Every day for the past 2 weeks, a client with schizophrenia stands up during group therapy and screams, “Get out of here right now! The elevator bombs are going to explode in 3 minutes!” The next time this happens, how should the nurse respond?
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Solution
“I know you think there are bombs in the elevator, but there aren’t.”
Option C: This C is the most therapeutic response because it orients the client to reality.
Options A and B: These are condescending.
Option D: This sounds punitive and could embarrass the client.
Propranolol (Inderal) is used in the mental health setting to manage which of the following conditions?
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Solution
Antipsychotic-induced akathisia and anxiety
Option A: Propranolol is a potent beta-adrenergic blocker and produces a sedating effect; therefore, it’s used to treat antipsychotic induced akathisia and anxiety.
Option B: Lithium (Lithobid) is used to stabilize clients with bipolar illness.
Option C: Antipsychotics are used to treat delusions.
Option D: Some antidepressants have been effective in treating OCD.
A client with a history of medication noncompliance is receiving outpatient treatment for chronic undifferentiated schizophrenia. The physician is most likely to prescribe which medication for this client?
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Solution
fluphenazine decanoate (Prolixin Decanoate)
Option D: Fluphenazine decanoate is a long-acting antipsychotic agent given by injection. Because it has a 4-week duration of action, it’s commonly prescribed for outpatients with a history of medication noncompliance.
Option A: Chlorpromazine, also an antipsychotic agent, must be administered daily to maintain adequate plasma levels, which necessitates compliance with the dosage schedule.
Options B and C: Imipramine, a tricyclic antidepressant, and lithium carbonate, a mood stabilizer, are rarely used to treat clients with chronic schizophrenia.
The nurse is assigned to a client with catatonic schizophrenia. Which intervention should the nurse include in the client’s plan of care?
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Solution
Meeting all of the client’s physical needs
Option A: Because a client with catatonic schizophrenia can’t meet physical needs independently, the nurse must provide for all of these needs, including adequate food and fluid intake, exercise, and elimination.
Option B: This client is incapable of expressing concerns; however, the nurse should try to verbalize the message conveyed by the client’s nonverbal behavior.
Option C: Lithium is used to treat mania, not catatonic schizophrenia.
Option D: Despite the client’s mute, unresponsive state, the nurse should provide nonthreatening stimulation and should spend time with the client, not leave the client alone all the time. Although aware of the environment, the client doesn’t interact with it actively; the nurse’s support and presence can be reassuring.
A client with persistent, severe schizophrenia has been treated with phenothiazines for the past 17 years. Now the client’s speech is garbled as a result of drug-induced rhythmic tongue protrusion. What is another name for this extrapyramidal symptom?
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Solution
Tardive dyskinesia
Option D: An adverse reaction to phenothiazines, tardive dyskinesia refers to choreiform tongue movements that commonly are irreversible and may interfere with speech.
Option A: Dystonia refers to involuntary contraction of a muscle group.
Option B: Akathisia is restlessness or inability to sit still.
Option C: Pseudoparkinsonism describes a group of symptoms that mimic those of Parkinson’s disease.
A client with schizophrenia is receiving antipsychotic medication. Which nursing diagnosis may be appropriate for this client?
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Solution
Ineffective protection related to blood dyscrasias
Option A: Antipsychotic medications may cause neutropenia and granulocytopenia, life-threatening blood dyscrasias, that warrant a nursing diagnosis of Ineffective protection related to blood dyscrasias. These medications also have anticholinergic effects, such as urine retention, dry mouth, and constipation.
Option B: Urinary frequency isn’t an approved nursing diagnosis.
Option C: Although antipsychotic medications may cause sedation, they don’t severely decrease the level of consciousness.
Option D: These drugs don’t cause electrolyte disturbances.
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: It 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 tells the nurse that people from Mars are going to invade the earth. Which response by the nurse would be most therapeutic?
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Solution
“That must be frightening to you. Can you tell me how you feel about it?”
Option A: This response addresses the client’s underlying fears without feeding the delusion.
Option B: Refuting the client’s delusion would increase anxiety and reinforce the delusion.
Option C: Asking the client to elaborate on the delusion would also reinforce it.
Option D: Voicing disbelief about the delusion wouldn’t help the client deal with underlying fears.
A client with a diagnosis of paranoid schizophrenia comments to the nurse, “How do I know what is really in those pills?” Which of the following is the best response?
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Solution
Allow him to open the individual wrappers of the medication.
Option B: This is correct because allowing a paranoid client to open his medication can help reduce suspiciousness.
Option A: This is incorrect because the client doesn’t know that it’s his medication and he’s obviously suspicious.
Options C and D: Telling the client not to worry or ignoring the comment isn’t supportive and doesn’t offer reassurance.
A client with schizophrenia who receives fluphenazine (Prolixin) develops pseudoparkinsonism and akinesia. What drug would the nurse administer to minimize extrapyramidal symptoms?
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Solution
benztropine (Cogentin)
Option A: Benztropine is an anticholinergic drug administered to reduce extrapyramidal adverse effects in the client taking antipsychotic drugs. It works by restoring the equilibrium between the neurotransmitters acetylcholine and dopamine in the central nervous system (CNS).
Option B: Dantrolene, a hydantoin drug that reduces the catabolic processes, is administered to alleviate the symptoms of neuroleptic malignant syndrome, a potentially fatal adverse effect of antipsychotic drugs.
Option C: Clonazepam, a benzodiazepine drug that depresses the CNS, is administered to control seizure activity.
Option D: Diazepam, a benzodiazepine drug, is administered to reduce anxiety.