A client’s medication order reads, “Thioridazine (Mellaril) 200 mg P.O. q.i.d. and 100 mg P.O. p.r.n.” The nurse should:
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Solution
question the physician about the order.
Option B: The nurse must question this order immediately. Thioridazine (Mellaril) has an absolute dosage ceiling of 800 mg/day. Any dosage above this level places the client at high risk for toxic pigmentary retinopathy, which can’t be reversed. As written, the order allows for administering more than the maximum 800 mg/day; it should be corrected immediately before the client’s health is jeopardized.
A man with a 5-year history of multiple psychiatric admissions is brought to the emergency department by the police. He was found wandering the streets disheveled, shoeless, and confused. Based on his previous medical records and current behavior, he is diagnosed with chronic undifferentiated schizophrenia. The nurse should assign the highest priority to which nursing diagnosis?
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Solution
Anxiety
Option A: For this client, the highest-priority nursing diagnosis is Anxiety (severe to panic-level), manifested by the client’s extreme withdrawal and attempt to protect himself from the environment. The nurse must act immediately to reduce anxiety and protect the client and others from possible injury.
Options B, C, and D: Impaired verbal communication, manifested by uncommunicativeness; Disturbed thought processes, evidenced by inability to understand the situation; and Self-care deficit: Dressing/grooming, evidenced by a disheveled appearance, are appropriate nursing diagnoses but aren’t the highest priority.
A client is admitted with a diagnosis of delusions of grandeur. This diagnosis reflects a belief that one is:
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Solution
highly important or famous.
Option A: A delusion of grandeur is a false belief that one is highly important or famous.
Option B: A delusion of persecution is a false belief that one is being persecuted.
Options C and D: A delusion of reference is a false belief that one is connected to events unrelated to oneself or a belief that one is responsible for the evil in the world.
The nurse is aware that antipsychotic medications may cause which of the following adverse effects?
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Solution
Lower seizure threshold
Option B: Antipsychotic medications exert an effect on brain neurotransmitters that lowers the seizure threshold and can, therefore, increase the risk of seizure activity.
Options A and C: Antipsychotics don’t affect insulin production or coagulation time.
Option D: Heart failure isn’t an adverse effect of antipsychotic agents.
The nurse is caring for a client who experiences false sensory perceptions with no basis in reality. These perceptions are known as:
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Solution
hallucinations.
Option B: Hallucinations are visual, auditory, gustatory, tactile, or olfactory perceptions that have no basis in reality.
Option A: Delusions are false beliefs, rather than perceptions, that the client accepts as real.
Option C: Loose associations are rapid shifts among unrelated ideas.
Option D: Neologisms are bizarre words that have meaning only to the client.
The nurse is providing care to a client with a catatonic type of schizophrenia who exhibits extreme negativism. To help the client meet his basic needs, the nurse should:
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Solution
tell the client specifically and concisely what needs to be done.
Option C: The client needs to be informed of the activity and when it will be done.
Option A: Giving the client choices isn’t desirable because he can be manipulative or refuse to do anything.
Options B and D: Negotiating and preparing the client ahead of time also isn’t therapeutic with this type of client because he may not want to perform the activity.
A client is admitted to the psychiatric unit with active psychosis. The physician diagnoses schizophrenia after ruling out several other conditions. Schizophrenia is characterized by:
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Solution
disturbances in affect, perception, and thought content and form.
Option C: The Diagnostic and Statistic Manual of Mental Disorders, 4th edition, defines schizophrenia as a disturbance in multiple psychological processes that affect thought content and form, perception, affect, sense of self, volition, relationship to the external world, and psychomotor behavior.
Option A: Loss of identity sometimes occurs but is only one characteristic of the disorder.
Option B: Multiple personalities typify multiple personality disorder, a dissociative personality disorder. Mood disorders are commonly accompanied by increased or decreased self-esteem.
Option D: Schizophrenia doesn’t cause a disturbance in sensorium, although the client may exhibit confusion, disorientation, and memory impairment during the acute phase.
When teaching the family of a client with schizophrenia, the nurse should provide which information?
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Solution
Support is available to help family members meet their own needs.
Option B: Because family members of a client with schizophrenia face difficult situations and great stress, the nurse should inform them of support services that can help them cope with such problems.
Options A and C: The nurse should also teach them that medication can’t prevent relapses and that environmental stimuli may precipitate symptoms.
Option D: Although stress can trigger symptoms, the nurse shouldn’t make the family feel responsible for relapses.
A client diagnosed with schizoaffective disorder is suffering from schizophrenia with elements of which of the following disorders?
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Solution
Mood disorder
Option B: According to the DSM-IV, schizoaffective disorder refers to clients suffering from schizophrenia with elements of a mood disorder, either mania or depression. The prognosis is generally better than for the other types of schizophrenia, but it’s worse than the prognosis for a mood disorder alone.
Option A: This is incorrect because personality disorders and psychotic illness aren’t listed together on the same axis.
Option C: This is incorrect because schizophrenia is a major thought disorder and the question asks for elements of another disorder.
Option D: Clients with schizoaffective disorder aren’t suffering from schizophrenia and an amnestic disorder.
Which non-antipsychotic medication is used to treat some clients with schizoaffective disorder?
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Solution
lithium carbonate (Lithane)
Option C: Lithium carbonate, an antimanic drug, is used to treat clients with cyclical schizoaffective disorder, a psychotic disorder once classified under schizophrenia that causes affective symptoms, including manic-like activity. Lithium helps control the affective component of this disorder.
Option A: Phenelzine is a monoamine oxidase inhibitor prescribed for clients who don’t respond to other antidepressant drugs such as imipramine.
Option B: Chlordiazepoxide, an antianxiety agent, generally is contraindicated in psychotic clients.
Option D: Imipramine, primarily considered an antidepressant agent, is also used to treat clients with agoraphobia and those undergoing cocaine detoxification.