NRSG 3200 Schizophrenia Unit 3 Exam 2025

Delusion of Persecution (Positive) - Correct Answer-The individual feels threatened and believes that others intend to harm or persecute him or her in some way (the FBI has bugged my room and intends to kill me. I can't take a shower in this bathroom; the nurses have put a camera in there so that they can watch everything I do.) Delusion of Grandeur (Positive) - Correct Answer-The individual has an exaggerated feeling of importance, power, knowledge, or identity (I am Jesus Christ) Delusion of Reference (Positive) - Correct Answer-All events within the environment are referred by the psychotic person to him or herself (someone is trying to get a message to me through the articles in this magazine; I must break the code so that I can receive the message) Delusion of Control or Influence (Positive) - Correct Answer-individual believes certain objects or persons have control over his or her behavior (The dentist put a filling in my tooth; I now receive transmissions through the filling that control what I think and do) Somatic Delusion (Positive) - Correct Answer-The individual has a false idea about the functioning of his or her body (I'm 70 years old and I will be the oldest person ever to give birth. The doctor says I'm not pregnant, but I know I am.) Nihilistic Delusion (Positive) - Correct Answer-The individual has a false idea that the self, a part of the self, others, or the world is nonexistent (The world no longer exists. I have no heart) Religiosity (Positive) - Correct Answer-An excessive demonstration of or obsession with religious ideas and behavior. An example is the individual who believes the voice they hear is God and incessantly searches the bible for interpretation Paranoia (Positive) - Correct Answer-Individuals have extreme suspiciousness of others and of their actions or perceived intentions (I won't eat this food. I know it has been poisoned) Magical Thinking (Positive) - Correct Answer-the person believes that his or her thoughts or behaviors have control over specific situations or people (the mother who believed if she scolded her son in any way he would be taken away from her) It is common in children (It is raining; the sky is sad. It snowed last night because I wished very hard that it would) Associative Looseness (Positive) - Correct Answer-Thinking process characterized by speech in which ideas shift from one unrelated subject to another. The individual is unaware that the topics are unconnected. (We wanted to take the bus, but the airport took all the traffic. Driving is the ticket when you want to get somewhere. No one needs a ticket to heaven. We have it all in our pockets) Neologisms (Positive) - Correct Answer-The psychotic person invents new words that are meaningless to others but have meaning to the psychotic person. (She wanted to give me a ride in her new uniphorum) Concrete Thinking (Positive) - Correct Answer-Literal interpretations of the environment. Abstract thinking is difficult. They may have difficulty describing the abstract meaning of sayings such as "It is raining cats and dogs" Clang Associations (Positive) - Correct Answer-Choice of words is governed by sounds. Often take the form of rhyming. (It is very cold. I am cold and bold. the gold has been sold.) Word Salad (Positive) - Correct Answer-A group of words that are put together randomly without any logical connection (Most forward action grows life double plays circle uniform) Circumstantiality (Positive) - Correct Answer-The individual delays in reaching the point of a communication because of unnecessary and tedious details. The point or goal is usually met but only with numerous interruptions by the interviewer to keep the person on track of the topic being discussed. Tangentiality (Positive) - Correct Answer-Differs from circumstantiality in that the person never really gets to the point of the communication. Unrelated topics are introduced, and the focus of the original discussion is lost. Mutism (Positive) - Correct Answer-an individual's inability or refusal to speak Perseveration (Positive) - Correct Answer-individual persistently repeats the same word or idea in response to different questions Auditory Hallucinations (Positive) - Correct Answer-False perceptions of sound. Most commonly they are voices, but the individual may report clicks, rushing noises, music, etc. Command hallucinations may place the individual or others in a potentially dangerous situation if the voices demand violence. Visual Hallucinations (Positive) - Correct Answer-False visual perceptions. They may consist of formed images, such as people, or unformed images, such as flashes of light. Tactile Hallucinations (Positive) - Correct Answer-False perceptions of the sense of touch, often of something on or under the skin. One specific example is formication, the sensation that something is crawling on or under the skin. Gustatory Hallucinations (Positive) - Correct Answer-False perception of taste. Most commonly described as unpleasant tastes Olfactory Hallucinations (Positive) - Correct Answer-False perceptions of the sense of smell Illusions (Positive) - Correct Answer-Misperceptions or misinterpretations of real external stimuli Echolalia (Positive) - Correct Answer-The individual may repeat words that they hear. This is an attempt to identify with the person speaking (The nurse says "John it is time for lunch." The client may respond, "It's time for lunch, it's time for lunch" or "Lunch, lunch, lunch, lunch") Echopraxia (Positive) - Correct Answer-Purposelessly imitate movements made by others Identification and Imitation (Positive) - Correct Answer-Ego defense mechanisms used by individuals with schizophrenia and reflect their confusion regarding self-identity. Because they have difficulty knowing where their ego boundaries end and another person's begins, their behavior often takes on the form of that which they see in the other person. Depersonalization (Positive) - Correct Answer-The unstable self-identity of an individual with schizophrenia may lead to feelings of unreality (feeling that one's extremities have changed in size, or a sense of seeing oneself from a distance) Inappropriate Affect (Negative) - Correct Answer-The individual's emotional tone is incongruent with the circumstances (a young woman who laughs when told of the death of her mother) Bland or Flat Affect (Negative) - Correct Answer-The emotional tone is very weak. The individual appears to be void of emotions. Apathy (Negative) - Correct Answer-An indifference to or disinterest in the environment. Emotional Ambivalence (Negative) - Correct Answer-The coexistence of opposite emotions toward the same object, person, or situation. These opposing emotions may interfere with the person's ability to make even a very simple decision. Need-fear dilemma. Deteriorated Appearance (Negative) - Correct Answer-Personal grooming and self-care activities may be neglected. The individual may appear disheveled and untidy and may need to be reminded of the need for personal hygiene. Impaired Social Interaction (Negative) - Correct Answer-Individual may cling to others and intrude on the personal space of others, exhibiting behaviors that are not socially and culturally acceptable Social Isolation (Negative) - Correct Answer-Individuals with schizophrenia sometimes focus on themselves to the exclusion of the external environment Anergia (Negative) - Correct Answer-Deficiency of energy. They may lack the energy to carry out activities of daily living or to interact with others. Waxy Flexibility (Negative) - Correct Answer-The individual allows body parts to be placed in bizarre or uncomfortable positions. Once placed in position, the arm, leg, or head remains in that position for long periods, regardless of how uncomfortable it is. (keeping arm raised even after the blood pressure cuff is removed) Posturing (Negative) - Correct Answer-Manifested by the voluntary assumption of inappropriate or bizarre postures Pacing and Rocking (Negative) - Correct Answer-Pacing back and forth and body rocking are common psychomotor behaviors of the individual with schizophrenia Anhedonia (Negative) - Correct Answer-The inability to experience pleasure. This is a particularly distressing symptom that compels some individuals to attempt suicide Regression (Negative) - Correct Answer-The retreat to an earlier level of development. A primary defense mechanism of schizophrenia. It is a dysfunctional attempt to reduce anxiety. It provides the basis for many of the behaviors associated with schizophrenia. Nursing Diagnoses for Schizophrenia - Correct Answer-Disturbed Sensory Perception Disturbed Thought Processes Social Isolation Risk for Violence: self-directed or other-directed Impaired Verbal Communication Self-Care Deficit Disabled Family Coping Ineffective Health Maintenance Impaired Home Maintenance Premorbid Phase - Correct Answer-Social maladjustment, social withdrawal, irritability, and antagonistic thoughts and behavior. Very shy and withdrawn, have poor peer relationships, do poorly in school, demonstrate antisocial behavior. Prodromal Phase - Correct Answer-Begins with the change from premorbid functioning and extends until the onset of psychotic symptoms. This phase usually lasts 2-5 years. The individual experiences substantial functional impairment and nonspecific symptoms such as a sleep disturbance, anxiety, irritability, depressed mood, poor concentration, fatigue, and behavioral deficits such as deterioration in role functioning and social withdrawal. Positive symptoms such as perceptual abnormalities, ideas of reference, and suspiciousness develop late in this phase and lead into the onset of psychosis. Recognition of these behaviors provides an opportunity for early intervention with a possibility for improvement in long-term outcomes. Current Treatment Guidelines during Prodromal Phase - Correct Answer-Therapeutic interventions that offer support with identified problems Cognitive therapies to minimize functional impairment Family interventions to improve coping and involvement with the schools to reduce the possibility of failure Active Schizophrenia Phase - Correct Answer-Psychotic symptoms are prominent 1. Delusions 2. Hallucinations 3. Disorganized speech 4. Grossly disorganized or catatonic behavior 5. Negative symptoms Decreased level of functioning in work, relationships, self-care, etc Continuous signs persist for at least 6 months with at least 1 month of symptoms. Residual Phase - Correct Answer-Usually follows an active phase of the illness. During this phase, symptoms are either absent or no longer prominent. Negative symptoms may remain, and the flat affect and impairment in role functioning are common. Residual impairment often increases between episodes of active psychosis. Individual Psychotherapy - Correct Answer-goals are to improve medication compliance, enhance social and occupational functioning, and prevent relapse. Reality-oriented individual therapy is most suitable for schizophrenia. Primary focus is to decrease anxiety and increase trust. Establishing a relationship with the patient will be difficult. Be honest, simple, and respectful. Long-term therapeutic approach; difficult because of patient's impairment in interpersonal functioning Group Therapy - Correct Answer-focuses on real-life plans, problems, and relationships. It is not helpful in inpatient situations. It reduces social isolation and increases cohesiveness. Some success if occurring over the long-term course of the illness; less successful in acute, short-term treatment. Behavior Therapy - Correct Answer-Reduces the frequency of bizarre and disturbing behaviors and increases appropriate behavior. Chief drawback has been inability to generalize to community setting after client has been discharged from treatment. Positive results with this therapy occur by: Clearly defining goals and how they will be measured. Attaching positive and negative reinforcements to adaptive and maladaptive behaviors. Using simple, concrete instructions and prompts to elicit the desired behavior. Social Skills Training - Correct Answer-Focuses on role play. Focus on small behaviors and proceed gradually. Emphasize functional skills needed for daily life. Use of role play to teach client appropriate eye contact, interpersonal skills, voice intonation, posture, and so on; aimed at improving relationship development. Milieu Therapy - Correct Answer-Better in outpatient setting. Emphasizes group and social interaction. Rules and expectations are mediated by peer pressure for normalization and adaptation. Patients should be viewed as responsible human beings. Family Therapy - Correct Answer-Aimed at helping family members cope with long-term effects of the illness Assertive Community Treatment (ACT) - Correct Answer-Case-management that takes a team approach in providing comprehensive, community-based psychiatric treatment, rehabilitation, and support to persons with serious and persistent mental illness such as schizophrenia The Recovery Model - Correct Answer-Focus on conceptual models of functional and process recovery. Typical Antipsychotics - Correct Answer-Haldol, Prolixin, Trilafon, Thorazine Atypical Antipsychotics - Correct Answer-Risperdal, Seroquel, Geodon, Abilify, Clozaril, Zyprexa Side Effects of Antipsychotics - Correct Answer-(anticholinergic effects) dry mouth, blurred vision, constipation, urinary retention, nausea, skin rash, sedation, orthostatic hypotension, photosensitivity, decreased libido, amenorrhea, weight gain, EKG changes, reduction of seizure threshold, agranulocytosis, hypersalivation, Extrapyramidal Symptoms (EPS) - Correct Answer-Pseudoparkinsonism (tremor, shuffling gait, drooling, rigidity) akinesia (muscle weakness) akathisia (continuous restlessness/fidgeting) dystonia (involuntary movements of the face/arms/legs/neck) oculogyric crisis (uncontrolled rolling back of the eyes) tardive dyskinesia (bizarre facial and tongue movements, stiff neck, difficulty swallowing) Neuroleptic Malignant Syndrome (NMS) - Correct Answer-severe parkinsonian muscle rigidity, very high fever, tachycardia, tachypnea, fluctuations in blood pressure, diaphoresis, and rapid deterioration of mental status to stupor and coma. Nursing Considerations for Antipsychotics - Correct Answer-Lowers seizure threshold May slow growth rate Monitor for urinary retention and d