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A nurse works with a patient diagnosed with schizophrenia regarding the importance of medication management. The patient repeatedly says, 'I don't like taking pills.' Which treatment strategy should the nurse discuss with the patient and health care provider?
- A. Use of long-acting antipsychotic injections
- B. Addition of a benzodiazepine, such as lorazepam
- C. Adjunctive use of an antidepressant, such as amitriptyline
- D. Inpatient hospitalization because of the high risk for exacerbation of symptoms
Correct Answer: A
Rationale: Medications such as paliperidone, fluphenazine decanoate, and haloperidol decanoate are long-acting forms of antipsychotic medications. They are administered by depot injection every 2 to 4 weeks, thus reducing daily opportunities for nonadherence. The incorrect options do not address the patient's dislike of taking pills.
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A patient diagnosed with schizophrenia has taken fluphenazine 5 mg orally twice daily for 3 weeks. The nurse now assesses a shuffling, propulsive gait; a masklike face; and drooling. Which term applies to these symptoms?
- A. Neuroleptic malignant syndrome
- B. Hepatocellular effects
- C. Pseudoparkinsonism
- D. Akathisia
Correct Answer: C
Rationale: Pseudoparkinsonism induced by antipsychotic medication mimics the symptoms of Parkinson disease. It frequently appears within the first month of treatment. Hepatocellular effects would produce abnormal liver test results. Neuroleptic malignant syndrome is characterized by autonomic instability. Akathisia produces motor restlessness.
A patient diagnosed with schizophrenia is acutely disturbed and violent. After several doses of haloperidol, the patient is calm. Two hours later the nurse sees the patient's head rotated to one side in a stiff position; the lower jaw is thrust forward, and the patient is drooling. Which effect is the patient demonstrating?
- A. Acute dystonic reaction
- B. Tardive dyskinesia
- C. Waxy flexibility
- D. Akathisia
Correct Answer: A
Rationale: Acute dystonic reactions involve painful contractions of the tongue, face, neck, and back; opisthotonos and oculogyric crisis may be observed. Dystonic reactions are considered emergencies that require immediate intervention. Tardive dyskinesia involves involuntary spasmodic muscular contractions that involve the tongue, fingers, toes, neck, trunk, or pelvis; it appears after prolonged treatment. Waxy flexibility is a symptom observed in catatonic schizophrenia. Akathisia is evidenced by internal and external restlessness, pacing, and fidgeting.
A patient diagnosed with schizophrenia is stuporous, demonstrates little spontaneous movement, and has waxy flexibility. The patient's activities of daily living are severely compromised. An appropriate outcome is that the patient will:
- A. demonstrate increased interest in the environment by the end of week 1.
- B. perform self-care activities with coaching by the end of day 3.
- C. gradually take the initiative for self-care by the end of week 2.
- D. voluntarily accept tube feeding by day 2.
Correct Answer: B
Rationale: Outcomes related to self-care deficit nursing diagnoses should deal with increasing the patient's ability to perform self-care tasks independently, such as feeding, bathing, dressing, and toileting. Performing the tasks with coaching by the nursing staff denotes improvement over the complete inability to perform the tasks. The incorrect options are not directly related to self-care activities; they are difficult to measure and are unrelated to maintaining nutrition.
A patient diagnosed with schizophrenia anxiously says, 'I can see the left side of my body merging with the wall, then my face appears and disappears in the mirror.' What phenomena is the patient describing?
- A. Derealization
- B. Concrete thinking
- C. Abstract thinking
- D. Depersonalization
Correct Answer: D
Rationale: Depersonalization: a nonspecific feeling of having lost one's identity; the self is different or unreal. People may be concerned that body parts do not belong to them, or they may have an acute sensation that the body has drastically changed. Derealization is the false perception that the environment has changed. Concrete thinking refers to an overemphasis on specific details and a literal interpretation of ideas. It is contrasted with abstract thinking. People who think in an abstract way look at the broader significance of ideas and information rather than the concrete details.
What assessment findings mark the prod sall prodromal stage of schizophrenia?
- A. Withdrawal, magical thinking, poor concentration, and perceptual disturbances
- B. Auditory hallucinations, ideas of reference, thought insertion, and broadcasting
- C. Stereotyped behavior, echopraxia, echolalia, and waxy flexibility
- D. Loose associations, concrete thinking, and echolalia neologisms
Correct Answer: A
Rationale: Early prodromal symptoms include social withdrawal and deterioration in functioning, depressive mood, perceptual disturbances, magical thinking, and peculiar behavior. Changes in self-care, sleeping or eating patterns, and changes in school or work performance may also be evidenced. The incorrect options each list the positive symptoms of schizophrenia that are more likely to be apparent during the acute stage of the illness.