Positive symptoms of schizophrenia include which of the following?
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Solution
Hallucinations, delusions, and disorganized thinking
Option A: The positive symptoms of schizophrenia are distortions of normal functioning. Option A lists the positive symptoms of schizophrenia.
Options B, C, and D: A flat affect, alogia, apathy, avolition, and anhedonia refer to the negative symptoms. Negative symptoms list the diminution or loss of normal function.
Important teaching for clients receiving antipsychotic medication such as haloperidol (Haldol) includes which of the following instructions?
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Solution
Use sunscreen because of photosensitivity. & B. Take the antipsychotic medication with food.
Options A and B: A and B are both correct in taking HALDOL.
Which information is most important for the nurse to include in a teaching plan for a schizophrenic client taking clozapine (Clozaril)?
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Solution
Report a sore throat or fever to the physician immediately.
Option B: A sore throat and fever are indications of an infection caused by agranulocytosis, a potentially life-threatening complication of clozapine.
Option A: Because of the risk of agranulocytosis, white blood cell (WBC) counts are necessary weekly, not monthly. If the WBC count drops below 3,000/µl, the medication must be stopped.
Option C: Hypotension may occur in clients taking this medication. Warn the client to stand up slowly to avoid dizziness from orthostatic hypotension.
Option D: The medication should be continued, even when symptoms have been controlled. If the medication must be stopped, it should be slowly tapered over 1 to 2 weeks and only under the supervision of a physician.
A client with paranoid schizophrenia is admitted to the psychiatric unit of a hospital. Nursing assessment should include careful observation of the client’s:
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Solution
thinking, perceiving, and decision-making skills.
Option A: Nursing assessment of a psychotic client should include careful inquiry about and observation of the client’s thinking, perceiving, symbolizing, and decision-making skills and abilities. Assessment of such a client typically reveals alterations in thought content and process, perception, affect, and psychomotor behavior; changes in personality, coping, and sense of self; lack of self-motivation; presence of psychosocial stressors; and degeneration of adaptive functioning.
Options B, C, and D: Although assessing communication processes, affect, behavior, and psychomotor activity would reveal important information about the client’s condition, the nurse should concentrate on determining whether the client is hallucinating by assessing thought processes and decision-making ability.
A woman is admitted to the psychiatric emergency department. Her significant other reports that she has difficulty sleeping, has poor judgment, and is incoherent at times. The client’s speech is rapid and loose. She reports being a special messenger from the Messiah. She has a history of depressed mood for which she has been taking an antidepressant. The nurse suspects which diagnosis?
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Solution
Bipolar illness
Option C: Bipolar illness is characterized by mood swings from profound depression to elation and euphoria. Delusions of grandeur along with pressured speech are common symptoms of mania.
Option A: Schizophrenia doesn’t exhibit mood swings from depression to euphoria.
Option B: Paranoia is characterized by unrealistic suspiciousness and is often accompanied by grandiosity.
Option D: OCD is a preoccupation with rituals and rules.
A client is admitted to the psychiatric unit with a tentative diagnosis of psychosis. Her physician prescribes the phenothiazine thioridazine (Mellaril) 50 mg by mouth three times per day. Phenothiazines differ from central nervous system (CNS) depressants in their sedative effects by producing:
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Solution
a calming effect from which the client is easily aroused.
Option C: Shortly after phenothiazine administration, a quieting and calming effect occurs, but the client is easily aroused, alert, and responsive and has good motor coordination.
The nurse is teaching a psychiatric client about her prescribed drugs, chlorpromazine and benztropine. Why is benztropine administered?
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Solution
To reduce extrapyramidal symptoms
Option B: Benztropine is an anticholinergic medication, administered to reduce the extrapyramidal adverse effects of chlorpromazine and other antipsychotic medications.
Options A, C, and D: Benztropine doesn’t reduce psychotic symptoms, relieve anxiety, or control nausea and vomiting.
During a group therapy session in the psychiatric unit, a client constantly interrupts with impulsive behavior and exaggerated stories that cast her as a hero or princess. She also manipulates the group with attention-seeking behaviors, such as sexual comments and angry outbursts. The nurse realizes that these behaviors are typical of:
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Solution
histrionic personality disorder.
Option C: This client’s behaviors are typical of histrionic personality disorder, which is marked by excessive emotionality and attention seeking. The client constantly seeks and demands attention, approval, or praise; may be seductive in behavior, appearance, or conversation; and is uncomfortable except when she is the center of attention.
Option A: Typically, a client with paranoid personality disorder is suspicious, cold, hostile, and argumentative.
Option B: Avoidant personality disorder is characterized by anxiety, fear, and social isolation.
Option D: Borderline personality disorder is characterized by impulsive, unpredictable behavior and unstable, intense interpersonal relationships.
A client, age 36, with paranoid schizophrenia believes the room is bugged by the Central Intelligence Agency and that his roommate is a foreign spy. The client has never had a romantic relationship, has no contact with family members, and hasn’t been employed in the last 14 years. Based on Erikson’s theories, the nurse should recognize that this client is in which stage of psychosocial development?
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Solution
Trust versus mistrust
Option D: This client’s paranoid ideation indicates difficulty trusting others.
Option A: The stage of autonomy versus shame and doubt deals with separation, cooperation, and self-control.
Option B: Generativity versus stagnation is the normal stage for this client’s chronologic age.
Option C: Integrity versus despair is the stage for accepting the positive and negative aspects of one’s life, which would be difficult or impossible for this client.
A 26-year-old client is admitted to the psychiatric unit with acute onset of schizophrenia. His physician prescribes the phenothiazine chlorpromazine (Thorazine), 100 mg by mouth four times per day. Before administering the drug, the nurse reviews the client’s medication history. Concomitant use of which drug is likely to increase the risk of extrapyramidal effects?
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Solution
droperidol (Inapsine)
Option B: When administered with any phenothiazine, droperidol may increase the risk of extrapyramidal effects.
Options A, C, and D: The other options are incorrect.