Predisposing Factors
What are the 4 biological factors?
Genetics, biochemical, anatomical abnormalities, and physiological factors
What is 1 example of a typical antipsychotic medication?
Chlorpromazine, fluphenazine, haloperidol, loxapine, perphenazine, thioridazine, thiothixewne, trifluoperazine
Josh, age 21, has been diagnosed with schizophrenia. He has been socially isolated and hearing voices telling him to kill his parents. He has been admitted to the psychiatric unit from the emergency department. The initial nursing intervention for Josh is to:
a. Give him an injection of Thorazine
b. Ensure a safe environment for him and others.
c. Place him in restraints
d. Order him a nutritious diet
b. Ensure a safe environment for him and others
What are 2 positive symptoms of schizophrenia?
Delusion, hallucinations, paranoia, magical thinking, catatonia, hyperactivity, hypervigilance, agitation, hostility, stereotyped, repetitive movements, unusual mannerisms/postures
This statement uses reasonable doubt as a therapeutic technique: "I understand that you believe this to be true, but I personally find it hard to believe."
a. True
b. False
a. True
What are 3 environmental factors?
Sociocultural, stressful life events, cannabis and genetic vulnerability
What are the side effects of the High Potency Agents?
Extrapyramidal Symptoms (dystonia, pseudoparkinsonism, akathisia, oculogyric crisis)
The nurse is interviewing a client on the psychiatric unit. The client tilts his head to the side, stops talking in midsentence, and listens intently. The nurse recognizes these behaviors as a symptom of the client's illness. The most appropriate nursing intervention for this symptom is to:
a. Ask the client to describe his physical symptoms
b. Ask the client to describe what he is hearing
c. Administer a dose of benztropine
d. Call the physician for additional orders
b. Ask the client to describe what he is hearing
What are 2 examples of negative symptoms?
Apathy, avolition, lack of interest or skills in interpersonal interaction, anosognosia, anhedonia, and lack of abstract thinking
The nurse is interviewing a patient on the psychiatric unit. The patient tilts his head to the side, stops talking in mid sentence, and listens intently. The nurse recognizes from these signs that the patient is likely experiencing which of the following?
a. Somatic delusions
b. Catatonic stupor
c. Auditory hallucinations
d. Pseudoparkinsonism
c. Auditory hallucinations
What substances can precipitate a psychotic episode?
Alcohol, cocaine, amphetamines
What is 1 example of a medication used to treat extrapyramidal symptoms (EPS)?
Anticholinergic medications (Benztropine & Trihexyphenidyl), Antihistamines (Benadryl), Beta Blockers (Propranolol)
A client diagnosed with brief psychotic disorder tells a nurse about voices telling him to kill the president. Which nursing diagnosis should the nurse prioritize for this client?
a. Disturbed sensory perception
b. Altered thought processes
c. Risk for violence: directed toward others
d. Risk for injury
c. Risk for violence: directed toward others
Which statement should indicate to a nurse that an individual is experiencing a delusion?
a. "There's an alien growing in my liver."
b. "I see my dead husband everywhere I go."
c. "The IRS may audit my taxes."
d. "I'm not going to eat my food. It smells like brimstone."
a. "There's an alien growing in my liver."
A client diagnosed with schizophrenia states, "Can't you hear him? It's the devil. He's telling me I'm going to hell." Which is the most appropriate nursing reply?
a. "Did you take your medicine this morning?"
b. "You are not going to hell. You are a good person."
c. "I'm sure the voices sound scary. The devil is not talking to you. This is part of your illness."
d. "The devil only talks to people who are receptive to his influence."
c. "I'm sure the voices sound scary. The devil is not talking to you. This is part of your illness."
A schizophrenic mother and non-schizophrenic father have a child. The child will have schizophrenia.
a. True
b. False
b. False
The nurse is caring for a patient with schizophrenia. Orders from the physician include haloperidol (Haldol)5 mg. IM STAT and then 3 mg PO did, 2 mg benztropine PO bid prn. Why is haloperidol ordered?
a. To reduce extrapyramidal symptoms
b. To prevent neuroleptic malignant syndrome
c. To decrease psychotic symptoms
d. To induce sleep
c. To decrease psychotic symptoms
Which nursing intervention would be most appropriate when caring for an acutely agitated client with paranoia?
a. Provide neon lights and soft music
b. Maintain continual eye contact throughout the interview
c. Use therapeutic touch to increase trust and rapport
d. Provide personal space to respect the client's boundaries
d. Provide personal space to respect the clients's boundaries
Which of the following statements about negative and positive symptoms of schizophrenia is true?
a. Negative symptoms are associated with a higher disease burden than positive symptoms
b. Positive symptoms are undertreated compared with negative symptoms.
c. Negative symptoms are experienced by all people with schizophrenia, whereas only some people with schizophrenia experience positive symptoms.
d. Negative symptoms are experienced by only some people with schizophrenia, whereas all people with schizophrenia experience positive symptoms.
a. Negative symptoms are associated with a higher disease burden than positive symptoms
Brandon, a patient on the psychiatric unit, has been diagnosed with schizophrenia. He begins to tell the nurse about how the CIA is looking for him and will kill him if they find him. Brandon's belief is an example of which of the following?
a. Delusion of persecution
b. Delusion of reference
c. Delusion of control or influence
d. Delusion of grandeur
a. Delusion of persecution
What is the dopamine hypothesis on schizophrenia?
Schizophrenia (or schizophrenia-like symptoms) may be caused by an excess of dopamine-dependent neuronal activity in the brain which may be related to increased production or release of the substance at nerve terminals, increased receptor sensitivity, too many dopamine receptors, or a combination of these mechanisms.
The nurse is caring for a client with Schizophrenia. Orders from the physician include 100 mg Chlorpromazine IM STAT and then 50 mg PO bid; 2mg Benztropine PO bid prn. Because Benztropine was ordered on a prn basis, which of the following assessments by the nurse would convey a need for this medication?
a. The client's level of agitation increases
b. The client complains of sore throat
c. The client's skin has a yellowish cast
d. The client develops muscles spasms
d. The clients develop muscle spasms
A college student has quit attending classes, isolates self because of hearing voices, and yells accusations at fellow students. Based on this information, which nursing diagnosis should the nurse prioritize?
a. Altered thought processes R/T hearing voices AEB increased anxiety
b. Risk for other-directed violence R/T yelling accusations
c. Social isolation R/T paranoia AEB absence from classes
d. Risk for self-directed violence R/T depressed mood
b. Risk for other-directed violence R/T yelling accusations
Which of the following is true about positive symptoms and the diagnosis of schizophrenia, according to the DSM-5?
a. Positive symptoms are not required to be present for a schizophrenia diagnosis.
b. Positive symptoms must be present for at least 2 months.
c. Both delusions and hallucinations are required.
d. Either delusions or hallucinations or disorganized speech is required.
d. Either delusions or hallucinations or disorganized speech is required
The client hears the word “match.” The client replies, “A match. I like matches. They are the light of the world. God will light the world. Let your light so shine.” Which communication pattern does the nurse identify?
a. Word salad
b. Clang association
c. Loose association
d. Ideas of reference
c. Loose association