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A patient diagnosed with schizophrenia has taken a first-generation antipsychotic medication for a year. Hallucinations are less intrusive, but the patient continues to have apathy, poverty of thought, and social isolation. The nurse expects a change to which medication?
- A. Haloperidol
- B. Olanzapine
- C. Chlorpromazine
- D. Diphenhydramine
Correct Answer: B
Rationale: Olanzapine is an atypical antipsychotic medication that targets both positive and negative symptoms of schizophrenia. Haloperidol and chlorpromazine are first-generation (conventional) antipsychotic agents that target only positive symptoms. Diphenhydramine is an antihistamine.
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A patient has taken trifluoperazine 30 mg/day orally for 3 years. The clinic nurse notes that the patient grimaces and constantly smacks both lips. The patient's neck and shoulders twist in a slow, snakelike motion. Which problem would the nurse suspect?
- A. Agranulocytosis
- B. Tardive dyskinesia
- C. Tourette syndrome
- D. Anticholinergic effects
Correct Answer: B
Rationale: Tardive dyskinesia is a neuroleptic-induced condition involving the face, trunk, and limbs. Involuntary movements such as tongue thrusting; licking; blowing; irregular movements of the arms, neck, and shoulders; rocking; hip jerks; and pelvic thrusts are observed. These symptoms are frequently not reversible, even when the drug is discontinued. The scenario does not present evidence consistent with the other disorders mentioned. Agranulocytosis is a blood disorder. Tourette syndrome is a condition in which tics are present. Anticholinergic effects include dry mouth, blurred vision, flushing, constipation, and dry eyes.
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.
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 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 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.