A nurse is caring for a client who has schizophrenia and notices changes in the client’s behavior.
Which of the following behaviors is the nurse’s priority to report to the provider?

Meaningless phrases

Refusal to eat

Substance use

Decreased energy level

Answer and Explanation

The Correct Answer is A

Choice A rationale:

Meaningless phrases are a hallmark symptom of schizophrenia and can indicate a worsening of the client's psychosis. This is a significant finding because it suggests that the client's ability to think clearly and communicate effectively is deteriorating.

Prompt reporting to the provider is crucial to ensure timely assessment and intervention, which may include medication adjustments or other therapeutic measures to address the worsening psychosis.

Early intervention is essential to prevent further decline in the client's mental state and to minimize the risk of harm to self or others.

I'll provide detailed rationales for the other choices, even though they are not the priority to report:

Choice B rationale:

Refusal to eat can be a symptom of schizophrenia, but it is not as immediate of a concern as meaningless phrases. It's important to monitor the client's nutritional intake and address any underlying causes of the refusal to eat, but this can typically be managed through nursing interventions without requiring immediate provider notification.

Choice C rationale:

Substance use can exacerbate schizophrenia symptoms and should be addressed, but it is not the priority to report in this scenario. The nurse should assess the client's substance use history and patterns, provide education and counseling on the risks of substance use, and collaborate with the provider to develop a treatment plan that addresses both the schizophrenia and the substance use.

Choice D rationale:

Decreased energy level can be a symptom of schizophrenia, but it is also a common symptom of many other conditions. It's important to assess the client's overall health and identify any potential causes of the decreased energy level, but it is not typically a priority to report to the provider unless it is severe or accompanied by other concerning symptoms

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Correct Answer is C

Explanation

Choice A rationale:

Psychomotor retardation is a characteristic of depression, not hypomania. In fact, individuals with hypomania typically exhibit psychomotor agitation, which is characterized by increased energy and activity levels.

Psychomotor retardation often manifests as slowed movements, speech, and thought processes. It can significantly impact an individual's ability to perform daily tasks and engage in social interactions.

While psychomotor retardation can occur in various mental health conditions, it is not typically associated with hypomania.

Choice B rationale:

Decreased self-esteem is also a characteristic of depression, not hypomania. Individuals with hypomania typically experience inflated self-esteem and grandiosity.

They may overestimate their abilities, make unrealistic plans, or engage in risky behaviors. This inflated sense of self-worth is often a hallmark feature of hypomania and can contribute to impaired judgment and decision-making.

Choice C rationale:

Euphoria is a hallmark symptom of hypomania. It is characterized by an elevated, expansive, or irritable mood that is persistent and noticeable to others.

Individuals with euphoria often feel excessively happy, cheerful, or optimistic. They may have increased energy, decreased need for sleep, and a heightened sense of well-being.

They may also be more talkative, outgoing, and engage in pleasurable activities more often.

This elevated mood is a core feature of hypomania and is often accompanied by other characteristic symptoms, such as increased activity levels, racing thoughts, and impulsivity.

Choice D rationale:

Hallucinations are not a typical feature of hypomania. They are more commonly associated with psychotic disorders, such as schizophrenia.

Hallucinations involve perceiving things that are not real, such as hearing voices or seeing things that are not there.

While hallucinations can occur in some individuals with hypomania, they are not a defining feature of the condition

A. Pseudoparkinsonism B. Acute dystonia C. Akathisia D. Tardive dyskinesias

Correct Answer is A

Explanation

Choice A rationale:

Pseudoparkinsonism is an extrapyramidal side effect (EPSE) of antipsychotic medications, particularly first-generation antipsychotics (FGAs) like haloperidol, that closely resembles the symptoms of Parkinson's disease. It's characterized by:

Stooped posture: A forward-leaning posture, often with rounded shoulders and a head that is bent forward.

Shuffling gait: Small, slow steps with reduced arm swing, often described as a "shuffling" or "dragging" walk.

Rigidity: Increased muscle stiffness throughout the body, leading to resistance to movement and a feeling of tightness.

Bradykinesia: Slowness of movement, both in initiating and completing actions.

Tremor: Involuntary shaking, often most noticeable in the hands, but can also affect the arms, legs, head, or jaw.

Masked facies: A decreased facial expression, often described as a "flat" or "expressionless" face.

Mechanism of pseudoparkinsonism:

Haloperidol primarily blocks dopamine D2 receptors in the nigrostriatal pathway of the brain.

Dopamine plays a crucial role in motor control, and its blockade in this pathway leads to a disruption in the balance of dopamine and acetylcholine, another neurotransmitter involved in movement.

This imbalance results in the characteristic symptoms of pseudoparkinsonism.

Risk factors for pseudoparkinsonism:

Older age

Female sex

Higher doses of antipsychotic medication

Prolonged use of antipsychotic medication

History of Parkinson's disease or other movement disorders

Presence of other EPSEs

Management of pseudoparkinsonism:

Dose reduction: If possible, the dose of the antipsychotic medication may be reduced.

Switching to a different antipsychotic: Some antipsychotics, such as second-generation antipsychotics (SGAs), have a lower risk of causing EPSEs.

Anticholinergic medications: These medications can help to counteract the effects of dopamine blockade on the acetylcholine system, but they can have their own side effects, such as dry mouth, constipation, and urinary retention.

Amantadine: This medication can also be used to treat pseudoparkinsonism, but it has the potential to cause side effects such as insomnia, anxiety, and livedo reticularis (a mottled skin rash).

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A nurse is caring for a client who has schizophrenia and notices changes in the client’s behavior. Which of the following behaviors is the nurse’s priority to report to the provider?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is collecting data from a client who has hypomania. Which of the following findings should the nurse expect?

Correct Answer is C

Explanation

A nurse is caring for a client who has schizophrenia and is taking haloperidol. The nurse observes that the client has developed a stooped posture and shuffling gait. The nurse should document these findings as which of the following extrapyramidal side effects of haloperidol?

Correct Answer is A

Explanation

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A nurse is caring for a client who has schizophrenia and notices changes in the client’s behavior.
Which of the following behaviors is the nurse’s priority to report to the provider?