Schizophrenia and Other Psychotic Disorders
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1.
A schizophrenic client has the nursing diagnosis of altered thought
process related to frightening delusions and hallucinations. The
desired outcome for this client is that the client will report decreased
feelings of anxiety that are associated with disruptions in cognitive
processes.
During lunch, while eating spaghetti, the client becomes apprehensive
and states, "There are worms on my plate!" What should the nurse say
in response to the client's statement
"I can see you are frightened, but I see spaghetti on your plate."
"Please think about it. Would the hospital really put worms on
your plate?"
"There are no worms on your plate. If you persist in this behavior
you will have to go to your room."
"Your thinking is inaccurate. You are out of touch with reality."
2.
When assessing a schizophrenic client for positive symptoms, the
nurse should look for
disorganization in thought and speech.
inability to express thoughts and feelings.
joylessness.
lack of goal-directed behavior.
3.
A schizophrenic client who has been very eager to be discharged from
an inpatient treatment program was just told that discharge would
occur in three days. The client replies, "OK." There is no change in the
client's facial expression and the client continues to sit quietly and
stares out the window. The client's affect should be described as
dulled.
flat.
inappropriate.
passive aggressive.
4.
Six months after being discharged from an inpatient treatment
program, a schizophrenic client is readmitted because of recurring
psychotic symptoms. The client's spouse asks, "Why did this happen?"
What should the nurse tell the spouse?
Relapse generally occurs because outpatient treatment programs
for schizophrenic clients are ineffective.
Relapse generally occurs because schizophrenic clients fail to
take their medications.
Schizophrenic clients are susceptible to relapse regardless of the
treatment approaches used.
Schizophrenic clients who are discharged from the inpatient
program before their symptoms are fully controlled will relapse.
5.
A schizophrenic client states, "I still have these scary thoughts that
make me want to run away and hide. But, I don't run away and hide
anymore." The nurse should evaluate this statement as a sign the
client
has recovered.
has relapsed.
is denying the significance of fear.
is making progress toward recovery.
6.
A client was diagnosed with paranoid schizophrenia twenty years ago.
The client no longer displays persecutory delusions, but lacks social
and self-care skills and is unable to work. What subtype of
schizophrenia is the client displaying?
Disorganized
Paranoid
Residual
Undifferentiated
7.
In response to a client's question about the cause of schizophrenia, a
nurse explains the various theories related to the etiology of
schizophrenia. Which statement by the client would indicate the
teaching was effective?
"Dysfunctional family interactions cause schizophrenia."
"Schizophrenia is caused by a specific, identifiable, biological
abnormality."
"There are several interrelated factors which may lead to
schizophrenia."
"The structure of the schizophrenic brain has been changed by
medications."
8.
When assessing a schizophrenic client for perseveration the nurse
should look for
difficulty with the verbal expression of abstract ideas.
use of privately invented words and phrases.
meaningless repetition of words recently heard by the client.
persistence of the same verbal response regardless of the
stimuli.
9.
When planning new innovated nursing interventions, it is important to
remember that schizophrenic clients
are very sensitive to change.
cannot change.
enjoy change.
must be responsible for planning changes.
10
.
To encourage a schizophrenic client's adherence to the medical
regimen, the nursing care plan should include all of the following
implementations except
assisting the client to recognize the need for medications.
discussing the side effects of the medications with the client.
encouraging the client to practice self-medication before
discharge from the health care facility.
insisting the client take medications at the exact times they are
ordered.
Schizophrenia and Other Psychotic Disorders
Case Study
Allison, a twenty-six-years old, has been admitted for schizophrenia, which was diagnosed six
years ago. She has had auditory hallucinations for several years, though there have been
times when her "special voices" have stopped. Lately, the hallucinations have been worse.
She lives with her parents, who are in their late 60s. When you meet with her parents, her
mother says, "I don't know what we are going to do. My husband had a heart attack last year.
Allison can't seem to control herself any more. She won't take her medications. We're getting
old." She begins to cry quietly. Allison's father then says, "She can't seem to concentrate
much any more or make sound decisions. Sometimes she doesn't even talk, and other times
we can't understand what she is saying-- it's so confusing. This is all new, and it's not good."
When you meet with Allison, you find that she is very quiet and appears to have little emotion.
She cannot remember what her last hospitalization was like. She does tell you that she has
been unable to go to her job for two months.
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1
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Based on this assessment data, how would you support the statement
that in the last few months Allison has experienced more negative
symptoms than positive symptoms? What is the difference between
these two types of symptoms? Why would you be concerned about this
change in Allison? [Hint]
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beginning of the paragraph, and </p> at the end.
Positive and negative symptoms occur. Positive symptoms are those experiences that
would not be there if you were healthy, and negative symptoms are energies and
drives that are not there but would be if you were healthy
2
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What should be included in the family education and interventions to
help her parents cope? [Hint]
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beginning of the paragraph, and </p> at the end.
Promoting Family Understanding and
Involvement
Schizophrenia and Other Psychotic Disorders
Care Plan
Eleanor has been going to the Community Mental Health Center for care for six years. She is
forty years old and has been diagnosed with paranoid schizophrenia. The Medication Clinic
monitors her medications. She takes haloperidol (Haldol), benztropine (Cogentin), and two
days ago her medical physician prescribed methyldopa (Aldomet). In the last three weeks,
she has exhibited involuntary movements of the tongue. Yesterday, she came to the Crisis
Intervention Unit saying she was very frightened that someone would hurt her and her
children, ages 8 and 10. She said she did not feel right. On assessment, Eleanor described
an elaborate plan to kill her. Communication with her was as difficult as it was confusing with
loose associations. When the nurse asked Eleanor if she was frightened, she said "Yes." but
she laughed when she said it. When her husband is called, he tells the nurse that Eleanor has
not been sleeping much and only leaves the house to come to her appointment at the
Medication Clinic. She did go into her medical doctor, as she was not feeling well. He
prescribed methyldopa, but the husband did not know why as Eleanor would not tell him. He
had not been able to reach the doctor. He did see Eleanor take the medication, but he noticed
yesterday that her prescription bottle of haloperidol was full. The nurse checks with the
Medication Clinic and finds that Eleanor has missed the last two biweekly visits. She has not
returned calls from the clinic. Her husband also says that Eleanor has been losing weight. He
says he does not know what to do with her anymore and is afraid to leave her alone as she is
"talking crazy." Eleanor is admitted for further evaluation of her psychiatric and medical
condition. Fill in the appropriate elements of the Care Plan for the client in the boxes below.
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1
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Assessment
2
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Nursing Diagnosis
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3
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Outcome Identification
4
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Planning and Implementation
5
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Evaluation
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