Psychiatric Nursing: Schizophrenia, Personality Disorders, and Substance Abuse

A client diagnosed with schizophrenia states, "can't you hear him? It's the devil. He's telling me I'm going to hell." What is an appropriate response to this statement?

"I'm sure the voices sound scary, but I don't hear any voices speaking."

The family of a client with schizophrenia asks the nurse the difference between typical (conventional) and atypical antipsychotic medications. The nurse's best answer may include which information?

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

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A client has an exaggerated sense of self-worth and believes they have the inalienable right to receive special consideration. This is a definition of what type of personality disorder?

Narcissistic Personality Disorder

A client with borderline personality disorder has been making progress and is ready for discharge. Which nursing intervention should be included in preparation for the client's discharge to home?

Ensuring that she has a thirty-day supply of antidepressants when she goes home.

A patient with Borderline Personality Disorder has multiple self-inflicted wounds that require dressing changes. What approach should the nurse take when providing wound care?

Adopt a neutral attitude to avoid rewarding the self-mutilating behavior.

Maladaptive responses to loss include:

exaggerated or distorted grief responses

delayed or inhibited grief

The nurse is assessing a client's alcohol use. Her use of alcohol has caused her to lose a job and her marriage of 15 years. She tells you that when she starts drinking, she can't seem to stop until she passes out. She has lost control. Physiological dependence is clearly evident. The client is in the

crucial phase

The word schizophrenia is derived from two Greek words and refers to a "split" personality.

False

A client has been prescribed the SSRI paroxetine (Paxil). His spouse is taking the tricyclic antidepressant nortriptyline (Pamelor). He comes to the emergency department complaining of restlessness, muscle spasms, twitching, and tremors. He is diaphoretic, tachycardic, and febrile. He is also starting to become confused. Based on these findings, which complication does the nurse suspect?

Serotonin syndrome from combining an SSRI with another antidepressant

The nurse completes the post-op assessment for a client following a fall. The client underwent an open reduction and internal fixation surgery to treat a fractured right radius. The nurse notes a history of four alcoholic drinks each night during the week, and six to eight per night on the weekends. Which assessment findings does the nurse expect to observe?

hand tremors

fatigue and lethargy

difficulty sleeping

Which of the following are considered to be positive signs of schizophrenia

illusions

delusions

disorganized thinking

hallucinations

The course of schizophrenia follows four phases: the phase that lasts from a few weeks to a few years with deterioration in role functioning and social withdrawal with perceptual abnormalities and ideas of reference is which phase?

prodromal phase

Two of the criteria for major depressive disorder is that there is no evidence of mania and there is impaired functioning persisting for at least 2 weeks.

true

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

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

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

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

When working with a client with a personality disorder, the nurse would expect the client to assess which?

motivation to change

inability to empathize with others

impaired interpersonal relationships

poor reality testing

The nurse working with a client with antisocial personality disorder would expect which behavior?

superficial friendliness towards others

seeking special privileges

exploitation of other clients

The nurse cares for a client diagnosed with schizophrenia. Which statement, if made by the nurse to the client, is considered non-therapeutic?

What issues in your past do you feel are contributing to your current situation?

Which statement would indicate that teaching about somatic symptom disorder has been effective?

" I will feel better when I begin handling stress more effectively."

The nurse has provided an in-service program on impaired professionals. She knows that teaching has been effective when staff identify which as the highest risk for substance abuse among professionals?

Most nurses are exposed to various substances and believe they are not at risk of developing the disease

An adult client lives with his parents and relies on them to make decisions about his work schedule, voting habits, finances, and social life. He sometimes disagrees with their decisions but is afraid to confront them and tries very hard to please them. Which personality disorder best describes the client's behaviors?

Dependent Personality Disorder (DPD)

The nurse is caring for a client with a history of opioid use disorder. The client is found unresponsive, apneic, and has a pulse. The nurse suspects accidental opioid overdose. What should the nurse do immediately after calling a code?

Tell someone to get naloxone (Narcan) and begin ventilating the patient.

A nurse working in PACU has noticed that a colleague sings out narcotic pain medication under other nurses' logins, disappears for long periods of time during the shift, and frequently offers to help you by medicating your clients when you are busy. The colleague's clients often complain that they are still in pain, despite the fact that this nurse signs out more pain medication than the other nurses. The most appropriate action for the nurse to take is to:

Go to the nurse manager with documented incidents of the colleague's behavior

For clients with a Somatic Symptom Disorder, the nurse should:

Encourage family to decrease special attention when client is in "sick" role.

Drug Diversion by a Healthcare Worker Harms:

Patient

The Employer

The Addict

Fellow Employees

A client with opioid use disorder requires higher doses of pain meds after surgery. This is due to:

tolerance

The nurse cares for a female adolescent who has sustained injuries because of sexual abuse. The client confides to the nurse, "I don't know what to tell the police. I really deserve this, and I don't want to get him in any trouble." Which response by the nurse is BEST?

"You did not deserve to be hurt."

A school nurse performs scoliosis screening and notes a large burn on a child's back in the shape of an iron. The child states, "I got the burn when I fell down the stairs and landed on top of an iron." In this situation, which is the nurse's responsibility?

Contacting the local child protective agency.

Diversion most commonly occurs during:

Wasting narcotic counts

We as nurses often enable our substance abusing colleagues.

True

The nurse who is working with a client during a flashback says, "I know you're scared, but you're in a safe place. Do you see the bed in your room? Do you feel the chair you're sitting on?" The nurse is using which technique?

Grounding

Which statement is true about touching a client who is experiencing a flashback?

The nurse should touch the client only after receiving permission to do so.

The home care nurse assesses an elderly client living with his son and notes that the client has poor hygiene and that th no no ere is a skin tear on the left forearm. The client is missing his hearing aids and glasses, and states that his son made withdrawals from the client's bank account to pay bills that are now past due. The nurse is concerned that the client is experiencing:

Elder abuse

A female client comes to an urgent care clinic and says, "I've just been raped." What should the nurse do?

Stay with the client until someone else arrives to be with her

Allow the client to express whatever she wants

Ask the client if staff can call a family or family friend for her

What is the best action for the nurse to take when assessing a child who might be abused?

Consult with a professional member of the health team about making a report

Characteristics of Violent Families Include:

Abuse of Power and Control

Social Isolation