NR 547 CHAMBERLAIN COLLEGE OF NURSING FINAL
STUDY GUIDE LATEST EDITION 2026
Decision making capacity guidelines
o Assess for communication barriers: language, hearing or vision impairments,
dysarthria
o Evaluate for reversible causes of incapacity: infection, medications or other
substances, acute neurologic and psychiatric disorders
o Identify values and cultural influences that may impact client decision making
o Ask questions: determine the client's ability to understand the treatment and how
treatment applies to their situation.
o Identify a surrogate if needed: healthcare advance directive, medical power of
attorney, spouse, adult children, other close relatives
o Document
Civil Commitment
o Involuntary civil commitment is a legal intervention directed by a judge to order a
person with serious symptoms of continued danger to self or others, grave
disability, or serious deterioration to either remain in a psychiatric hospital or
attend supervised outpatient treatment for a period (SAMSHA, 2019).
Use of restraints- selection criteria
o A face-to-face evaluation and written order are required to initiate restraints or
seclusion for the management of violent or self-destructive behavior
o The evaluation must be completed within one hour of the application of restraint
or seclusion, although some state laws may be more restrictive.
AEIO risk assessment categories- be able to select appropriately in a case scenario
o Agitation/Arousal - Is the client able to sit still? Are they pacing? Are they demonstrating
aggressive behaviors?
o Environment - Is the client in a safe location? Identify potential exits, equipment in the
room, and the distance of the room from the rest of the unit.
o Intent - Does the client have thoughts of harming themselves or others? Is the client
having psychotic experiences that may cause them to harm themselves or others?
o Objects - Does the client have access to firearms, blades, medications, lighters, or
clothing items that could be used to harm themselves or others?
Clozapine Initiation and what to monitor
• Clozapine is the gold standard for treatment-resistant schizophrenia, but it requires
careful initiation and intensive monitoring due to potentially life-threatening adverse
effects.
• Absolute Neutrophil Count – 1500 to 8000 – under 1000 immediate attention – risk of
agranulocytosis
• CMP – LFTs electrolytes – hepatic monitoring
• Fasting glucose or A1c and lipids – metabolic risk – diabetic risk/ dyslipidemia
• EKG – Myocarditis risk/QTc
• Pregnancy test – teratogenic risk assessment
• ANC Mandatory monitoring schedule – First 6 months Weekly, Months 6-12 Every 2
weeks, After 12 Months Monthly
, • Starting dose – 12mg once to twice daily. Titration: Increase by 25-50 mg/day. Target
range 300-450mg/day. Max dose 900mg/day.
Serotonin Syndrome Both Neuroleptic Malignant Syndrome
Fast & Hyper Confusion Slow & Stiff
Caused by Excess Serotonin High Fever Caused by Dopamine Blockade
Usually from combining Rigid Muscles Usually trigged by Antipsychotics/
serotonergic SSRI+MAOI abrupt withdrawal of dopamine
Agitation agonists (common drugs
Onset: Rapid – within hours haloperidol, risperidone)
Normal CK: 30-200
Hyperreflexia, Dilated Pupils. Onset: Slower – Develops over 1-3
Headache Days
Treatment: Mild – stop Hyporeflexia, Stupor, “lead pipe”
medication. Moderate/Severe Rigidity. Catatonia.
– Benzos, Supportive
Cooling, Serotonin Treatment: ICU. Ventilation, IV,
Antagonist (Cyproheptadine) Electrolytes, etc. Heparin to prevent
clots.
DSM-5-TR Schizophrenia Schizophreniform Schizoaffective
Criteria
Core ≥2 of the following for ≥1 Same as Same Criterion A
Psychotic month (1 must be 1–3): schizophrenia as schizophrenia
Symptoms 1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly
disorganized/catatonic behavior
5. Negative symptoms
Duration of ≥6 months total (includes 1 month to <6 ≥6 months total
Illness prodromal/residual phases) months (including mood
episodes)
Functional Yes No Yes
Decline
Required?
Mood If present, occur for a minority If present, occur for Present for the
Episodes of total illness duration a minority majority of total
Present? illness duration
Psychosis Yes Yes Required ≥2
STUDY GUIDE LATEST EDITION 2026
Decision making capacity guidelines
o Assess for communication barriers: language, hearing or vision impairments,
dysarthria
o Evaluate for reversible causes of incapacity: infection, medications or other
substances, acute neurologic and psychiatric disorders
o Identify values and cultural influences that may impact client decision making
o Ask questions: determine the client's ability to understand the treatment and how
treatment applies to their situation.
o Identify a surrogate if needed: healthcare advance directive, medical power of
attorney, spouse, adult children, other close relatives
o Document
Civil Commitment
o Involuntary civil commitment is a legal intervention directed by a judge to order a
person with serious symptoms of continued danger to self or others, grave
disability, or serious deterioration to either remain in a psychiatric hospital or
attend supervised outpatient treatment for a period (SAMSHA, 2019).
Use of restraints- selection criteria
o A face-to-face evaluation and written order are required to initiate restraints or
seclusion for the management of violent or self-destructive behavior
o The evaluation must be completed within one hour of the application of restraint
or seclusion, although some state laws may be more restrictive.
AEIO risk assessment categories- be able to select appropriately in a case scenario
o Agitation/Arousal - Is the client able to sit still? Are they pacing? Are they demonstrating
aggressive behaviors?
o Environment - Is the client in a safe location? Identify potential exits, equipment in the
room, and the distance of the room from the rest of the unit.
o Intent - Does the client have thoughts of harming themselves or others? Is the client
having psychotic experiences that may cause them to harm themselves or others?
o Objects - Does the client have access to firearms, blades, medications, lighters, or
clothing items that could be used to harm themselves or others?
Clozapine Initiation and what to monitor
• Clozapine is the gold standard for treatment-resistant schizophrenia, but it requires
careful initiation and intensive monitoring due to potentially life-threatening adverse
effects.
• Absolute Neutrophil Count – 1500 to 8000 – under 1000 immediate attention – risk of
agranulocytosis
• CMP – LFTs electrolytes – hepatic monitoring
• Fasting glucose or A1c and lipids – metabolic risk – diabetic risk/ dyslipidemia
• EKG – Myocarditis risk/QTc
• Pregnancy test – teratogenic risk assessment
• ANC Mandatory monitoring schedule – First 6 months Weekly, Months 6-12 Every 2
weeks, After 12 Months Monthly
, • Starting dose – 12mg once to twice daily. Titration: Increase by 25-50 mg/day. Target
range 300-450mg/day. Max dose 900mg/day.
Serotonin Syndrome Both Neuroleptic Malignant Syndrome
Fast & Hyper Confusion Slow & Stiff
Caused by Excess Serotonin High Fever Caused by Dopamine Blockade
Usually from combining Rigid Muscles Usually trigged by Antipsychotics/
serotonergic SSRI+MAOI abrupt withdrawal of dopamine
Agitation agonists (common drugs
Onset: Rapid – within hours haloperidol, risperidone)
Normal CK: 30-200
Hyperreflexia, Dilated Pupils. Onset: Slower – Develops over 1-3
Headache Days
Treatment: Mild – stop Hyporeflexia, Stupor, “lead pipe”
medication. Moderate/Severe Rigidity. Catatonia.
– Benzos, Supportive
Cooling, Serotonin Treatment: ICU. Ventilation, IV,
Antagonist (Cyproheptadine) Electrolytes, etc. Heparin to prevent
clots.
DSM-5-TR Schizophrenia Schizophreniform Schizoaffective
Criteria
Core ≥2 of the following for ≥1 Same as Same Criterion A
Psychotic month (1 must be 1–3): schizophrenia as schizophrenia
Symptoms 1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly
disorganized/catatonic behavior
5. Negative symptoms
Duration of ≥6 months total (includes 1 month to <6 ≥6 months total
Illness prodromal/residual phases) months (including mood
episodes)
Functional Yes No Yes
Decline
Required?
Mood If present, occur for a minority If present, occur for Present for the
Episodes of total illness duration a minority majority of total
Present? illness duration
Psychosis Yes Yes Required ≥2
