A client with paranoid-type schizophrenia becomes angry and tells the nurse to leave him alone. The nurse should
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Solution
tell him that she’ll leave for now but will return soon.
Option A: If the client tells the nurse to leave, the nurse should leave but let the client know that she’ll return so that he doesn’t feel abandoned.
Option B: Not heeding the client’s request can agitate him further.
Option C: Also, challenging the client isn’t therapeutic and may increase his anger.
Option D: False reassurance isn’t warranted in this situation
During the assessment stage, a client with schizophrenia leaves his arm in the air after the nurse has taken his blood pressure. His action shows evidence of:
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Solution
waxy flexibility.
Option B: The correct answer is waxy flexibility, which is defined as retaining any position that the body has been placed in.
Option A: Somatic delusions involve a false belief about the functioning of the body.
Option C: Neologisms are invented meaningless words.
Option D: Nihilistic delusions are false ideas about self, others, or the world.
A client with schizophrenia tells the nurse, “My intestines are rotted from the worms chewing on them.” This statement indicates a:
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Solution
somatic delusion.
Option C: Somatic delusions focus on bodily functions or systems and commonly include delusions about foul odor emissions, insect infestations, internal parasites, and misshapen parts.
Option A: Delusions of persecution are morbid beliefs that one is being mistreated and harassed by unidentified enemies.
Option B: Delusions of grandeur are gross exaggerations of one’s importance, wealth, power, or talents.
Option D: Jealous delusions are delusions that one’s spouse or lover is unfaithful.
While looking out the window, a client with schizophrenia remarks, “That school across the street has creatures in it that are waiting for me.” Which of the following terms best describes what the creatures represent?
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Solution
Delusion
Option D: A delusion is a false belief based on a misrepresentation of a real event or experience.
Option A: Although anxiety can increase delusional responses, it isn’t considered the primary symptom.
Option B: Projection is falsely attributing to another person one’s own unacceptable feelings.
Option C: Hallucinations, which characterize most psychoses, are perceptual disorders of the five senses; the client may see, taste, feel, smell, or hear something in the absence of external stimulation
A client with chronic schizophrenia who takes neuroleptic medication is admitted to the psychiatric unit. Nursing assessment reveals rigidity, fever, hypertension, and diaphoresis. These findings suggest which life-threatening reaction:
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Solution
neuroleptic malignant syndrome.
Option C: The client’s signs and symptoms suggest neuroleptic malignant syndrome, a life-threatening reaction to neuroleptic medication that requires immediate treatment.
Option A: Tardive dyskinesia causes involuntary movements of the tongue, mouth, facial muscles, and arm and leg muscles.
Option B: Dystonia is characterized by cramps and rigidity of the tongue, face, neck, and back muscles.
Option D: Akathisia causes restlessness, anxiety, and jitteriness.
A client has a history of chronic undifferentiated schizophrenia. Because she has a history of noncompliance with antipsychotic therapy, she’ll receive fluphenazine decanoate (Prolixin Decanoate) injections every 4 weeks. Before discharge, what should the nurse include in her teaching plan?
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Solution
Sitting up for a few minutes before standing to minimize orthostatic hypotension
Option B: The nurse should teach the client how to manage common adverse reactions, such as orthostatic hypotension and anticholinergic effects.
Option A: Droperidol increases the risk of extrapyramidal effects when given in conjunction with phenothiazines such as fluphenazine.
Options C: Antipsychotic effects of the drug may take several weeks to appear.
Option D: Tardive dyskinesia is a possible adverse reaction and should be reported immediately
A man is brought to the hospital by his wife, who states that for the past week her husband has refused all meals and accused her of trying to poison him. During the initial interview, the client’s speech, only partly comprehensible, reveals that his thoughts are controlled by delusions that he is possessed by the devil. The physician diagnoses paranoid schizophrenia. Schizophrenia is best described as a disorder characterized by:
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Solution
disturbed relationships related to an inability to communicate and think clearly.
Option A: Schizophrenia is best described as one of a group of psychotic reactions characterized by disturbed relationships with others and an inability to communicate and think clearly. Schizophrenic thoughts, feelings, and behavior commonly are evidenced by withdrawal, fluctuating moods, disordered thinking, and regressive tendencies.
Option B: Severe mood swings and periods of low to high activity are typical of bipolar disorder.
Option C: Multiple personality, sometimes confused with schizophrenia, is a dissociative personality disorder, not a psychotic illness.
Option D: Many schizophrenic clients have auditory hallucinations; tactile hallucinations are more common in organic or toxic disorders
A client is receiving haloperidol (Haldol) to reduce psychotic symptoms. As he watches television with other clients, the nurse notes that he has trouble sitting still. He seems restless, constantly moving his hands and feet and changing position. When the nurse asks what is wrong, he says he feels jittery. How should the nurse manage this situation?
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Solution
Give an as needed dose of a prescribed anticholinergic agent to control akathisia.
Option C: Akathisia, characterized by restlessness, is a common but often overlooked adverse reaction to haloperidol and other antipsychotic agents; it may be confused with psychotic agitation. To control akathisia, the nurse should give an as needed dose of a prescribed anticholinergic agent.
Option A: The client can’t control the movements, so asking him to sit still would be pointless.
Option B: Asking him to leave the room wouldn’t address the underlying cause of the problem. Encouraging him to talk about the symptoms wouldn’t stop them from occurring.
Option D: Giving more antipsychotic medication would worsen akathisia.
The nurse must administer a medication to reverse or prevent Parkinson-type symptoms in a client receiving an antipsychotic. The medication the client will likely receive is:
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Solution
Benztropine (Cogentin).
Option A: Benztropine, trihexyphenidyl, or amantadine are prescribed for a client with Parkinson-type symptoms.
Option B: Diphenhydramine provides rapid relief for dystonia.
Option C: Propranolol relieves akathisia.
Option D: Haloperidol can cause Parkinson-type symptoms.
Which of the following groups of characteristics would the nurse expect to see in the client with schizophrenia?
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Solution
Loose associations, grandiose delusions, and auditory hallucinations
Option A: Loose associations, grandiose delusions, and auditory hallucinations are all characteristic of the classic schizophrenic client. These clients aren’t able to care for their physical appearance. They frequently hear voices telling them to do something either to themselves or to others. Additionally, they verbally ramble from one topic to the next.
Option B: Periods of hyperactivity and irritability alternating with depression are characteristic of bipolar or manic disease.
Option C: Delusions of jealousy and persecution, paranoia, and mistrust are characteristics of paranoid disorders.
Option D: Sadness, apathy, feelings of worthlessness, anorexia, and weight loss are characteristics of depression.