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A health care provider considers which antipsychotic medication to prescribe for a patient diagnosed with schizophrenia who has auditory hallucinations and poor social functioning. The patient is also overweight. Which drug should the nurse advocate?
- A. Clozapine
- B. Ziprasidone
- C. Olanzapine
- D. Aripiprazole
Correct Answer: D
Rationale: Aripiprazole is an atypical antipsychotic medication that is effective against both positive and negative symptoms of schizophrenia. It causes little or no weight gain and no increase in glucose, high- or low-density lipoprotein cholesterol levels, or triglycerides, making it a reasonable choice for a patient with obesity or heart disease. Clozapine may produce agranulocytosis, making it a poor choice as a first-line agent. Ziprasidone may prolong the QT interval, making it a poor choice for a patient with cardiac disease. Olanzapine fosters weight gain.
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A patient diagnosed with schizophrenia demonstrates paranoid thinking. The patient angrily tells a nurse, 'You are mean and nasty. No one trusts you or wants to be around you.' What is the likely motivation behind this behavior?
- A. Attempting to manipulate the nurse by using negative comments
- B. The prelude to disorganization and catatonia in the near future
- C. Jealousy of the nurse's position of power in the relationship
- D. Identifying another person's shortcomings in order to preserve his or her own self-esteem
Correct Answer: D
Rationale: Patients with paranoid ideation often use disparaging comments to preserve their own self-esteem. There is no evidence the patient is trying to manipulate the nurse or is jealous. This behavior is not predictive of catatonia or disorganization.
A patient diagnosed with schizophrenia has been stable for a year; however, the family now reports the patient is tense, sleeps 3 to 4 hours per night, and has difficulty concentrating. The patient says, 'Demons are in the basement and they can come through the floor.' The nurse can correctly assess this information as what?
- A. Need for psychoeducation
- B. Medication nonadherence
- C. Chronic deterioration
- D. Relapse
Correct Answer: D
Rationale: Signs of potential relapse include feeling tense, difficulty concentrating, trouble sleeping, increased withdrawal, and increased bizarre or magical thinking. Medication noncompliance may not be implicated. Relapse can occur even when the patient is regularly taking his or her medication. Psychoeducation is more effective when the patient's symptoms are stable. Chronic deterioration is not the best explanation.
A nurse at the mental health clinic plans a series of psychoeducational groups for persons diagnosed with schizophrenia. Which two topics would take priority?
- A. How to complete an application for employment?
- B. The importance of correctly taking your medication.
- C. How to dress when attending community events?
- D. How to give and receive compliments?
- E. Ways to quit smoking.
Correct Answer: B,E
Rationale: Stabilization is maximized by the adherence to the antipsychotic medication regimen. Because so many patients with schizophrenia smoke cigarettes, this topic relates directly to the patients' physiological well-being. The other topics are also important but are not priority topics.
A patient diagnosed with schizophrenia is demonstration catatonia. The patient has little spontaneous movement and waxy flexibility. Which patient needs are of priority importance?
- A. Psychosocial
- B. Physiological
- C. Self-actualization
- D. Safety and security
Correct Answer: B
Rationale: Physiological needs must be met to preserve life. A patient who is catatonic may need to be fed by hand or tube, toileted, and given range-of-motion exercises to preserve physiological integrity. The assessment findings do not suggest safety concerns. Higher-level needs (psychosocial and self-actualization) are of lesser concern.
A patient diagnosed with schizophrenia says, 'My coworkers are out to get me. I also saw two doctors plotting to overdose me.' What term identifies how this patient is perceiving the environment?
- A. Disorganized
- B. Unpredictable
- C. Dangerous
- D. Bizarre
Correct Answer: C
Rationale: The patient sees the world as hostile and dangerous. This assessment is important because the nurse can be more effective by using empathy to respond to the patient. Data are not present to support any of the other options.