Chapter 24: Schizophrenia Spectrum & Other Psychotic Disorders: Management of Thought Disorders - PrepU

The nurse observes a client with schizophrenia sitting alone, laughing occasionally, and turning his head as if listening to another person. The nurse assesses this behavior to indicate that the client is experiencing auditory hallucinations and says ...

"are you hearing something?"

A client with schizoaffective disorder is receiving multiple psychiatric medications. The nurse would ensure obtaining a baseline electrocardiogram if the client is prescribed which medication?

Ziprasidone

Explanation:

Ziprasidone (Geodon) is more likely than other second-generation antipsychotics to prolong the QT interval and change the heart rhythm. For these clients, baseline electrocardiograms may be ordered. Benztropine, Lorazepam and Propanolol do not require a baseline electrocardiogram because they do not have the same potential to alter the QT interval and heart rhythm.

The client diagnosed with schizophrenia a year ago is being prescribed clozapine because other medications have been ineffective. The nurse educates the client and family about this medication. The nurse determines the education was successful when the client makes which statement?

"It is important to keep appointments for weekly lab draws to check the blood count."

A client was admitted to the psychiatric intensive care unit with schizophrenia. Among the client's signs and symptoms, the client was experiencing nihilistic delusions. The nurse understands that these delusions involve a belief about what?

An impending calamity, such as death

Explanation:

Delusions are erroneous, fixed beliefs that cannot be changed by reasonable argument. Nihilistic delusions involve the belief that one is dead or a calamity is impending; when these delusions involve bodily illness, they take hypochondriacal concerns to the utmost extreme.

Grandiose delusions

involve the belief that one has exceptional powers, wealth, skill, influence, or destiny.

Persecutory delusions

involve the belief that one is being watched, ridiculed, harmed, or plotted against.

Referential delusions, or ideas of reference,

involve a belief that communications such as television broadcasts or website posts are directed toward the client or have special meaning for the client.

A client diagnosed with schizophreniform disorder must have symptoms present for at least 1 month but with a duration of less than:

6 months.

Explanation:

The essential features of schizophreniform disorder are identical to those of criteria A for schizophrenia, with the exception of the duration of the illness, which can be less than 6 months. Symptoms must be present for at least 1 month to be classified as a schizophreniform disorder.

A novice nurse is having a first experience in an inpatient psychiatric unit and is frightened by the behavior of a client with schizophrenia. The nurse will take which action to deal with fear?

Stay in an open area while talking with the client

Explanation:

The novice nurse may be genuinely frightened or threatened if the client's behavior is hostile or aggressive. The novice nurse must acknowledge these feelings and take measures to ensure their safety. This may involve talking to the client in an open area rather than in a more isolated location or having an additional staff person present rather than being alone with the client. If the novice nurse pretends to be unafraid, the client may sense the fear anyway and feel less secure, leading to a greater potential for the client to lose personal control. It is not possible for a seasoned nurse to accompany the novice nurse at all times.

The client with schizophrenia tells the nurse, "I can't go outside or answer the phone; the boss man has people watching me because I know too much. The boss is afraid I will rat out the operation to the Feds." The nurse documents the client's statement as which type of delusion?

persecutory

Explanation:

The client is experiencing persecutory delusions. These delusions, for example, are that the boss is out to kill them, or perhaps a mob, the mafia, or a gang.

An example of a grandiose delusion

is believing they are stronger than a superhero in a movie.

An example of a nihilistic delusion

is that a part of their body no longer exists (e.g., their arm, leg, eye, etc.).

A somatic delusion

is one believing their body is disintegrating into another substance or infested with insects, such as spiders under the skin or bugs.

When preparing a class presentation about schizophrenia, what would the nurse most likely include?

Improvement in symptoms can occur as a client with a history of schizophrenia reaches older adulthood.

A nurse provides care to a client with schizoaffective disorder during hospitalization for acute psychosis. Nursing interventions to help the client to establish trust with the health care team is best accomplished by what?

Offering reassurance in a soft, nonthreatening voice

Which of the following would be the most accurate nursing diagnosis within the social domain for a female client with a delusional disorder who is having martial conflict?

Interrupted family processes related to delusional disorder

The nurse is caring for a client who was diagnosed with schizoaffective disorder two years ago. Which of the following assessments should the nurse prioritize?

suicide

During a client interview, a client diagnosed with delusional disorder states, "I know my spouse is being unfaithful to me with a colleague from work."The nurse interprets the client's statements as suggesting which type of delusion?

Persucatory/paranoid

Explanation:

The client's statements reflect persucatory/paranoid delusions that focus on the unfaithfulness or infidelity of a spouse or lover. Such delusions involve the belief that others are untrustworthy in some way.

A client with schizophrenia is prescribed an antipsychotic medication. Which immediate side effects would the nurse include in the education plan for this medication?

The potential for sedation

Explanation:

Sedation with antipsychotic medication will likely happen immediately after initiating the medication. The nurse should be sure to inform the client they he or she will experience this side effect readily. The other options are examples of side effects that are possible with longer term treatment using antipsychotic medications. Weight gain is commonly associated with many antipsychotic medications. The potential for weight loss with antipsychotic medication is not typically discussed with clients.

Schizoaffective disorder is most likely to be diagnosed at which of the following stages of life?

early adulthood

Clients diagnosed with schizophrenia may experience disordered water balance that may lead to water intoxication. Which may occur as a result of water intoxication?

Hyponatremia

Explanation:

Hyponatremia is a life-threatening complication of unknown cause. When a client ingests an unusually large volume of water, the kidneys' capacity to excrete water is overwhelmed, and serum sodium concentrations rapidly fall below the normal range.

The nurse enters the room of a client with schizophrenia the day after the client has been admitted to an inpatient setting and says, "I would like to spend some time talking with you." The client stares straight ahead and remains silent. Which would be the best response by the nurse?

"You don't need to talk right now. I'll just sit here for a few minutes."

A client has been taking haloperidol for 5 years when the client is admitted to the inpatient unit for relapse of symptoms of schizophrenia. Upon assessment, the client demonstrates akathisia, dystonia, a stiff gait, and rigid posture. The nurse correctly identifies these symptoms are indicative of what?

Extrapyramidal side effects

Explanation:

Extrapyramidal side effects include severe restlessness, muscle spasms, or contractions; chronic motor problems such as tardive dyskinesia; and the pseudoparkinsonian symptoms of rigidity, masklike faces, and stiff gait.

The nurse is working with a client with schizophrenia who has cognitive deficits. It is time for the client to get up and eat breakfast. Which statement by the nurse would be most effective in helping the client prepare for breakfast?

"First, wash your face and brush your teeth. Then put your clothes on."

Explanation:

The client needs clear direction, with tasks broken into small steps, to begin to participate in the client's own self-care. The client, not the nurse, should perform the steps.

Research related to the development of schizophrenia has shown what?

The disorder is thought to arise from the interaction of a biological predisposition and environmental stressors.

A client diagnosed with delusional disorder who uses excessive health care resources most likely has which type of delusions?

somatic

Explanation:

Persons who have somatic delusions believe they have a physical ailment. Clients with somatic delusions use excessive health care resources

A nurse is caring for a client diagnosed with schizophreniform disorder. The nurse demonstrates understanding of this disorder when identifying that the client is at risk for developing what?

Schizophrenia

Explanation:

About one third of the individuals with schizophreniform disorder recover with the other two thirds developing schizophrenia. Schizophreniform disorder is not associated with the development of personality disorder, major depression, or substance abuse.

Which has not been proposed as a potential mechanism for the etiology of thought disorders?

Neglect in childhood

A nurse is assessing a client who is reporting the sensation of "bugs crawling under the skin" and intense itching and burning. The client states, "I know bugs have invaded my body." There is no evidence to support the client's report. The nurse interprets this as which type of delusion?

Somatic

Explanation:

Somatic delusions involve bodily functions or sensations, such as insects having infested the skin. The client vividly describes crawling, itching, burning, swarming, and jumping on the skin surface or below the skin. The client maintains the conviction that he or she is infested with parasites in the absence of objective evidence to the contrary

A client has been prescribed clozapine for treatment of schizophrenia. The client must be taught to monitor which blood concentrations weekly while taking this drug?

white blood cells

A client diagnosed with delusional disorder is experiencing persecutory delusions involving the belief that someone is putting poison in his food. When developing the client's plan of care, which nursing diagnosis would be most likely?

Imbalanced Nutrition, Less than Body Requirements

Explanation:

Imbalanced Nutrition, Less Than Body Requirements would be most likely for a client who is fearful that his food is being poisoned. As a result, the client would not be obtaining adequate nutrition

Which increases the risk for neuroleptic malignant syndrome (NMS)?

Dehydration

Explanation:

Dehydration, poor nutrition, and concurrent medical illness all increase the risk for NMS.

A client had been withdrawn in the client's room for 3 days, not eating or sleeping, prior to his admission to the inpatient unit. Upon interview, the client demonstrates difficulty answering questions, appears to have no facial expressions, and cannot follow simple instructions. This cluster of symptoms can be described as what?

Negative symptoms

Explanation:

Common negative symptoms of schizophrenia include alogia, affective blunting, avolition, anhedonia, and attentional impairment.

Which type of antipsychotic medication is most likely to produce extrapyramidal effects?

First-generation antipsychotic drugs

Explanation:

The conventional, or first-generation, antipsychotic drugs are potent antagonists of dopamine receptors D2, D3, and D4. This makes them effective in treating target symptoms but also produces many extrapyramidal side effects because of the blocking of the D2 receptors.

A client is diagnosed with schizoaffective disorder (SAD). The nurse understands that in addition to psychosis, the client must also exhibit:

Mood disorder

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 intervention should the nurse respond?

Establish a routine and set goals.

Explanation:

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.

A client has been taking haloperidol for 5 years when the client is admitted to the inpatient unit for relapse of symptoms of schizophrenia. Upon assessment, the client demonstrates akathisia, dystonia, a stiff gait, and rigid posture. The nurse correctly identifies these symptoms are indicative of what?

Extrapyramidal side effects

Explanation:

Extrapyramidal side effects include severe restlessness, muscle spasms, or contractions; chronic motor problems such as tardive dyskinesia; and the pseudoparkinsonian symptoms of rigidity, masklike faces, and stiff gait.

Which would a nurse expect to administer to a client with schizophrenia who is experiencing a dystonic reaction?

Benztropine

Explanation:

A client experiencing a dystonic reaction should receive immediate treatment with benztropine.

Risperidone and aripiprazole

are antipsychotics that may cause dystonic reactions.

Trihexyphenidyl

is used to treat parkinsonism due to antipsychotic drugs.

The nurse is teaching the client about negative symptoms of schizophrenia. What will the nurse include in the education? Select all that apply.

-symptoms develop slowly over time

-leads to isolation and withdrawal

-reflects an inability to deal with illness

-may lead to substance use

-inability to interact with others

Delusional disorders are primarily characterized by which of the following? Select all that apply.

Paranoia

Jealousy

Distrust

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?

Clients with delusional disorder typically have problems with medication adherence.

Explanation:

By the time a client with a diagnosis of 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.

Which extrapyramidal side effect is noted by a client who has bradykinesia and a shuffling gait?

Pseudoparkinsonism

Explanation:

Pseudoparkinsonism is noted by a resting tremor, rigidity, a masklike face, and a shuffling gait.

Akathisia

occurs when the client has motor restlessness evidenced by pacing, rocking, or shifting from foot to foot.

Symptoms of acute dystonia

are intermittent or fixed abnormal postures of the eyes, face, tongue, neck, trunk, and extremities.

After assessing a client with schizophrenia, the nurse notes that the client exhibits signs and symptoms related to being unable to experience pleasure. The nurse documents this finding as what?

Anhedonia

Explanation:

Anhedonia refers to the inability to experience pleasure. Diminished emotional expression is reflected by a restriction or flattening in the range and intensity of emotion.

Alogia

refers to a reduced fluency and productivity of thought and speech

Avolition

refers to withdrawal and inability to initiate and persist in goal-directed activity.

When developing the plan of care for a client with schizophrenia who is in the acute phase of illness, the nurse understands that the client is at high risk for what?

Suicide

Explanation:

During the acute illness, individuals with schizophrenia are at high risk for suicide. Clients are hospitalized usually to protect themselves or others. Clients with schizophrenia who have an abnormality in the hippocampus may experience disordered water balance, whereupon individuals drink compulsively as a result of neuroendocrine dysfunction, placing them at risk for water intoxication. However, this is not the priority. Mania and depression are unrelated to schizophrenia during the acute illness.

A client is diagnosed with schizoaffective disorder. The interdisciplinary plan of care includes key family members. The nurse understands that a major reason for doing so involves which of the following?

Strengthening the client's recovery

Explanation:

By collaborating with family members, the client's willingness to follow treatment, monitor symptoms, and continue with rehabilitation and recovery can be strengthened. Although family members can monitor the client's behavior and assist with boundaries, they cannot keep the behavior from occurring, preventing a relapse or maintain the client's boundaries.

A client is admitted with the diagnosis of possible schizophrenia and to rule out (R/O) organic pathology. Based on this information, what treatment will the nurse assist with for this client?

Prepare the client for a computed tomography (CT) of the brain.

Explanation:

The CT will reveal structural changes in the brain that might be responsible for symptoms of psychosis (e.g., abscess, tumor).

A client with schizophrenia leaves the room and begins marching in the hall. When approached by the nurse, the client says, "God says I'm supposed to guard the area." Which response would be best?

"I understand you hear a voice. You and I are the only ones in the hall, and I don't hear a voice."

A client diagnosed with schizophrenia is laughing and talking while sitting alone. Which is the best response by the nurse?

"Tell me what is happening."

A nurse teaching a client about prescribed antipsychotic medication informs the client to contact a health care provider immediately if the client notices:

A dramatic change in temperature.

Explanation:

Advise clients to contact their case coordinators or health care providers immediately if they experience dramatic changes in body temperature. The client may be at risk for neuroleptic malignant syndrome.

A psychiatric-mental health nurse is conducting a review class for a group of colleagues about schizoaffective disorder. The nurse determines that the class was successful based on which description of the condition by the group?

Clients are often misdiagnosed as having schizophrenia.

Explanation:

Mental health providers find 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).

A client who has a major fear of people dressed in black tells the nurse that, for the past 2 weeks, the client has been hearing voices and at times thinks that they are being followed. The nurse interprets these findings as suggesting which condition?

paranoid type schizophrenia