The etiology of schizophrenia is best described by:
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Solution
a combination of biological, psychological, and environmental factors.
Option D: A reliable genetic marker hasn’t been determined for schizophrenia. However, studies of twins and adopted siblings have strongly implicated a genetic predisposition. Since the mid-19th century, excessive dopamine activity in the brain has also been suggested as a causal factor. Communication and the family system have been studied as contributing factors in the development of schizophrenia. Therefore, a combination of biological, psychological, and environmental factors are thought to cause schizophrenia.
Which of the following is one of the advantages of the newer antipsychotic medication risperidone (Risperdal)?
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Solution
A lower incidence of extrapyramidal effects
Option B: Risperdal has a lower incidence of extrapyramidal effects than the typical antipsychotics.
Option A: Risperdal does produce anticholinergic effects and neuroleptic malignant syndrome can occur.
Option C: Photosensitivity isn’t an advantage.
A client with paranoid schizophrenia repeatedly uses profanity during an activity therapy session. Which response by the nurse would be most appropriate?
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Solution
“Your behavior won’t be tolerated. Go to your room immediately.”
Option A: The nurse should set limits on client behavior to ensure a comfortable environment for all clients. The nurse should accept hostile or quarrelsome client outbursts within limits without becoming personally offended.
Option B: This is incorrect because it implies that the client’s actions reflect feelings toward the staff instead of the client’s own misery.
Option D: Judgmental remarks may decrease the client’s self-esteem.
A client is about to be discharged with a prescription for the antipsychotic agent haloperidol (Haldol), 10 mg by mouth twice per day. During a discharge teaching session, the nurse should provide which instruction to the client?
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Solution
Apply a sunscreen before being exposed to the sun.
Option C: Because haloperidol can cause photosensitivity and precipitate severe sunburn, the nurse should instruct the client to apply a sunscreen before exposure to the sun.
Options A, B, and D: The nurse also should teach the client to take haloperidol with meals — not 1 hour before — and should instruct the client not to decrease or increase the dosage unless the physician orders it.
How soon after chlorpromazine (Thorazine) administration should the nurse expect to see a client’s delusional thoughts and hallucinations eliminated?
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Solution
Several weeks
Option D: Although most phenothiazines produce some effects within minutes to hours, their antipsychotic effects may take several weeks to appear.
A client with paranoid personality disorder is admitted to a psychiatric facility. Which remark by the nurse would best establish rapport and encourage the client to confide in the nurse?
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Solution
“I get upset once in a while, too.”
Option A: Sharing a benign, nonthreatening, personal fact or feeling helps the nurse establish rapport and encourages the client to confide in the nurse. The nurse can’t know how the client feels.
Option B: Telling the client otherwise would justify the suspicions of a paranoid client; furthermore, the client relies on the nurse to interpret reality.
Option C: This is incorrect because it focuses on the nurse’s feelings, not the client’s.
Option D: This wouldn’t help establish rapport or encourage the client to confide in the nurse.
Drug therapy with thioridazine (Mellaril) shouldn’t exceed a daily dose of 800 mg to prevent which adverse reaction?
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Solution
Retinal pigmentation
Option D: Retinal pigmentation may occur if the thioridazine dosage exceeds 800 mg per day.
Options A, B, and C: The other options don’t occur as a result of exceeding this dose.
Since admission 4 days ago, a client has refused to take a shower, stating, “There are poison crystals hidden in the shower head. They’ll kill me if I take a shower.” Which nursing action is most appropriate?
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Solution
Accepting these fears and allowing the client to take a sponge bath
Option D: By acknowledging the client’s fears, the nurse can arrange to meet the client’s hygiene needs in another way.
Option A: Because these fears are real to the client, providing a demonstration of reality wouldn’t be effective at this time.
Options B and C: These would violate the client’s rights by shaming or embarrassing the client.
The nurse formulates a nursing diagnosis of Impaired verbal communication for a client with schizotypal personality disorder. Based on this nursing diagnosis, which nursing intervention is most appropriate?
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Solution
Establishing a one-on-one relationship with the client
Option B: By establishing a one-on-one relationship, the nurse helps the client learn how to interact with people in new situations.
Options A, C, and D: The other options are appropriate but should take place only after the nurse-client relationship is established.
The nurse is caring for a client with schizophrenia. Which of the following outcomes is the least desirable?
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Solution
The client spends more time by himself.
Option A: The client with schizophrenia is commonly socially isolated and withdrawn; therefore, having the client spend more time by himself wouldn’t be a desirable outcome. Rather, a desirable outcome would specify that the client spends more time with other clients and staff on the unit. Delusions are false personal beliefs.
Option B: Reducing or eliminating delusional thinking using talking therapy and antipsychotic medications would be a desirable outcome.
Option C: Protecting the client and others from harm is a desirable client outcome achieved by close observation, removing any dangerous objects, and administering medications.
Option D: Because the client with schizophrenia may have difficulty meeting his or her own self-care needs, fostering the ability to perform self-care independently is a desirable client outcome.