Psych Exam 2 - Ch. 12 (Schizophrenia Spectrum Disorders)
A patient diagnosed with schizophrenia was experiencing paranoid thinking. Which statement by this
patient most clearly indicates the antipsychotic medication was effective? ans: "I think the staff wants to
help me."
Recognizing that the staff desires to be helpful suggests the paranoia is gone or has subsided. Finishing an
art project, thinking the nurse is giving too much medicine, and believing that one no longer has a
problem show a statement of accomplishment, paranoia, and anosognosia.
pp. 203-205, Case Study and Nursing Care Plan
A patient with schizophrenia was changed to clozapine 3 weeks ago. The patient calls the clinic nurse
complaining of sore throat, fever, and malaise. Which laboratory test would be most helpful in
determining the cause of these findings? ans: Complete blood cell count
Agranulocytosis is the reduction of white blood cells (WBCs) and is a possible adverse effect of
antipsychotic drugs, particularly clozapine. Chief complaints are flulike symptoms. A complete blood cell
count would show the reduction in WBCs. Serum lithium level, liver panel, and urinalysis are not
necessary.
p. 217
A nurse is caring for a patient with schizophrenia. Upon the nurse's report, the primary health care
provider prescribed 25 mg of diphenhydramine hydrochloride to the patient. What had the nurse reported
to the primary health care provider about the patient? ans: The patient has tremors and tardive dyskinesia.
Patients with schizophrenia are generally prescribed antipsychotic drugs. These drugs cause
extrapyramidal side effects, like tremors, and abnormal involuntary movements, like tardive dyskinesia.
Diphenhydramine hydrochloride 25 mg by the intramuscular or intravenous route is prescribed to such
patients to treat extrapyramidal side effects. Diphenhydramine hydrochloride is contraindicated in
patients with peptic ulcer and asthma because it causes stomach distress like nausea, vomiting, and
diarrhea. Physostigmine and benzodiazepines are administered to control these symptoms.
Photosensitivity and mydriasis are symptoms of anticholinergic toxicity. Dry mucous membranes can be
a symptom of anticholinergic toxicity but are not a major concern with the administration of
diphenhydramine hydrochloride.
p. 211
The nurse is addressing a primary symptom of schizophrenia when ans: Reinforcing the patient's ability to
interrupt intrusive paranoid thoughts
Primary symptoms are ones that are directly caused by the mental illness, such as paranoid thoughts.
Stress is a secondary symptom of schizophrenia resulting from stressors related to coping with the illness.
A need for assistance while living independently is a secondary symptom of schizophrenia resulting from
stressors created by the illness. Alcohol abuse is a secondary symptom of schizophrenia resulting from
the use of alcohol to manage the stress of the hallucinations (a primary symptom).
p. 193
, A patient with schizophrenia was prescribed antipsychotics. After daily observation, the nurse finds the
patient's blood pressure has decreased. What is the most appropriate action by a nurse before
administering the prescribed drug to the patient? ans: The nurse should tell the patient to rise slowly.
Antipsychotics block the α 2-receptor, which may cause hypotension. The nurse can give advice to the
patient to rise slowly from the bed because the patient may feel dizzy as a result of reduced blood
pressure. The nurse cannot administer the adrenergic agonist but can report to the health care provider if
the patient's diastolic pressure falls below 80 mm Hg. The nurse should not stop administering the drug
because that may worsen the schizophrenic symptoms. The nurse should not advise the patient to avoid
fluid intake, because the patient may feel dehydrated and the total pressure exerted on the blood vessels
maybe reduced.
pp. 215-216, Table 12-6
A patient with undifferentiated schizophrenia lives in a community care home and takes olanzapine daily
with supervision. During the patient's monthly outpatient visits with a psychiatric nurse, which
assessment parameter takes priority? ans: Weight
An important part of the nurse's role in the community is monitoring the patient's response to
medications, compliance, and potential side or adverse effects. Key side effects of sexual dysfunction and
weight gain are particularly important to monitor for persons taking antipsychotic medications.
Olanzapine is an atypical antipsychotic drug that can cause significant weight gain, which results in
diabetes for many patients. Neither height, mucous membrane integrity, nor pupil response takes priority
over weight.
p. 202, Box 12.2
A patient diagnosed with residual schizophrenia is uninterested in community activities, lacks initiative,
demonstrates both poverty of content and poverty of speech, and seems unable to follow the schedule for
taking prescribed antipsychotic medication. The case manager continues to direct care with the
knowledge that this behavior most likely is prompted by ans: Neural dysfunction
Schizophrenia is considered a neurobiological disorder. The course of schizophrenia involves recurrences.
With each relapse further deterioration is noted. Residual schizophrenia refers to the disorder when active
phase symptoms are no longer present and the individual is left with two or more of the following
symptoms: lack of initiative, social withdrawal, impaired role function, marked speech deficits, and odd
beliefs.
p. 194
What statement is true regarding schizophrenia?
(SATA) ans: -Schizophrenia is a potentially devastating brain disorder.
-Social behavior and emotions are affected by schizophrenia.
-The disorder often affects an individual's language and thinking skills.
-The disorder disturbs a person's ability to determine what is or is not real.
Schizophrenia spectrum and other psychotic disorders disturb the fundamental inability to determine what
is or is not real. Schizophrenia is a potentially devastating brain disorder that affects a person's thinking,
language, emotions, social behavior, and ability to perceive reality accurately. It affects more than 3.5
million people in the United States and is among the most disruptive and disabling of mental disorders.
A patient diagnosed with schizophrenia was experiencing paranoid thinking. Which statement by this
patient most clearly indicates the antipsychotic medication was effective? ans: "I think the staff wants to
help me."
Recognizing that the staff desires to be helpful suggests the paranoia is gone or has subsided. Finishing an
art project, thinking the nurse is giving too much medicine, and believing that one no longer has a
problem show a statement of accomplishment, paranoia, and anosognosia.
pp. 203-205, Case Study and Nursing Care Plan
A patient with schizophrenia was changed to clozapine 3 weeks ago. The patient calls the clinic nurse
complaining of sore throat, fever, and malaise. Which laboratory test would be most helpful in
determining the cause of these findings? ans: Complete blood cell count
Agranulocytosis is the reduction of white blood cells (WBCs) and is a possible adverse effect of
antipsychotic drugs, particularly clozapine. Chief complaints are flulike symptoms. A complete blood cell
count would show the reduction in WBCs. Serum lithium level, liver panel, and urinalysis are not
necessary.
p. 217
A nurse is caring for a patient with schizophrenia. Upon the nurse's report, the primary health care
provider prescribed 25 mg of diphenhydramine hydrochloride to the patient. What had the nurse reported
to the primary health care provider about the patient? ans: The patient has tremors and tardive dyskinesia.
Patients with schizophrenia are generally prescribed antipsychotic drugs. These drugs cause
extrapyramidal side effects, like tremors, and abnormal involuntary movements, like tardive dyskinesia.
Diphenhydramine hydrochloride 25 mg by the intramuscular or intravenous route is prescribed to such
patients to treat extrapyramidal side effects. Diphenhydramine hydrochloride is contraindicated in
patients with peptic ulcer and asthma because it causes stomach distress like nausea, vomiting, and
diarrhea. Physostigmine and benzodiazepines are administered to control these symptoms.
Photosensitivity and mydriasis are symptoms of anticholinergic toxicity. Dry mucous membranes can be
a symptom of anticholinergic toxicity but are not a major concern with the administration of
diphenhydramine hydrochloride.
p. 211
The nurse is addressing a primary symptom of schizophrenia when ans: Reinforcing the patient's ability to
interrupt intrusive paranoid thoughts
Primary symptoms are ones that are directly caused by the mental illness, such as paranoid thoughts.
Stress is a secondary symptom of schizophrenia resulting from stressors related to coping with the illness.
A need for assistance while living independently is a secondary symptom of schizophrenia resulting from
stressors created by the illness. Alcohol abuse is a secondary symptom of schizophrenia resulting from
the use of alcohol to manage the stress of the hallucinations (a primary symptom).
p. 193
, A patient with schizophrenia was prescribed antipsychotics. After daily observation, the nurse finds the
patient's blood pressure has decreased. What is the most appropriate action by a nurse before
administering the prescribed drug to the patient? ans: The nurse should tell the patient to rise slowly.
Antipsychotics block the α 2-receptor, which may cause hypotension. The nurse can give advice to the
patient to rise slowly from the bed because the patient may feel dizzy as a result of reduced blood
pressure. The nurse cannot administer the adrenergic agonist but can report to the health care provider if
the patient's diastolic pressure falls below 80 mm Hg. The nurse should not stop administering the drug
because that may worsen the schizophrenic symptoms. The nurse should not advise the patient to avoid
fluid intake, because the patient may feel dehydrated and the total pressure exerted on the blood vessels
maybe reduced.
pp. 215-216, Table 12-6
A patient with undifferentiated schizophrenia lives in a community care home and takes olanzapine daily
with supervision. During the patient's monthly outpatient visits with a psychiatric nurse, which
assessment parameter takes priority? ans: Weight
An important part of the nurse's role in the community is monitoring the patient's response to
medications, compliance, and potential side or adverse effects. Key side effects of sexual dysfunction and
weight gain are particularly important to monitor for persons taking antipsychotic medications.
Olanzapine is an atypical antipsychotic drug that can cause significant weight gain, which results in
diabetes for many patients. Neither height, mucous membrane integrity, nor pupil response takes priority
over weight.
p. 202, Box 12.2
A patient diagnosed with residual schizophrenia is uninterested in community activities, lacks initiative,
demonstrates both poverty of content and poverty of speech, and seems unable to follow the schedule for
taking prescribed antipsychotic medication. The case manager continues to direct care with the
knowledge that this behavior most likely is prompted by ans: Neural dysfunction
Schizophrenia is considered a neurobiological disorder. The course of schizophrenia involves recurrences.
With each relapse further deterioration is noted. Residual schizophrenia refers to the disorder when active
phase symptoms are no longer present and the individual is left with two or more of the following
symptoms: lack of initiative, social withdrawal, impaired role function, marked speech deficits, and odd
beliefs.
p. 194
What statement is true regarding schizophrenia?
(SATA) ans: -Schizophrenia is a potentially devastating brain disorder.
-Social behavior and emotions are affected by schizophrenia.
-The disorder often affects an individual's language and thinking skills.
-The disorder disturbs a person's ability to determine what is or is not real.
Schizophrenia spectrum and other psychotic disorders disturb the fundamental inability to determine what
is or is not real. Schizophrenia is a potentially devastating brain disorder that affects a person's thinking,
language, emotions, social behavior, and ability to perceive reality accurately. It affects more than 3.5
million people in the United States and is among the most disruptive and disabling of mental disorders.
