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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.
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A person diagnosed with schizophrenia has had difficulty keeping a job because of severe paranoia. Today the person shouts, 'They're all plotting to destroy me.' Select the nurse's most therapeutic response.
- A. Everyone here is trying to help you. No one wants to harm you.
- B. Feeling that people want to destroy you must be very frightening.
- C. That is not true. People here are trying to help if you will let them.
- D. Staff members are health care professionals who are qualified to help you.
Correct Answer: B
Rationale: Resist focusing on content; instead, focus on the feelings the patient is expressing. This strategy prevents arguing about the reality of delusional beliefs. Such arguments increase patient anxiety and the tenacity with which the patient holds to the delusion. The other options focus on content and provide opportunity for argument.
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.
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.
A nurse sits with a patient diagnosed with schizophrenia. The patient starts to laugh uncontrollably, although the nurse has not said anything funny. Select the nurse's best response.
- A. Why are you laughing?
- B. Please share the joke with me.
- C. I don't think I said anything funny.
- D. You are laughing. Tell me what's happening.
Correct Answer: D
Rationale: The patient is likely laughing in response to inner stimuli such as hallucinations or fantasy. Focusing on the hallucinatory clue (i.e., the patient's laughter) and then eliciting the patient's observation is best. The incorrect options are less useful in eliciting a response; no joke may be involved, 'Why' questions are difficult to answer, and the patient is probably not focusing on what the nurse has said in the first place.
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.