Mental
A patient with schizophrenia refuses to take his medication because he believes he is not ill. What phenomenon most likely underlies this presentation?____________ A.The patient is unable to face having an illness and is in denial.____________ B. Stigma causes the patient to refuse to admit his mental illness.____________ C. The illness itself is preventing the patient from realizing he is ill.___________ D. Command hallucinations are instructing him to deny the illness.
What is: The illness itself is preventing the patient from realizing he is ill.
A patient with catatonic schizophrenia exhibits little spontaneous movement and demonstrates waxy flexibility. Which nursing intervention should receive the highest priority? a. Conducting passive range-of-motion exercises______ b. Exposing the patient to auditory and visual stimuli____ c. Interacting with the patient as if he is responding_____ d. Including the patient in a variety of milieu activities____
What is Conducting passive range-of-motion exercises
When a patient diagnosed with paranoid schizophrenia was discharged from the unit 6 months ago, the plan was for him to take chlorpromazine (Thorazine), a conventional (first generation) antipsychotic medication, 300 mg po daily. He tells the nurse he stopped taking his pills after a few months because they made him feel like a “zombie.” What other common side effects should the nurse determine if the patient experienced? a.Sweating, nausea, and weight gain b.Sedation, tremor, and muscle stiffness c.Headache, watery eyes, and runny nose d.Mild fever, sore throat, and skin rash
What is Sedation, tremor, and muscle stiffness
A newly admitted patient diagnosed with paranoid schizophrenia is hypervigilant and constantly scans the environment. He states that he saw two doctors talking in the hall and knows they were plotting to kill him. When charting, how should the nurse identify this behavior? A. Idea of reference B. Delusion of infidelity C. Auditory hallucination D. Echolalia
What is: Idea of reference
Flattening of emotions refers to:
What is: blunted affect Blunted affect is the flattening of emotions. The patient's face may be immobile and inexpressive, with poor eye contact.
___________ A. neurobiological-genetic model.______ B. stress model.______ C. family theory model.______ D. developmental model.______
What is neurobiological-genetic model
A catatonic patient admitted in a stuporous condition begins to demonstrate increased motor activity. During his assessment, the psychiatrist raises the patient’s arm above his head and releases it. The patient maintains the position his arm was placed in, immobile in that position for 15 minutes, moving only when the nurse gently lowers his arm. What symptom is demonstrated by this assessment technique? a. Echopraxia_____ b. Waxy flexibility_____ c. Depersonalization_____ d. Thought withdrawal_____
What is waxy flexibity
A patient with schizophrenia is admitted to the psychiatric unit in an acutely disturbed, violent state. He is given several doses of haloperidol (Haldol) and becomes calm and approachable. During rounds the nurse notices the patient has his head rotated to one side in a stiffly fixed position. His lower jaw is thrust forward and he appears severely anxious. The patient has _________ , and the nurse should _________. A. a dystonic reaction…administer PRN IM benztropine (Cogentin) B. tardive dyskinesia…seek a change in the drug or its dosage C. waxy flexibility…continue treatment with antipsychotic drugs D. akathisia…administer PRN diphenhydramine (Benadryl) PO
What is a dystonic reaction…administer PRN IM benztropine (Cogentin)
When a patient with paranoid schizophrenia has a recurrence of positive symptoms after stopping his antipsychotic medication because of its postural hypotension (orthostasis) side effect, he is readmitted to the mental health unit. What measure should the nurse suggest to help the patient address this side effect? a.Ask the doctor to prescribe an anticholinergic drug like trihexyphenidyl (Artane). b.Chew sugarless gum or use sugarless hard candy to moisten your mouth. c.Increase the amount of sleep you get, and try to take frequent rest breaks. d.Wear elastic support hose, drink adequate fluids, and change position slowly.
What is wear elastic support hose, drink adequate fluids, and change position slowly.
False ideas or beliefs that the patient accepts as real are called:
What is: delusions Delusions are false ideas or beliefs accepted as real by the patient. Among schizophrenics, delusions of grandeur, persecution, and reference are common.
A patient was admitted to the mental health unit after arguing with co-workers and threatening to kill them. He is diagnosed with paranoid schizophrenia. On the unit he is aloof and suspicious. He mentioned that two physicians he saw talking were plotting to kill him. On the basis of data gathered at this point, which two primary nursing diagnoses should the nurse consider?_________________ A. Disturbed thought processes and Risk for other-directed violence__________ B. Spiritual distress and Social isolation_________ C. Risk for loneliness and Knowledge deficit________ D. Disturbed personal identity and Nonadherence_______
What is Disturbed thought processes and Risk for other-directed violence
A patient moving from chair to chair in the day room and pacing in the hallway repeatedly, rapidly, and for extended periods is likely demonstrating _________ , and the nurse should __________. A. a dystonic reaction…administer PRN IM benztropine (Cogentin) B. anxiety… teach and guide the patient to use relaxation exercises C. akathisia…administer PRN diphenhydramine (Benadryl) PO D. tardive dyskinesia…recommend a change in medication
What is akathisia…administer PRN diphenhydramine (Benadryl) PO
A patient received maintenance doses of fluphenazine decanoate (Prolixin Decanoate) 25 mg IM every 2 weeks for 2 years. The clinic nurse notes the patient is grimacing and seems to be constantly smacking her lips. On the next clinic visit, the patient’s neck and shoulders twist in a slow, snakelike motion. The nurse should suspect the presence of ________ and should __________. A. agranulocytosis…check the patient’s complete blood count for changes B. tardive dyskinesia…administer the Abnormal Involuntary Movement Scale C. Tourette’s syndrome…consult the patient’s physician about a neuro evaluation D. anticholinergic effects…consult the physician about possible medication changes
What is tardive dyskinesia…administer the Abnormal Involuntary Movement Scale
A highly suspicious patient who has delusions of persecution about being poisoned has refused all hospital meals for 3 days. Which of the following interventions would be most appropriate under these circumstances? a. Feed the patient via tube, involuntarily via court order if needed. b.Offer to taste each food item on the tray yourself while he watches. c. Allow the patient to contact a local restaurant to deliver his meals. d. Allow him supervised access to use food vending machines in the hospital lobby.
What is Allow him supervised access to use food vending machines in the hospital lobby.
A schizophrenic patient who began taking haloperidol (Haldol) 1 week ago now exhibits jerking movements of the neck and mouth. These are signs of:
What is dystonia Haloperidol and other high-potency conventional antipsychotics cause a high incidence of dystonia and other extrapyramidal adverse effects. Dystonia is marked by prolonged, repetitive muscle contractions that cause twisting or jerking movements - especially of the neck, mouth, and tongue.
A patient’s nursing care plan includes assessment for auditory hallucinations. Indicators that suggest the patient may be hallucinating include:_________ A. aloofness, increased distractibility, and suspicion.______ B. elevated mood, hypertalkativeness, and distractibility._________________ C. performing rituals and avoiding open places.____________ D. darting eyes, distracted, and mumbling to self.________
What is darting eyes, distracted, and mumbling to self.
A patient with the diagnosis of schizophrenia, disorganized type, approaches the nurse and says, “It’s beat, it’s eat. No room for doom.” The nurse can correctly assess this verbalization as: A. neologisms. B. clanging. C. ideas of reference. D. associative looseness.
What is clanging.
The physician prescribes haloperidol (Haldol), a first-generation antipsychotic drug, for a patient with schizophrenia who displays delusions, hallucinations, apathy, and social isolation. Which symptoms should most be monitored to evaluate the expected improvement from this medication? A. Talking to himself, belief that others will harm him B. Flat affect, avoidance of social activities, poor hygiene C. Loss of interest in recreational activities, alogia D. Impaired eye contact, needs help to complete tasks
What is Talking to himself, belief that others will harm him
A newly admitted patient with schizophrenia approaches the unit nurse and says, “The voices are bothering me. They are yelling and telling me stuff. They are really bad.” Which response by the nurse would be most appropriate? a. “Do you hear these voices very often?” b. “Do you have a plan for getting away from the voices?” c. “I’ll stay with you. Tell me what you are hearing.” d.“Try to ignore them and play cards with the others.”
What is “I’ll stay with you. Tell me what you are hearing.”
A positive symptom of schizophrenia is:
What is hallucination Characterized by an excess or distortion of normal functions, positive symptoms of schizophrenia include hallucinations and delusions.
Police bring a 63-year-old woman to the emergency room, reporting that her behavior is disorganized and disruptive, that her speech makes little sense, and that she does not seem able to take care of herself. The woman has had elective surgeries at the hospital previously and was seen in the ER last week after a fall; records show no history of similar symptoms or mental illness. The ER physician speaks with the patient but does not examine her medically, diagnoses her with schizophrenia, and orders admission to the inpatient psychiatric unit. Which response by the nurse would be most appropriate?__________ a. Ask another physician with more of an interest in psychiatry to also take a look at this patient, explaining that you just want to be as thorough as possible.________ b. Suggest that a psychiatric consult be requested before admitting the patient to a psychiatric unit, to validate the diagnosis and speed the initiation of medication.____________ c. Remind the physician that schizophrenia usually develops earlier in life, that such presentations may be caused by medical problems, and suggest a medical work-up.____________ d. Note that the patient’s blood pressure and respirations were elevated when she arrived, and suggest that they be evaluated before admitting the patient to the psychiatric unit._________
What is Remind the physician that schizophrenia usually develops earlier in life, that such presentations may be caused by medical problems, and suggest a medical work-up.
The wife of a patient with schizophrenia is worried about her 17-year-old daughter and asks the nurse what symptoms mark the prodromal stage of schizophrenia. The nurse should respond by listing behaviors such as: A. withdrawal, poor concentration, phobic or obsessive behavior, oddities of speech. B. auditory hallucinations, ideas of reference, thought insertion, and broadcasting. C. stereotyped behavior, echopraxia, echolalia, waxy flexibility, thought-blocking. D. looseness of associations, concrete thinking, echolalia, paranoid delusions.
What is withdrawal, poor concentration, phobic or obsessive behavior, oddities of speech.
A patient has not come out of her room for breakfast. The nurse finds the patient moving restlessly about her room in a disorganized manner. The patient is talking to herself, and her verbal responses to the nurse are nonsensical and suggest disorientation. The nurse notices that the patient’s skin is hot and dry, and her pupils are somewhat dilated. All these symptoms are significant departures from the patient’s recent presentation. The patient is likely experiencing ________ , and the nurse should ___________. A. anticholinergic toxicity…check vital signs and prepare to use a cooling blanket stat B. relapse of her psychosis…administer PRN antipsychotic drugs and notify her physician C. neuroleptic malignant syndrome…contact her physician for a transfer to intensive care D. agranulocytosis…hold her antipsychotic and draw blood for a complete blood count
What is anticholinergic toxicity…check vital signs and prepare to use a cooling blanket stat
The nurse is sitting with a patient diagnosed as having schizophrenia, disorganized type, who starts to laugh uncontrollably, although nothing funny has occurred. The nurse should say: A. “Please share the joke with me.” B. “Why are you laughing?” C. “I don’t think I said anything funny.” D. “You’re laughing. Tell me what’s happening.”
What is “You’re laughing. Tell me what’s happening.”
A salesman has had difficulty holding a job because he accuses co-workers of conspiring to take his sales. Today, he argued with several office mates and threatened to kill one of them. The police were called, and he was brought to the mental health center for evaluation. He has had previous admissions to the unit for stabilization of paranoid schizophrenia. When the nurse meets him, he points at staff in the nursing station and states loudly, “They’re all plotting to destroy me. Isn’t that true?” Which would be the most appropriate response? A. “No, that is not true. People here are trying to help you if you will let them.” B. “Let’s think about it: what reason would people have to want to destroy you?” C. “Thinking that people want to destroy you must be very frightening.” D. “That doesn’t make sense; staff are health care workers, not murderers.”
What is “Thinking that people want to destroy you must be very frightening.”