Schizophrenia
A client diagnosed with schizophrenia is having delusions that he is being plotted against by the government. This would be documented as which of the following types of delusion?
1. Somatic
2. Grandiose
3. Persecution
4. Magical thinking
3. Persecution
A persecutory delusion is a belief that one is being watched, ridiculed, harmed, or plotted against. The belief that one has exceptional powers, wealth. skill, influence, or destiny is a grandiose delusion. A nihilistic delusion is the belief that one is dead or a calamity is impending. A somatic delusion is the belief about abnormalities in bodily functions or structures
A client with schizophrenia is prescribed second-generations antipsychotic. The client's mother asks, "About how long will it take until we see any changes in his symptoms?" Which response by the nurse would be most appropriate?
1. "Generally, it takes about one to two weeks to be effective in changing symptoms"
2. "You should see improvement in about 36 to 48 hours"
3. "His symptoms should subside almost immediately"
4. "It will take about 6 to 12 weeks until the drug is effective"
1. "Generally, it takes about one to two weeks to be effective in changing symptoms"
Generally, it takes about one to two weeks for antipsychotic drugs to effect a change in symptoms. During the stabilization period, the selected drug should be given an adequate trial, generally 6 to 12 weeks, before considering a change in the drug prescription. If treatment effects are not seen, another antipsychotic agent may be tried
A nurse assesses a client suspected of having major depressive disorder. Which client symptom would eliminate this diagnosis?
A. The client is disheveled and malodorous.
B. The client refuses to interact with others.
C. The client is unable to feel any pleasure.
D. The client has maxed-out charge cards and exhibits promiscuous behaviors.
ANS: D
The nurse should assess that a client who has maxed-out credit cards and exhibits promiscuous behavior would be exhibiting manic symptoms, these symptoms would rule out the diagnosis of major depressive disorder and would point to bipolar disorder.
What should be the priority nursing diagnosis for a client experiencing alcohol withdrawal?
A. Risk for injury R/T central nervous system stimulation
B. Disturbed thought processes R/T tactile hallucinations
C. Ineffective coping R/T powerlessness over alcohol use
D. Ineffective denial R/T continued alcohol use despite negative consequences
ANS: A
The priority nursing diagnosis for a client experiencing alcohol withdrawal should be risk for injury R/T central nervous system stimulation.
Alcohol withdrawal may include the following symptoms: course tremors of hands, tongue, or eyelids; seizures; nausea or vomiting; malaise or weakness; tachycardia; sweating; elevated blood pressure; anxiety; depressed mood; hallucinations; headache; and insomnia.
A patient is diagnosed with advanced leukemia. The patient is hopeless about the treatment. Which nursing interventions would help the patient to overcome the lack of hope? Select all that apply.
1. Treating chronic pain
2. Advising dietary modification
3. Providing economical support
4. Identifying sources of social support
5. Providing opportunities to express positive life events
1. Treating chronic pain
4. Identifying sources of social support
5. Providing opportunities to express positive life events
Treatment of pain can make the patient more comfortable and help in building a positive outlook. The nurse can approach family members, friends, and support groups for help. Providing opportunities to express positive life events helps the patient to focus on positivity rather than negativity related to the ailment. Dietary modification and economical support do not relieve hopelessness.
After teaching a group of nursing students about neurotransmitters associated with schizophrenia, the nursing instructor determines that the education was successful when the students verify which of the following as playing a role in the positive symptoms of schizophrenia?
1. Glutamate
2. Serotonin
3. Dopamine
4. Gamma-aminobutyric acid (GABA)
3. Dopamine
Positive symptoms of schizophrenia, specifically hallucinations and delusions, are thought to be related to dopamine hyperactivity. Studies are revealing that schizophrenia does not result from the dysregulation of a single neurotransmitter or biogenic amine, such as norepinephrine or serotonin. Hypothesis suggests a role for glutamate and GABA. However, dopamine dysfunction is also thought to be involved in psychosis with other disorders
Which of the following would the nurse expect to administer to a client with schizophrenia who is experiencing a dystonic reaction?
1. Risperidone (Risperdal)
2. Trihexyphenidyl (Artane)
3. Benztropine (Cogentin)
4. Aripiprazole (Abilify)
3. Benztropine (Cogentin)
A client experiencing a dystonic reaction should receive immediate treatment with benztropine (Cogentin).
Risperidone (Risperdal) and aripiprzole (Abilify) are antipsychotics that may cause dystonic reactions. Trihexyphenidyl (Artane) is used to treat Parkinsonism due to antipsychotic drugs
What is the rationale for a nurse to perform a full physical health assessment on a client admitted with a diagnosis of major depressive disorder?
A. The attention during the assessment is beneficial in decreasing social isolation.
B. Depression can generate somatic symptoms that can mask actual physical disorders.
C. Physical health complications are likely to arise from antidepressant therapy.
D. Depressed clients avoid addressing physical health and ignore medical problems.
ANS: B
The nurse should determine that a client with a diagnosis of major depressive disorder needs a full physical health assessment because depression can generate somatic symptoms that can mask actual physical disorders. Somatization is the process by which psychological needs are expressed in the form of physical symptoms.
Which client statement indicates a knowledge deficit related to substance abuse?
A. "Although it's legal, alcohol is one of the most widely abused drugs in our society."
B. "Tolerance to heroin develops quickly."
C. "Flashbacks from LSD use may reoccur spontaneously."
D. "Marijuana is like smoking cigarettes. Everyone does it. It's essentially harmless."
ANS: D
The nurse should determine that the client has a knowledge deficit related to substance abuse when the client compares marijuana to smoking cigarettes and claims it to be harmless. Cannabis is the second most widely abused drug in the United States.
Which person is experiencing anticipatory grief?
1. Person whose former spouse is dead.
2. Person who is caring for a patient with severe dementia.
3. Person who has a conflicted relationship with the deceased.
4. Person whose husband's body is not found after a terrorist attack.
2. Person who is caring for a patient with severe dementia.
A person who is caring for a patient with severe dementia experiences anticipatory grief. In this grief, people predict loss and begin to prepare for it. A person whose former spouse is dead experiences disenfranchised grief. A person who has a conflicted relationship with the deceased experiences complicated grief. A person whose husband's body is not found after a terrorist attack may experience disenfranchised grief.
Parents ask a nurse how they should reply when their child, diagnosed with paranoid schizophrenia, tells them that voices command him to harm others. Which is the appropriate nursing reply?
A. "Tell him to stop discussing the voices."
B. "Ignore what he is saying, while attempting to discover the underlying cause."
C. "Focus on the feelings generated by the hallucinations and present reality."
D. "Present objective evidence that the voices are not real."
ANS: C
The most appropriate response by the nurse is to instruct the parents to focus on the feelings generated by the hallucinations and present reality. The parents should maintain an attitude of acceptance to encourage communication but should not reinforce the hallucinations by exploring details of content. It is inappropriate to present logical arguments to persuade the client to accept the hallucinations as not real.
A psychiatrist prescribes a monoamine oxidase inhibitor (MAOI) for a client. Which foods should the nurse teach the client to avoid?
A. Pepperoni pizza and red wine
B. Bagels with cream cheese and tea
C. Apple pie and coffee
D. Potato chips and diet cola
ANS: A
The nurse should instruct the client to avoid pepperoni pizza and red wine. Foods with high tyramine content can induce hypertensive crisis within 2 hours of ingestion. Symptoms of hypertensive crisis include severe occipital and/or temporal pounding headaches with occasional photophobia, sensations of choking, palpitations, and a feeling of "dread."
A nurse is implementing a one-on-one suicide observation level with a client diagnosed with major depressive disorder. The client states, "I'm feeling a lot better so you can stop watching me. I have taken up too much of your time already." Which is the best nursing reply?
A. "I really appreciate your concern but I have been ordered to continue to watch you."
B. "Because we are concerned about your safety, we will continue to observe you."
C. "I am glad you are feeling better. The treatment team will consider your request."
D. "I will forward you request to your psychiatrist because it is his decision."
ANS: B
Often suicidal clients resist personal monitoring which impedes the implementation of a suicide plan. A nurse should continually observe a client when risk for suicide is suspected.
Which client statement demonstrates positive progress toward recovery from substance abuse?
A. "I have completed detox and therefore am in control of my drug use."
B. "I will faithfully attend Narcotic Anonymous (NA) when I can't control my carvings."
C. "As a church deacon, my focus will now be on spiritual renewal."
D. "Taking those pills got out of control. It cost me my job, marriage, and children."
ANS: D
A client who takes responsibility for the consequences of substance abuse/dependence is making positive progress toward recovery. This client would most likely be in the working phase of the counseling process in which acceptance of the fact that substance abuse causes problems occurs.
What are the different stages of dying based on the Kübler-Ross classic behavioral theory? Select all that apply.
1. Anger
2. Denial
3. Anxiety
4. Yearning
5. Depression
1. Anger
2. Denial
5. Depression
Kübler-Ross describes five stages of dying, including anger, denial, and depression. In the anger stage, the person expresses resistance and intense anger toward God or other people for the loss. Denial is the stage wherein the person is not able to accept the loss. In the depression stage, the person realizes the full impact of the loss. Anxiety and yearning are not stages of dying in this theory.
STUDY TIP: Use the mnemonic "DABDA" to recall Kübler-Ross's stages of dying: Denial, Anger, Bargaining, Depression, and Acceptance. To help you distinguish between the two Ds and two As, consider that it seems logical that denial would be the first response and that several stages are likely needed before acceptance is possible
A nurse is assessing a client diagnosed with paranoid schizophrenia. The nurse asks the client, "Do you receive special messages from certain sources, such as the television or radio?" Which potential symptom of this disorder is the nurse assessing?
A. Thought insertion
B. Paranoid delusions
C. Magical thinking
D. Delusions of reference
ANS: D
The nurse is assessing for the potential symptom of delusions of reference. A client who believes that he or she receives messages through the radio is experiencing delusions of reference. When a client experiences these delusions, he or she interprets all events within the environment as personal references.
A nurse is planning care for a child who is experiencing depression. Which medication is approved by the U.S. Food and Drug Administration (FDA) for the treatment of depression in children and adolescents?
A. Paroxetine (Paxil)
B. Sertraline (Zoloft)
C. Citalopram (Celexa)
D. Fluoxetine (Prozac)
ANS: D
Fluoxetine (Prozac) is FDA approved for the treatment of depression in children and adolescents. Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) used in the treatment of depression. All antidepressants carry an FDA warning for increased risk of suicide in children and adolescents.
Which collaborative process of initial monitoring should the nurse implement for a client who has been prescribed lithium?
1. Testing lithium serum levels every 1-3 days
2. Arranging for therapy sessions every 1-3 days
3. Arranging for blood urea nitrogen (BUN) and creatinine levels every 1-3 days
4. Testing sodium levels every 1-3 days
Testing lithium serum levels every 1-3 days
The window between lithium toxicity and therapy is short, and close monitoring is required.
A lonely, depressed divorcée has been self-medicating with cocaine for the past year. Which term should a nurse use to best describe this individual's situation?
A. The individual is experiencing psychological dependency.
B. The individual is experiencing physical dependency.
C. The individual is experiencing substance dependency.
D. The individual is experiencing social dependency.
ANS: A
The nurse should use the term "psychological dependency" to best describe this client's situation. A client is considered to be psychologically dependent on a substance when there is an overwhelming desire to use a substance in order to produce pleasure or avoid discomfort.
What are the different stages of mourning according to Bowlby's attachment theory? Select all that apply.
1. Depression
2. Bargaining
3. Reorganization
4. Yearning and searching
5. Disorganization and despair
3. Reorganization
4. Yearning and searching
5. Disorganization and despair
1. One or more major areas of social or occupational functioning markedly below previously achieved levels
2. Continuous signs for at least six months
3. Delusions present for a significant portion of time during a one-month period
4. Major depression occurring concurrently with active symptoms
5. A direct physiologic effect of a substance or medical condition
1. One or more major areas of social or occupational functioning markedly below previously achieved levels
2. Continuous signs for at least six months
3. Delusions present for a significant portion of time during a one-month period
Key diagnostic criteria includes continuous signs for at least six months, one or more major areas of social or occupational functioning markedly below previously achieved levels, and delusions present for a significant portion of time during a one-month period. Other criteria include the absence, or insignificant duration, of major depressive, manic, or mixed episodes occurring concurrently with active symptoms, and that the disease is not a direct physiologic effect of a substance or medical condition
A confused client has recently been prescribed sertraline (Zoloft). The client's spouse is taking paroxetine (Paxil). The client presents with restlessness, tachycardia, diaphoresis, and tremors. What complication does a nurse suspect and what could be its possible cause?
A. Neuroleptic malignant syndrome caused by ingestion of two different seratonin reuptake inhibitors (SSRIs)
B. Neuroleptic malignant syndrome caused by ingestion of an SSRI and a monoamine oxidase inhibitor (MAOI)
C. Serotonin syndrome caused by ingestion of an SSRI and an MAOI
D. Serotonin syndrome caused by ingestion of two different SSRIs
ANS: D
The nurse should suspect that the client is suffering from serotonin syndrome possibly caused by ingesting two different SSRIs (Zoloft and Paxil). Symptoms of serotonin syndrome include confusion, agitation, tachycardia, hypertension, nausea, abdominal pain, myoclonus, muscle rigidity, fever, sweating, and tremor.
The healthcare provider has prescribed lithium carbonate for a client diagnosed with bipolar disorder. Which information should the nurse include in the client teaching? (Select all that apply.)
1. "This medication may be used with an anticonvulsant used as a mood stabilizer."
2. "Monitor for constipation, as this could indicate lithium toxicity."
3. "Monitor for nausea and vomiting, as this could indicate lithium toxicity."
4. "This medication needs to be closely monitored by a healthcare provider if you suspect that you may be pregnant."
5. "Lab work will be needed to monitor the therapeutic level of this medication."
1. "This medication may be used with an anticonvulsant used as a mood stabilizer."
2. "Monitor for nausea and vomiting, as this could indicate lithium toxicity."
4. "This medication needs to be closely monitored by a healthcare provider if you suspect that you may be pregnant."
5. "Lab work will be needed to monitor the therapeutic level of this medication."
Nausea, vomiting, and diarrhea, not constipation, are symptoms of lithium toxicity. Lithium carbonate needs to be closely monitored in pregnant clients. Anticonvulsants used as mood stabilizers are often used in treating bipolar disorder along with lithium or antipsychotic medications. Lab work is needed to monitor the therapeutic level of this medication.
. Which client and family teaching is most important regarding the cause of substance addiction?
1) An individual's social and cultural environment can be implicated in the cause of substance addiction.
2) Biological, psychological, and sociocultural factors can all be implicated in the cause of substance addiction.
3) Evidence of a genetic link accounts for most cases of substance addiction.
4) Reinforcing properties of the substance encourage progression from use to addiction.
2) Biological, psychological, and sociocultural factors can all be implicated in the cause of substance addiction.
A patient lost a sibling in a car accident. On the same day, the patient lost his job, but the patient does not seem upset about the job loss. Which grief type is indicated by the patient's presentation?
1. Delayed grief
2. Masked grief
3. Exaggerated grief
4. Disenfranchised grief
1. Delayed grief