Chapter 15: Schizophrenia Part 2

Neuroleptic malignant syndrome (NMS)

occurs in about 0.2% to 1% of people who have taken conventional antipsychotic medications, although it can occur with atypical medication as well. Acute reduction in brain dopamine activity plays a role in its development. NMS is a life-threatening medical emergency and is fatal in about 10% of cases. It can occur any time during treatment.

NMS is characterized by reduced consciousness, increased muscle tone (muscular rigidity), and autonomic dysfunction, including hyperpyrexia, labile hypertension, tachycardia, tachypnea, diaphoresis, and drooling. Treatment consists of early detection, discontinuation of the antipsychotic, management of fluid balance, temperature reduction, and monitoring for complications.

Mild cases of NMS may be treated with benzodiazepines, vitamins E and B6, or bromocriptine.

Agranulocytosis is a serious, potentially fatal, adverse effect. Liver impairment may also occur

Anticholinergic-induced delirium

is a potentially life-threatening adverse effect usually seen in older persons, although it can occur in younger people as well. It is also seen in patients taking multiple antipsychotic medications.

Paranoia

an irrational suspiciousness or distrust of others

Projection is the

most common defence mechanism used in paranoia: when individuals with paranoia feel angry (or self-critical), they project the feeling onto others and believe that others are angry with (or harshly critical toward) them, as if to say, “I’m not angry—you are!”

excited phase of catatonia

During the excited stage of catatonia, the patient is in a state of greatly increased motor activity. They may talk or shout continually and incoherently, requiring the nurse's communication to be clear, direct, and loud (enough to focus the patient's attention on the nurse) and to reflect concern for the safety of the patient and others.

A person who is constantly and intensely hyperactive can become completely exhausted and be at risk of death if medical attention is not available.

1. Which characteristic in an adolescent female is sometimes associated with the prodromal phase of schizophrenia?

a. Always afraid another student will steal her belongings.

b. An unusual interest in numbers and specific topics.

c. Demonstrates no interest in athletics or organized sports.

d. Appears more comfortable among males.

a. Always afraid another student will steal her belongings.

2. Which nursing intervention is particularly well chosen for addressing a population at high risk for developing schizophrenia?

a. Screening a group of males between the ages of 15 and 25 for early symptoms.

b. Forming a support group for females ages 25 to 35 who are diagnosed with substance use issues.

c. Providing a group for patients between the ages of 45 and 55 with information on coping skills that have proven to be effective.

d. Educating the parents of a group of developmentally delayed 5- to 6-year-olds on the importance of early intervention.

a. Screening a group of males between the ages of 15 and 25 for early symptoms.

3. To provide effective care for the patient diagnosed with schizophrenia, the nurse should frequently assess for which associated conditions? Select all that apply.

a. Alcohol use disorder.

b. Major depressive disorder.

c. Stomach cancer.

d. Polydipsia.

e. Metabolic syndrome.

a. Alcohol use disorder.

b. Major depressive disorder.

d. Polydipsia.

e. Metabolic syndrome.

4. A female patient diagnosed with schizophrenia has been prescribed a first-generation antipsychotic medication. What information should the nurse provide to the patient regarding her signs and symptoms?

a. Her memory problems will likely decrease.

b. Depressive episodes should be less severe.

c. She will probably enjoy social interactions more.

d. She should experience a reduction in hallucinations.

d. She should experience a reduction in hallucinations.

5. Which characteristic presents the greatest risk for injury to others by the patient diagnosed with schizophrenia?

a. Depersonalization.

b. Pressured speech.

c. Negative symptoms.

d. Paranoia.

d. Paranoia.

6. Gilbert, age 19, is described by his parents as a "moody child" with an onset of odd behaviour at about age 14, which caused Gilbert to suffer academically and socially. Gilbert has lost the ability to complete household chores, is reluctant to leave the house, and is obsessed with the locks on the windows and doors. Due to Gilbert's early and slow onset of what is now recognized as schizophrenia, his prognosis is considered:

a. Favourable with medication.

b. In the relapse stage.

c. Improvable with psychosocial interventions.

d. To have a less positive outcome.

d. To have a less positive outcome.

7. Which therapeutic communication statement might a psychiatric mental health registered nurse use when a patient’s nursing diagnosis is Altered thought processes?

a. “It must be difficult to hear voices like that, though I cannot hear them.”

b. “Stop listening to the voices, they are NOT real.”

c. “You say you hear voices; what are they telling you?”

d. “Just tell the voices to leave you alone for now.”

c. "You say you hear voices; what are they telling you?"

8. When patients diagnosed with schizophrenia suffer from anosognosia, they often refuse medication, believing that:

a. Medications provided are ineffective.

b. Nurses are trying to control their minds.

c. The medications will make them sick.

d. They are not actually ill.

d. They are not actually ill.

9. Kyle, a patient with schizophrenia, began to take the first-generation antipsychotic haloperidol (Haldol) last week. One day you find him sitting very stiffly and not moving. He is diaphoretic, and when you ask if he is okay, he seems unable to respond verbally. His vital signs are BP 170/100, P 110, T 40.1°C/104.2°F. What is the priority nursing intervention?

a. Hold his medication and contact his prescriber.

b. Wipe him with a washcloth wet with cold water or alcohol.

c. Administer a medication such as benztropine IM to correct this dystonic reaction.

d. Reassure him that although there is no treatment for his tardive dyskinesia, it will pass.

e. Hold his medication for now and consult his prescriber when he comes to the unit later today.

a. Hold his medication and contact his prescriber.

b. Wipe him with a washcloth wet with cold water or alcohol.

10. Tomas is a 21-year-old male with a recent diagnosis of schizophrenia. Tomas's nurse recognizes that self-medicating with excessive alcohol is common in this disease and can co-occur along with:

a. Generally good health despite the mental illness.

b. An aversion to drinking fluids.

c. Anxiety and depression.

d. The ability to express his needs.

c. Anxiety and depression.