Schizophrenia (24 Questions)

1.1 Mr. Brodeur, 22 years old, was hospitalized last evening following a relapse of paranoid schizophrenia. Since admission, he has received two IM doses of haloperidol 5 mg to manage agitation. At 14:00 today, he was also given lorazepam (Ativan) 2 mg PO, which helped calm him slightly.

Now at 16:15, you observe that Mr. Brodeur appears:
*Anxious and restless
*Unable to sit still (akathisia)
*Complaining of neck and limb stiffness
*Mistrustful, tense, and isolating himself

His current medical orders include:
*Risperidone (Risperdal) 2 mg PO bid
*Haloperidol 5 mg PO or IM q4h PRN if agitated
*Lorazepam (Ativan) 2 mg PO or SL q4h PRN if anxious
*Chloral hydrate 500 mg PO at bedtime
*Benztropine mesylate 2 mg PO or IM PRN if extrapyramidal symptoms (EPS)

Question:
Based on Mr. Brodeur’s current presentation, which medication should the nurse administer? *
1.2 Question:
Which two clinical signs observed in Mr. Brodeur justify the administration of benztropine? *
1.3 At 10:30 AM, Mr. Brodeur, 22 years old, hospitalized for paranoid schizophrenia, is visibly anxious and irritable. He is:
*Pacing rapidly, knocking objects over as he passes
*Holding his hands over his ears and mumbling unintelligibly
*Becoming increasingly aggressive: he threatens, shoves the nurse, and clenches his fists
*His face is flushed, and he appears very tense

Earlier at 08:30, Mr. Brodeur received lorazepam (Ativan) 2 mg PO for anxiety, with little effect.

His current PRN orders include:
*Haloperidol 5 mg PO or IM q4h PRN if agitated
*Lorazepam 2 mg PO or SL q4h PRN if anxious
*Benztropine mesylate 2 mg PO or IM PRN if extrapyramidal symptoms

Question:
What is the most appropriate medication to administer now? *
1.4 Question:
What is the most important action the nurse must take before administering the medication? *
1.5 Question:
What is the priority nursing intervention while you wait for the medication to begin working? *
1.6 “We don’t understand why our son is acting like this. He’s never been violent before. What is happening to him?”

Question:
Based on Mr. Brodeur’s medical diagnosis, what is one appropriate explanation the nurse can give to help his parents understand his behavior? *
1.9 Mr. Brodeur, 22 years old, remains hospitalized for paranoid schizophrenia. During a calm moment, he opens up about his past and shares that he occasionally uses cannabis and stimulants with friends when feeling "too low" or "wired." He says, “I don’t think it’s a big deal. It helps me get through the day.”

As part of discharge planning, the team asks you to provide education on how illicit drug use may affect his mental health and recovery.

Question:
What should the nurse include when teaching Mr. Brodeur about the impact of illicit substance use on schizophrenia symptoms? *
1.10 The care team wants to ensure he understands the importance of recognizing early warning signs of relapse to prevent future hospitalization.

You are reviewing this with him before discharge.

Question:
Which of the following should the nurse emphasize as early signs of relapse in schizophrenia? *
2.1 Mr. Jérémie Paquette, 29 years old, has been hospitalized for treatment-resistant schizophrenia. He has had multiple failed trials with other antipsychotic medications. The psychiatrist has prescribed clozapine starting today.

Question:
The nurse is preparing to administer the first dose. What is the priority nursing intervention? *
2.2 During his follow-up today, the nurse notices that Mr. Paquette appears pale, weak, and complains of a sore throat and fever (38.8°C). He mentions having mouth ulcers and says he feels “worse than usual.” The nurse checks his latest lab results:
WBC (White Blood Cell Count):
Patient value: 2,000 cells/µL
Normal values: (4,500 – 11,000 cells/µL)
ANC (Absolute Neutrophil Count):
Patient value: 400 cells/µL
Normal value: > 1,500 cells/µL
Mild neutropenia: 1,000 – 1,500 cells/µL
Moderate neutropenia: 500 – 1,000 cells/µL
Severe neutropenia: < 500 cells/µL

Question:
What do you suspect is happening to the patient? *
2.3 Question:
What is your priority nursing intervention? *
3. M. Tremblay, 24 years old, admitted for an acute psychotic episode, is pacing the hallway. He stops abruptly, tilts his head to the side as if listening, and looks fearful. He mutters, "No, I can't do that."

Medical Order: Risperidone 1 mg PO BID.

Question:
What is your priority assessment question? *
4. Mme Gagnon, 35 years old, refuses to eat her lunch. She whispers to you, "I know the FBI put a microchip in this mashed potato to track my thoughts. I won't eat it."

Question:
What is the most therapeutic response? *
5. M. Roy, 19 years old, was started on Haloperidol (Haldol) 5 mg PO two days ago. He comes to the nursing station in panic. His head is twisted painfully to the side (torticollis), his jaw is locked, and his eyes are rolling upward.

Medical Order: Benztropine (Cogentin) 2 mg IM PRN for EPS.

Question:
What is happening, and what is your intervention? *
6. Mme Lefebvre has chronic schizophrenia. She sits in the dayroom for hours staring at the floor. When you ask her a question, she replies with one word (alogia). She has not bathed in 3 days (avolition) and shows no facial expression (flat affect).

Question:
How do you classify these symptoms? *
7. M. Cloutier, 45 years old, has been taking Chlorpromazine (Largactil). You notice he is confused and diaphoretic (sweating profusely).

Vital Signs: BP 170/100, HR 110, Temp 39.8°C.

His muscles feel rigid like a pipe.

Question:
What is your immediate priority action? *
8. Mme Poirier, 28 years old, has refractory schizophrenia and takes Clozapine (Clozaril) 100 mg PO BID. She comes to the clinic complaining of a sore throat and general malaise.

Medical Order: CBC (Complete Blood Count) STAT.

Question:
Which lab value is the physician specifically looking for? *
9. M. Dubé is observed drinking constantly from the water fountain, the sink in his room, and even attempting to drink from the toilet. He appears confused and is stumbling (ataxic).

Medical Order: Electrolytes STAT.

Question:
What physiological imbalance are you most concerned about? *
10. M. Fortin, 30 years old, has been hospitalized 4 times in the last year. Each time he is discharged on oral medication, he stops taking it after 2 weeks because "I forget" or "I feel fine," leading to relapse.

Question:
What pharmacological strategy would best address this cycle of non-compliance? *
11. Mme Caron is standing in the corner of the dayroom, eyeing the other patients suspiciously. You invite her to join the group therapy session on "Coping Skills." She backs away and says, "No, they are all talking about me."

Question:
What is the appropriate nursing intervention? *
12. You are discharging M. Lambert home to live with his parents. You are teaching the parents about early warning signs of relapse.

Question:
Which sign indicates the need to contact the treatment team immediately? *
13. You are the primary nurse for M. Lapointe, a 26-year-old male admitted to the psychiatric unit three days ago for an acute exacerbation of schizophrenia. During your morning assessment, you observe that M. Lapointe is pacing the hallway rapidly. He appears disheveled, has a strong body odor, and has not brushed his teeth since admission despite your reminders (avolition). When you approach him to offer his morning medication, he stops, looks at you with a completely blank facial expression (flat affect), and says in a monotonous voice: "I cannot swallow that pill. The CIA replaced the medicine with a tracking device to monitor my thoughts. I can hear them adjusting the frequency right now."

Medical Order: Olanzapine (Zyprexa) 10 mg PO daily at 09:00.

Question:
Among the clinical manifestations observed during this interaction, which one is classified as a positive symptom of schizophrenia? *