Nokea
A patient diagnosed with schizophrenia begins a new prescription for lurasidone HCl. The patient is 5 feet 6 inches tall and currently weighs 204 pounds. Which topic is most important for the nurse to include in the teaching plan related to this medication?
- A. How to recognize tardive dyskinesia?
- B. Weight management strategies.
- C. Ways to manage constipation.
- D. Sleep hygiene measures.
Correct Answer: B
Rationale: Lurasidone HCl (Latuda) is an atypical antipsychotic medication. The incidence of weight gain, diabetes, and high cholesterol is high with this medication. The patient is overweight now, so weight management is especially important. The incidence of tardive dyskinesia is low with atypical antipsychotic medications. Constipation may occur, but it is less important than weight management. This drug usually produces drowsiness.
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An acutely violent patient diagnosed with schizophrenia receives several doses of haloperidol. Two hours later the nurse notices the patient's head rotated to one side in a stiffly fixed position; the lower jaw is thrust forward, and the patient is drooling. Which intervention by the nurse is indicated?
- A. Administer diphenhydramine 50 mg IM from the PRN medication administration record.
- B. Reassure the patient that the symptoms will subside. Practice relaxation exercises with the patient.
- C. Give trihexyphenidyl 5 mg orally at the next regularly scheduled medication administration time.
- D. Administer atropine sulfate 2 mg subcutaneously from the PRN medication administration record.
Correct Answer: A
Rationale: Diphenhydramine, trihexyphenidyl, benztropine, and other anticholinergic medications may be used to treat dystonias. Swallowing will be difficult or impossible; therefore, oral medication is not an option. Medication should be administered immediately; therefore, the intramuscular route is best. In this case, the best option given is diphenhydramine.
A patient diagnosed with schizophrenia says, 'Everyone has skin lice that jump on you and contaminate your blood.' Which problem is evident?
- A. Poverty of content
- B. Concrete thinking
- C. Neologisms
- D. Paranoia
Correct Answer: D
Rationale: The patient's unrealistic fear of contamination indicates paranoia. Neologisms are invented words. Concrete thinking involves literal interpretation. Poverty of content refers to an inadequate fund of information.
A patient's care plan includes monitoring for auditory hallucinations. Which assessment findings suggest the patient may be hallucinating?
- A. Aloofness, haughtiness, suspicion
- B. Darting eyes, tilted head, mumbling to self
- C. Elevated mood, hyperactivity, distractibility
- D. Performing rituals, avoiding open places
Correct Answer: B
Rationale: Clues to hallucinations include looking around the room as though to find the speaker; tilting the head to one side as though intently listening; and grimacing, mumbling, or talking aloud as though responding conversationally to someone.
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 begins to talk about 'cracklomers' in the local shopping mall. The term 'cracklomers' should be documented using what term?
- A. Neologism
- B. Concrete thinking
- C. Thought insertion
- D. An idea of reference
Correct Answer: A
Rationale: A neologism is a newly coined word having special meaning to the patient. 'Cracklomers' is not a known word. Concrete thinking refers to the inability to think abstractly. Thought insertion refers to thoughts of others that are implanted in one's mind. An idea of reference is a type of delusion in which trivial events are given personal significance.