A client with schizophrenia tells the nurse he hears the voices of his dead parents. To help the client ignore the voices, the nurse should recommend that he:
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Solution
listen to a personal stereo through headphones and sing along with the music.
Option B: Increasing the amount of auditory stimulation, such as by listening to music through headphones, may make it easier for the client to focus on external sounds and ignore internal sounds from auditory hallucinations.
Option A: This would make it harder for the client to ignore the hallucinations.
Option C: Talking about the voices would encourage the client to focus on them.
Option D: This is incorrect because exercise alone wouldn’t provide enough auditory stimulation to drown out the voices.
A client is admitted to the inpatient unit of the mental health center with a diagnosis of paranoid schizophrenia. He’s shouting that the government of France is trying to assassinate him. Which of the following responses is most appropriate?
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Solution
“I find it hard to believe that a foreign government or anyone else is trying to hurt you. You must feel frightened by this.”
Option B: Responses should focus on reality while acknowledging the client’s feelings.
Option A: Arguing with the client or denying his belief isn’t therapeutic.
Option C: Arguing can also inhibit the development of a trusting relationship. Continuing to talk about delusions may aggravate the psychosis.
Option D: Asking the client if a foreign government is trying to kill him may increase his anxiety level and can reinforce his delusions.
While pacing in the hall, a client with paranoid schizophrenia runs to the nurse and says, “Why are you poisoning me? I know you work for central thought control! You can keep my thoughts. Give me back my soul!” How should the nurse respond during the early stage of the therapeutic process?
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Solution
“I’m a nurse, and you’re a client in the hospital. I’m not going to harm you.”
Option B: The nurse should directly orient a delusional client to reality, especially to place and person.
Options A and C: These may encourage further delusions by denying poisoning and offering information related to the delusion.
Option D: Validating the client’s feelings occurs during a later stage in the therapeutic process.
A dystonic reaction can be caused by which of the following medications?
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Solution
practice saying “Go away” or “Stop” when they hear voices.
Option B: Researchers have found that some clients can learn to control bothersome hallucinations by telling the voices to go away or stop.
Option A: Taking an as needed dose of psychotropic medication whenever the voices arise may lead to overmedication and put the client at risk for adverse effects. Because the voices aren’t likely to go away permanently, the client must learn to deal with the hallucinations without relying on drugs.
Option C: Although distraction is helpful, singing loudly may upset other clients and would be socially unacceptable after the client is discharged.
Option D: Hallucinations are most bothersome in a quiet environment when the client is alone, so sending the client to his room would increase, rather than decrease, the hallucinations.
A client with paranoid schizophrenia has been experiencing auditory hallucinations for many years. One approach that has proven to be effective for hallucinating clients is to:
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Solution
practice saying “Go away” or “Stop” when they hear voices.
Option B: Researchers have found that some clients can learn to control bothersome hallucinations by telling the voices to go away or stop.
Option A: Taking an as needed dose of psychotropic medication whenever the voices arise may lead to overmedication and put the client at risk for adverse effects. Because the voices aren’t likely to go away permanently, the client must learn to deal with the hallucinations without relying on drugs.
Option C: Although distraction is helpful, singing loudly may upset other clients and would be socially unacceptable after the client is discharged.
Option D: Hallucinations are most bothersome in a quiet environment when the client is alone, so sending the client to his room would increase, rather than decrease, the hallucinations.
Which medication can control the extrapyramidal effects associated with antipsychotic agents?
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Solution
amantadine (Symmetrel)
Option C: Amantadine is an anticholinergic drug used to relieve drug-induced extrapyramidal adverse effects, such as muscle weakness, involuntary muscle movement, pseudo-parkinsonism, and tardive dyskinesia. Other anticholinergic agents used to control extrapyramidal reactions include benztropine mesylate (Cogentin), trihexyphenidyl (Artane), biperiden (Akineton), and diphenhydramine (Benadryl).
Options A, B, and D: Perphenazine is an antipsychotic agent; doxepin, an antidepressant; and clorazepate, an antianxiety agent. Because these medications have no anticholinergic or neurotransmitter effects, they don’t alleviate extrapyramidal reactions.
A 24-year-old client is experiencing an acute schizophrenic episode. He has vivid hallucinations that are making him agitated. The nurse’s best response at this time would be to:
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Solution
explore the content of the hallucinations.
Option B: Exploring the content of the hallucinations will help the nurse understand the client’s perspective on the situation.
Option A: The client shouldn’t be touched, such as in taking vital signs, without telling him exactly what is going to happen.
Option C: Debating with the client about his emotions isn’t therapeutic.
Option D: When the client is calm, engage him in reality-based activities.
A client receiving haloperidol (Haldol) complains of a stiff jaw and difficulty swallowing. The nurse’s first action is to:
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Solution
administer as needed dose of benztropine (Cogentin) I.M. as ordered.
Option B: The client is most likely suffering from muscle rigidity due to haloperidol. I.M. benztropine should be administered to prevent asphyxia or aspiration.
Option A: Lorazepam treats anxiety, not extrapyramidal effects. Another dose of haloperidol would increase the severity of the reaction.
The nurse is providing care for a female client with a history of schizophrenia who’s experiencing hallucinations. The physician orders 200 mg of haloperidol (Haldol) orally or I.M. every 4 hours as needed. What is the nurse’s best action?
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Solution
Call the physician to clarify the order because the dosage is too high.
Option C: The dosage is too high (normal dosage ranges from 5 to 10 mg daily).
Options A and B: May lead to an overdose.
Option D: This is incorrect because haloperidol helps with symptoms of hallucinations.
A client with disorganized type schizophrenia has been hospitalized for the past 2 years on a unit for chronic mentally ill clients. The client’s behavior is labile and fluctuates from childishness and incoherence to loud yelling to slow but appropriate interaction. The client needs assistance with all activities of daily living. Which behavior is characteristic of disorganized type schizophrenia?
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Solution
Extreme social impairment
Option A: Disorganized-type schizophrenia (formerly called hebephrenia) is characterized by extreme social impairment, marked inappropriate affect, silliness, grimacing, posturing, and fragmented delusions and hallucinations.
Option B: A client with a paranoid disorder typically exhibits suspicious delusions, such as a belief that evil forces are after him.
Option C: Waxy flexibility, a condition in which the client’s limbs remain fixed in uncomfortable positions for long periods, characterizes
catatonic schizophrenia.Option D: Elevated affect is associated with schizoaffective disorder.