NOTES:  muscle tension, dry mouth, frequent

Anxiety – neurosis but doesn’t mean it urination

will lead to hallucinations  Diaphoresis, headache
Psychosis – has hallucinations  Inc. BP, pulse and respiration

ANXIETY Emotional
- feeling of apprehension and dread,  Increased irritability
impending doom
 motivated to decrease anxiety
- caused by a subjective threat
 Use of palliative coping mechanism
- both a stressor and for adaptation
- communicable
Mgmt:
- has degrees
decrease anxiety
- decrease GABA
refocus attention
oral medication if needed
4 Levels
Mild
Slight perspiration
Moderate
has difficulty concentrating
Severe
e.g. during exam
Panic
Mgmt: mild and moderate
I. Mild Anxiety
help client identify anxiety
encourage client to talk about feelings
Cognitive
assist CL problem solving
 éalertness, é to learn
refocus attention
 Logical reasoning oral meds.
 Problem solving skills
III. Severe
Physical
 restlessness, fidgeting, G.I. butterflies, Cognitive
difficulty sleeping, hypersensitive to  ê perception
noise  Perception focused to one detail or
 Slight Muscle tension scattered details
Distorted perceptions
Emotional
 Irritability Physical
 Can be motivating  fight or flight response
 Use of adaptive coping mechanism  é V/S
 extreme Muscle tension
Mgmt.  severe headache, nausea & vomiting,
discuss source of anxiety diarrhea
problem solve
 vertigo, tachycardia, chest pain
accept as natural
benefit from it
Emotional
 Extreme discomfort
II. Moderate
 Feeling of dread
Cogntive  Use of maladaptive mechanisms
 narrowed perception
e.g. witnessing a car accident
 focused to immediate task
 selective attention
Mgmt:
-reduce anxiety quickly
Physical
-don’t engage client in problem solving
 é use of automatism and speech, -use calm manner
pacing -remain with the client
-minimize environmental stimuli
-use clear and simple statements
-use low pitch voice
-attend to physical needs of client
-provide gross motor activity
Anti-anxiety (oral as ordered)
IV. Panic
Cognitive
 Disorganized perception
 Disorganized problem solving
 Out of contact with reality
 Neologism, clang association
OCD
 Obsessions – persistent, intrusive
thoughts that one is unable to omit.
o Religion
o Sexuality
o Violence
 Compulsion – repetitious,
uncontrollable acts to decrease
anxiety
o e.g.cleaning ritual
Ego def – mech used: repression, undoing,
isolation, reaction formation
Rxn formation – Obsession
Undoing – Compulsion

Physical Management
 actual fight & flight
 Suicidal, hysterical > Short-term:
 Mute, incoherent 1. allow compulsion
2. limit setting
Emotional 3. diversional activity – art therapy
 Feeling overwhelmed
 Rage desperation > Long term goal:
1. psychotherapy
 Totally drained
2. Anti-anxiety medications
 Use of dysfunctional coping Take note! accdg. To ma’am,
mechanisms anti-depressants talaga dapat kasi anti-
anxiety meds, nakakaadik …
e.g. during earthquake
Phobic Disorder
Mgmt:
 Irrational fear from stimulus (obj.,
provide client safety
situation)
emotional support
structured environment  Avoidance of the feared obj.= free
Restraints if needed from anxiety
smaller room – don’t place client in the
middle, but in the corner Ego def. Mech:
anti-anxiety (parental as ordered)  Symbolization
 Projection
I. ANXIETY DISORDERS  Displacement
OCD
Phobic NOTES!
Gen. Anxiety Disorder Types of Phobia:
Panic Disorder Social Phobia – fear of speaking
Post Traumatic Stress Disorder infront, etc .. because you don’t want
Acute Stress Disorder humiliation
Agoraphobia – fear of open
COMMON TO ANXIETY DISORDER spaces
 Central cause – anxiety Specific Phobia – fear of blood,
 conflict , unacceptable to person heights, etc …
 CL unaware of cause (repression)
Mgmt:
 Obtain gains
1. MILIEU Therapy
o Primary
2. Systematic Desensitization - gradual
o secondary
exposure to the feared object

NOTES!
Nurse will also be a model, you will
teach patient how to relax
Systematic Desensitization is under
Behavioral Model / Therapy, it says that
“behavior can be learned so it can also be
unlearned.”
3. Psychotherapy
4. Behavior modification – reward &
recognition
5. Pharmacotherapy
General Anxiety Disorder
 unrealistic or excessive worry
occurring more days than not in a 6-
month period
 at least 3 of the following symptoms
occur: restlessness, irritability,
fatigue,
 muscle tension, sleep disturbance,
impaired concentration
Panic Disorder – with or without
agoraphobia
 real illness accompanied by physical
and psychological component
 Sudden frightening and uncomfortable
symptoms:
o Terror, sense of unreality, fear
of loosing control, Chest pain,
Palpitations, Tachycardia,
Diaphoresis, Shortness of
Breath, Choking sensation, Fear
of going crazy
 After the panic attack, client
exhibits concern of future attacks
Post Traumatic Stress Disorder
- re-experiencing trauma / flashback
- emotional numbness
- hypervigilance, hyperalertness,
irritable
> should occur 1 month after the event
to be able to diagnose as PTSD
Acute Stress Disorder
 differentiated from PTSD in that
symptoms occur
 immediately after the trauma
 last for at least 2 days - 4 weeks
 dissociative symptoms - derealization,
depersonalization, or dissociative
amnesia
 traumatic event persistently
experienced, marked anxiety,
impaired functioning
Mgmt: to reduce anxiety
1. provide a calm and quiet environment
2. ask patient to identify what and how they
feel
3. encourage to discuss feelings
4. listen to patient’s feeling of worthlessness
and hopelessness
5. assess for suicidal thoughts
6. provide recreational activity ie
walking,games
Mgmt: ASD and PTSD
1.Verbalization – esp. anger,gradually done,
and only what client wants to talk about
-acknowledge any unfairness or injustice
related to trauma
2. assure them that their feelings are typical
reactions to trauma
3. encourage adaptive coping
strategies,relaxation techniques,and sleep
promoting strategies
4. facilitate progressive review of the trauma
and it’s consequences
5. encourage to establish and re-establish
relationships
6.Psychotherapy
Management
Pharmacotherapy:
 Anti-anxiety Drugs
 Anti- depressant – Clomipramine
(Anafranil)
*GABA- an inhibitory NT - ê in anxiety
ANTI-ANXIETY, ANXIOLYTICS, MINOR
TRANQUILIZER
 Tx for anxiety disorders, insomnia,
OCD, depression, alcohol withdrawal
TYPES:
1. Propanediol compounds:
2. Benzodiazepine group (BDZ)
3. Non-Phenothiazine group
4. Non-Benzodiazepine group
Propanediol compounds
1.Meprobamate (equanil)
2. Phenaglycodol ( Ultran)
3.Tybamate (solacen)
Adverse effect: hypotension, headache,
insomnia, hypersensitivity service.

Benzodiazepine group (BDZ)
1.Chlordiazepoxide (Librium)
2.Clorazepate (tranxene)
3.Diazepam (valium)
4.Oxazepam(serax)
5.Alprazolam (xanax)
Non-Phenothiazine group
1.Hydrozyzine HCL (atarax)
2.hydroxyzine pamoate (visiril)
Non-Benzodiazepine group
1. Buspirone (Buspar)
General Adverse effect: drowsiness,
hypotension , relaxation , inability to
concentrate, muscle relaxation,
hypersensitivity reaction
Client teaching
- Teach client about the tendency for
physical dependence
- Clients should not drink alcohol when
taking anxiolytics
- Slower reflexes-clients should not be
operating heavy machineries and
cautioned against driving.
- Orthostatic hypotension – dangle 1st
before standing
- Anti-Cholinergic effects:
Dry mouth – oral hygiene
Constipation – hydration
Urine retention-positioning
It’s Quiz Time!
1. Before an anxious client begins treatment
it is most important to assess the client’s:
a. Level of motivation for treatment
b. Situational and emotional support
c. Stressors and coping mechanisms
d. Use of alcohol or other central nervous
system depressant agents
2. The nursing assessment indicates a client
is experiencing a panic attack. The client is
unable to understand directions and
preoccupied with thoughts of danger. Which
of the ff. would be the most appropriate
nursing diagnosis:
Altered health maintenance
Altered thought process
Ineffective individual coping
Impaired communication
3. Which of the ff. would be the most
appropriate goal for a client who has been
diagnosed as having GAD:
The client will describe dissociative
symptoms
The client will display the ability to cope with
mild anxiety
The client will verbalize a sense of control
over ritualistic behavior
The client will relive the traumatic event
4. A client states, “I am always late for
everything because I can’t leave my house
without checking every door and window to
make sure it’s locked. If I don’t make sure
everything is locked I get so worried and I
have to go back home. I can’t seem to stop
my behavior. The nurse should encourage
this client to:
Explore childhood experience that may have
led to the behavior
Remain at home until the symptoms subside
Stop worrying about the locks
Adjust the personal schedule to allow time
for the ritual
5. Which of the ff. statements made by a
client with obsessive-compulsive disorder
would be the best indicator of improvement:
“I know that my behaviors and thoughts are
not normal”
“I only do my ritual to reward myself when I
have been good”
“My friends don’t know about my disorder”
“I have more control over my thoughts and
behavior”
6. Which of the ff. statements by a client
taking triazolam (Halcion) for anxiety
indicates that teaching has not been
effective:
“The doctor wants me to take this drug at
bedtime to help me sleep better”
“I should not abruptly stop taking this
medication”
“I might not be able to drive while I am
taking this medication”
“I will probably have to take this medication
for the rest of my life”
II. SOMATOFORM DISORDERS
> Characterized by physiologic complaints or
symptoms that are not under voluntary
control, and do not demonstrate organic
findings
> symbolizes repressed and unresolved
conflicts
Somatization
Somatoform Pain Disorder  alteration/loss of sensory or motor
Hypochondriasis function
Conversion Disorder  Young age, female
 common conversion - blindness,
II. Somatoform III. Psycho- paralysis, mutism, paresthesias
disorders physiolo  Symptom has a symbolic relation to
VERSUS gic the unconscious conflict
Disorder  “La belle indifference” – e.g. okay
> No medical > Medical condition lang sakin na mabulag atleast
condition with physiologic hindi ko nararamdaman ang
> (-) diagnosis, no lab. basis anxiety..
Findings > (+) diagnosis, lab
> NO MEDICAL findings Body Dysmorphic Disorder
REGIMEN > CNS – migraine,
 preoccupation with a imagined defect
tension, headache
in his or her appearance
> CVD – CAD, HPN
 Imagined subjective feeling of ugliness
> Respi – Asthma
> NM – arthritis  Young adolescent – young adult,
> GIT – Peptic Ulcer female
> Endocrine –  common complains are facial flaws
Diabetes Mellitus  noselifts, facelifts
> MEDICAL
REGIMEN & Goals of Care
CONTINUED 1. Functional as his condition will allow to do
TREATMENT not focus on body
2. No specific medical regimen
3. Anti-anxiety meds.
Somatization Disorder 4. Analgesic
 Polysymptomatic – the client has 5. Stress mgmt. Theory
multi-organ complaints - relaxation
 Young age, female - deep breathing
- imagery – music
 Familial
- meditations
 Recurrent and chronic 6. Psychotherapy
 anxiety and depression often seen
 frequent attempts at suicide Its Quiz Time!
 frequently submits self to surgery A client who developed a glove anesthesia of
 antisocial behavior the right (dominant) hand was unable to play
in a piano competition yesterday. The
Somatoform Pain Disorder consequence of this symptom, not having to
 pain is the predominant focus perform, is best described as:
 Older 4th or 5th decade, female Phobia
 Familial Primary gain
 intense pain unrelieved by analgesics Carpal tunnel dysmorphia
 involves different parts of the body Secondary gain

Hypochondriasis 2. A female client with a 15-year history of

somatization disorder is to be discharged
 morbid preoccupation of a serious
from her first psychiatric hospitalization.
illness
Which statement would indicate that nursing
 Middle or old age, male-female equal care has been effective:
 doctor shopping “I need to make sure all my medications are
 anxiety, depression and compulsive sent home with me”
personality traits “My family is so good to me when I’m sick
like this”
Conversion Disorder
“There are so many illnesses that you nurses
don’t know about”
“I see that when I get stressed, my body
speaks for me”
3. A client convinced that her pelvic pain is
from an advance malignancy, and that she is
likely to die. Extensive testing has revealed
no abnormalities, “You think this is in my
head, don’t you?” she asks. The nurse’s best
response is:
“Sometimes doctors miss a diagnosis”
“Yes I think you have pain”
“It must be hard for you to hear the testing
results”
“How about resting now and asking your
doctor later”
2.Sexual Arousal Disorder
a.female sexual desire disorder-dyspareunia
caused by lack of desire,hormonal
b.male erectile disorder-erectile dysfunction
or impotence,maybe organic or psychological
3.Orgasm Disorders
a.anorgasmia - absence or delayed orgasm
b.premature ejaculation
4.Sexual Pain Disorders
a.dyspareunia - genital pain before,during or
after intercourse
b.vaginismus - involuntary muscle
constriction of the outer third of the
vagina(rape trauma)

4. A client with somatization disorder has Paraphilias (sexual perversions)

been attending group therapy. Which -sexual instinct is expressed in ways that are
statement indicates that the care has been socially unacceptable and is prohibited
effective: -peaks between the age 15 and 25 and
“I think I’d better get some pills. My back decreases in incidence by age
hurts from sitting in group” -always enters the cycle of sexual perversion
“The other women in the group have mental -exhibitionism
problems! -incest
“I haven’t said much, but I get a lot out -fetishism
of listening” -necrophilia
d. “I feel better physically just from getting -frotteurism
a chance to talk” -sexual masochism
-voyeurism
SEXUAL DISORDERS -coprophilia
 Inhibition of the sexual appetite or -pedophilia
psycho-physiological changes that -sexual sadism
compromise the sexual response cycle -bestiality
-pyromania
The sexual response cycle -nymphomania
Phase 1: Desire-fantasies and sexual desire -satyriasis
Phase 2: Excitement-Psychological and -telephone scatologia
physiological stimulation (30 sec-3 minutes)
Phase 3: Orgasm-peak of sexual pleasure (3- Not otherwise classified
15 sec, dec LOC),inc VS Cunnilingus
Phase 4: Resolution-detumescence, resting anilingus
stage,refractory period(males) Fellatio
Masturbation
Predisposing Factors Homosexuality
1.biological
2. psychosocial Txt: Psychotherapy,group therapy,sex
3. relationship therapy, behavior therapy,
Antiandrogen(depo-provera)
1.Sexual Desire Disorders
a. Hypoactive disorder-deficiency or EATING DISORDERS
absence of fantasy and desire for sexual  Anorexia-profound disturbance in body
activity image and a relentless pursuit of
b. Sexual aversion disorder-avoidance of thinness to the point of starvation
genital contact with a partner  common in females 10-30 y/o
 Regression
Diagnostic criteria include Isolation
1. refusal to maintain body weight at a Intellectualization
normal BMI or is less than 85% of DBW
2. intense fear of gaining weight Management
3. disturbed body image 1. Refeeding Therapy
4. self evaluation is based on body weight or 1-2 lbs. Initially / week
shape is experienced NGT at night
5. amenorrhea at least 3 consecutive cycles Oral
Combination
ANOREXIA NERVOSA 2. Behavior Modification Program – token
Self imposed starvation > Stress > NOTES na galing kay Hazel!
Anxiety > eating behavior > decreased 3. MILIEU
anxiety - observation during and after
mealtimes
Etiology - monitoring bathroom use precise
 Disturbed body image mealtimes
 Conflict in growing up - coherence to selected menu
 dominating / authoritative parents
 this is in belief -regular weighing
-weekly, biweekly
 dysfunction in hypothalamus
-same time of day
-before morning meal
Manifestations
-after voiding
 starving - wt. loss by 15-85%
-gown, bra, and pants only
 amenorrhea – starvation effect on LH
 dehydration -monitor VS, fluid and electrolytes
 serum Na and electrolyte imbalance, -monitor exercise
hypoglycemia -monitor elimination pattern
 V/Sx – hypotension, bradycardia -client privileges correlated with
hypothermia weight gain

As the disorder progresses: 3. Provide contract

 dry flaky skin 4. Go with client when eating
 brittle hair and nails 5. Set limits-remind contract
 constipation 6. No laxative
 skeletal appearance, BMR 16 below 7. Family therapy
 lanugo 8. CBT – Cognitive Behavioral Therapy
9. Psychotherapy
Warning signs that should alert 10. Medications
parents: -anti-depressants
-anti-histamine - Cyproheptadine
 drastic wt. loss, unusual eating habits
(Periactin)
(fasting)
Weight gain, depression
 obsession with neatness, frequent
mirror gazing
Nursing Dx.
 hostility Altered Nutrition less than Body
 calorie counting, excessive exercise Requirements
 frequent weighing Disturbed Body Image
 amenorrhea Anxiety
 wearing loose fitting to hide physical Chronic Low Esteem
appearance
BULIMIA NERVOSA
Ego Defense Mechanism > consist of recurring episodes of binge
Denial, Displacement eating in a discrete period of time and a
Projection sense of lack of control over eating large
amounts of food accompanied by a feeling of Promote safety
out of control Stabilize medical condition
>feelings of guilt, depression, and self Behavior modification-limit setting
disgust after bingeing Cognitive behavioral therapy
>presence of recurrent compensatory Psychotherapy
behaviors: purging, fasting or excessive
exercise It’s Quiz Time!
>they maintain normal body weight A teenager is being evaluated for anorexia
>self evaluation is unduly influenced by body nervosa. Which of the ff. symptoms would
weight and shape suggest anorexia nervosa:
>diagnostic criteria include: recurrent, The client has episodes of overeating and
at least twice a week for the past 3 progressive weight gain
months The client expresses a positive self-image
The client has had severe weight loss caused
Etiology by self-imposed dietary restrictions
 Thin is in belief The client refuses to discuss the topic of food
 Poor impulse control
2. In bulimia nervosa, the client typically
Medical Consequence Due to Bingeing responds to increased levels of anxiety by:
and Purging: Rigidly controlling what he or she eats
 inflammation of esophageal lining Bingeing and purging
 esophageal rupture Overeating
Consuming alcohol
 electrolyte imbalance-metabolic
alkalosis, arrhythmias
3. In teaching a group of young girls about
 heart problems
eating disorders, the nurse would evaluate
 dental caries-erosion of the enamel the sessions as effective if the participants
state that anorexia nervosa is best defined
Manifestations: as an eating disorder that occurs:
-bingeing Only in young girls who are depressed
-purging Primarily in young girls who perceive
-Underweight or slightly overweight themselves to be grossly overweight
-sign of guilt, remorse, relief of anxiety and In young girls and does not have serious
depression consequences
-compulsive eater In young boys and girls alike
-person is aware that behavior is abnormal
-self-critical 4. In formulating a plan of care for the
-depression anorexic client,it is most important for the
nurse to:
Nursing Dx: Allow 2 hours of exercise per day to prevent
Risk for Injury exhaustion
Binge: Altered Nutrition less than Body Remind the contract that tokens will not be
Requirements given if she does not gain weight rapidly
Purge : Altered Nutrition less than Body Set firm limits on eating behaviors and the
Requirements use of laxatives
Ineffective coping Walking with the client during stressful times
Management SCHIZOPHRENIA
 Diary – for recording eating habits > a most extreme form of withdrawal from
 Remove anxiety –before eating to reality. Characterized by deteriorating
relieve > Personality with loss of reality testing and
 Anti-anxiety drug the 4 A’s of Schizophrenia
 Anti-depressant Fluoxetine (Prozac)
Criteria for Diagnosis
Nursing Interventions for Eating 1. at least 2 characteristic symptoms:
Disorders -Delusions
 -grossly disorganized or catatonic
behavior Negative Sign
-hallucinations  anergia – lack of energy
-negative symptoms  avolition – lack of motivation
-disorganized speech  inattention – lack of attention
2. social and occupational dysfunction and  anhedonia – inability to gain pleasure
deterioration
 asocial behavior – inability to form
3. disturbance for at least 6 months
close relationships to feel intimacy
4. not caused by substance abuse or a
 alogia – lacko of speech
medical condition
 apathy – lack of emotion
Etiology
1. Biologic theories TYPES OF SCHIZOPHRENIA
-genetic component present Paranoid –paranoia, hallucination, delusion
-Dopamine synthesis Disorganized – disorganized speech &
2. Developmental theories behavior,flat affect – most regressed type
-poor ego boundaries,fragile ego,ego Catatonic – waxy flexibility, inc. motor
disintegration activity, mutism
3. Family theories Undifferentiated - Mixed positive and
-schizophrenogenic mother negative symptoms
-dysfunctional family theory Residual – (-) symptoms only
-double - bind
4. Vulnerability stress model Nursing Dx
Alteration in thought process
Manifestations Alteration in sensory perception
4 A’S of Schizophrenia Alteration in self – concept
affect – flat, inappropriate Alteration in social interaction
ambivalence – 2 opposing feelings at Impaired verbal communication
the same time *if client is mute – explain procedure
autism – self absorption to client but don’t expect him to answer
associative looseness * If client is talking – use open- ended
sentences
Types of Delusions *If client has concrete thinking –
direct , concise statement
 Grandeur
Self Care Deficit
 Persecution
Altered Nutrition less than Body Requirement
 reference Ineffective coping
 religiosity Potential for Injury
 somatic Potential for violence

2 TYPES Nursing Interventions

Positive Sign 1. general principles for a therapeutic
 delusions – Nihilistic – CL believes he relationship
is dead or a part of his body is -be calm when talking to patients
removed. -accept patient not the behavior
 disorganized speech -keep all promises
 neologisms -be consistent
 word salad -be honest
 clang association 2. Do not reinforce delusions nor
 verbigeration hallucinations
3. Orient clients to time and place if
 Disorganized behavior.
indicated
 Regressed
4. Do not touch patient without warning
 catatonic behavior - WAXY FLEXIBILITY 5. Avoid whispering or laughing without the
- retention of a same position for a patient hearing it
long period of time 6. Reinforce positive behavior
7. Avoid competitive activities
8. Do not embarrass patients
9. Start with one to one interactions
10. Allow verbalization of feelings
Drugs
Anti Psychotic Drugs /
Neuroleptics/Major Tranquilizer
MOA: to block dopamine receptors at
Post synaptic area
I. Conventional Antipsychotic:
a. Phenothiazine Group
Chlorpromazine(Thorazine) –
minor antipsychotic
Thioridazine(Mellaril)
Trifluoperazine(Stelazine)
Perphenazine(Trilafon)
Mesoridazine(Serentil)
b. Butyrophenone Group:
Haloperidol(Haldol)- major anti
psychotic
Droperidol(Inapsine)
II. Atypical Antipsychotic
Clozapine (Clozaril)
Risperidone(Risperdal)
Olanzapine(Zyprexa)
Quetiapine(Seroquel)
Clozapine weekly-CBC
Adverse Effect
Sedation / drowsiness
anti-cholinergic effect
orthostatic hypotension
endocrine changes
Amenorrhea-Women/Gynecomastia-
men
G.I. upset
Photosensitivity
E.P.S. (Extra Pyramidal Symtoms)
akathisia – Jitteriness, anxiety,
fidgeting, restlessness
medication-Propranolol (Inderal)
akinisia – weakness & fatigue
dystonia – cramping, protrusion of
tongue at sides, drooling
eyes rolled up backwards (oculogyric
crisis)
neck torsion or rigidity
opisthotonus, torticollis, wry neck)
Pseudoparkinsonism – tremors, rigidity, mask
– like facies
Neuroleptic Malignant Syndrome
hyperthermia – 1st to occur
profuse sweating
Muscle spasm – convulsion
Stupor, coma, death
Nursing Interventions:
anti psychotics
1. Check BP before administration
2. Monitor periodic liver function test
3. Observe for warning signs of adverse
effects
4. Note complaints of sore
throat,nosebleed,rash,fever,other signs of
infection
5. Warn client drowsiness may occur until
tolerance develops
6. Teach client to:
- avoid alcohol
- Consult before taking other
medications
- Precautions to avoid skin
damage
ie
photosensitivity,photophobia
- take high fiber
diets,fluids,exercise
and good oral hygiene
It’s Quiz Time!
1.While talking with a client diagnosed with
schizophrenia, you notice the client loses
eye contact with you and starts staring at
the wall. The client is making facial grimaces.
The most appropriate nursing intervention
would be to:
a.End the conversation because the client is
not listening to you
b.administer trihexyphenidyl as prescribed
c. ask the client directly, “what are you
seeing on the wall?”
d. redirect the client’s attention to continue
your conversation
2. A client taking antipsychotic complains to
the nurse of feeling nervous. The nurse
notices that the client has jitters and pacing
unable to remain still. The client is most
likely experiencing:
a.Dystonia
b. tardive dyskinesia
c. akinesia
d.akathisia
3. A client is exhibiting symptoms that are
characteristic of schizophrenia, but is also
exhibiting manic behaviors. This client’s
most likely diagnosis:
a. Schizophreniform disorder
 b. brief psychotic disorder
c. shared psychotic disorder
d. schizoaffective disorder
4. A male client on the unit has a diagnosis
of paranoid schizophrenia. The new mental
health care worker on this unit approaches
the nurse and asks about the best way to
work with this client, the nurse replies:
a.“avoid touching this client and invading
personal space”
b. “offer back rubs at bedtime to
decrease the client’s anxiety”
c. “greet this client with a firm
handshake”
d. “ Place your hand on the client very
softly when you speak to him”
5. What nursing diagnosis is most likely to be
associated with a client as having
schizophrenia, residual type:
a.Impaired verbal communication
b. self care deficits
c. social isolation
d. anxiety