HESI Case Study: Schizophrenia
Based on this assessment, what is the most important nursing intervention?
- Establish rapport and trust.
- Assess for hallucinations.
- Maintain adequate social space.
- Plan to give a PRN antipsychotic.
What is the most accurate assessment if the client believes that the healthcare providers are FBI agents and that there are cameras in his apartment to monitor his moves?
- Hallucinations.
- Delusions.
- Confabulation.
- Thought broadcasting.
Which behavior is characteristic of a thought disorder?
- Blunted affect.
- Irritability.
- Lability of mood.
- Preoccupation with guilty feelings.
The nurse understands that schizophrenia can be differentiated from psychosis by which assessment?
- Disorganized speech.
- Disorganized behavior.
- Auditory hallucinations.
- Negative symptoms.
Which finding depicts negative symptoms of schizophrenia?
- Difficulty sitting still.
- Rapid and disorganized speech.
- Flat affect and social inattentiveness.
- Delusional statements.
Which nursing problem has priority?
- Ineffective community coping.
- Disturbed thought processes. 1 / 2
- Sensory-perceptual disturbance.
- Ineffective denial.
What is the reason that Prolixin is prescribed for this client?
- Disorganized thoughts.
- Difficulty sleeping at night.
- Feelings of depression.
- Stabilize client's mood.
The nurse understands that a client with schizophrenia will experience which benefit from fluphenazine decanoate (Prolixin decanoate) if it is administered intramuscularly?
- Prevent more extrapyramidal side effects.
- Maintain long-term medication compliance.
- Minimize side effects from benztropine (Cogentin).
- Prevent risk of cardiac or renal disease.
Which client behavior validates the need for involuntary hospitalization?
- Beliefs about FBI surveillance.
- Diagnosis of schizophrenia.
- Violence towards father.
- Guarded and suspicious.
If a client who has voluntarily chosen to be hospitalized should want to leave the hospital, which assessment would be most important in deciding to release the client against medical advice (AMA)?
- Mental status of client.
- Reason that client wants to leave.
- Response to medications.
- Potential danger to self or others.
Which nursing action is best?
- Obtain a prescription to begin the Cogentin.
- Monitor Sam for medication side effects.
- Ask Sam if he had any side effects from the Prolixin.
- Do not give the Prolixin and document the reason.
Which side effects would the nurse most likely observe with fluphenazine (Prolixin), a traditional antipsychotic?
- High extrapyramidal effects, low anticholinergic effects.
- High anticholinergic effects and low extrapyramidal effects.
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