CHAPTER 12, SCHIZOPHRENIA
SPECTRUM DISORDERS EXAM #2
QUESTIONS WITH COMPLETE
SOLUTIONS
A patient diagnosed with schizophrenia has taken fluphenazine 5 mg po bid for 3 weeks.
The nurse now observes a shuffling propulsive gait, a mask-like face, and drooling.
Which term applies to these symptoms?
a. Neuroleptic malignant syndrome
b. Hepatocellular effects
c. Pseudoparkinsonism
d. Akathisia - ANSWER-C
Pseudoparkinsonism induced by antipsychotic medication mimics the symptoms of
Parkinson's disease. It frequently appears within the first month of treatment and is more
common with first-generation antipsychotic drugs. Hepatocellular effects would produce
abnormal liver test results. Neuroleptic malignant syndrome is characterized by
autonomic instability. Akathisia produces motor restlessness.
A patient diagnosed with schizophrenia is very disturbed and violent. After several doses
of haloperidol, the patient is calm. Two hours later the nurse sees the patient's head
rotated to one side in a stiff position, the lower jaw thrust forward, and drooling. Which
problem is most likely?
a. An acute dystonic reaction
b. Tardive dyskinesia
c. Waxy flexibility
d. Akathisia - ANSWER-A
Acute dystonic reactions involve painful contractions of the tongue, face, neck, and back.
Opisthotonos and oculogyric crisis may be observed. Dystonic reactions are considered
emergencies requiring immediate intervention. Tardive dyskinesia involves involuntary
spasmodic muscular contractions that involve the tongue, fingers, toes, neck, trunk, or
pelvis. It appears after prolonged treatment. Waxy flexibility is a symptom seen in
catatonic schizophrenia. Internal and external restlessness, pacing, and fidgeting are
characteristics of akathisia.
An acutely violent patient diagnosed with schizophrenia received 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 thrust forward, and 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 subcut from the prn medication administration record.
- ANSWER-A
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, so the
intramuscular route is best. In this case, the best option given is diphenhydramine.
A patient diagnosed with schizophrenia has received fluphenazine decanoate twice a
month for 3 years. The clinic nurse notes that the patient grimaces and constantly
smacks both lips. The patient's neck and shoulders twist in a slow, snakelike motion.
Which problem would the nurse suspect?
a. Agranulocytosis
b. Tardive dyskinesia
c. Tourette's syndrome
d. Anticholinergic effectS - ANSWER-B
Fluphenazine decanoate is a first-generation antipsychotic medication. Tardive
dyskinesia is a condition involving the face, trunk, and limbs that occurs more frequently
with first-generation antipsychotics than second or third generation. Involuntary
movements, such as tongue thrusting; licking; blowing; irregular movements of the arms,
neck, and shoulders; rocking; hip jerks; and pelvic thrusts, are seen. These symptoms
are frequently not reversible even when the drug is discontinued. The scenario does not
present evidence consistent with the other disorders mentioned. Agranulocytosis is a
blood disorder. Tourette's syndrome is a condition in which tics are present.
Anticholinergic effects include dry mouth, blurred vision, flushing, constipation, and dry
eyes.
A patient diagnosed with schizophrenia exhibits little spontaneous movement and
demonstrates waxy flexibility. Which patient needs are of priority importance?
a. Self-esteem
b. Psychosocial
c. Physiological
d. Self-actualization - ANSWER-C
Physiological needs must be met to preserve life. A patient with waxy flexibility must be
fed by hand or tube, toileted, given range-of-motion exercises, and so forth to preserve
physiological integrity. Waxy flexibility may also precipitate a risk for falls; therefore,
safety is a concern. Higher level needs are of lesser concern.
A patient diagnosed with schizophrenia demonstrates little spontaneous movement and
has waxy flexibility. The patient's activities of daily living are severely compromised. An
appropriate outcome would be that the patient will
a. demonstrate increased interest in the environment by the end of week 1.
b. perform self-care activities with coaching by the end of day 3.
c. gradually take the initiative for self-care by the end of week 2.
d. accept tube feeding without objection by day 2. - ANSWER-B
Outcomes related to self-care deficit nursing diagnoses should deal with increasing
ability to perform self-care tasks independently, such as feeding, bathing, dressing, and
toileting. Performing the tasks with coaching by nursing staff denotes improvement over
SPECTRUM DISORDERS EXAM #2
QUESTIONS WITH COMPLETE
SOLUTIONS
A patient diagnosed with schizophrenia has taken fluphenazine 5 mg po bid for 3 weeks.
The nurse now observes a shuffling propulsive gait, a mask-like face, and drooling.
Which term applies to these symptoms?
a. Neuroleptic malignant syndrome
b. Hepatocellular effects
c. Pseudoparkinsonism
d. Akathisia - ANSWER-C
Pseudoparkinsonism induced by antipsychotic medication mimics the symptoms of
Parkinson's disease. It frequently appears within the first month of treatment and is more
common with first-generation antipsychotic drugs. Hepatocellular effects would produce
abnormal liver test results. Neuroleptic malignant syndrome is characterized by
autonomic instability. Akathisia produces motor restlessness.
A patient diagnosed with schizophrenia is very disturbed and violent. After several doses
of haloperidol, the patient is calm. Two hours later the nurse sees the patient's head
rotated to one side in a stiff position, the lower jaw thrust forward, and drooling. Which
problem is most likely?
a. An acute dystonic reaction
b. Tardive dyskinesia
c. Waxy flexibility
d. Akathisia - ANSWER-A
Acute dystonic reactions involve painful contractions of the tongue, face, neck, and back.
Opisthotonos and oculogyric crisis may be observed. Dystonic reactions are considered
emergencies requiring immediate intervention. Tardive dyskinesia involves involuntary
spasmodic muscular contractions that involve the tongue, fingers, toes, neck, trunk, or
pelvis. It appears after prolonged treatment. Waxy flexibility is a symptom seen in
catatonic schizophrenia. Internal and external restlessness, pacing, and fidgeting are
characteristics of akathisia.
An acutely violent patient diagnosed with schizophrenia received 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 thrust forward, and 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 subcut from the prn medication administration record.
- ANSWER-A
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, so the
intramuscular route is best. In this case, the best option given is diphenhydramine.
A patient diagnosed with schizophrenia has received fluphenazine decanoate twice a
month for 3 years. The clinic nurse notes that the patient grimaces and constantly
smacks both lips. The patient's neck and shoulders twist in a slow, snakelike motion.
Which problem would the nurse suspect?
a. Agranulocytosis
b. Tardive dyskinesia
c. Tourette's syndrome
d. Anticholinergic effectS - ANSWER-B
Fluphenazine decanoate is a first-generation antipsychotic medication. Tardive
dyskinesia is a condition involving the face, trunk, and limbs that occurs more frequently
with first-generation antipsychotics than second or third generation. Involuntary
movements, such as tongue thrusting; licking; blowing; irregular movements of the arms,
neck, and shoulders; rocking; hip jerks; and pelvic thrusts, are seen. These symptoms
are frequently not reversible even when the drug is discontinued. The scenario does not
present evidence consistent with the other disorders mentioned. Agranulocytosis is a
blood disorder. Tourette's syndrome is a condition in which tics are present.
Anticholinergic effects include dry mouth, blurred vision, flushing, constipation, and dry
eyes.
A patient diagnosed with schizophrenia exhibits little spontaneous movement and
demonstrates waxy flexibility. Which patient needs are of priority importance?
a. Self-esteem
b. Psychosocial
c. Physiological
d. Self-actualization - ANSWER-C
Physiological needs must be met to preserve life. A patient with waxy flexibility must be
fed by hand or tube, toileted, given range-of-motion exercises, and so forth to preserve
physiological integrity. Waxy flexibility may also precipitate a risk for falls; therefore,
safety is a concern. Higher level needs are of lesser concern.
A patient diagnosed with schizophrenia demonstrates little spontaneous movement and
has waxy flexibility. The patient's activities of daily living are severely compromised. An
appropriate outcome would be that the patient will
a. demonstrate increased interest in the environment by the end of week 1.
b. perform self-care activities with coaching by the end of day 3.
c. gradually take the initiative for self-care by the end of week 2.
d. accept tube feeding without objection by day 2. - ANSWER-B
Outcomes related to self-care deficit nursing diagnoses should deal with increasing
ability to perform self-care tasks independently, such as feeding, bathing, dressing, and
toileting. Performing the tasks with coaching by nursing staff denotes improvement over
