-Style Chapter Review Questions

17. The nurse notes that a client with schizophrenia sits in a chair rocking back and forth. What does the nurse recognizes this as?

a. Catatonic excitement

b. A sign of anxiety

c. Catatonic stupor

d A side effect of medication

a

Catatonic excitement

In catatonic excitement, clients may show uncontrolled and aimless motor activity. They may engage in in repetitive stereotypic movements with no apparent purpose, such as rocking back and forth for hours. Clients also may manifest normal mannerisms out of context, such as grimacing for no reason.

Videbeck Ch.16 NCLEX-Style Chapter Review Questions

18. The nurse is evaluating the plan of care for a client with schizophrenia. Which of the following observations best suggest that the plan has been effective?

a. The client reports that she no longer has hallucinations.

b. The client no longer believes that she has special powers.

c. The client has been compliant with taking her medications and attending therapy session.

d. The client has resumed employment had has been attending social functions at the community center.

d

The client has resumed employment had has been attending social functions at the community center.

Major goals for the care of a client with schizophrenia are to experience improved thought processes and fewer psychotic symptoms, to not engage in violent behavior, to acquire improved social skills and engage in satisfying social interaction, and to gain knowledge about the disease process and treatment.

Videbeck Ch.16 NCLEX-Style Chapter Review Questions

19. A client tells the nurse she has bugs in her brain and asks the nurse if she can see them. Which of the following responses by the nurse is most therapeutic?

a. "You have a though disorder and only think you have bugs in your brain. There really aren't any. You don't have to worry because we would give you medicine for any medical problems."

b. "No, I don't see any bugs. That sounds scary for you."

c. "Your thinking is a little illogical. I wouldn't be able to see bugs if they were inside your brain. Would you like to talk more about this?"

d. "No, I don't see any bugs. Are you seeing bugs or hearing unusual sounds or voices?"

b

"No, I don't see any bugs. That sounds scary for you."

The person who hallucinates is preoccupied and frightened by what he or she hears or sees. The hallucination is real to the client, and the nurse cannot argue away, dismiss, or ignore it. Although the hallucination is real to the client, nurses make it clear that they do not hear the voices or see the visual images. Nurses do, however, communicate concern that the client is bothered, upset, or frightened by the hallucination.

Videbeck Ch.16 NCLEX-Style Chapter Review Questions

20. Which of the following is an appropriate intervention for a client having auditory hallucinations?

a. Encourage the client to discuss the content of the hallucinations with staff as they occur.

b. Tell the client to talk back to the voices and tell them to go away.

c. Ask the client to keep a journal about what the voices tell him and to bring the journal to therapy sessions.

d. Encourage the client to spend quiet time alone until hallucinations cease.

b

Tell the client to talk back to the voices and tell them to go away.

Interventions for managing hallucinations include dismissal intervention (i.e., telling the voices to go away), various coping strategies (e.g., jogging, telephoning, playing games, seeking out others, employing relaxation techniques), or competing stimuli (e.g., listening to music or another's or one's own voice to overcome auditory hallucinations, and visual stimuli to overcome visual hallucinations).

Videbeck Ch.16 NCLEX-Style Chapter Review Questions

21. A married couple arrives at the outpatient clinic. Upon assessment, the nurse finds that the couple believes that the police have been following them and tapping their phones for 2 months. This couple most likely suffers from which of the following disorders?

a. Psychotic disorder NOS

b. Conjugal delusion

c. Folie a deux

d. Delusional disorder, paranoid type

c

Folie a deux

Share psychotic disorder, or folie a deux, involves two individuals who have a close relationship and share the same delusion. This occurrence is attributed to the strong influence of the more dominant person. It is seen more frequently in women who are isolated by language, culture, or geography. Such persons are often related by blood or marriage and have lived together for an extended period of time. Contributing factors include old age, low intelligence, sensory impairment, cerebrovascular disease, and alcohol abuse. This disorder has been diagnosed in twins and individuals, both of whom had a chronic psychotic disorder. This disorder also has occurred in a group of individuals or in families in which the parent is the primary case (inducer).

Videbeck Ch.16 NCLEX-Style Chapter Review Questions

22. A client who has a major depressive episode tells the nurse that, for the past two weeks, he has been hearing voices and at times thinks that someone is following him. A history reveals that he has had these alternating symptoms before. He also has experienced time with neither of these symptoms and has been able to function adequately. The nurse interprets these findings as suggesting which of the following?

a. Brief psychotic disorder

b. Schizoaffective disorder

c. Paranoid schizophrenia

d. Undifferentiated schizophrenia

b

Schizoaffective disorder

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 affect.

Videbeck Ch.16 NCLEX-Style Chapter Review Questions

23. 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 his ability to function at work. He also is exhibiting catatonic excitement, echopraxia, loose associations, and pressured speech. The nurse suspects which of the following?

a. Schizoaffective disorder

b. Schizophrenia

c. Schizophreniform disorder

d. Brief Psychotic disorder

c

Schizophreniform disorder

The essential features of the schizophreniform disorder are identical to those of criteria A for schizophrenia (delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, 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, hallucination, disorganized speech, disorganized or catatonic behavior, or negative symptoms.

Videbeck Ch.16 NCLEX-Style Chapter Review Questions

24. A client is being released from the inpatient psychiatric unit with a diagnosis of schizophrenia and treatment with antipsychotic medications. After teaching the client and family about managing the disorder, the nurse determines that the education was effective when they state that which of the following should be reported immediately?

a. Tremor

b. Weight gain

c. Decreased blood pressure

d. Elevated temperature

d

Elevated temperature

Clients receiving antipsychotic therapy need to be alerted to the potential for complications, including neuroleptic malignant syndrome, a life-threatening condition that can occur with antipsychotic agents. This syndrome is manifested by severe muscle rigidity and elevated temperature that can rapidly accelerate. The nurse should instruct the client to seek immediate care if an elevated temperature develops. Tremor also should be reported, but this is not a life-threatening manifestation. Decreased blood pressure and weight gain can occur with antipsychotic agents, but these are not life threatening.

Videbeck Ch.16 NCLEX-Style Chapter Review Questions

25. A client diagnosed with schizoaffective disorder and severe depression is being treated with antipsychotic medications. The client tells the nurse about difficulty with self-care activities. with which of the following interventions should the nurse respond?

a. contact the physician for a change in medications

b. gain assistance from family members

c. outline the side effects of the medications

d. establish a routine and set goals

d

establish a routine and set goals

The most useful approach for the nurse to try is to help the client establish a routine and set goals for accomplishing the activities of daily living.

Videbeck Ch.16 NCLEX-Style Chapter Review Questions

26. The client with delusional disorder may neglect hygiene because of which of the following delusions?

a. Persecutory

b. Grandiosity

c. Somatic

d. Erotomanic

a

Persecutory

A client may neglect personal hygiene as a result of deterioration in functional ability or delusions of persecution. If a client believes someone is trying to poison him, for example, he may be reluctant to use toothpaste, soaps, deodorants, and other hygiene products.

Videbeck Ch.16 NCLEX-Style Chapter Review Questions

27. A nurse who works in a psychiatry unit finds that young clients with schizophrenia have worse prognoses when compared with clients who are diagnosed later in life. Which of the following reasons should lead the nurse to make this observation? Select all that apply.

a. Have less sense of personal identity

b. Are less likely to have experiences of independent living

c. Are less adherent to the treatment schedule

d. Are inherently more susceptible to receive a poor prognosis

e. Are not able to accurately communicate their issues and concerns.

a,b,d

Have less sense of personal identity, Are less likely to have experiences of independent living, Are inherently more susceptible to receive a poor prognosis

Young clients with schizophrenia have a poor prognosis when compared with older clients. Possibly reasons include that young clients have a less developed sense of personal identity and have not had experiences of successful independent living. Differences in treatment adherence are not related to age. Difficulty in communicating problems dose not depend on the age of the client. Age at onset appears to be an important factor in how well the client fares: those who develop the illness earlier show worse outcomes than those who develop it later.

Videbeck Ch.16 NCLEX-Style Chapter Review Questions

28. A client with schizophrenia is exhibiting disorganized behavior. Which of the following would the nurse most likely observe?

a. Neologism

b. Tangentiality

c. Echolalia

d. Echopraxia

d

Echopraxia

Echopraxia, or the involuntary imitation of another person's movements and gestures, is a disorganized behavior. Neologism, echolalia, and tangeniality reflect disorganized thinking.

Videbeck Ch.16 NCLEX-Style Chapter Review Questions

29. Which of the following statements best reflects schizoaffective disorder?

a. Delusions are present but hallucinations are absent.

b. Clients are often misdiagnosed as having schizophrenia.

c. Mood symptoms must occur consistently positive symptoms

d. The symptoms typically run a fairly constant course.

b

Clients are often misdiagnosed as having schizophrenia.

Mental health providers find schizoaffective (SAD) difficult to conceptualize, diagnose, and treat because of the variable clinical course. Clients are often misdiagnosed as having schizophrenia. To be diagnosed with SAD, a 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 (e.g., diminished emotional expression, alogia, or avolition). In addition, the positive symptoms (delusions or hallucinations) must be present without the mood symptoms at some time during this period (for at least 2 weeks).

Videbeck Ch.16 NCLEX-Style Chapter Review Questions

30. A nurse is developing a plan of care for a client diagnosed with delusional disorder. Which of the following would the nurse need to keep in mind?

a. Psychopharmacologic agents are quite helpful in alleviating the delusions.

b. The delusions have probably just recently developed.

c. Clients with delusional disorder typically have problems with medication adherence.

d. Female clients with delusional disorder often act on their delusions.

c

Clients with the delusional disorder typically have problems with medication adherence.

By the time a client with a diagnosis of the delusional disorder is seen in a psychiatric setting, he or she has generally had the delusion for a long time. It is deeply ingrained and many times unshakable even with psychopharmacologic intervention. These clients rarely comply with medication regimens. Male clients who have the erotomanic subtype are more likely to require special care because they are more likely than other clients to act on their delusions (for example, by continued attempts to contact the loved object or stalking).

Videbeck Ch.16 NCLEX-Style Chapter Review Questions

31. The nurse suspects that a client is experiencing a brief psychotic pisode based on which of the following? Select all that apply.

a. Gradual onset of symptoms

b. Mild confusion

c. Evidence of hallucinations

d. Recent life stressor

e. Intense changes in affect

c,d,e

Evidence of hallucinations, Recent life stressor, Intense changes in affect

In brief psychotic disorder, the length of the episode is at least 1 day but less than 1 month. The onset is sudden and includes at least one of the positive symptoms of criteria A for schizophrenia (delusions or hallucinations). The person generally experiences overwhelming confusion and rapid, intense shifts of affect (APA, 2013). Brief psychotic disorder can often occur in the context of a recent life stressor such as giving birth.

Videbeck Ch.16 Chapter Study Guide pg.293-294

Multiple Choice Questions

1. The family of a client with schizophrenia asks the nurse about the difference between conventional and atypical antipyschotic medications. The nurse's answer is based on which of the following?

a. Atypical antipsychotics are newer medications but act in the same ways as conventional antipsychotics.

b. Atypical antipsychotics are newer medications but act in the same ways as conventional antipsychotics.

c. Conventional antipsychotics have serious side effects; atypical antipsychotics have virtually no side effects.

d. Atypical antipsychotics are dopamine and serotonin antagonists; conventional antipsychotics are only dopamine antagonists.

d

Atypical antipsychotics are dopamine and serotonin antagonists; conventional antipsychotics are only dopamine antagonists.

Videbeck Ch.16 Chapter Study Guide pg.293-294

Multiple Choice Questions

2. The nurse is planning discharge teaching for a client taking clozapine (Clozaril). Which of the following is essential to include?

a. Caution the client not to be outdoors in the sunshine without protective clothing.

b. Remind the client to go to the lab to have blood drawn for a white blood cell count.

c. Instruct the client about dietary restrictions.

d. Give the client a chart to record the daily pulse rate.

b

Remind the client to go to the lab to have blood drawn for a white blood cell count.

Videbeck Ch.16 Chapter Study Guide pg.293-294

Multiple Choice Questions

3. The nurse is caring for a client who has been taking fluphenazine (Prolixin) for 2 days. The client suddenly cries out, his neck twists to one side, and his eyes appear to roll back in the sockets. The nurse finds the following PRN medications ordered for the client. Which one should the nurse administer?

a. Benztropine (Cogentin), 2 mg PO, bid, PRN

b. Fluphenazine (Prolixin), 2 mg PO, tid, PRN

c. Haloperidol (Haldol), 5 mg IM, PRN ectreme agitation

d. Diphenhydramine (Benadryl), 25 mg IM, PRN

d

Diphenhydramine (Benadryl), 25 mg IM, PRN

Videbeck Ch.16 Chapter Study Guide pg.293-294

Multiple Choice Questions

4. Which of the following statements would indicate that family teaching about schizophrenia had been effective?

a. "If our son takes his medication properly, he won't have another psychotic episode."

b. "I guess we'll have to face the fact that our daughter will eventually be institutionalized."

c. "It's a relief to find out that we did not cause our son's schizophrenia."

d. "It is a shame our daughter will never be able to have children."

c

"It's a relief to find out that we did not cause our son's schizophrenia."

Videbeck Ch.16 Chapter Study Guide pg.293-294

Multiple Choice Questions

5. When the client describes fear of leaving his apartment as well as the desire to get out and meet others, it is called

a. ambivalence

b. anhedonia

c. alogia

d. avoidance

a

ambivalence

Videbeck Ch.16 Chapter Study Guide pg.293-294

Multiple Choice Questions

6. The client who hesitates 30 seconds before responding to any question is described as having

a. blunted affect

b. latency of response

c. Paranoid delusions

d. poverty of speech

b

latency of response

Videbeck Ch.16 Chapter Study Guide pg.293-294

Multiple Choice Questions

7. The overall goal of psychiatric rehabilitation is for the client to gain

a. control of symptoms

b. freedom from hospitalization

c. management of anxiety

d. recovery from the illness

d

Recovery from the illness

Videbeck Ch.16 Chapter Study Guide pg.293-294

Multiple-Response Questions. Select all that apply.

1. A teaching plan for the client taking an antipsychotic medication will include which of the following?

a. Apply sun block lotion before going outdoors.

b. Drink sugar-free beverages for dry mouth.

c. Have serum blood levels drawn once a month.

d. Rise slowly from a sitting position.

e. Skip any dose that is not taken on time.

f. Take medication with food to avoid nausea.

a,b,d

Apply sunblock lotion before going outdoors, Drink sugar-free beverages for dry mouth, Rise slowly from a sitting position

Videbeck Ch.16 Chapter Study Guide pg.293-294

Multiple-Response Questions. Select all that apply.

2. Which of the following are considered to be positive signs of schizophrenia?

a. Anhedonia

b. Delusions

c. Hallucinations

d. Disorganized thinking

e. Illusions

f. Social withdrawal

b,c,d

Delusions, Hallucinations, Disorganized thinking

Videbeck Ch.16 Chapter Study Guide pg.293-294

Clinical Example

John Jones, 33, has been admitted to the hospital for the third time with a diagnosis of paranoid schizophrenia. John had been taking haloperidol (Haldol) but stopped taking it weeks ago, telling his case manager it was "the poison that is making me sick." Yesterday, John was brought to the hospital after neighbors called the police because he had been up all night yelling loudly in his apartment. Neighbors reported him saying, "I can't do it! They don't deserve to die!" and similar statements.

John appears guarded and suspicious and has very little to say to anyone. His hair is matted, he has a strong body odor, and he is dressed in several layers of heavy clothing even though the temperature is warm. So far, John has been refusing any offers of food or fluids. When the nurse approached John with a dose of haloperidol, he said, "Do you want to to die?"

1. What additional assessment data dose the nurse need to plan care for John?

Additional assessment data (examples): discover the content of any command hallucinations; ask about preferences for hygiene (e.g., shower or bath); and determine whether there is a thing or place that makes him feel safe and secure.

Videbeck Ch.16 Chapter Study Guide pg.293-294

Clinical Example

2. Identify the three priorities, nursing diagnoses, and expected outcomes for John's care, with your rationales for the choices.

Disturbed thought processes: client will have 5-minute interactions that are reality based; client will express feelings and emotions.

Ineffective therapeutic regimen management (medication refusal): client will take medication as prescribed; client will verbalize difficulties in following medication regimen.

Self-care deficit: client will shower or bathe, wash hair and clean clothes every other day; client will wear appropriate clothing for the weather or activity.

Videbeck Ch.16 Chapter Study Guide pg.293-294

Clinical Example

3. Identify at least two nursing interventions for the three priorities listed above.

Disturbed thought process: engage client in present, here-and-now topics not related to delusional ideas; focus on client's emotions and feelings.

Ineffective therapeutic regimen management: offer scheduled medications in a matter-of-fact manner; allow client to open unit-dose packets; assess for side effects, and give medications or provide nursing interventions to relieve side effects; provide factual information to the client: "This medication will decrease the voices you're hearing."

Self-care deficit: provide supplies and privacy for hygiene activities; give feedback about body odor, dirty clothes, and so forth; help client store extra clothing where he has access to it and believes it is safe.

Videbeck Ch.16 Chapter Study Guide pg.293-294

Clinical Example

4. What community referrals or supports might be beneficial for John when he is discharged?

John might benefit from a case manager in the community and a community support program or a clinic for possible depot injections of his medication.