Misc
A nurse is caring for a patient with schizophrenia. Which accurately describes genetic and environmental causes of schizophrenia?
1. One single gene is responsible for producing schizophrenia.
2. The chance of both monozygotic twins having schizophrenia is 100%.
3. Environmental factors do not affect the risk of developing schizophrenia.
4. First-degree relatives have an increased risk of developing schizophrenia.
Answer: 4
Explanation: 4. An individual's risk of developing schizophrenia spectrum disorder risk is higher than the general population by approximately 12 times if the disorder is present in one biological parent and by 40 times if present in both biological parents. One single gene is not responsible for producing schizophrenia. There is strong evidence that environmental factors do affect the risk of developing schizophrenia. The chance of monozygotic (identical) twins both having schizophrenia is 25 to 39%, not 100%.
The nurse is assessing the patient with schizophrenia. Which will the nurse recognize as negative symptoms associated with the disorder? Select all that apply.
1. The patient is withdrawn.
2. The patient has a blunted affect.
3. The patient reports auditory hallucinations.
4. The patient reports lack of motivation.
5. The patient introduces himself as Pope Francis.
Answer: 1, 2, 4
Explanation: 1. Negative symptoms refer to affects and behaviors that are diminished or absent in patients with SSDs. These include social withdrawal, lack of motivation (avolition), thought blocking, and a blunted affect. Positive symptoms involve additions to normal experiences and include hallucinations and delusions as well as abnormal movements and problems with speech. Cognitive symptoms include memory and attention deficits, language difficulties, and problems with executive functioning. Neural symptoms refer to symptoms dealing with brain functioning.
2. Negative symptoms refer to affects and behaviors that are diminished or absent in patients with SSDs. These include social withdrawal, lack of motivation (avolition), thought blocking, and a blunted affect. Positive symptoms involve additions to normal experiences and include hallucinations and delusions as well as abnormal movements and problems with speech. Cognitive symptoms include memory and attention deficits, language difficulties, and problems with executive functioning. Neural symptoms refer to symptoms dealing with brain functioning.
4. Negative symptoms refer to affects and behaviors that are diminished or absent in patients with SSDs. These include social withdrawal, lack of motivation (avolition), thought blocking, and a blunted affect. Positive symptoms involve additions to normal experiences and include hallucinations and delusions as well as abnormal movements and problems with speech. Cognitive symptoms include memory and attention deficits, language difficulties, and problems with executive functioning. Neural symptoms refer to symptoms dealing with brain functioning.
A patient with schizophrenia spectrum disorder presents to the emergency department (ED) with a temperature of 103.5o F. The nurse suspects the patient is experiencing neuroleptic malignant syndrome (NMS), an adverse effect of his antipsychotic medications. For what other symptoms of NMS will nurse assess? Select all that apply.
1. Grimacing
2. Diaphoresis
3. Muscle rigidity
4. Increased blink rates
5. Autonomic dysfunction
Answer: 2, 3, 5
Explanation: 2. Neuroleptic malignant syndrome (NMS) is rare, life-threatening, and sometimes fatal side effect of antipsychotic medications. Symptoms include body temperature that can increase to over 105o F, muscle rigidity, excessive sweating, difficulty swallowing, tremor, incontinence, changes in level of consciousness, inability to speak, autonomic dysfunction, leukocytosis, and elevated creatine kinase. Grimacing and increased blink rates are neurologic soft signs that may occur as symptoms of schizophrenia spectrum disorders and are not indicative of NMS.
3. Neuroleptic malignant syndrome (NMS) is rare, life-threatening, and sometimes fatal side effect of antipsychotic medications. Symptoms include body temperature that can increase to over 105o F, muscle rigidity, excessive sweating, difficulty swallowing, tremor, incontinence, changes in level of consciousness, inability to speak, autonomic dysfunction, leukocytosis, and elevated creatine kinase. Grimacing and increased blink rates are neurologic soft signs that may occur as symptoms of schizophrenia spectrum disorders and are not indicative of NMS.
5. Neuroleptic malignant syndrome (NMS) is rare, life-threatening, and sometimes fatal side effect of antipsychotic medications. Symptoms include body temperature that can increase to over 105o F, muscle rigidity, excessive sweating, difficulty swallowing, tremor, incontinence, changes in level of consciousness, inability to speak, autonomic dysfunction, leukocytosis, and elevated creatine kinase. Grimacing and increased blink rates are neurologic soft signs that may occur as symptoms of schizophrenia spectrum disorders and are not indicative of NMS.
The nurse caring for a patient with schizophrenia spectrum disorder will include which factors in the patient assessment? Select all that apply.
1. Medical history
2. Pain assessment
3. Home safety check
4. Suicide assessment
5. Height and weight assessment
Answer: 1, 2, 4, 5
Explanation: 1. The nurse caring for a patient with SSD will include the following as part of the nursing assessment: psychiatric and medical history, symptom description, precipitating factors, and a suicide/violence assessment. The nurse will also assess the patient's height and weight to determine body mass index (BMI) either as part of the baseline assessment or ongoing to compare against the patient's baseline. Home safety checks are not typically included in the assessment of the patient with SSDs.
2. The nurse caring for a patient with SSD will include the following as part of the nursing assessment: psychiatric and medical history, symptom description, precipitating factors, and a suicide/violence assessment. The nurse will also assess the patient's height and weight to determine body mass index (BMI) either as part of the baseline assessment or ongoing to compare against the patient's baseline. Home safety checks are not typically included in the assessment of the patient with SSDs.
4. The nurse caring for a patient with SSD will include the following as part of the nursing assessment: psychiatric and medical history, symptom description, precipitating factors, and a suicide/violence assessment. The nurse will also assess the patient's height and weight to determine body mass index (BMI) either as part of the baseline assessment or ongoing to compare against the patient's baseline. Home safety checks are not typically included in the assessment of the patient with SSDs.
5. The nurse caring for a patient with SSD will include the following as part of the nursing assessment: psychiatric and medical history, symptom description, precipitating factors, and a suicide/violence assessment. The nurse will also assess the patient's height and weight to determine body mass index (BMI) either as part of the baseline assessment or ongoing to compare against the patient's baseline. Home safety checks are not typically included in the assessment of the patient with SSDs.
The nurse is helping a patient with schizophrenia develop an exercise plan. The patient has obtained medical clearance for walking and light exercise. Which nursing interventions are the most appropriate? Select all that apply.
1. Assess medication adherence.
2. Assess patient confidence level.
3. Provide memory prompts.
4. Provide reality orientation.
5. Assess body mass index.
Answer: 2, 3
Explanation: 2. A significant symptom of schizophrenia spectrum disorder (SSD) is lack of motivation. One aspect of motivation is self-efficacy, which includes confidence in ability to perform tasks and expectations of benefits from successfully performing tasks. Nurses can help motivate patients to participate in regular exercise by assessing their confidence in participating in the type of exercise and providing memory prompts of earlier physical competence. Assessments of body mass index and medication adherence, although important when working with patients with SSDs, are not nursing interventions to help motivate patients to exercise. Nurses provide reality orientation to patients who are experiencing delusions to decrease false perceptions and enhance self-worth.
3. A significant symptom of schizophrenia spectrum disorder (SSD) is lack of motivation. One aspect of motivation is self-efficacy, which includes confidence in ability to perform tasks and expectations of benefits from successfully performing tasks. Nurses can help motivate patients to participate in regular exercise by assessing their confidence in participating in the type of exercise and providing memory prompts of earlier physical competence. Assessments of body mass index and medication adherence, although important when working with patients with SSDs, are not nursing interventions to help motivate patients to exercise. Nurses provide reality orientation to patients who are experiencing delusions to decrease false perceptions and enhance self-worth.
The nurse is reviewing the etiology of schizophrenia. What statement is correct regarding the brain structure of individuals with schizophrenia?
1. The brain displays changes in the hippocampal area.
2. The brain displays no changes in the mesocortical pathway.
3. The brains display no changes from those without schizophrenia.
4. The brain displays changes in the bilateral occipital lobe cortical gray matter.
Answer: 1
Explanation: 1. The brains of individuals with schizophrenia do show changes in the mesocortical pathway. The brains of individuals with schizophrenia do have alterations in the brain compared to those without schizophrenia. The brain of individuals with schizophrenia shows changes in the hippocampal area of the brain and in the bilateral frontal (not occipital) lobe cortical gray matter.
The nurse caring for a patient with schizophrenia spectrum disorder knows that the appearance of hard signs indicates which types of impairment? Select all that apply.
1. Reflexes
2. Grimacing
3. Asterognosis
4. Increased blink rates
5. Oculomotor abnormalities
Answer: 1, 5
Explanation: 1. Neurologic signs are divided into hard and soft signs. Hard signs indicate impaired reflex, sensory, or motor functioning and include hypoalgesia, impaired olfactory functioning, and oculomotor abnormalities. Soft signs are deficits that do not implicate specific brain areas and include grimacing, increased blink rates, problems sequencing motor tasks, and asterognosis.
5. Neurologic signs are divided into hard and soft signs. Hard signs indicate impaired reflex, sensory, or motor functioning and include hypoalgesia, impaired olfactory functioning, and oculomotor abnormalities. Soft signs are deficits that do not implicate specific brain areas and include grimacing, increased blink rates, problems sequencing motor tasks, and asterognosis.
When working with patients who have had psychotic episodes, the nurse knows to monitor for which laboratory analysis for the patient taking clozapine (Clozaril)?
1. WBC
2. RBC count
3. Fasting blood sugar
4. Pro-times and creatine kinase
Answer: 1
Explanation: 1. Clozapine (Clozaril), the first of the second-generation antipsychotics (SGAs), can cause agranulocytosis but is very efficacious. APA (2004) guidelines recommend strict WBC monitoring. The WBC count should be between 2000 and 3000 while using clozapine. RBC count, fasting blood sugars, and pro-times and creatine kinase are not factors that require close monitoring in patients taking clozapine.
The nurse is caring for a patient with delusional verbalizations. Which is an appropriate intervention for patients exhibiting this symptom?
1. Allow patient to determine delusion and truth through reflection.
2. Provide family members with educational material regarding medication adherence.
3. If delusions are expressed, present patient with reality without arguing.
4. Provide teaching related to titration of medication based on patient perception of symptoms.
Answer: 3
Explanation: 3. Providing gentle reality orientation without argument decreases false perceptions and enhances the patient’s sense of self-worth and personal dignity. Reflection is not an intervention appropriate for patients experiencing delusions. Although patient and family education are important, they are not appropriate interventions for the patient who is experiencing active delusions.
A patient is admitted to the inpatient unit with a diagnosis of schizophrenia. What is the priority nursing diagnosis for this patient?
1. Disturbed Thought Process
2. Impaired Social Interaction
3. Impaired Verbal Communication
4. Risk for Injury
Answer: 4
Explanation: 4. Risk for Injury is most closely related to patient safety, which is the highest priority in nursing care of any patient. Impaired Social Interaction, Disturbed Thought Processes, and Verbal Communication are accurate and important nursing diagnoses, but patient safety is the highest priority for planning care.
The nurse caring for a patient with schizophrenia spectrum disorder knows that the risk of disease increases according to which neurochemical explanations? Select all that apply.
1. Use of drugs that increase dopaminergic activity
2. A decrease in dopaminergic activity in the brain
3. An increase in gray matter in the anterior cingulate and hippocampus
4. A reduction in the structural gray matter of the bilateral frontal lobe and amygdala
5. Mitochondrial reduction of density and volume, including defective mitochondrial energy production
Explanation: 1. There are a number of neurochemical explanations for schizophrenia spectrum disorder (SSD). The most common is the dopamine hypothesis, which states that the most effective antipsychotic medications may have antagonistic actions on the dopamine type 2 (D2) receptor in the brain. Therefore, drugs that increase (not decrease) dopaminergic activity would produce a condition that resembles psychosis. Another explanation lies with neuropathology, which suggests that SSDs are composed of structural defects in multiple areas with a reduction (not increase) of gray matter in the anterior cingulate, bilateral frontal lobe, hippocampus, and amygdala. A study on brain metabolism dysfunction posits that there is a presence of mitochondrial dysfunction in patients with SSD that results in reduced mitochondrial density and volume, as well as defective mitochondrial energy production.
4. There are a number of neurochemical explanations for schizophrenia spectrum disorder (SSD). The most common is the dopamine hypothesis, which states that the most effective antipsychotic medications may have antagonistic actions on the dopamine type 2 (D2) receptor in the brain. Therefore, drugs that increase (not decrease) dopaminergic activity would produce a condition that resembles psychosis. Another explanation lies with neuropathology, which suggests that SSDs are composed of structural defects in multiple areas with a reduction (not increase) of gray matter in the anterior cingulate, bilateral frontal lobe, hippocampus, and amygdala. A study on brain metabolism dysfunction posits that there is a presence of mitochondrial dysfunction in patients with SSD that results in reduced mitochondrial density and volume, as well as defective mitochondrial energy production.
5. There are a number of neurochemical explanations for schizophrenia spectrum disorder (SSD). The most common is the dopamine hypothesis, which states that the most effective antipsychotic medications may have antagonistic actions on the dopamine type 2 (D2) receptor in the brain. Therefore, drugs that increase (not decrease) dopaminergic activity would produce a condition that resembles psychosis. Another explanation lies with neuropathology, which suggests that SSDs are composed of structural defects in multiple areas with a reduction (not increase) of gray matter in the anterior cingulate, bilateral frontal lobe, hippocampus, and amygdala. A study on brain metabolism dysfunction posits that there is a presence of mitochondrial dysfunction in patients with SSD that results in reduced mitochondrial density and volume, as well as defective mitochondrial energy production.
When working with patients who have had psychotic episodes, the nurse knows that which is a critical feature for psychological adjustment?
1. Reflection on psychological milestones
2. Insight into learning how to cope with life
3. Progressive goal direction through thought processes
4. Re-engagement in normal daily interactions
Answer: 4
Explanation: 4. Within the psychological domain a critical feature of psychological adjustment is the courage and ability to re-engage in normal daily interactions. Progressive goal direction through thought processes occurs in the biological domain. Insight into learning how to cope with life occurs across domains and disorders. Reflection on psychological milestones occurs within the psychological domain, but is not a critical feature.
The nurse is caring for a patient with schizophrenia spectrum disorder who is taking olanzapine (Zyprexa). The nurse knows the patient requires education related to avoiding which drugs and/or foods?
1. Phenytoin
2. Grapefruit juice
3. Dexamethasone
4. Garlic supplements
Answer: 1
Explanation: 1. Nursing considerations for patients on olanzapine (Zyprexa) include teaching the patient to avoid drugs and foods that may increase/decrease the levels of the drug. Contraindicated items include phenytoin (Dilantin), St. John's wort, cruciferous vegetables, and smoking. Grapefruit, dexamethasone, and garlic supplements do not affect olanzapine (Zyprexa).
Which intervention will increase the patient's likelihood of taking psychotropic medications for the treatment of schizophrenia?
1. Encourage the patient to use measures to manage side effects.
2. Encourage the patient to take all medications at the same time.
3. Give family members information about the patient's medication.
4. Give the patient a pamphlet explaining the positive effects of psychotropic medication.
Answer: 1
Explanation: 1. Encouraging the patient to use measures to manage side effects increases the potential for the patient to cope with side effects, which may help the patient adhere to the treatment plan. The nurse should help the patient develop a schedule for taking medications that will provide the most therapeutic response. Not all medication should be taken at the same time. The nurse should provide instruction and information about the patient's medication to a family member or caretaker; however, validation of the patient's understanding is needed to facilitate adherence. Providing the patient with a pamphlet does not ensure the patient understands the information provided. Validation of understanding is needed to facilitate adherence.
A patient is pacing in the hall when the nurse overhears the patient say, "Leave me alone. I am not in the Mafia." What is the best response from the nurse?
1. "Tell me, are you hearing voices again?"
2. "Tell me what you are hearing right now."
3. "You are safe from the Mafia here in the hospital."
4. "You need to attend the next recreation group. That will help you ignore the voices."
Answer: 2
Explanation: 2. "Tell me what you are hearing right now" is an open statement that invites the patient to describe what the patient is experiencing to the nurse. The nurse does not presume to know what the patient is experiencing. "Tell me, are you hearing voices again?" is a close-ended question that invites only a year or no answer and assumes the patient is hearing voices. "You need to attend the next recreation group. That will help you ignore the voices" does not ask for an explanation of the patient's experiences and implies that a patient can ignore voices. "You are safe from the Mafia here in the hospital" does not ask for an explanation of the patient's experiences and may not be addressing the patient's needs at this time.
The nurse understands that which alteration or deficit explains the memory alterations observed in patients with schizophrenia spectrum disorder?
1. Neuropathology
2. Biochemical alterations
3. Neural circuitry deficits
4. Brain metabolism dysfunction
Answer: 3
Explanation: 3. Neural circuitry deficits may explain the memory alterations observed in patients with schizophrenia spectrum disorder. Biochemical alterations may confirm dopamine dysfunction. Neuropathology consists of structural defects in multiple areas. Brain metabolism dysfunction indicates the presence of mitochondrial dysfunction.
The nurse caring for a patient with schizophrenia spectrum disorder (SSD) knows that, as a result of severe impairments in the sociocultural domain, the patient may experience which type of event?
1. Loss of job
2. Re-establishment of identity
3. Return to independent functioning
4. Distraction from symptoms
Answer: 1
Explanation: 1. SSDs can result in sever impairments across the domains of wellness. In the sociological domain, many patients with SSDs have difficult family relationships, are socially isolated, and struggle to maintain employment. Re-establishing identity occurs in the spiritual domain. The ability to function independently and the ability to distract from symptoms occur in the psychological domain.
The nurse knows that the patient taking aripiprazole (Abilify) 20 mg/day PO requires which specific follow-up assessment?
1. Vital signs each visit
2. Height and weight at each visit
3. Weekly assessment for extrapyramidal symptoms
4. Every six month checks for tardive dyskinesia
Answer: 4
Explanation: 4. Abilify is a third-generation antipsychotic with a partial agonist function for dopamine like the first-generation antipsychotics. The patient taking first-generation antipsychotics should be evaluated for tardive dyskinesia every 6 months, while the patient using second-generation antipsychotics should be checked once per year. While the other assessments are recommended for patients with SSDs, the tardive dyskinesia assessment is the most important when taking antipsychotics.
The nurse is assessing a patient who is experiencing a relapse of symptoms of schizophrenia. The nurse knows that the patient's abilities in which areas will have the greatest impact on the plan of care? Select all that apply.
1. Listening
2. Concentration
3. Decision making
4. Retaining new information
5. Maintaining adequate coping strategies
Answer: 1, 2, 3, 4
Explanation: 1. Nursing interventions depend on the patient's ability to concentrate and listen, retain new information, and make decisions. The patient experiencing symptom acuity associated with initial onset or relapse may experience impairment of these abilities, and this will affect the patient's plan of care. Through a multidisciplinary approach to treatment the patient will be able to develop and maintain adequate coping strategies.
2. Nursing interventions depend on the patient's ability to concentrate and listen, retain new information, and make decisions. The patient experiencing symptom acuity associated with initial onset or relapse may experience impairment of these abilities, and this will affect the patient's plan of care. Through a multidisciplinary approach to treatment the patient will be able to develop and maintain adequate coping strategies.
3. Nursing interventions depend on the patient's ability to concentrate and listen, retain new information, and make decisions. The patient experiencing symptom acuity associated with initial onset or relapse may experience impairment of these abilities, and this will affect the patient's plan of care. Through a multidisciplinary approach to treatment the patient will be able to develop and maintain adequate coping strategies.
4. Nursing interventions depend on the patient's ability to concentrate and listen, retain new information, and make decisions. The patient experiencing symptom acuity associated with initial onset or relapse may experience impairment of these abilities, and this will affect the patient's plan of care. Through a multidisciplinary approach to treatment the patient will be able to develop and maintain adequate coping strategies.
The nurse knows that the patient taking olanzapine for SSD will need to be followed in order to help manage which aspect of care?
1. Weight
2. Anxiety
3. Vital signs
4. Physical competence
Answer: 1
Explanation: 1. Research shows serious weight gain issues for patients using olanzapine and the need for aggressive management of symptoms with diet and nutritional education interventions. Vital signs, physical competence, or anxiety will not need to be followed to help manage care.
A patient tells the nurse, "I refuse to take quetiapine (Seroquel) because it is manufactured by terrorists. If I take it, I'll die." The nurse recognizes the patient's statement as indicative of what symptoms commonly seen in schizophrenia?
1. Alogia
2. Delusion
3. Ambivalence
4. Avolition
Answer: 2
Explanation: 2. The patient's statement is an example of the positive symptom of schizophrenia called delusion, which is a mistaken or false fixed belief about the self or the environment. The patient's statement is not an example of ambivalence, which is defined as concurrent conflicting emotions, thoughts, or actions toward a person, object, or concept. It is also not an example of the tendency to use few words when speaking, called alogia, or of a lack of motivation, called avolition.
A nurse is caring for a patient with schizophrenia who is prescribed antipsychotic medications. Which statement is accurate regarding schizophrenia and medication treatment?
1. Typical antipsychotic medications block serotonin and dopamine.
2. Dopamine receptors exist in only one region of the brain, making treatment difficult.
3. Atypical antipsychotic medications cause fewer extrapyramidal side effects than traditional antipsychotic medications.
4. Positive symptoms of schizophrenia respond more readily to atypical antipsychotic medications than traditional medications.
Answer: 3
Explanation: 3. Negative symptoms of schizophrenia respond more readily to atypical antipsychotic medications than the newer atypical medications. Atypical, not typical, antipsychotic medications block serotonin and dopamine. Numerous types of dopamine receptors have been found to exist in various regions of the brain. Atypical antipsychotic medications cause fewer extrapyramidal side effects than traditional antipsychotic medications.
The nurse is caring for a patient experiencing a relapse of a schizophrenia spectrum disorder. As the nurse considers the plan of care, which type of nursing intervention will the nurse give priority?
1. Patient education
2. Direct action
3. Disease prevention
4. Family involvement
Answer: 2
Explanation: 2. Patients experiencing a relapse of an SSD lack insight into their illness and its manifestations. Because of this, the nurse must implement direct and concrete actions and interventions. Patients experiencing acute relapse are not able to participate in education and disease prevention interventions due to a lack of insight. Family involvement is important to the patient's care; however, this is not the type of nursing intervention that will work best for a patient with schizophrenia who is experiencing relapse.
The nurse knows when planning lifestyle interventions for patients with schizophrenia spectrum disorders which aspect is most important?
1. Nicotine replacement
2. Spiritual counseling
3. Reduction of triggers
4. Reminders and repetition
Answer: 1
Explanation: 1. Commonly recommended lifestyle interventions for patients with schizophrenia spectrum disorders include dietary changes, physical exercise, and smoking cessation. Smoking reduces plasma levels of medications, inhibiting drug efficacy, and nicotine replacement therapy has been shown to significantly improve the chances of smoking reduction or cessation in SSD patients. Patients may need repetition, reminders, and positive reinforcement for dietary teaching and changes to help offset the memory and attention deficits that come with SSDs. Nurses do not provide spiritual counseling, but can lend spiritual support to patients. Through treatment, patients learn to recognize and manage symptom triggers.
When planning nursing care for patients with schizophrenia spectrum disorders whose symptoms do not respond to medication, the nurse will discuss which therapy with the prescribing provider?
1. Exercise therapy
2. Social skills therapy
3. Cognitive-behavioral therapy
4. Alternative medication therapy
Answer: 3
Explanation: 3. Research has shown that cognitive-behavioral therapy is a psychosocial treatment for patients with SSD that enhances coping and reduces symptoms in patients that do not respond to medication therapy. Exercise, social skills, and alternative medication therapy may be helpful, but they are not the first choice when discussing treatment for patients with symptoms that do not respond to pharmacotherapy.