HESI CS - Schizophrenia

Which behavior is characteristic of a thought disorder? a. Blunted affect. b. Irritability. c. Lability of mood. d. Preoccupation with guilty feelings.

A A blunted or flat affect can occur as part of the negative or "soft" symptoms associated with a thought disorder. It can also occur with a mood disorder. Irritability is more commonly associated with a mood disorder. Lability of mood is more commonly associated with bipolar disorder. Preoccupation with guilty feelings is more commonly associated with a mood disorder.

Which group is most therapeutic for the client? a. Structured medication group. b. Unstructured group about personal issues. c. Psychoeducational group about self-esteem. d. Supportive therapy group.

A A structured medication group is the most therapeutic because clients with schizophrenia have concrete thinking processes and will respond best to structured activities. Groups that support medication education are important to promote medication compliance. A group about personal issues is less structured, so the client may have poor attention and difficulty staying focused on a single task or accurately testing reality. Psychoeducational groups are beneficial, but self-esteem is more abstract and less concrete so the client may have difficulty focusing attention. A self-esteem group is not the most therapeutic at this point in treatment. Supportive therapy is not the most therapeutic group at this time. This group may be helpful at a later point in treatment, when thinking processes are less concrete.

What is the reason that fluphenazine decanoate is prescribed for this client? a. Disorganized thoughts. b. Feelings of depression. c. Stabilize client's mood. d. Difficulty sleeping at night.

A Antipsychotic medications are useful to manage symptoms related to cognitive impairment such as delusions and/or hallucinations, as well as behaviors related to agitation and aggression. (B) Fluphenazine decanoate is used as an antipsychotic medication. (C) Fluphenazine decanoate is used as an antipsychotic medication. Medications such as lithium, carbamazepine, or valproic acid are mood stabilizers. (D) The side effects of fluphenazine decanoate may lead to feelings of drowsiness, but this is not the reason for prescribing fluphenazine decanoate. Sedative-hypnotics will be prescribed for sleep.

Which strategy is best for clients who hear voices? a. Identify measures to control auditory hallucinations. b. Smoke more cigarettes. c. Decrease caffeine use. d. Take more medication.

A Strategies such as avoiding situations that increase symptoms can be helpful to minimize symptoms. Other general strategies include distraction, help seeking, or attempts to feel better such as taking a shower or performing relaxation exercises. This includes focusing on real events. (B) Increased caffeine and nicotine can affect the action of psychotropic medications and increase the metabolism of the medications. (C) Decreasing caffeine consumption will make a difference with the metabolism of psychotropic medications, but this is not the best strategy if the client is hearing voices. (D) Taking additional medications increases adverse effects and other problems and is not the most desirable intervention.

What will be the most important group activity to promote wellness in the community? a. Explore symptom management. b. Review education about medications. c. Practice social skills. d. Identify community coping resources.

A Symptom management exploration is an important activity for clients with schizophrenia so that relapse can be prevented. Clients often continue to experience symptoms such as hallucinations while living in the community. Medication education is important, but this is not the most important activity. Social skills are important for clients with schizophrenia, but this is not the most important group activity. Providing resources for coping should be included in the discharge plan, but this is not the most important group activity.

What is the greatest benefit of a caseworker for this client? a. Coordinate services for the client. b. Make sure the client takes prescribed medications. c. Empower the client to be independent. d. Provide guidance for disability income.

A The greatest benefit of the case worker is to coordinate services related to housing, finances, and medical appointments, for example. (B) The case worker can work to ensure that the client is taking medications as prescribed, but there is another, more important role. (C) The case worker can empower the client and be an important client advocate, but there is another, more important role. (D) The case worker will often assist the client with financial issues as needed, but the case worker has another, more comprehensive role.

Based on this assessment, what is the most important nursing intervention? a. Establish rapport and trust. b. Assess for hallucinations. c. Maintain adequate social space. d. Plan to give a PRN antipsychotic.

A The most important intervention for a client who is suspicious and guarded is to establish rapport and trust. When clients have cognitive disorders and difficulty processing language, the beginning of trust is more readily established through nonverbal communication. If a client is suspicious, assessing for hallucinations is not the priority. This will cause the client to question the nurse's intentions. Maintaining adequate social space is important, as well as approaching the client with calmness and gentle eye contact, but this is not the most important intervention. Giving a PRN antipsychotic is helpful to minimize the client's cognitive symptoms, but other nonpharmacologic interventions take priority.

What is the nurse's best response? a. Explain how even when taking medications as prescribed, hallucinations can still happen. b. Suggest that the client may have forgotten to take the medication as prescribed. c. Ask the client how long they have been taking the medications. d. Reinforce that compliance with medications will prevent relapse.

A The nurse should explain that relapse can occur even if the client has been taking medications as prescribed. (B) A client may forget to take some medications, but this does not necessarily lead to hospitalization. (C) The nurse can question the client about the medications, but this is not the best response. (D) Compliance with medications can help prevent relapse, but relapse can still occur.

Which data is most important to obtain before the client begins the olanzapine, which is an atypical antipsychotic? a. Baseline weight. b. Orthostatic blood pressure. c. Complete blood count. d. Screening for tardive dyskinesia.

A Weight gain occurs with the atypical antipsychotics, especially olanzapine. The client may experience dizziness as a result of orthostatic blood pressure changes, but this is not the most important nursing intervention. Orthostatic blood pressures are taken when the client reports dizziness. A complete blood count is not necessary if the client begins an atypical antipsychotic medication. Other lab work such as a fasting glucose level may be ordered because hyperglycemia can occur. Screening for tardive dyskinesia should be done after 90 days' exposure to an antipsychotic and every 6 months thereafter. However, this is not the most important intervention as the client changes medication.

Which medication with potentially life-threatening side effects should the nurse expect the healthcare provider to prescribe for clients who do not respond to the use of other antipsychotics? a. Clozapine. b. Haloperidol decanoate. c. Fluphenazine decanoate. d. Perfenazine.

A When a client has failed to respond to antipsychotic medications or long-acting antipsychotics, clozapine may be initiated. Clozapine is used for clients with schizophrenia who have not responded to other antipsychotics. The potentially serious side effect of agranulocytosis requires that WBC counts be done weekly or every 2 weeks. Haldol decanoate is not a medication with potentially life-threatening side effects. Fluphenazine decanoate is not a medication with potentially life-threatening side effects. Perfenazine is not a medication with potentially life-threatening side effects.

In planning this client's care, what is the most important short-term client outcome? a. Interact without expressing delusional thoughts. b. Create a support network within the community. c. Identify at least one symptom management technique. d. Identify actions to take to prevent relapse.

A When a client is delusional, interacting without expressing delusional thoughts is an important short-term outcome. As the client gains insight into the symptoms, the client can differentiate experiences with delusions from those that are reality. (B) While the creation or identification of a network of support is important, especially as the client is preparing to be discharged, it is not the most important short-term client outcome. (C) Teaching clients to manage symptoms and to identify symptom management techniques is an important intervention for schizophrenia, but it is not the most important short-term client outcome. (D) Identifying an action plan to prevent relapse is important, but other short-term outcomes are more important.

Which explanations are best? (Select all that apply.) Select all that apply a. Knowing symptom triggers and how to manage them can help prevent relapse. b. Identifying symptom triggers may prevent the risk of violence and promote safety. c. Managing symptom triggers promotes communication with your caseworker. d. Keeping informed about triggers allows you to increase your medications immediately. e. Reducing exposure to triggers helps improve the client's prognosis by minimizing relapses.

A, B, E A client can learn to cope with symptom triggers and prevent relapse and hospitalization. Identifying triggers can prevent the risk of violence, as sometimes triggers lead to violence. Minimizing the onset and duration of relapses is believed to improve the prognosis. Early assessment plays a key role in improving the prognosis for persons with schizophrenia. (B) If a client talks to his or her caseworker about difficulty with symptom management, it can promote interaction about the client's illness, but this is not the best explanation. (C) Symptom triggers can be managed in a variety of ways including medications, coping skills, resources in the community, and other community support options, so this is not the best explanation.

Which side effect(s) are characteristic of atypical antipsychotics? (Select all that apply.) Select all that apply a. Decreased tardive dyskinesia. b. Less incidence of weight gain. c. Fewer extrapyramidal effects. d. More extrapyramidal effects. e. Insomnia.

A, C, E Two advantages of the atypical agents are that they are effective in treating negative symptoms and that they are unlikely to cause symptoms of EPS, including tardive dyskinesia. Weight gain, drowsiness, unsteady gait, headache, insomnia, depression, diabetes mellitus, and dyslipidemia are common side effects of atypical antipsychotics. Weight gain does occur with the use of atypical antipsychotics. Traditional antipsychotics have more extrapyramidal effects.

What is the most accurate assessment finding if the client believes that the healthcare providers are FBI agents and that there are cameras everywhere monitoring the client? a. Hallucinations. b. Delusions. c. Confabulation. d. Thought broadcasting.

B Delusions are fixed, false beliefs that the nurse should avoid trying to logically disprove to the client. A hallucination is an alteration in sensory perception. Most hallucinations are auditory, then visual, gustatory, tactile, and olfactory. Confabulation occurs more often with clients who have dementia and who are trying to fill in memory gaps. Thought broadcasting occurs when the client believes that thoughts are being broadcast to the outside world.

Which nursing problem has priority? a. Not able to cope in the community. b. Alteration in thought processes. c. Alteration in sensory perception. d. Denial of problems.

B Disturbed thought processes is a priority problem because the client is delusional. (A) Ineffective community coping would be a nursing problem prior to admission, but it is not a priority problem for the nursing care plan after admission. (C) The client has not demonstrated verbal or nonverbal cues of hallucinations or sensory-perceptual disturbance, so this is not a current nursing problem. (D) Ineffective denial is a conscious or unconscious attempt to reduce anxiety or fear, which can impact health. There is no evidence that this is a current nursing problem.

What type of reaction should the nurse suspect? a. Akathisia. b. Dystonia. c. Parkinsonism. d. Synergistic.

B Dystonia is acute, tonic muscle spasms, often of the tongue, jaw, eyes, and neck but sometimes of the whole body. These spasms sometimes occur during the first few days of antipsychotic administration. Akathisia is motor restlessness, an extrapyramidal symptom. Symptoms of parkinsonism include fine tremors, cogwheel rigidity, and shuffling gait. Synergistic reactions occur between two medications.

The nurse understands that a client with schizophrenia will experience which benefit from fluphenazine decanoate if it is administered intramuscularly? a. Prevent more extrapyramidal side effects. b. Maintain long-term medication compliance. c. Minimize side effects from benztropine. d. Prevent risk of cardiac or renal disease.

B Fluphenazine decanoate is a long-acting medication that is administered as an injection every 1 to 3 weeks to promote compliance with the medication regimen. (A) Fluphenazine decanoate can cause extrapyramidal side effects regardless of whether it is given by injection or orally. (C) Fluphenazine decanoate will not minimize side effects from benztropine. Benztropine is an antiparkinsonian agent used to relieve drug-induced extrapyramidal symptoms. (D) Fluphenazine decanoate is contraindicated in clients with liver, renal, or cardiac insufficiency.

The client is concerned about experiencing another relapse. Which intervention best promotes effective communication? a. Have the client identify symptom management techniques. b. Explain the importantance of medication compliance. c. Encourage consistant participation with community support. d. Tell the client about the need to maintain healthy living practices.

B One of the most common causes of relapse relates in some way to medications. Relapse is likely to occur if the clients are not taking their medications as prescribed or stop taking them altogether. Symptom management is important to prevent relapse; it does not cause relapse. A lack of support can lead to relapse; however, this is not the most common cause. Poor health practices can relate to relapse, but this is not the most common cause.

Which nursing problem should be included on the treatment plan? a. Problems with adjustment. b. Isolated socially. c. Anxiety. d. Confusion.

B Social isolation is manifested by behaviors such as the client sitting alone continuously without interacting with others. Impaired adjustment is the inability to adjust to situations that arise in the client's environment. Anxiety is a subjective experience that is evidenced by the client's verbal and nonverbal actions. The client is sitting alone without peer interaction and does not exhibit confusion.

How should the nurse explain symptom triggers to the clients? a. Symptom triggers are stressors that lead to increased difficulty handling anger. b. Symptom triggers can be related to health, the environment, or attitudes. c. Symptom triggers are behaviors that lead to medication noncompliance. d. Symptom triggers are stressors caused by hospitalization.

B Symptom triggers are stimuli, or combinations of stimuli, and stressors that precede a new episode of the illness. These triggers can be related to nutrition, lack of sleep, fatigue, housing difficulties, changes in life events, and feeling overpowered, for example. (A) Difficulty handling anger may result from the inability to handle stressors or triggers, but this is not the best explanation of symptom triggers. (C) Triggers may lead to medication noncompliance, but this may not always happen if the client learns to cope with them. Consequently, this is not the best explanation of symptom triggers. (D) While symptom triggers may lead to hospitalization, this is not the best explanation of symptom triggers.

How should the nurse interpret the client's belief about being a famous movie star and that a limousine driver will arrive to get the client later in the day? a. Psychotic thinking. b. Delusional thoughts. c. Flight of ideas. d. Confabulation.

B The client's thoughts are delusional because of false beliefs about being a movie star and that a limousine will pick the client up. The client demonstrates symptoms of psychosis, but this is not the best way to document the symptom. A flight of ideas is evident when a client has rapid, overproductive speech and rapidly shifts from one topic to another with fragmented ideas. Confabulation occurs when a client fills in memory gaps.

Which intervention by the nurse will best assess if this goal has been met? a. Observe the client for signs of talking to self. b. Talk to the client for at least 20 minutes. c. Ask the client to describe current feelings. d. Ask the client to explain how the medication is helping.

B The nurse should be able to talk to the client without observing the presence of delusional thoughts. This would be evidence that therapy is working and delusions are not evident. (A) A client who talks to self may be experiencing auditory hallucinations. (C) Asking the client how he feels will not determine if the client is still delusional. (D) Talking to the client about medications will not assess whether or not the long-term goal is met.

Which is the nursing priority? a. Monitor the client for medication side effects. b. Obtain a prescription to begin the benztropine. c. Do not give the fluphenazine and document the reason. d. Ask the client about any side effects from the fluphenazine.

B The nurse should request a prescription for benztropine, which will help prevent the extrapyramidal side effects of the fluphenazine, with the exception of tardive dyskinesia. There is a risk of decreased efficiency of fluphenazine when the client is also taking benztropine. The nurse can monitor the client for medication side effects, but this is not the priority nursing intervention. The nurse should continue giving fluphenazine because "altered thoughts" is the priority nursing problem. The nurse can ask the client about any side effects from the fluphenazine, but if taking benztropine, extrapyramidal effects may not have been evident.

Which side effects would the nurse most likely observe with fluphenazine, a traditional antipsychotic? a. Blood dyscrasias such as thrombocytopenia. b. High extrapyramidal effects, low anticholinergic effects. c. High anticholinergic effects and low extrapyramidal effects. d. Risk for agranulocytosis, fever, and elevated blood pressure.

B Traditional antipsychotics generally have high extrapyramidal effects and low anticholinergic effects. Blood dyscrasias are less likely to be observed with the traditional antipsychotics. As compared with atypical antipsychotics, traditional antipsychotics do not have high anticholinergic effects and low extrapyramidal effects. Risk for agranulocytosis, fever, and elevated blood pressure occurs with clozapine, an atypical antipsychotic.

The nurse understands that an atypical antipsychotic like olanzapine can require what period of time to reach full clinical level? a. 2 weeks. b. 4 days. c. 6 weeks or more. d. 2 days.

C Atypical antipsychotics can take 6 weeks or more to achieve full clinical level. Client should be educated to continue to take medication as prescribed and to report adverse side effects.

Which nursing assessment accurately describes the client's lack of energy? a. Apathy. b. Anhedonia. c. Avolition. d. Affective.

C Avolition is a lack of energy or drive. Apathy is the lack of feelings, emotions, interests, or concerns. Anhedonia is the inability, or decreased ability, to experience pleasure, joy, intimacy, and closeness. Affective refers to emotion and behaviors, such as hand and body movements, facial expression, and pitch of voice that can be observed when a person is expressing and experiencing feelings and emotions.

Which finding depicts negative symptoms of schizophrenia? a. Difficulty sitting still. b. Rapid and disorganized speech. c. Flat affect and social inattentiveness. d. Delusional statements.

C Flat affect and social inattentiveness, or "spaciness," are examples of negative symptoms characteristic of schizophrenia. Difficulty sitting still is not a negative symptom and may be related to akathisia, an extrapyramidal side effect. Rapid and disorganized speech is not a negative symptom. Rapid speech is characteristic of flight of ideas. Delusional statements are not a negative symptom of schizophrenia.

What is the most important step the nurse should use to teach about effective symptom management? a. Talk about specific support systems. b. Review current ways to manage symptoms. c. Identify problem symptoms. d. Discuss other ways to manage symptoms.

C Identifying problem symptoms is the first step of effective symptom management. When a client can recognize early and seek support, the client is more likely to need an acute care intervention. (A) Support systems are important to have in place prior to discharge. Support will help the clients manage their disease and possibly keep them from needing acute care. However, the clients must recognize their triggers and symptoms in order to reach out to their support systems. (B) Recognition of symptoms is necessary prior to understanding how to manage them. (D) Recognizing symptoms occur before understanding how to manage them.

How should the nurse respond? a. State that this is unlikely and ask the client what the thought process is behind this. b. Ask the client what will happen if the limousine does not come. c. State that it sounds like the client is anxious to leave. d. Everything is confidential, and doubtful of occurring.

C Responding to the underlying feelings rather than the illogical content of the delusion will encourage discussion of fears, anxiety, and anger about hospitalization, without assuming that the delusion is right or wrong. (A) Explaining that this is unlikely may result in the client feeling rejected and becoming angry. (B) If the client perceives that the nurse is going along with the delusion, it may become confusing, especially if the client senses that the nurse is trying to gain cooperation. (D) Explaining that it is doubtful that this will happen may lead the client to become defensive and angry, unless the nurse has established rapport with the client and attempted other strategies to intervene. Submit

Which client behavior validates the need for involuntary hospitalization? a. Beliefs about FBI surveillance. b. Diagnosis of schizophrenia. c. Violence towards family. d. Guarded and suspicious.

C Risk for violence toward self or others is a criterion for involuntary hospitalization. Delusional thoughts alone do not justify the need for hospitalization. A diagnosis of schizophrenia does not justify the need for involuntary hospitalization. Guarded and suspicious behaviors do not justify involuntary hospitalization.

What is the best response by the nurse? a. Have the client say what thoughts are occurring. b. Get the client to express what feelings are happening. c. Ask if the client about hearing any voices. d. Tell the client about being observed talking to someone.

C Tilting the head to one side is a nonverbal cue that the client is hearing voices. The nurse should assess for the presence of auditory hallucinations. (A) The client's nonverbal cues suggest that another intervention is more important. (B) Inquiring about feelings is a useful communication strategy; however, another intervention is more useful based on the client's behaviors. (D) Pointing out observations to the client is a useful communication strategy, but it is not the best nursing intervention.

Which speech process should the nurse document on the daily mental status exam record? a. Loose associations. b. Tangential. c. Monotone. d. Poverty of speech.

D A client who demonstrates poverty of speech gives simple one- or two-word answers to questions, even when the nurse asks an open-ended question. Loose associations refers to a lack of a logical relationship between thoughts and ideas so that speech is vague and unfocused. Tangential is the inability to return to the central point of the conversation so that the client never answers the original question. Monotone speech does not have any inflection in the tone of voice.

The nurse understands that schizophrenia can be differentiated from psychosis by which assessment? a. Disorganized speech. b. Disorganized behavior. c. Auditory hallucinations. d. Negative symptoms.

D Negative symptoms are characteristic of schizophrenia and include behaviors such as minimal eye contact, poor grooming and hygiene, and apathy. Disorganized speech is characteristic of both psychosis and schizophrenia. Disorganized behavior is characteristic of both psychosis and schizophrenia. Hallucinations are characteristic of both psychosis and schizophrenia.

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)? a. Mental status of client. b. Reason that client wants to leave. c. Response to medications. d. Potential danger to self or others.

D Potential danger to self and others is the most important consideration when a client wants to leave the hospital AMA. The mental status of the client is important documentation for an AMA request and dismissal, but another assessment is more important. The client's own description of the reasons for wanting to leave is important documentation for an AMA request, but another assessment is more important. Response to medications is important to consider as it relates to the client's mental status, but it is not the most important consideration for releasing the client AMA.

Based on the client's statement about all the medication side effects, which nursing problem should the nurse document for the group progress note? a. Denial that is unproductive. b. Lack of knowledge. c. Unable to cope. d. Probable difficulty with adherence.

D Risk for adherence is evident because if the client perceives that the medication has too many side effects, he may choose to stop taking it. Ineffective denial is a conscious or unconscious attempt to reduce anxiety or fear, which can impact health. There is insufficient evidence for ineffective denial in the client's statement. Knowledge deficit occurs when the client lacks sufficient information about a problem or health need. The nurse can infer that knowledge deficit may be present, but another nursing problem is evident. The client's statement does not suggest that coping is ineffective.

Which understanding is most accurate? a. There is an imbalance of the brain neurotransmitters dopamine and serotonin. b. There is a marked increase in brain volume, which causes abnormal functioning. c. Schizophrenia develops when at least one parent or distant relative has schizophrenia. d. This brain disorder has many predisposing factors and a biological basis.

D Schizophrenia is a brain disorder with many predisposing factors. These factors include biological factors related to genetics, neurobiology, neurotransmitters, and neurodevelopment of structural, functional, and chemical brain changes that occur in early years of life and before birth. (A) It is accurate that serotonin has a modulating effect on dopamine, and both neurotransmitters have been implicated in schizophrenia, but this is not the best answer. (B) Images of the brains of individuals with schizophrenia show decreased brain volume and abnormal functioning. (C) There is a genetic predisposition for schizophrenia; however, this is not the best answer.

Which statement will assist the nurse to assess if this goal has been met? a. Review with the client any history of violence. b. Have the client describe relationships with family members. c. Tell the client to express feelings about family members now. d. Ask the client about thoughts about hurting anyone now.

D The nurse should directly ask the client about thoughts of harm. (A) A history of violence is the best predictor of violence, but it will not determine if the client is currently a risk for harm to self or others. (B) Interaction about the relationship with family members may not assess the risk for harm. (C) This statement may be helpful, but it does not directly assess the risk for harm.

Which thought process does this exemplify? a. Concrete thinking. b. Flight of ideas. c. Word salad. d. Thought blocking.

D Thought blocking is the sudden stopping in the client's train of thought or in the middle of a sentence. Concrete thinking is the inability to abstract so that clients interpret the literal meaning of words. Flight of ideas is rapid shifting from one topic to another and fragmented ideas. Word salad is a series of words that seem totally unrelated.

The client smiles at the nurse but refuses to answer.

On the third day of hospitalization, the nurse must assign the client to one of the unit groups.

After 96 hours of involuntary commitment, a client must be asked to sign consent for hospitalization.

The client is admitted to the mental health unit for 96 hours. The nurse reviews the routine admission laboratory and medication prescriptions and notes that the client will resume the fluphenazine decanoate. The benztropine has not been prescribed.

The nurse understands that the client has a thought disorder rather than a mood disorder. Thought disorders include psychosis and schizophrenia.

The nurse assesses that the client's behavior is guarded and suspicious.