Etiology
True or False: First-degree relatives of people with schizophrenia more likely to develop schizophrenia.
Hallucinations and delusions; positive or negative symptoms?
Positive symptoms
Name two strategies for interacting with suspicious/paranoid client:
Promote trust
Avoid physical contact
Avoid laughing, whispering, etc
Be assertive and matter-of-fact
Haloperidol and chlorpromazine belong to which class of antipsychotics?
first-generation/typical antipsychotics
A client with schizophrenia tells the nurse, “Voices are telling me I am worthless and should die.” What is the nurse’s priority response?
A. “The voices aren’t real, and you shouldn’t listen to them.”
B. “I understand that the voices are upsetting. Are you thinking about hurting yourself right now?”
C. “Tell me more about what the voices are saying.”
D. “If you keep busy, the voices may go away.”
Correct Answer: B. Ask directly about suicidal intent
Rationale: Safety is the top priority. The nurse should acknowledge the client’s feelings and assess for risk of self-harm. Exploring the content or offering distraction may be appropriate later, but suicide assessment must come first.
Which gender typically has an earlier onset and poorer prognosis?
Male
Name two common negative symptoms of schizophrenia.
Apathy, Affect (Blunted/flat), Avolition, Ambivalence, Anhedonia, Alogia, Anergia
List two psychosocial interventions that support recovery in schizophrenia.
Group therapy, social skills training, case management, coping skills, family support.
Risperidone (Risperdal), olanzapine (Zyprexa), and quetiapine (Seroquel) belong to which medication class?
Second generation/Atypicals
Which statement by a nursing student demonstrates understanding of positive vs. negative symptoms of schizophrenia?
A. “Delusions and hallucinations are considered negative symptoms.”
B. “Flat affect and lack of motivation are positive symptoms.”
C. “Positive symptoms reflect an excess of normal function, such as disorganized speech.”
D. “Negative symptoms include paranoia and bizarre behaviors.”
Correct Answer: C. Positive symptoms reflect an excess of normal function
Rationale: Positive symptoms include hallucinations, delusions, bizarre behavior, and disorganized thought processes (excesses). Negative symptoms involve deficits such as flat affect, poverty of speech, social withdrawal, and avolition.
Schizophrenia is most strongly associated with excess activity of which neurotransmitter in the brain?
A client believes the CIA implanted a microchip in their brain. This is an example of what type of delusion?
Delusion of control (or persecutory delusion)
A client states "I'm hearing terrible things". What is the priority assessment question for the hallucinations?
Assess for command hallucinations. E.g. “What are the voices telling you to do?”
Which lab value is most important to monitor for clients taking clozapine?
ANC
A client with schizophrenia is prescribed haloperidol. Which finding is the priority for the nurse to report to the healthcare provider?
A. Akathisia (restlessness, pacing)
B. Tremors and muscle rigidity
C. Oral dryness and constipation
D. Temperature of 103°F (39.4°C) with muscle stiffness
Correct Answer: D. Temperature of 103°F with muscle stiffness
Rationale: This indicates neuroleptic malignant syndrome (NMS), a life-threatening reaction to antipsychotics characterized by fever, rigidity, altered mental status, and autonomic instability. Akathisia, tremors, and anticholinergic effects are significant but not immediately life-threatening.
The lifetime prevalence of schizophrenia is approximately what percentage of the population?
1%
Echopraxia, catatonia, and waxy flexibility fall under what category of symptoms?
Disorganized behavior/motor symptoms
Patient teaching should emphasize that sudden stopping of medications may cause what?
Relapse of symptoms and rebound psychosis.
What is the treatment for acute EPS symptoms?
Immediately give anticholinergic– IM or IV
Benztropine (Cogentin)
Diphenhydramine (Benadryl)
Which teaching point should the nurse emphasize for a client starting clozapine therapy?
A. “You should increase your sun exposure to boost vitamin D.”
B. “Report signs of infection such as fever or sore throat immediately.”
C. “Stop the medication as soon as you feel better.”
D. “No bloodwork is required once you start this medication.”
Correct Answer: B
Rationale: Clozapine carries a risk of agranulocytosis, requiring close monitoring and prompt reporting of infection signs. Clients must continue medication even when symptoms improve.
Neuroimaging studies of clients with schizophrenia often show enlargement of which brain structures?
Lateral and third ventricles
A client says, “I walked to the park dark mark bark.” This speech pattern is known as what?
clang association
The downward drift hypothesis suggests schizophrenia leads to what social consequence?
Poverty and poor social conditions
Name at least two symptoms of neuroleptic malignant syndrome (NMS).
Fever, Encephalopathy (Confusion, Disoriented), Vital Sign Instability (Unstable BP, Tachycardia, Tachypnea), Enzyme Elevation (Elevated CPK from rhabdomyolysis), Rigidity of muscles
A client receiving chlorpromazine develops tremors, shuffling gait, and drooling. Which medication would the nurse anticipate being prescribed?
A. Lorazepam
B. Benztropine
C. Lithium
D. Fluoxetine
Correct Answer: B
Rationale: These are signs of pseudoparkinsonism (EPS). Anticholinergic medications like benztropine or diphenhydramine are used to treat EPS