Schizophrenia Nursing Care for the NCLEX

Positive Symptoms (Excess)

• Hallucinations (most common: auditory)
• Delusions (paranoid, grandiose, persecutory)
• Disorganized speech and behavior
• Agitation

Negative Symptoms (Deficit)

• Flat affect
• Alogia (poverty of speech)
• Avolition (lack of motivation)
• Anhedonia (inability to feel pleasure)
• Social withdrawal

Antipsychotic Medications

• Typical (first-gen): Haloperidol - blocks dopamine. Monitor for EPS: dystonia, akathisia, tardive dyskinesia, neuroleptic malignant syndrome
• Atypical (second-gen): Risperidone, olanzapine, quetiapine - fewer EPS, monitor for metabolic syndrome (weight gain, diabetes)
• Clozapine: Treatment-resistant schizophrenia. Monitor WBC/ANC weekly - risk of agranulocytosis

Nursing Interventions

• Do NOT argue with delusions - redirect, build trust
• For hallucinations: "I don't hear the voices, but I understand they're real to you"
• Maintain safety, consistent routine
• Medication adherence is the biggest challenge

Learn more at Psychiatric Nursing cheat sheet and Psychiatric Medications deep dive.