Overview
At what age does schizophrenia most commonly begin in men?
18-25 years old
There are two major classes of antipsychotic medications used to treat schizophrenia. What are they?
First-generation (Typical) & Second-generation (Atypical) Antipsychotics
Your patient tells you, 'The TV is sending me secret messages.' What symptom of schizophrenia is the patient experiencing?
Delusion of reference.
The nurse should assess for these because they can increase the risk of self-harm or harm to others.
What are paranoid delusions and command hallucinations?
A nurse is assessing a client suspected of having schizophrenia. Which finding best supports the diagnosis?
A. Symptoms of psychosis lasting 2 weeks
B. Hallucinations and delusions lasting at least 6 months
C. Depressive symptoms lasting 3 months
D. Anxiety and panic attacks for 1 month
What type of hallucination is the most common in schizophrenia?
Auditory hallucinations
Which dopamine pathway is associated with positive symptoms such as hallucinations and delusions?
Mesolimbic
A patient is sitting alone, has poor hygiene, speaks very little, and shows little emotion. Are these positive or negative symptoms of schizophrenia?
Negative symptoms
This type of environment helps decrease anxiety and distracts the patient from constant thoughts about hallucinations.
What is a structured, safe environment or milieu?
A client with schizophrenia tells the nurse, "The people on the radio keep changing the songs to send me warnings about what I should do next." Which type of delusion is the client experiencing?
A. Delusion of persecution
B. Delusion of reference
C. Delusion of grandeur
D. Somatic delusion
How long must symptoms be present before schizophrenia can be diagnosed?
At least 6 months
A nurse is teaching a patient about first-generation and second-generation antipsychotic medications. What is one major difference between these two medication classes?
First-generation antipsychotics are generally less effective at treating negative symptoms and have a higher risk of movement-related side effects (EPS). Second-generation antipsychotics may provide greater improvement in negative symptoms and have a higher risk of metabolic side effects.
A patient says, 'I hear voices.' What is the most important question the nurse should ask next, and why?
"Can you tell me what the voices are saying?"
A patient says, “The CIA is trying to kill me,” and the nurse responds, “I do not see evidence that the CIA is here, but I can tell this feels frightening for you.” What is this technique being used by the nurse.
What is presenting reality while acknowledging the patient’s feelings?
A nurse is providing medication teaching to a client who is prescribed paliperidone (Invega Sustenna®) for schizophrenia. Which statement by the client indicates an understanding of the teaching?
A. "I can receive this injection without ever taking the oral medication."
B. "This medication is a long-acting injection that can help improve medication adherence."
C. "I should expect this medication to cause severe extrapyramidal symptoms."
D. "I will need weekly CBC monitoring while taking this medication."
Name 2 positive symptoms.
Hallucinations, Delusions, Disorganized Speech or Disorganized Behavior
A patient taking haloperidol develops muscle rigidity, tremors, and restlessness. Which nursing intervention is most appropriate?
Notify the provider and anticipate treatment with benztropine (Cogentin) or diphenhydramine (Benadryl).
A patient tells you, 'The voices are telling me to leave the hospital because the staff is trying to poison me.' As the nurse, what are your immediate priorities, and why?
Assess safety, determine if the hallucinations are commanding harmful actions, remain calm, stay with the patient if needed, and maintain a safe environment.
A schizophrenic patient says, “The voices are telling me to hurt my roommate.” This is the highest priority nursing diagnosis because command hallucinations can place the patient or others in danger.
What is Risk for Violence / Risk for Self-Harm?
Which second-generation antipsychotic requires routine CBC monitoring because of the risk for agranulocytosis?
A. Olanzapine
B. Risperidone
C. Clozapine
D. Quetiapine
Name 3 risk factors for developing schizophrenia.
Family history of schizophrenia, older paternal age, viral infection during pregnancy, poor maternal nutrition, substance use during pregnancy, birth complications, CNS infection during early childhood, cannabis use during adolescence
A patient taking an antipsychotic medication develops a high fever, severe muscle rigidity, and confusion. What life-threatening condition should the nurse suspect, and what is the priority nursing intervention?
The patient is experiencing Neuroleptic Malignant Syndrome (NMS). The priority intervention is to stop the antipsychotic medication immediately, notify the provider, and begin supportive care.
A patient with schizophrenia tells you, 'I know the voices are real.' How would you respond using therapeutic communication while maintaining the patient's trust and safety?
'I understand the voices seem real to you, but I don't hear them. Can you tell me what they're saying?'
These patient strategies can help manage auditory hallucinations: listening to music, walking, attending activities, or talking to a trusted person.
What are healthy coping strategies for hallucinations?
A client diagnosed with schizophrenia tells the nurse, "The voices keep telling me to hurt myself." What is the nurse's priority action?
A. Tell the client the voices are not real.
B. Encourage the client to ignore the voices.
C. Assess the content of the hallucinations and ensure safety.
D. Ask the client to write down what the voices are saying.