WHAT IS SCHIZOPHRENIA
(etiology/patho)
(etiology/patho)
Which of the following is NOT a “high offender” neurotransmitter associated with Schizophrenia.
a. glutamate
b. norepinephrine
c. dopamine
d. serotonin
Answer: B. Norepinephrine
Dopamine, serotonin and glutamate are the high offenders
A client diagnosed with schizophrenia has disorganized thoughts. Which of the following interventions is inappropriate for this patient?
A. Interacting with a neutral attitude
B. Using concrete language
C. Giving multistep directions
D. Providing nutritional supplements
answer: c
Giving multistep directions
Which medication has the least impact on negative symptoms of schizophrenia and high levels of side effects?
A. Haloperidol
B. Olanzapine
C. Risperidone
D. Aripiprazole
Answer: A Haloperidol
First-generation antipsychotic medications primarily effect positive symptoms with little effect on negative symptoms. Second generations can treat both negative and positive symptoms with less side effects. (p.210)
What are the four types of EPS symptoms from 1st or 2nd generation antipsychotic medications
1. Acute Dystonia
2. Akathisia
3. Pseudoparkinsonism
4. Tardive Dyskinesia
Which of the following is a community-based support group for patients with schizophrenia
A. Alcoholics Anonymous
B. National Alliance on Mental Illness
D. Mothers Against Drunk Driving
Answer: B. National Alliance on Mental Illness (NAMI)
What type of therapy can address cognitive deficits in patients and help to increase their ability to function?
A. Psychoeducation
B. Cognitive behavioral therapy
C. Cognitive remediation therapy
D. Cognitive analytic therapy
Answer: C. Cognitive Remediation Therapy
Cognitive remediation therapy teaches recall, attentional and other skills to maximize their quality of life. (p.217)
CBT is different, this therapy focuses on changing the way you think thereby changing the way you feel and behave. It replaces distorted thoughts with more realistic ones.
In Schizophrenia, hallucinations and delusions are what kind of symptoms?
What is Positive Symptoms
Name one way to keep anxiety from escalating with a patient who has schizophrenia
A. Calm environment by keeping stimuli low and maintain a quiet room
B. Disagree with the patient regarding their delusions
C. Place the patient in seclusion
D. Administer an anti-anxiety medications such as lorazepam
Answer: A. Calm environment by keeping stimuli low and maintain a quiet room
A patient with a history of schizophrenia taking Second-Generation Antipsychotic medications, starts complaining of a fever, chills, a sore throat and weakness. Which medication is highly likely to cause these side effects?
A. Olanzapine
B. Clozapine
C. Risperidone
D. Aripiprazole
Answer: B Clozapine
Agranulocytosis, a serious and life-threatening condition, is most associated with Clozapine. Symptoms of Agranulocytosis include signs of infection such as fever, chills, malaise and body aches. Those individuals taking this medication should have neutrophil monitoring. (p.214 & 217)
This is an acute life threatening medical emergency. The client with schizophrenia is presenting with the following side effects: Severe Muscle Rigidity, decreased responsiveness, and is excessively sweating. With the following Vital Signs: Temperature is 104 F, Heart Rate is 120, BP is 140/100
A. Agranulocytosis
B. Metabolic Syndrome
C. Neuroleptic Malignant Syndrome (NMS)
D. Fatal blood Dyscracia
Answer: C
NEUROLEPTIC MALIGNANT SYNDROME
What are some helpful websites, online videos or books that would help a patient learn about their illness?
A. Surviving Schizophrenia (6th edition) A family Manual
B. A book titled "I Am Not Sick, I Don't Need Help! How to Help Someone with Mental Illness Accept Treatment"
C. Online website: Living with Schizophrenia
E. ALL OF THE ABOVE
E. ALL OF THE ABOVE
ADDITIONAL RESOURCES INCLUDE:
Website to also include:
1. NAMI
2. NATIONAL INSTITUTE OF MENTAL HEALTH
3. MINDS ON THE EDGE (VIDEO)
4. OUT OF THE SHADOWS
Which support group would a person with schizophrenia benefit most from?
a. NAMI Peer to Peer Group
b. NAMI Family Support Group
c. AA meeting
d. Unity Recovery Meeting
Answer: A. NAMI PEER TO PEER GROUP
NAMI is the National Alliance on Mental Illness. A Peer to Peer group is beneficial for individuals living with schizophrenia, whereas a Family Support Group is for family members or loved ones of someone with schizophrenia. AA is for alcoholics and Unity Recovery focuses on all types of recovery, may not be specific enough
Which is a hallmark symptom of schizophrenia?
a. Psychosis
b. Somatic symptoms
c. Grandiose delusions
d. Compulsions
Answer: A. PSYCHOSIS
Which one of these is not an intervention for someone who has schizophrenia
A. Correct the patient who is actively experience hallucinations or delusions
B. Calm a patient by minimizing stimuli
C. Encourage the patient to participate in reality based activities
D. Acknowledge the patient's delusions/hallucinations are real
Answer: A. Correct the patient who is actively experience hallucinations or delusions
Rationale: Acknowledge that the voices and sightings are real to the client, but clearly state that you do not hear or see them
Which is NOT a correct teaching statement made to a patient regarding Antipsychotic medications?
A. It usually take 2-6 weeks to achieve desired effects.
B. Antipsychotic medications are not addictive
C. Antipsychotic medications do not need to be discontinued gradually.
D. Antipsychotics medications are likely to be lethal in overdose situations.
Answer: C Antipsychotic medications do not need to be discontinued gradually.
While antipsychotic medications are not addictive, they should be discontinued gradually to minimize discontinuation syndrome. These symptoms can include dizziness, nausea, tremors, insomnia, electric shock like pains and anxiety. (p.210)
This side effect can present with the following 4 symptoms below.
-Acute painful contractions of tongue, face, neck and back.
-Spasms of the muscles causing backward arching of the head and neck-TORTICOLLIS.
-Oculogyric crisis
-This side effect can threaten the airway
What EPS side effect is this and what medication can be given to treat it?
ACUTE DYSTONIC REACTION
GIVE 25-50MG IM/IV OF DIPHENHYDRAMINE HYDROCHOLORIDE (BENEDRYL) OR ADMINISTER ANTIPARKINSONIAN AGENT (IM)
Name 4 things to teach a patient with schizophrenia regarding early warning signs of relapse
1. sleep disturbance
2. troubling thoughts,
3. difficulty thinking or remembering,
4. hearing voices,
5. becoming more uncomfortable around others,
6. being unsure of what is real
This is an evidence-based therapeutic intervention for patients and their loved ones that provides information and cope with illness
Answer: Psychoeducation
A patient diagnosed with schizophrenia says, “I think the CIA is following my every move. Put away your cell phone, they’re listening to everything we say.” This patient is having a disturbance in which assessment?
a. Thought Content
b. Speech
c. Judgement
d. Behavior
Answer: A. Thought Content
A. Ask the client if an injection is preferable
B. Insist that the patient takes the medication as prescribed.
C. Withhold the medication until the patient is less suspicious
D. Ask the client about any previous problems with psychotropic medications.
Answer: D. Ask the client about any previous problems with psychotropic medications.
RATIONALE: The nurse needs to clarify the patient's previous experience with psychotropic medication in order to understand the meaning of the client's statement
Which medication should NOT be given to a patient with diabetes and high cholesterol?
A. Olanzapine
B. Ziprasidone
C. Aripiprazole
D. Lurasidone
Answer: A Olanzapine
Olanzapine can cause significant weight gain and a rise in blood cholesterol levels. These effects along with diabetes can increase the risk for developing heart disease. (p.212)
NAME ONE SIGN AND SYMPTOMS OF AKATHISIA, ONE PHARMACOLOGICAL INTERVENTION, AND ONE NONPHARMACOLOGICA INTERVENTION
A. SIMPLE ANXIOUS REPITITION THAT ONLY INVOLVES EXTREMITIES, GIVE AN ANTIPSYCHOTIC MEDICATION, SECLUSION.
B. ROCKING WHILE SITTING, GIVE PROPANOLOL, DO RELAXATION TECHNIQUES
C. PACING BACK AND FORTH, GIVE ANTIDEPRESSANT, ENCOURAGE RUNNING ON A TREADMILL
D. LIP SMACKING, GIVE LORAZAPAM, ENCOURAGE DEEP BREATHING TECHNIQUES
ANSWER: B
MOTOR RESTLESSNESS SUCH AS PACING, UNABLE TO STAND STILL, ROCKING WHILE SITTING.
GIVE PROPANOLOL (INDERAL), CAN ALSO GIVE LORAZAPAM OR DIAZEPAM
RELAXATION EXERCISES
Name 3 important topics to teach a family and patient regarding relapse prevention?
1. Medication Adherence
2. managing stress through stress avoidance
3. relaxation techniques
4. Sleep hygiene
This therapy provides support, education and opportunities for the patients with schizophrenia to vent their frustrations. SELECT ALL THAT APPLY
A. Family Therapy
B. Support Groups such as NAMI
C. Schizophrenia and Related Disorders Alliance of America
D. Cognitive Distortion Therapy
Answer:
A. Family Therapy
B. Support Groups such as NAMI
C. Schizophrenia and Related Disorders Alliance of America
pg.217
Which individual is among the highest prevalence for the onset schizophrenia?
a. A 1 year old, Caucasian Female
b. A 21 year old, Caucasian Male
c. A 68 year old, Asian Female
d. An 8 year old, African American Male
Answer: B. 21 year old, Caucasian Male
Males between the ages of 15-25 are at high risk.
Name two interventions for a patient with schizophrenia who presents with anosognosia
1. Establish trust/rapport
2. Do not argue with the patient about his/her symptoms of illness
3. Reorient patient towards reality
4. Seek areas of commonality
5. Involve the patient in activities where he will encounter peers who have gained insight despite once having had anosognosia.
A patient taking Fluphenazine starts complaining of restlessness and is unable to remain still. He seems agitated, anxious and unable to sleep. The nurse also witnessed him pacing around the room. What medication can be given to treat this side effect?
A. Propranolol
B. Olanzapine
C. Lorazepam
D. Either A or C
Answer: D. Propranolol or Lorazepam
Give antiparkinsonian agent as ordered lorazepam. Propranolol (Inderal), Lorazepam (Ativan), or diazepam (Valium) may be used . (p.215)
A patient has been on prolong treatment of first generation antipsychotic medication. The patient has involuntary rhythmic movements that are slow & snake like movements. Her hips jerk and twist occasionally. She has a protruding or writhing tongue with smacking lips alternating with grimaces.
What problem is most likely occurring?
TARDIVES DYSKINESIA
Name four ways to teach stress management for a patient with schizophrenia
1. Avoid loud or stressful places or activities
2. going for a walk
3. meditation
4. reading or listening to music
5. taking a hot bath
Psychosocial rehabilitation is a treatment method that focuses on (select all that apply):
a. Analyzing family issues and past problems
b. Developing social skills and supports
c. Learning how to live independently in a community
d. Learning job skills for employment
e. Treating family members affected by the illness
answer: b,c,d
R: The goal of psychosocial rehabilitation as a treatment method is to help the client develop the skills and supports necessary for successful living, learning, and working in the community.