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An older adult client is prescribed an antipsychotic medication for the management of psychotic behaviors. The client's spouse asks, “Why is the dose prescribed lower than the range listed in the teaching materials we received?” Which response by the nurse would be most appropriate?
A. “The dosage is low at the beginning to allow for increases as symptoms increase.”
B. “An older adult's immune system can trigger allergic reactions if the dose is too high.”
C. “Changes to liver and kidney function normally experienced with age require smaller doses.”
D. “The dosage was determined by your spouse's weight, gender, and severity of symptoms.”
Answer: C
Rationale: The impact of age-related physiologic changes on antipsychotic medication therapy accounts for many of the serious side effects that occur in older adults. Because, among other changes, older adults have a slower liver metabolism and renal clearance than young adults, they need far less of these drugs to produce a therapeutic effect. Dosage may be increased as symptoms warrant but that is not the criterion for low dosing among the older client population. The tendency to be allergic to a medication is not necessarily associated with age. While it is true in some cases, antipsychotic medication dosages are not based on weight, gender, and severity of symptoms.
A client states, “Little green men are implanting destructive asteroids in my brain.” The nurse interprets this statement as reflecting which concept?
A. Thought broadcasting
B. Thought insertion
C. Thought withdrawal
D. Delusion of reference
Answer: B
Rationale: Thought insertion occurs when a person believes that the thoughts of others can be inserted into their mind. Thought broadcasting occurs when the client believes that their thoughts can be heard by others. Thought withdrawal indicates a belief that others are robbing thoughts from one's brain. Delusion of reference is a false belief that the behavior of others in the environment refers to oneself.
A nurse is gathering data about a client diagnosed with schizophrenia. Which finding would the nurse document as a negative symptom?
A. Autism
B. Delusions
C. Agitation
D. Flat affect
Answer: D
Rationale: Negative symptoms of schizophrenia include flat affect, lack of energy, and anhedonia. Positive symptoms include autism, delusions, and agitation.
A client is exhibiting lip smacking, facial grimacing, and protruding tongue movements. The nurse would document these extrapyramidal side effects using which term?
A. Akathisia
B. Tardive dyskinesia
C. Drug-induced parkinsonism
D. Dystonia
Answer: B
Rationale: Tardive dyskinesia includes manifestations that are late-appearing and irreversible movements of the mouth and face that include grimacing, lip smacking, and protruding tongue movements. Akathisia is an inability to sit still. Dystonia is the rigidity of the muscles that control posture, gait, and eye movement. Drug-induced parkinsonism includes tremors, rigidity, and akinesia.
A client is experiencing extrapyramidal side effects secondary to prescribed antipsychotic therapy. The nurse anticipates which class of medication as being prescribed as treatment?
A. Anticonvulsants
B. Antiparkinson
C. Antihypertensives
D. Anxiolytics
Answer: B
Rationale: Antiparkinson agents such as benztropine (Cogentin) and trihexyphenidyl (Artane) are used to relieve drug-induced extrapyramidal side effects of antipsychotic medications. None of the other medication classifications are used for extrapyramidal effects.
A client is experiencing water intoxication secondary to schizophrenia. The client’s partner asks the nurse about what might have caused this condition. When responding to the partner, the nurse would explain the effects of the connection between antipsychotic medications and which gland?
A. Parathyroid
B. Thyroid
C. Pituitary
D. Pineal
Answer: C
Rationale: It is thought that a possible cause of water overload seen in water intoxication is related to the effect of antipsychotic medications on the pituitary gland, which produces antidiuretic hormone (ADH) and thus inhibits the excretion of water. None of the other organs have been associated with this phenomenon.
A nurse is reviewing the medical record of a client. History reveals that the client is demonstrating delusions and disorganized thinking in conjunction with mania. The nurse interprets this data as indicating which disorder?
A. Delusional disorder
B. Brief psychotic disorder
C. Schizophreniform disorder
D. Schizoaffective disorder
Answer: D
Rationale:
Schizoaffective disorder is characterized by a combined presence of schizophrenic symptoms and those of a mood disorder (bipolar disorder or major depressive disorder). The variance from a mood disorder lies in the presence of the primary symptoms of schizophrenia for at least 2 weeks without any mood symptoms. Delusional disorder involves delusional thoughts coinciding with life situations that could be true and last for at least 1 month (i.e., feeling of being followed or stalked). A brief psychotic disorder occurs when there are short periods of psychotic behavior, usually in response to a crisis or severely stressful event, with quick recovery. Schizophreniform disorder occurs when schizophrenic symptoms last at least 1 month but less than 6 months.
The nurse is reviewing a care plan for a client diagnosed with schizophrenia who has been prescribed an antipsychotic medication. The nurse would expect to find which outcome as the priority for this client?
A. Decrease in delusional thinking
B. Improvement in communication
C. Adherence to therapeutic medication regimen
D. Ability to meet self-care needs
Answer: C
Rationale: When monitoring the effectiveness of planned interventions, the nurse should look for signs that indicate improved functioning of the client. It is anticipated that adherence with medication therapy will diminish the positive symptoms of psychosis the client experiences. Hopefully, this is accompanied by an increase in the client’s understanding of actual and real events that precipitate the perceptual and delusional alterations. This is demonstrated as the client is able to identify these factors and practice diversional techniques to avoid the anxiety that encourages the psychotic behavior. Communication with staff and other clients in an appropriate and reality-based conversation is evidence of improved thinking processes.
A client diagnosed with schizophrenia comes to the outpatient mental health clinic displaying a very disheveled appearance, with body odor and an unkempt beard. The nurse uses which term to document this finding?
A. Anhedonia
B. Avolition
C. Alogia
D. Autism
Answer: B
Rationale: The person experiencing avolition lacks motivation to make decisions or initiate self-care such as hygiene and grooming. Anhedonia is seen as a lack of pleasure in previously enjoyable activities. Alogia is a decrease in the amount or speed of speech. Autism occurs when the client has impaired communication with others and lacks social relationships.
A client is prescribed a new medication, haloperidol (Haldol), for chronic schizophrenia. Assessment reveals muscular rigidity, hyperthermia, and an altered level of consciousness. The nurse identifies these findings as suggestive of which condition?
A. Akathisia
B. Dystonia
C. Neuroleptic malignant syndrome
D. Tardive dyskinesia
Answer: C
Rationale: Neuroleptic malignant syndrome is a potentially fatal reaction most often seen with the high-potency antipsychotic agents. Symptoms include muscular rigidity, tremors, altered level of consciousness, and hyperthermia. Akathisia is an inability to sit still. Dystonia is the rigidity of the muscles that control posture, gait, and eye movement. Tardive dyskinesia includes manifestations that are late-appearing and irreversible movements of the mouth and face that include grimacing, lip smacking, and protruding tongue movements.
A client is diagnosed with schizophrenia, catatonic type. Which should be the priority nursing intervention identified on the client's plan of care?
A. Preventing damage to muscles and skin
B. Administering prescribed lithium carbonate
C. Meeting the client’s basic needs
D. Promoting client communication of feelings
Answer: C
Rationale: The client diagnosed with catatonic schizophrenia has severely decreased motor activity and responsiveness to the environment. It would be very important for the nurse to meet the basic needs of this client. The prevention of muscle and skin damage is related to those individuals demonstrating waxy flexibility. At this point, the client is unable to express feelings. Lithium is used for mania, not schizophrenia.
A client diagnosed with schizophrenia states, “Everyone is out to get me. They are trying to get into my head. They are watching me.” The nurse identifies these statements as supporting which form of schizophrenia?
A. Residual
B. Disorganized
C. Paranoid
D. Undifferentiated
Answer: C
Rationale: People with paranoid type of schizophrenia experience prominent hallucinations and delusions. The client with residual type of schizophrenia has experienced prominent psychotic symptoms with a previous diagnosis of schizophrenia but no longer has them. There is lingering evidence of unusual behavior, a blunted affect, some unrealistic thinking, or social withdrawal. Clients with disorganized schizophrenia exhibit disorganized and unintelligible speech, bizarre behavior, and a flat affect. The client with schizophrenia of the undifferentiated type exhibits symptoms such as delusions, hallucinations, and strange behavior. The symptoms are not defined to meet the criteria for any other subtype.
The nurse cares for a client diagnosed with paranoid schizophrenia. Which assessment parameter should be the priority for the nurse to monitor?
A. Hygiene
B. Communication patterns
C. Decision-making ability
D. Motor activity
Answer: C
Rationale: Clients diagnosed with paranoid type of schizophrenia experience hallucinations and delusions, which may affect their decision-making process. Thought processes and perceptions should be investigated. Hygiene, communication patterns, and motor activity are important to assess, but decision-making ability takes precedence.
A client is prescribed clozapine for the treatment of schizophrenia. The nurse understands that the client is at risk for which life-threatening side effect?
A. Neuroleptic malignant syndrome
B. Tardive dyskinesia
C. Agranulocytosis
D. Dystonia
Answer: C
Rationale: Agranulocytosis, a blood dyscrasia is a life-threatening side effect of clozapine. Neuroleptic malignant syndrome is a potentially fatal reaction most often seen with high-potency antipsychotic agents. Symptoms include muscular rigidity, tremors, altered level of consciousness, and hyperthermia. Dystonia is rigidity of the muscles that control posture, gait, and eye movement. Tardive dyskinesia includes manifestations that are late-appearing and irreversible movements of the mouth and face that include grimacing, lip smacking, and protruding tongue movements.
The nurse is reviewing the plan of care for an assigned client diagnosed with schizophrenia experiencing persecutory delusions. Which should be a priority diagnosis for this client?
A. Risk for other-directed violence
B. Altered nutrition, less than body requirements
C. Defensive coping
D. Altered family processes
Answer: A
Rationale: The client is at risk for other-directed or self-directed violence due to persecution-oriented delusions. The other diagnoses may be appropriate for the client but would not be the priority.
Assessment of a client with schizophrenia reveals evidence of perceptual disturbances. The nurse would most likely document which finding(s)? Select all that apply.
A. Hallucinations
B. Illusions
C. Delusions
D. Thought withdrawal
E. Loose associations
Answer: A, B
Rationale: Hallucinations and illusions are perceptual disturbances. Delusions, thought withdrawal, and loose associations reflect disorganized thinking.
A client receiving antipsychotic therapy experiences extrapyramidal side effects. Which medication(s) may be used to counteract extrapyramidal side effects? Select all that apply.
A. Haloperidol
B. Chlorpromazine
C. Fluphenazine
D. Benztropine
E. Trihexyphenidyl
Answer: D, E
Rationale: Antiparkinson agents are used to relieve the drug-induced extrapyramidal side effects associated with antipsychotic agents. The two most commonly used antiparkinson agents are benztropine and trihexyphenidyl. Haloperidol, chlorpromazine, and fluphenazine are typical antipsychotics that may further increase the extrapyramidal side effects.
A nurse is reviewing the history of a client with psychosis. Which diagnoses, if noted in the client’s chart, would the nurse identify as increasing the client's risk for the development of psychotic behaviors? Select all that apply.
A. Depression
B. Obsessive-compulsive disorder
C. Bipolar disorder
D. Dementia
E. Alcohol use disorder
Answer: A, C, D, E
Rationale: Associated causes of psychosis include depression, bipolar disorder, epilepsy, brain tumors, dementia, stroke, and alcohol or drug use disorder. Obsessive-compulsive disorder is not generally considered a psychotic trigger.
A client is experiencing negative symptoms associated with schizophrenia. Which nursing intervention(s) should the nurse consider for inclusion in the client's plan of care? Select all that apply.
A. Monitor for behavioral clues indicating client is experiencing visual hallucinations.
B. Challenging the client’s persecutory delusions.
C. Keep prepackaged snack foods on the unit for the client expressing paranoid beliefs.
D. Provide help in meeting bathing, dressing, and grooming needs in a matter-of-fact manner.
E. Implement appropriate safeguards for suicidal thoughts and behaviors.
Answer: A, D, E
Rationale: Negative symptoms develop slowly over time. They are reflected in the person's inability to deal with the way the illness affects their life. Negative symptoms may include avolition or the lack of motivation to make decisions or initiate self-care, such as hygiene and grooming, and anhedonia, which is seen as little interest shown in activities that were previously enjoyed. Depression with a suicidal end to the helpless and isolated pattern of living is not uncommon and must be monitored for and addressed appropriately. Persecutory delusions as well as other disorganized thinking such as hallucinations and paranoia are characteristic positive symptoms of schizophrenia.
A client diagnosed with schizophrenia is prescribed fluphenazine therapy. The nurse determines that the medication is achieving its desired effect based on which finding(s)? Select all that apply.
A. More coherent expression of organized thoughts
B. Reduction in word for word repetition of another’s speech
C. Reports of no longer hearing voices
D. Demonstration of pleasure in activities
E. Affect appropriate to the situation
Answer: A, B, C
Rationale: Fluphenazine is a typical antipsychotic. The positive symptoms are quite responsive to this class of medications. These medications also help to improve reasoning and decrease the ambivalent feelings and delusional thought processes. Therefore, improvement in the client’s positive symptoms such as more coherent expression of organized thoughts (reduced word salad), reduced echolalia and absence of auditory hallucinations would indicate effectiveness. Later generation antipsychotic medications, classified as atypical because they do not fall into any particular chemical class, have had a major impact on the reduction of negative symptoms of psychoses (such as flattened affect, verbal deficits, and diminished drive) with a reduced risk of extrapyramidal side effects. The reduction of negative symptoms as evidenced by a demonstration of pleasure in activities and appropriate affect for the situation would reflect effectiveness of atypical antipsychotic therapy.