Education and guidelines on Psychosis
Name at least two medical conditions that may cause psychotic symptoms
Migraine headache, renal disease, temporal lobe epilepsy, vitamin deficiency (Curtis & Tuzo, 2017 p.187)
Which medication is a typical antipsychotic medication?
A.Prochlorperazine (Prochlorazine)
B. Brexpiprazole (Rexulti)
C. Capriprazine (Vraylar)
D. Pimavanserin (Nuplazid)
Answer is A (Willihnganz et. al., 2022, p.266)
Name two positive and two negative symptoms of schizophrenia
Positive: Paranoia, magical thinking, hallucinations, etc…
Negative: Regression, apathy, inappropriate affect, ect…
(Curtis & Tuzo, 2017 p.188)
True or false: The AIMS scale aids in late detection of movement disorders and provides means for ongoing surveillance.
False: The AIMS scale aids in early detection (Townsend & Morgan, 2020, p. 75)
True or False: A nurse should not set verbal limits with a patient who has schizophrenia and has a history of getting angry.
Answer is False
Rationale: Consistency in enforcing the consequences is essential if positive outcomes are to be achieved. Inconsistency creates confusion and encourages testing of limits (Townsend & Morgan 2021, P. 252)
Can patients smoke while they are on psychotic medications?
No, consult with your doctor. Smoking increases the metabolism of antipsychotics, requiring and adjustment in dosage to achieve a therapeutic effect.(Morgan &Townsend, 2021 p.471)
Identify significant side effects of tricyclic antidepressants
Ans: Orthostatic hypotension (Morgan &Townsend, 2021 p. 62)
What is the most common type of hallucination?
Auditory – voices
(Curtis & Tuzo, 2017 p.188)
True or false: Dystonia should be treated as an emergency because laryngospasm follows these symptoms and can be fatal
True (Townsend & Morgan, 2020, p. 75
True or false: The nurse should role model ways of expressing anger assertively such as “I feel angry when you say those things about me”
Answer is True
Rationale: Role modeling is one of the strongest methods of learning(Townsend & Morgan 2021, P. 252)
What can happen when driving or operating dangerous machinery while on psychotic medications?
Drowsiness and dizziness can occur.(Morgan &Townsend, 2021 p.471)
What teachings should a nurse provide to a patient taking Anti-anxiety medications ?
Ans: Patient to rise slowly from a sitting to a standing (Morgan &Townsend, 2021 p. 471).
What does the nurse usually ask the patient if they express hallucination?
What are the voices saying?
(Curtis & Tuzo, 2017 p.188)
True or false: Benztropine mesylate (Congentin) is the first drug of choice for treating Tardive Dyskinesia
False: Valbenazine (Ingrezza) is the first FDA approved drug for treating tardive dyskinesia; Intravenous or intramuscular benztropine mesylate (Cogentin) is commonly administered for Dystonia (Townsend & Morgan, 2020, p. 75)
What is a response to a specific behavior that is pleasurable or offers reward?
Negative reinforcement
Role modeling
Aggression
Positive reinforcement
Answer is 4
Rationale :If a child is throwing a temper tantrum after getting told no to something and then is given a treat to help calm them down this is positive reinforcement (Townsend & Morgan 2021, P. 252)
Can patients take other medications while they are on psychotic medications?
Avoid taking other medications without talking to your doctor. Many medications contain substances that interact with antipsychotics in a way that may be harmful.(Morgan &Townsend, 2021 p.471
The nurse is planning care for a patient taking imipramine (Tofranil). Which finding if presented would most likely be an adverse effect of the drug?
Ans: Sedation and dry mouth (Morgan &Townsend, 2021 p. 471).
What else can a patient with a psychotic disorder hear besides voices?
Click, rushing noises, music and other noises.
(Curtis & Tuzo, 2017 p.188)
What is considered a symptom of acute dystonia and can be mistaken for seizure activity?
Akinesia
Akathisia
Pseudoparkinsonism
Oculogyric crisis
D: Oculogyric crisis is a symptom of acute dystonia (involuntary muscle spasms in the face, arms, or neck) and can be mistaken for seizure activity. As with other symptoms of acute dystonia, this side effect should be treated as a medical emergency (Townsend & Morgan, 2020, p. 2020)
A patient is pacing the hall near the nurses' station, swearing loudly. An appropriate initial intervention for the nurse would be to address the patient by name and say:
a. "What is going on?"
b. "Please be quiet and sit down in this chair immediately."
c. "I'd like to talk with you about how you're feeling right now."
d. "You must go to your room and try to get control of yourself."
Answer is C
rationale: Often, anger is displaced onto a safer object or person. If resolution is to occur, the first step is to identify the source of the anger(Townsend & Morgan 2021, P. 252)
The client is experiencing paranoid delusions. What behaviors could the nurse expect to assess?
a) Altered speech and extreme suspiciousness.
b) Psychomotor retardation.
c) Regressive and primitive behaviors
d) Anger and aggressive act.
Answer is D
Rationale:
Clients experiencing paranoid delusions are often angry, aggressive, and guarded due to their belief that others are threating harm. Angry and aggressive behaviors are the client’s attempt to protect self from this fictitious threat.(Curtis & Tuzo, 2017 p.203)
According to the following medications, which of the following is recognized as the most effective medication in providing Caroline’s immediate relief from neuroleptic -induced extrapyramidal side effects (EPS)
a) Benztropine (Cogentin) 2mg PO
b) Diazepam (Valium) 5 mg PO
c) Lorazepam (Ativan) 1 mg by mouth PO
d) Haloperidol (Haldol) 2 mg intramuscular (IM).
Ans: a Benztropine ( Cogentin) The symptom of neuroleptic induces EPS include, but are not limited to tremors, chorea, dystonia, akinesia, and akathisia. Cogentin 1 to 4 mg given once or twice daily is the drug of choice to treat these symptoms.
Diazepam (Valium) is an anxiolytic medication used for management of anxiety,
preoperative sedation, and conscious sedation but not for relief of EPS.
Haloperidol ( Haldol) is an antipsychotic medication used for acute and chronic
psychotic disorder. To give more Haldol would increase the intensity of EPS
Lorazepam (Ativan) is an anxiolytic medication used for the management and
insomnia, not for relief of EPS (Curtis & Tuzo, 2017 p. 187)
To deal with client’s hallucination therapeutically, which nursing intervention should be implemented?
a) Reinforce the perceptual distortions until the client develops new defenses.
b) Provide an unstructured environment.
c) Avoid making connections between anxious situations and hallucinations.
d) Distract the client’s attention.
Answer is D
Rationale:
The nurse should first emphasize with the client by focusing on feelings generated by the hallucinations, present objective reality, and then distract or redirect the client to reality-based activities.(Curtis & Tuzo, 2017 p.203)
Part of the nurse’s ongoing assessment of the client taking antipsychotic medications is to observe for extrapyramidal symptoms. Which of the following are examples of extrapyramidal symptoms for tardive dyskinesia?
Bizzare face and tongue movements
Involuntary muscle spasms in arm, face, and neck
Absence or impairment in voluntary movement
Tremors and shuffling gait
A: Extrapyramidal side effects for tardive dyskinesia include bizarre face and tongue movements, stiff neck, and difficulty swallowing (Townsend & Morgan, 2020, p. 75)
Which is an effective nursing intervention to assist an angry patient learn to manage anger without violence?
a.Encourage the patient to keep a diary of angry thoughts and feelings, what triggered them, and how they were handled
b. Provide negative reinforcement such as restraint or seclusion in response to angry outbursts, whether or not violence is present.
c. Use aversive conditioning, such as popping a rubber band on the wrist, to help extinguish angry feelings.
d. Administer an antipsychotic or anti-anxiety medication
Answer is A
Rationale: this will provide the patient with a more objective measure of the problem. It will encourage problem solving.(Townsend & Morgan 2021, P. 252)