BSN 346 - HESI CASE STUDY Schizophrenia
Meet the Client
A client is brought to the
emergency department by
the police after being
violent at home. The client
has multiple past
hospitalizations and
treatment for
schizophrenia. The client
believes that the
healthcare providers are
FBI agents and that the
client's apartment is a
site for slave trading. The
client believes that the
FBI has cameras to
monitor every move and
to broadcast them on
TV.
, Establish rapport and trust.
The most important intervention for a client who is
suspicious and guarded is to establish rapport and
trust. When clients have cognitive disorders and
difficulty processing language, the beginning of trust
is more readily established through nonverbal
communication.
Based on this
assessment, what is the
RATIONALE FOR INCORRECT:
most important nursing
Assess for hallucinations.
intervention?
If a client is suspicious, assessing for hallucinations is
Establish rapport and
not the priority. This will cause the client to question
trust. Assess for
the nurse's intentions.
hallucinations. Maintain
Maintain adequate social space.
adequate social space.
Maintaining adequate social space is important, as
Plan to give a PRN
well as approaching the client with calmness and
antipsychotic.
gentle eye contact, but this is not the most
important intervention.
Plan to give a PRN antipsychotic.
Giving a PRN antipsychotic is helpful to minimize the
client's cognitive symptoms, but other
nonpharmacologic interventions take priority.
The nurse understands
that the client has a
thought disorder rather
than a mood disorder.
Thought disorders include
psychosis and
schizophrenia.
The nurse assesses that
the client's behavior is
guarded and suspicious.
, Blunted affect.
A blunted or flat affect can occur as part of the
negative or "soft" symptoms associated with a thought
disorder. It can also occur with a mood disorder.
Which behavior is
characteristic of a thought
RATIONALE FOR INCORRECT:
disorder?
Irritability.
Blunted affect.
Irritability is more commonly associated with a mood
Irritability.
disorder.
Lability of mood.
Lability of mood.
Preoccupation with guilty
Lability of mood is more commonly associated with
feelings.
bipolar disorder.
Preoccupation with guilty feelings.
Preoccupation with guilty feelings is more commonly
associated with a mood disorder.
Section 2
The nurse completes
the mental status exam
and records that the
client's grooming and
hygiene are fair. The
client continually paces
in the hall and is unable
to sit still for longer than 1
or 2 minutes. Speech is
rapid and difficult to
follow. The client's affect
is anxious, inattentive,
appears distracted, and
facial expression is
blunted.
, Negative symptoms.
Negative symptoms are characteristic of
schizophrenia and include behaviors such as minimal
The nurse understands eye contact, poor grooming and hygiene, and
that schizophrenia can be apathy.
differentiated from
psychosis by which RATIONALE FOR INCORRECT:
assessment? Disorganized speech.
Disorganized speech. Disorganized speech is characteristic of both
Disorganized behavior. psychosis and schizophrenia.
Auditory hallucinations. Disorganized behavior.
Negative symptoms. Disorganized behavior is characteristic of both
psychosis and schizophrenia.
Auditory hallucinations.
Hallucinations are characteristic of both psychosis
and schizophrenia.
Flat affect and social inattentiveness.
Flat affect and social inattentiveness, or "spaciness,"
are examples of negative symptoms characteristic of
schizophrenia.
Which finding
depicts negative RATIONALE FOR INCORRECT:
symptoms of Difficulty sitting still.
schizophrenia? Difficulty sitting still is not a negative symptom
Difficulty sitting still. and may be related to akathisia, an extrapyramidal
Rapid and disorganized side effect.
speech. Rapid and disorganized speech.
Flat affect and social Rapid and disorganized speech is not a negative
inattentiveness. symptom. Rapid speech is characteristic of flight of
Delusional statements. ideas.
Delusional statements.
Delusional statements are not a negative symptom of
schizophrenia.
Meet the Client
A client is brought to the
emergency department by
the police after being
violent at home. The client
has multiple past
hospitalizations and
treatment for
schizophrenia. The client
believes that the
healthcare providers are
FBI agents and that the
client's apartment is a
site for slave trading. The
client believes that the
FBI has cameras to
monitor every move and
to broadcast them on
TV.
, Establish rapport and trust.
The most important intervention for a client who is
suspicious and guarded is to establish rapport and
trust. When clients have cognitive disorders and
difficulty processing language, the beginning of trust
is more readily established through nonverbal
communication.
Based on this
assessment, what is the
RATIONALE FOR INCORRECT:
most important nursing
Assess for hallucinations.
intervention?
If a client is suspicious, assessing for hallucinations is
Establish rapport and
not the priority. This will cause the client to question
trust. Assess for
the nurse's intentions.
hallucinations. Maintain
Maintain adequate social space.
adequate social space.
Maintaining adequate social space is important, as
Plan to give a PRN
well as approaching the client with calmness and
antipsychotic.
gentle eye contact, but this is not the most
important intervention.
Plan to give a PRN antipsychotic.
Giving a PRN antipsychotic is helpful to minimize the
client's cognitive symptoms, but other
nonpharmacologic interventions take priority.
The nurse understands
that the client has a
thought disorder rather
than a mood disorder.
Thought disorders include
psychosis and
schizophrenia.
The nurse assesses that
the client's behavior is
guarded and suspicious.
, Blunted affect.
A blunted or flat affect can occur as part of the
negative or "soft" symptoms associated with a thought
disorder. It can also occur with a mood disorder.
Which behavior is
characteristic of a thought
RATIONALE FOR INCORRECT:
disorder?
Irritability.
Blunted affect.
Irritability is more commonly associated with a mood
Irritability.
disorder.
Lability of mood.
Lability of mood.
Preoccupation with guilty
Lability of mood is more commonly associated with
feelings.
bipolar disorder.
Preoccupation with guilty feelings.
Preoccupation with guilty feelings is more commonly
associated with a mood disorder.
Section 2
The nurse completes
the mental status exam
and records that the
client's grooming and
hygiene are fair. The
client continually paces
in the hall and is unable
to sit still for longer than 1
or 2 minutes. Speech is
rapid and difficult to
follow. The client's affect
is anxious, inattentive,
appears distracted, and
facial expression is
blunted.
, Negative symptoms.
Negative symptoms are characteristic of
schizophrenia and include behaviors such as minimal
The nurse understands eye contact, poor grooming and hygiene, and
that schizophrenia can be apathy.
differentiated from
psychosis by which RATIONALE FOR INCORRECT:
assessment? Disorganized speech.
Disorganized speech. Disorganized speech is characteristic of both
Disorganized behavior. psychosis and schizophrenia.
Auditory hallucinations. Disorganized behavior.
Negative symptoms. Disorganized behavior is characteristic of both
psychosis and schizophrenia.
Auditory hallucinations.
Hallucinations are characteristic of both psychosis
and schizophrenia.
Flat affect and social inattentiveness.
Flat affect and social inattentiveness, or "spaciness,"
are examples of negative symptoms characteristic of
schizophrenia.
Which finding
depicts negative RATIONALE FOR INCORRECT:
symptoms of Difficulty sitting still.
schizophrenia? Difficulty sitting still is not a negative symptom
Difficulty sitting still. and may be related to akathisia, an extrapyramidal
Rapid and disorganized side effect.
speech. Rapid and disorganized speech.
Flat affect and social Rapid and disorganized speech is not a negative
inattentiveness. symptom. Rapid speech is characteristic of flight of
Delusional statements. ideas.
Delusional statements.
Delusional statements are not a negative symptom of
schizophrenia.
