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Patients diagnosed with schizophrenia who are suspicious and withdrawn generally present with what additional characteristic?
- A. Universally fear sexual involvement with therapists.
- B. Are socially disabled by the positive symptoms of schizophrenia.
- C. Exhibit a high degree of hostility as evidenced by rejecting behavior.
- D. Avoid relationships because they become anxious with emotional closeness.
Correct Answer: D
Rationale: When an individual is suspicious and distrustful and perceives the world and the people in it as potentially dangerous, withdrawal into an inner world can be a defense against uncomfortable levels of anxiety. When someone attempts to establish a relationship with such a patient, the patient's anxiety rises until trust is established. No evidence suggests that withdrawn patients with schizophrenia universally fear sexual involvement with therapists. In most cases, it is not considered true that withdrawn patients with schizophrenia are socially disabled by the positive symptoms of schizophrenia or exhibit a high degree of hostility by demonstrating rejecting behavior.
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The family members of a patient newly diagnosed with schizophrenia state that they do not understand what has caused the illness. The nurse's response should be based on which models?
- A. Neurobiological
- B. Environmental
- C. Family theory
- D. Genetic
- E. Stress
Correct Answer: A,D
Rationale: Compelling evidence exists that schizophrenia is a neurological disorder probably related to neurochemical abnormalities, neuroanatomical disruption of brain circuits, and genetic vulnerability. Stress and family disruption may contribute but are not considered etiological factors. Environmental factors are not recognized as causative variables in schizophrenia.
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 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.
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 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.