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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.
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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.
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 receiving risperidone reports severe muscle stiffness at 10:30 am. By noon, the patient is diaphoretic, drooling, and has difficulty swallowing. By 4:00 pm, vital signs are body temperature, 102.8°F; pulse, 110 beats/min; respirations, 26 breaths per minute; and blood pressure, 150/90 mm Hg. Select the nurse's best analysis and action.
- A. Agranulocytosis. Institute reverse isolation.
- B. Tardive dyskinesia. Withhold the next dose of medication.
- C. Cholestatic jaundice. Begin a high-protein, low-fat diet.
- D. Neuroleptic malignant syndrome. Immediately notify the health care provider.
Correct Answer: D
Rationale: Taking an antipsychotic medication coupled with the presence of extrapyramidal symptoms, such as severe muscle stiffness and difficulty swallowing, hyperpyrexia, and autonomic symptoms (pulse elevation), suggest neuroleptic malignant syndrome, a medical emergency. The symptoms given in this scenario are not consistent with the medical problems listed in the incorrect options.
A newly admitted patient diagnosed with schizophrenia is hypervigilant and constantly scans the environment. The patient states, 'I saw two doctors talking in the hall. They were plotting to kill me.' The nurse may correctly assess this as what classic behavior?
- A. Echolalia
- B. An idea of reference
- C. A delusion of infidelity
- D. An auditory hallucination
Correct Answer: B
Rationale: Ideas of reference are misinterpretations of the verbalizations or actions of others that give special personal meanings to these behaviors; for example, when seeing two people talking, the individual assumes they are talking about him or her. The other terms do not correspond with the scenario.
A patient diagnosed with schizophrenia says, 'High heat. Last time here. Did you get a coat?' What type of verbalization is evident?
- A. Neologism
- B. Idea of reference
- C. Thought broadcasting
- D. Associative looseness
Correct Answer: D
Rationale: Looseness of association refers to jumbled thoughts incoherently expressed to the listener. Neologisms are newly coined words. Ideas of reference are a type of delusion. Thought broadcasting is the belief that others can hear one's thoughts.