Mental Health/Psych Nursing - Boyd - Exam 2 - Chaps. 18-27

After assessing a client with schizophrenia, the nurse suspects that the client is experiencing an anticholinergic crisis. Which of the following would the nurse most likely have assessed? Select all that apply. A) Dilated reactive pupils B) Blurred vision C) Ataxia D) Coherent speech E) Facial pallor F) Disorientation

B, C, F b) Blurred vision c) Ataxia f) Disorientation CH 22

A nurse is developing a teaching plan for a client with schizophrenia. Which method would the nurse use to be most effective? A) Engaging the client the trial and error learning B) Having the client write down information after directly being given the correct information C) Asking the client questions that encourage the client to guess at the correct answer D) Using visual aids that are very colorful and full of descriptive graphic images

B. Having the client write down information after directly being given the correct information Why is this? CH 22

After teaching a group of students about the epidemiology of schizoaffective disorder, the instructor determines that the teaching was successful when the students state which of the following? A) The disorder occurs often in children. B) It is more likely to occur in women. C) Most persons are African Americans. D) The disorder is rare in family relatives.

B. It is more likely to occur in women CH 22

A client with schizophrenia tells the nurse, I'm being watched constantly by the FBI because of my job. Which response by the nurse would be most appropriate? A) Tell me more about how you are being watched. B) It must be frightening to feel like you're always been watched. C) You're not being watched; it's all in your mind. D) You are experiencing a delusion because of your illness.

B. It must be frightening to feel like you're always been watched. CH 22

What EPS side effect is noted by a client who has bradykinesia and a shuffling gait? A. Tardive dyskinesia B. Pseudoparkinsonism C. Acute dystonia D. Akathisia

B. Pseudoparkinsonism Pseudoparkinsonism is noted by a resting tremor, rigidity, a masklike face, and a shuffling gait. Akathisia occurs when the client has motor restlessness evidenced by pacing, rocking, or shifting from foot to foot. Symptoms of acute dystonia are intermittent or fixed abnormal postures of the eyes, face, tongue, neck, trunk, and extremities. CH 22

A client has been prescribed clozapine for treatment of schizophrenia. The client must be taught to monitor which blood concentrations weekly while taking this drug? A. hemoglobin B. WBCs C. platelets D. hematocrit

B. WBCs Agranulocytosis can develop with the use of all antipsychotic drugs but it is most likely to develop with clozapine use. Clients taking clozapine should have regular blood tests. White blood cell and granulocyte counts should be measured before treatment is initiated and at least weekly or twice weekly after treatment begins. CH 22

A client with schizophrenia is prescribed clozapine because other prescribed medications have been ineffective. After teaching the client and family about the drug, the nurse determines that the teaching was successful when they state which of the following? A) He needs to have an electrocardiogram periodically when taking this drug. B) We'll need to make sure that he has his blood count checked at least weekly. C) He might develop toxic levels of the drug if he smokes cigarettes. D) We need to watch to make sure that he doesn't lose too much weight.

B. We'll need to make sure that he has his blood count checked at least weekly. CH 22

A group of nursing students is reviewing information about emotional responses to stress and the themes associated with them. The students demonstrate understanding of the information when they identify which emotion as associated with being moved by anothers suffering and wanting to help? A) Relief B) Hope C) Compassion D) Love

C CH 18

A nurse is assessing a patient and the patients social networks. When evaluating this area, the nurse integrates knowledge that which of the following is an important component? A) Blood relationships B) Bonding with one another C) Reciprocity D) Emotional support

C CH 18

A patient has come to the clinic to discuss the stress she is experiencing because of failing two exams at school. Initially, she described her failures as the worst thing that has ever happened to me, and she stated, There is absolutely nothing I can do to pass this course now. In response to the nurses questions, the nurse finds out there are three more equally weighted exams scheduled for the course in question. The nurse and patient collaborate and decide to use interventions to facilitate emotion-focused coping. Which additional comment from the patient would the nurse identify as providing support for this decision? A) You've got to figure out something for me to do to get me out of this situation! B) This is a waste of time because absolutely nothing you or I can do will make it any better. C) I overreacted; surely together we can figure out something for me to do. D) This is the worst thing that could ever happen to me. Im nothing but a failure.

C CH 18

A nurse is preparing an in-service program for a group of psychiatric mental health nurses about schizophrenia. Which of the following would the nurse include as a major reason for relapse? A) Lack of family support B) Accessibility to community resources C) Non-adherence to prescribed medications D) Stigmatization of mental illness

C) Non-adherence to prescribed medications CH 22

While assessing a client with schizophrenia, the client states, Everywhere I turn, the government is watching me because I know too much. They are afraid that I might go public with the information about all those conspiracies. The nurse interprets this statement as indicating which type of delusion? A) Grandiose B) Nihilistic C) Persecutory D) Somatic

C) Persecutory CH 22

After teaching a class on antipsychotic agents, the instructor determines that the teaching was successful when the class identifies which of the following as an example of a second-generation antipsychotic agent? A) Fluphenazine (Prolixin) B) Thiothixene (Navane) C) Quetiapine (Seroquel) D) Chlorpromazine (Thorazine)

C) Quetiapine (Seroquel) CH 22

While caring for a hospitalized client with schizophrenia, the nurse observes that the client is listening to the radio. The client tells the nurse that the radio commentator is speaking directly to him. The nurse interprets this finding as which of the following? A) Autistic thinking B) Concrete thinking C) Referential thinking D) Illusional thinking

C) Referential thinking CH 22

A nurse assesses the health status of soldiers returning from Afghanistan. Screening will be a priority for signs and symptoms of which health problems? Select all that apply. a. Schizophrenia b. Eating disorder c. Traumatic brain injury d. Seasonal affective disorder e. Post-traumatic stress disorder

C,E c. TBI e. PTSD

Assessment of a client with schizophrenia reveals that he is hearing voices that tell him that people are staring at him and illusions. When developing the plan of care for this client, which nursing diagnosis would be most appropriate? A) Disturbed thought processes B) Risk for self-directed violence C) Disturbed sensory perception D) Ineffective coping

C. Disturbed sensory perception CH 22

Which is the central focus of persecutory delusions? A. Unfaithfulness B. Involving bodily functions or sensations C. Injustice that must be remedied by legal action D. A great, unrecognized talent

C. Injustice that must be remedied by legal action The focus of persecutory delusions is often on some injustice that must be remedied by legal action. Clients often see satisfaction by repeatedly appealing to courts and other government agencies. The central theme of somatic delusions involves bodily functioning or sensations. The central theme of the jealous subtype is the unfaithfulness or infidelity of a spouse or lover. Clients representing with grandiose delusions are convinced they have a great, unrecognized talent or have made an important discovery. CH 22

A client with schizoaffective disorder is prescribed clozapine to treat her symptoms. Which of the following instructions would the nurse provide? A) Keep a record of how often and how long you experience the side effect of dry mouth. B) Monitor your urinary output and notify your doctor if your urine changes color. C) Keep an eye on your weight, and if you gain weight rapidly, notify your doctor. D) If you experience any drowsiness, discontinue taking this medication.

C. Keep an eye on your weight, and if you gain weight rapidly, notify your doctor. CH 22

Encephalopathic syndrome has occurred in a few clients when haloperidol is taken with which medication? A. Furosemide (Lasix) B. Diazepam (Activan) C. Lithium carbonate (Lithium) D. Ibuprofen (Motrin)

C. Lithium carbonate (Lithium) A few clients talking haloperidol and lithium have experienced an encephalopathic syndrome followed by irreversible brain damage. Taking haloperidol (Haldol) with diazepam, furosemide, or ibuprofen does not cause encephalopathic syndrome. CH 22

A group of nursing students is reviewing information about other psychotic disorders. The students demonstrate understanding of this information when they identify which disorder as involving an inducer? A) Brief psychotic disorder B) Schizophreniform disorder C) Shared psychotic disorder D) Psychotic disorder attributable to a substance

C. Shared psychotic disorder CH 22

Which of the following would be most important for the nurse to keep in mind when establishing the nurse-patient relationship with a client with schizophrenia to promote recovery? A) The relationship typically develops over a short period of time. B) Decisions about care are the responsibility of interdisciplinary team. C) Short, time-limited interactions are best for the client experiencing psychosis. D) Typically, clients with schizophrenia readily engage in a therapeutic relationship.

C. Short, time-limited interactions are best for the client experiencing psychosis. CH 22

While interviewing a client diagnosed with a delusional disorder, the client states, I have this really strange odor coming out of my mouth. I stop to brush my teeth almost every hour and then rinse with mouthwash every half hour to get rid of this smell. Ive seen so many doctors, and they cant tell me whats wrong. The nurse interprets the clients statement as reflecting which type of delusion? A) Erotomanic B) Grandiose C) Somatic D) Jealous

C. Somatic CH 22

The nurse is assessing a newly admitted client diagnosed with schizoaffective disorder. The nurse assesses the clients level of anxiety and reactions to stressful situations, obtaining this information for which reason? A) To help determine the clients outcomes after treatment B) To help identify whether or not the clients mental competency is intact C) To act as a predictor of the clients risk for a suicide attempt D) To provide a basis for evaluating the clients social skills

C. To act as a predictor of the clients risk for a suicide attempt CH 22

When investigating biologic theories related to schizophrenia, which neuroanatomic findings would be consistent with this mental health disorder? A. Enlarged hippocampus B. Smaller third ventricle C. enlarged lateral ventricle D. enlarged brain volume

C. enlarged lateral ventricle The lateral and third ventricles are somewhat larger and total brain volume is somewhat smaller in persons with schizophrenia compared with those without schizophrenia. The thalamus and the medial temporal lobe structures, including the hippocampus, superior temporal, and prefrontal cortices, also tend to be smaller. CH 22

A nurse has completed an assessment of a patient who is experiencing significant stress. The assessment revealed intense anger and acting out behaviors along with statements of negative emotions. Which nursing diagnosis would be most appropriate? A) Disturbed though processes B) Low self-esteem C) Hopelessness D) Ineffective coping

D CH 18

A nurse is assessing a patient and uses the Recent Life Changes Questionnaire as part of the assessment. The nurse determines that the patient has experienced major life crisis with which score on the questionnaire? A) 150 B) 250 C) 350 D) 450

D CH 18

A nurse is reviewing the assessment findings of several patients. Which patient would the nurse identify as having a type D personality? A) A man who threatens the receptionist in the emergency department with bodily harm if a doctor does not see him right away B) A woman who sits quietly reading in a waiting room before seeing her doctor for her annual physical examination C) A quiet teen who drinks a six pack of beer against his better judgment because of peer pressure D) A man who reacts negatively to almost everything but never discusses his feelings with anyone

D CH 18

After teaching a group of students about appraisal and the stress response, the instructor determines that additional teaching is needed when the students identify which of the following as part of the primary appraisal? A) Relevance of the goal B) Consistency of goal with values C) Personal commitment D) Outcome explanation

D CH 18

While leading a student class presentation about general adaptation syndrome and its stages, which of the following would the student describe as the final stage? A) Perception of a threat B) Use of coping mechanisms C) Physiologic response D) Exhaustion

D CH 18

When assessing a client for possible disordered water balance, the nurse checks the clients urine specific gravity. Which result would lead the nurse to suspect that the client is experiencing severe disordered water balance? A) 1.020 B) 1.011 C) 1.005 D) 1.002

D) 1.002 CH 22

A client has been diagnosed with schizophrenia. Assessment reveals that the client lives alone. His clothing is disheveled, his hair is uncombed and matted, and his body has a strange odor. During an interview, the clients family voices a desire for the client to live with them when he is discharged. Based on the assessment findings, which nursing diagnosis would be the priority? A) Ineffective Role Performance related to symptoms of schizophrenia. B) Social Isolation related to auditory hallucinations. C) Dysfunctional Family Processes related to psychosis. D) Bathing Self-Care Deficit related to symptoms of schizophrenia.

D) Bathing Self-Care Deficit related to symptoms of schizophrenia. CH 22

The nurse is caring for a client who was just admitted with a diagnosis of schizoaffective disorder with depression. Which agent would the nurse anticipate as being prescribed for this client? A) Lithium B) Haloperidol C) Chlorpromazine D) Clozapine

D) Clozapine CH 22

A client hospitalized for treatment of schizophrenia has been receiving olanzapine (Zyprexa) for the past 2 months. The nurse would be especially alert for which of the following? A) Weight loss B) Hypertension C) Diarrhea D) Diabetes

D) Diabetes CH 22

The nurse is caring for a client in an inpatient mental health setting. The nurse notices that when the client is conversing with other clients, he repeats what they are saying word for word. The nurse interprets this finding and documents it as which of the following? A) Echopraxia B) Neologisms C) Tangentiality D) Echolalia

D) Echolalia CH 22

The nurse is caring for a client diagnosed with a delusional disorder. While assessing this client, which of the following would the nurse expect to find? A) History of chronic major depression B) Consistently disrupting behavior patterns C) Verbalization of bizarre delusions D) Living with one or more delusions for a period of time

D) Living with one or more delusions for a period of time

The nurse is caring for a client who has been receiving treatment for schizophrenia with chlorpromazine for the past year. It would be essential for the nurse to monitor the client for which of the following? A) Weight loss B) Torticollis C) Hypoglycemia D) Tardive dyskinesia

D) Tardive dyskinesia CH 22

The nurse is preparing to document information obtained from a client diagnosed with a delusional disorder who is experiencing somatic delusions. Which of the following would the nurse most likely document? A) Disorientation B) Reduced attention span C) Above average intelligence D) Body complaints

D. Body complaints CH 22

The nurse is preparing to interview a client who has a delusional disorder. Which of the following would the nurse expect? A) Cognitive impairment B) Normal behavior C) Labile affect D) Evidence of motor symptoms

D. Evidence of motor symptoms CH 22

A client diagnosed with schizophrenia is having delusions that the client is being plotted against by the government. This would be documented as which type of delusion? A. Grandiose B. Somatic C. Nihilistic D. Persecutory

D. Persecutory A persecutory delusion is a belief that one is being watched, ridiculed, harmed, or plotted against. The belief that one has exceptional powers, wealth, skill, influence, or destiny is a grandiose delusion. A nihilistic delusion is the belief that one is dead or a calamity is impending. A somatic delusion is a belief about abnormalities in bodily functions or structures. CH 22

What is an anticholinergic side effect associated with some antipsychotic medications? A. Salivation B. Diarrhea C. Increased tearing D. Photophobia

D. Photophobia Photophobia, dry mouth, decreased lacrimation, and constipation are anticholinergic side effects associated with some antipsychotic medications. CH 22

A client who has a major depressive episode tells the nurse that for the past 2 weeks, he has been hearing voices and at times thinks that someone is following him. History reveals that he had these alternating symptoms before along with times when he has experienced neither of these symptoms and has been able to function adequately. The nurse interprets these findings as suggesting which of the following? A) Paranoid schizophrenia B) Undifferentiated schizophrenia C) Brief psychotic disorder D) Schizoaffective disorder

D. Schizoaffective disorder CH 22

When obtaining a clients history, the nurse determines that the client has been experiencing delusions and hallucinations for the past 3 months, which has caused some problems in his ability to function on a daily basis at work. He also is exhibiting catatonic excitement, echopraxia, loose associations, and pressured speech. The nurse suspects which of the following? A) Schizophrenia B) Schizoaffective disorder C) Brief Psychotic disorder D) Schizophreniform disorder

D. Schizophreniform disorder CH 22

A client with schizoaffective disorder is prescribed medication therapy. Which type of medications would be most likely be ordered? a) atypical antipsychotic b) typical antipsychotics c) antidepressants d) mood stabilizers

a) atypical antipsychotics Although numerous drugs may be prescribed, atypical antipsychotics are generally prescribed because of their efficacy for psychosis and for their thymoleptic (mood-stabilizing) properties. Atypical antipsychotics have been used more often than typical antipsychotics. If depressive symptoms persist despite antipsychotic use, antidepressants may be prescribed. Mood stabilizers are an alternative adjunct for mood states associated with the bipolar type of the disorder.

Which statement is true about delusional disorder? a) Psychosocial functioning is often markedly impaired. b) Behavior is relatively normal except when focused on the delusion. c) The individual's personality changes dramatically. d) The disease onset is usually gradual.

b) Behavior is relatively normal except when focused on the delusion. The course of delusional disorder is variable. The onset can be acute, or the disorder can occur gradually and become chronic. Clients usually live with delusions for years, rarely receiving psychiatric treatment unless their delusion relates to their health (somatic delusion) or they act on the basis of their delusion and violate laws or social rules. Apart from the direct impact of the delusion, psychosocial functioning is not markedly impaired. Behavior is remarkably normal except when the client focuses on the delusion. At that time, the client's thinking, attitudes, and mood may change abruptly. Personality does not usually change, but the client is gradually, progressively involved with the delusional concern. CH 22

When describing the difference between schizoaffective disorder (SAD) and schizophrenia, the nurse would address which as associated with SAD? a) decreased risk for suicide b) increased mood responses c) delusions but no hallucinations d) lower level of functioning

b) increased mood responses Clients with SAD have many similar responses to their disorder as people with schizophrenia, with one exception. These clients have many more "mood" responses and are very susceptible to suicide. Persons with SAD usually have higher functioning than those with schizophrenia, with severe negative symptoms and early onset of illness. To be diagnosed with SAD, a client must have an uninterrupted period of illness when there is a major depressive, manic, or mixed episode along with two of the following symptoms of schizophrenia: delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, or negative symptoms.

A client with schizophrenia is prescribed clozapine. The nurse would monitor the client closely for specific signs of: a) hypotension b) infection c) weight loss d) nausea

b) infection Agranulocytosis can develop with the use of all antipsychotic drugs, but it is most likely to develop with clozapine use. Therefore, the nurse needs to be alert for signs of infection, particularly bacterial infection. Hypotension may occur with any antipsychotic drug. Nausea is a common side effect of many drugs. Weight gain, not loss, can occur with olanzapine and clozapine. CH 22

A client with schizophrenia is prescribed a second-generation antipsychotic. The client's mother asks, "About how long will it take until we see any changes in his symptoms?" Which response by the nurse would be most appropriate? a) "His symptoms should subside almost immediately." b) "You should see improvement in about 36 to 48 hours." c) "Generally, it takes about 1 to 2 weeks to be effective in changing symptoms." d) "It will take about 6 to 12 weeks until the drug is effective."

c) "Generally, it takes about 1 to 2 weeks to be effective in changing symptoms. " Generally, it takes about 1 to 2 weeks for antipsychotic drugs to effect a change in symptoms. During the stabilization period, the selected drug should be given an adequate trial, generally 6 to 12 weeks, before considering a change in the drug prescription. If treatment effects are not seen, another antipsychotic agent may be tried.

A client diagnosed with schizophreniform disorder must have symptoms present for at least 1 month but with a duration of less than: a) 2 weeks b) 4 weeks c) 12 months d) 6 months

d) 6 months The essential features of schizophreniform disorder are identical to those of criteria A for schizophrenia, with the exception of the duration of the illness, which can be less than 6 months. Symptoms must be present for at least 1 month to be classified as a schizophreniform disorder. CH 22

Which would a nurse expect to administer to a client with schizophrenia who is experiencing a dystonic reaction? a) Risperidone b) Aripiprazole c) Trihexyphenidyl d) Benztropine

d) Benztropine A client experiencing a dystonic reaction should receive immediate treatment with benztropine. Risperidone and aripiprazole are antipsychotics that may cause dystonic reactions. Trihexyphenidyl is used to treat parkinsonism due to antipsychotic drugs. CH 22

After teaching a group of nursing students about neurotransmitters associated with schizophrenia, the nursing instructor determines that the education was successful when the students identify what as playing a role in the positive symptoms of schizophrenia? a) Serotonin b) Glutamate c) Gamma-aminobutyric acid (GABA) d) Dopamine

d) Dopamine Positive symptoms of schizophrenia, specifically hallucinations and delusions, are thought to be related to dopamine hyperactivity. Studies are revealing that schizophrenia does not result from the dysregulation of a single neurotransmitter or biogenic amine, such as norepinephrine or serotonin. Hypothesis suggests a role for glutamate and GABA. However, dopamine dysfunction is also thought to be involved in psychosis with other disorders.

When preparing a class presentation about schizophrenia, what would the nurse most likely include? a) Delusions are more commonly noted in younger children with schizophrenia. b) Very few individuals with schizophrenia reach older adulthood. c) Schizophrenia is more commonly diagnosed in children than in adolescents. d) Improvement in symptoms can occur as a client with a history of schizophrenia reaches older adulthood.

d) Improvement in symptoms can occur as a client with a history of schizophrenia reaches older adulthood. People with schizophrenia do reach older adulthood and others develop schizophrenia late in life. For older clients who have had schizophrenia since young adulthood, this may be a time in which they experience some improvement in symptoms or a decrease in relapse fluctuations. The diagnosis of schizophrenia in children before adolescence is rare. If it does occur, hallucinations tend to be more visual and delusions are less developed.

A client diagnosed with delusional disorder is telling everyone that the client is the president of the United States. This client is exhibiting which type of delusion? a) erotomanic b) somatic c) jealous d) grandiose

d) grandiose Clients presenting with grandiose delusions are convinced they have a great, unrecognized talent or have made an important discovery. A less common presentation is the delusion of a special relationship with a prominent person or actually being a prominent person. Erotomanic delusions are characterized by the delusional belief that the client is loved intensely by the "loved object," who is usually married, of a higher socioeconomic status, or otherwise unattainable. Persons who have somatic delusions believe they have a physical ailment. The central theme of the jealous subtype is the unfaithfulness or infidelity of a spouse or lover. CH 22

A client with schizophrenia is experiencing delusions. The client states, 'There's a huge apocalypse coming and the end of the world is near." The nurse interprets this statement as which type of delusion? a) somatic b) grandiose c) persecutory d) nihilistic

d) nihilistic A nihilistic delusion involves the belief that one is dead or a calamity is impending. A grandiose delusion involves the belief that one has exceptional powers, wealth, skill, influence, or destiny. A persecutory delusion involves the belief that one is being watched, ridiculed, harmed, or plotted against. A somatic delusion involves a belief about abnormalities in bodily structure or functions. CH 22

A nurse is assessing a client who reports the sensation of "bugs crawling under the skin" and intense itching and burning. The client states, "I know bugs have invaded my body." There is no evidence to support the client's statement. The nurse interprets this as which type of delusion? a) grandiose b) jealous c) persecutory d) somatic

d) somatic Somatic delusions involve bodily functions or sensations, such as insects having infested the skin. The client vividly describes crawling, itching, burning, swarming, and jumping on the skin surface or below the skin. The client maintains the conviction that he or she is infested with parasites in the absence of objective evidence to the contrary. The central theme of the jealous subtype is the unfaithfulness or infidelity of a spouse or lover. Clients presenting with grandiose delusions are convinced they have a great, unrecognized talent or have made an important discovery. The central theme of persecutory delusions is the client's belief that he or she is being conspired against, cheated, spied on, followed, poisoned, drugged, maliciously maligned, harassed, or obstructe in pursuit of long-term goals. CH 22

A patient visits the clinic and tells the nurse about being under a great deal of stress on the job for the past month. Applying the factors that determine the stress response, which question would be most appropriate for the nurse to ask? A) What effect is the stress having on your job performance? B) How would you describe the social network within your family? C) What is the specific event that you find most stressful? D) When did you first become aware of experiencing this stress?

A CH 18

After interviewing a patient about social supports, the nurse determines that the patient is experiencing emotional support from these social supports based on which statement? A) I'm glad I have someone that I can talk to. B) The person who cut my lawn was great! C) I received a small community grant for groceries. D) The senior center gave me a booklet about my medications.

A CH 18

During an interview, a patient states, I feel so guilty, and Im so ashamed of what I did. The nurse interprets this as which of the following? A) Negative emotion B) Positive emotion C) Borderline emotion D) Nonemotion

A CH 18

The nurse is preparing to care for a patient under severe stress resulting from caring for her elderly aunt diagnosed with leukemia. When assessing the patients psychological domain, which question would the nurse ask first? A) Let's talk about what you have been feeling. B) Tell me about your depressed moods. C) How long have you been caring for your aunt? D) Are you feeling overwhelmed by caring for your aunt?

A CH 18

The nurse is caring for a client who has been taking clozapine (Clozaril) for 2 weeks. The client tells the nurse, My throat is sore, and I feel weak. The nurse assesses the clients vital signs and finds that the client has a fever. The nurse notifies the physician, expecting an order to obtain which laboratory test? A) A white blood cell count B) Liver function studies C) Serum potassium level D) Serum sodium level

A) A white blood cell count CH 22

The nurse is caring for a patient who has been under severe stress while caring for her elderly mother who is in the advanced stages of Alzheimers disease. The nurse explains that the patient is adapting to the stress is she is experiencing because of which of the following? A) Ability to survive in the midst of severe stress B) Acceptance of others help in caring for her mother C) Success at being able to solve problems D) Capability in setting reasonable personal goals

A) Ability to survive in the midst of severe stress CH 18

The nurse is caring for an elderly client who has been taking an antipsychotic medication for 1 week. The nurse notifies the physician when he observes that the client has muscle rigidity that resembles Parkinson's disease. Which agent would the nurse expect the physician to prescribe? A) Anticholinergic B) Anxiolytic C) Benzodiazepine D) Beta-blocker

A) Anticholinergic CH 22

The nurse is interviewing a client with schizophrenia when the client begins to say, Kite, night, right, height, fright. The nurse documents this as which of the following? A) Clang association B) Stilted language C) Verbigeration D) Neologisms

A) Clang association CH 22

A hospitalized client with schizophrenia is receiving antipsychotic medications. While assessing the client, the nurse identifies signs and symptoms of a dystonic reaction. Which agent would the nurse expect to administer? A) Diphenhydramine (Benadryl) B) Propranolol (Inderal) C) Risperidone (Risperdal) D) Aripiprazole (Abilify)

A) Diphenhydramine (Benadryl) CH 22

A group of nursing students is reviewing the various theories related to the etiology of schizophrenia. The students demonstrate understanding of the information when they identify which neurotransmitter as being responsible for hallucinations and delusions? A) Dopamine B) Serotonin C) Norepinephrine D) GABA

A) Dopamine CH 22

A client is being released from the inpatient psychiatric unit with a diagnosis of schizophrenia and treatment with antipsychotic medications. After teaching the client and family about managing the disorder, the nurse determines that the teaching was effective when they state which of the following should be reported immediately? A) Elevated temperature B) Tremor C) Decreased blood pressure D) Weight gain

A) Elevated temperature CH 22

The nurse is planning a presentation to a group of nursing students on the topic of anxiety disorders. Which of the following would the nurse include when describing panic disorder? A) Individuals may believe they are having a heart attack when a panic attack occurs. B) People with panic attacks often have fewer attacks if they also have agoraphobia. C) Typically, individuals experience this disorder after the age of 30 years. D) Persons rarely have an underlying comorbid condition of depression.

A) Individuals may believe they are having a heart attack when a panic attack occurs.

A nursing instructor is developing a class lecture that compares and contrasts schizoaffective disorder with schizophrenia. When describing one of the differences between these two diagnoses, which of the following would the instructor include as reflecting schizoaffective disorder? A) It is episodic in nature. B) It involves difficulties with self-care. C) It has less severe hallucinations. D) It is associated with a lower suicide risk.

A) It is episodic in nature. CH 22

A patient diagnosed with schizophrenia was hospitalized after arguing with co-workers and threatening to harm them. The patient is aloof, suspicious, and says, "Two staff members I saw talking were plotting to kill me." Based on data gathered at this point, which nursing diagnoses relate? Select all that apply. a. Risk for other-directed violence b. Disturbed thought processes c. Risk for loneliness d. Spiritual distress e. Social isolation

A,B a. Risk for other-directed violence b. Disturbed thought processes Delusions of persecution and ideas of reference support the nursing diagnosis of disturbed thought processes. Risk for other-directed violence is substantiated by the patient's feeling endangered by persecutors. Fearful individuals may strike out at perceived persecutors or attempt self-harm to get away from persecutors. Data are not present to support the other diagnoses.

When assessing a client with delusional disorder, the nurse would most likely expect to find impairment in which of the following? Select all that apply. A) Social functioning B) Marital functioning C) Intellectual functioning D) Occupational functioning E) Mental status functioning

A,B a) Social functioning b) Marital functioning CH 22

A nurse is conducting an assessment of a patients social network. Which of the following would the nurse assess? Select all that apply. A) How big is your network of contacts? B) What benefits do you receive from these people? C) Who is responsible for providing the support? D) Do any of the members know one another? E) What services do you think might be helpful?

A,B,C,D CH 18

A client is diagnosed with schizoaffective disorder. The nurse monitors the client closely based on the understanding that the client is at risk for suicide. Which would the nurse identify as increasing the client's risk? Select all that apply. a) alcohol use b) accompanying depression c) substance use d) no previous suicide attempts e) Hospitalization

A,B,C,E a) alcohol use b) accompanying depression c) substance use e) Hospitalization Clients with SAD are at risk for suicide. The risk for suicide in clients with psychosis is increased by the presence of depression. Risk factors for suicide increase with the use of alcohol or substances, cigarette smoking, previous suicide attempts and hospitalizations.

Which are key diagnostic criteria of schizophrenia? Select all that apply. A. Continuous signs for at least 6 months B. One or more major areas of social or occupational functioning markedly below previously achieved levels C. A direct physiologic effect of a substance or medical condition D. Major depression occurring concurrently with active symptoms E. Delusions present for a significant portion of time during a I month period

A,B,E A. Continuous signs for at least 6 months B. One or more major areas of social or occupational functioning markedly below previously achieved levels E. Delusions present for a significant portion of time during a I month period Key diagnostic criteria include continuous signs for at least 6 months, one or more major areas of social or occupational functioning markedly below previously achieved levels, and delusions present for a significant portion of time during a 1 month period. Other criteria include the absence, or insignificant duration, of major depressive, manic, or mixed episodes occurring concurrently with active symptoms and that the disease is not a direct physiologic effect of a substance o medical condition. CH 22

A nurse at the mental health clinic plans a series of psychoeducational groups for persons newly diagnosed with schizophrenia. Which two topics take priority? a. "The importance of taking your medication correctly" b. "How to complete an application for employment" c. "How to dress when attending community events" d. "How to give and receive compliments" e. "Ways to quit smoking"

A,E e. "Ways to quit smoking" a. "The importance of taking your medication correctly" Stabilization is maximized by adherence to the antipsychotic medication regimen. Because so many persons with schizophrenia smoke cigarettes, this topic relates directly to the patients' physiological well-being. The other topics are also important but are not priority topics.

Positive symptoms, specifically hallucination and delusions, are thought to be caused by hyperactivity of which neurotransmitter? A. Dopamine B. Norepinephrine C. Epinephrine D. Acetylcholine

A. Dopamine Positive symptoms of schizophrenia, such as delusions and hallucinations, are thought to be caused by dopamine hyperactivity in the mesolimbic tract at the D2 receptor site in the striatal area, where memory and emotion are regulated. Hyperactivity of acetylcholine, norepinephrine, and epinephrine are not associated with schizophrenia. CH 22

The nurse is caring for a client who was diagnosed with schizoaffective disorder. Based on the nurses understanding of this disorder, the nurse develops a plan of care to address which issue as the top priority? A) Suicide B) Aggression C) Substance abuse D) Eating disorder

A. Suicide CH 22

A nurse is performing an assessment interview with a patient. The patient tells the nurse that he has a type A personality. Based on the nurses interpretation, the nurse would expect which behavior by the patient? A) Appearing relaxed and easygoing throughout the interview B) Wanting the interview to be over as quickly as possible C) Being pleased with the overall pace of the interview D) Speaking slowly, requiring time to consider his answers

B CH 18

A patient is talking to the nurse about her friendship with another person. She comments, That person is always there for me, and I am always there for her. We help each other out; sometimes she's helping me, and sometimes I am helping her. The nurse interprets the patients statements about her social network as reflecting which of the following? A) Denseness B) Reciprocity C) Social support D) Constraints

B CH 18

When describing the concept of allostatic load to a group of students, which of the following would the instructor identify as abnormalities of which of the following as indicative of the overall changes? A) Nuclear imaging studies B) Laboratory test results C) Bone radiographs D) Cardiac studies

B CH 18

A client with schizoaffective disorder is having difficulty adhering to the medication regimen that requires the use of several agents. The client also is experiencing several side effects contributing to this nonadherence. The physician plans to change the clients medication. Which agent would the nurse anticipate that the physician would prescribe? A) Lithium B) Aripiprazole C) Clozapine D) Olanzapine

B) Aripiprazole CH 22

The nurse is caring for a hospitalized client who has schizophrenia. The client has been taking antipsychotic medications for 1 week when the nurse observes that the clients eyes are fixed on the ceiling. The nurse interprets this finding as which of the following? A) Akathisia B) Oculogyric crisis C) Retrocollis D) Tardive dyskinesia

B) Oculogyric crisis CH 22

A family member of a client diagnosed with schizoaffective disorder asks a nurse what causes the disorder. Which response by the nurse would be most appropriate? A) Dysfunctional family dynamics has been identified as a strong link. B) Research has suggested that the cause is predominately genetic. C) Dopamine, a substance in the brain, appears to be underactive. D) Studies have indicated that birth order is strongly associated with this disorder.

B) Research has suggested that the cause is predominately genetic. CH 22

A client comes to the emergency department because he thinks he is having a heart attack. Further assessment determines that the client is not having a heart attack but is having a panic attack. When beginning to interview the client, which question would be most appropriate for the nurse to use? A) Are you feeling much better now that you are lying down? B) What did you experience just before and during the attack? C) Do you think you will be able to drive home? D) What do you think caused you to feel this way?

B) What did you experience just before and during the attack?

What are the negative symptoms associated with schizophrenia? Select all that apply A. Anhedonia B. Hallucinations C. Ambivalence D. Delusions E. Avolition

A,C,E A. Anhedonia C. Ambivalence E. Avolition Positive s/sx would be delusions and hallucinations. CH 22

A nursing instructor is preparing a class lecture about schizophrenia and outcomes focusing on recovery. Which of the following would the instructor include as a major goal? A) Continuity of care B) Shorter in-patient stays C) Immediate crisis stabilization D) Social engagement

A. Continuity of care CH 22

As part of an interdisciplinary team, a nurse is assisting in developing the plan of care for a client with a delusional disorder. Which of the following would the team be least likely to include in the plan? A) Insight-oriented therapy B) Psychoeducation C) Cognitive therapy D) Support therapy

A. Insight-oriented therapy CH 22

Schizoaffective disorder has symptoms typical of both schizophrenia and which type of disorder? A. Mood disorder B. Anxiety disorder C. Eating disorder D.Substance use disorder

A. Mood disorder CH 22

When assessing a person with delusional disorder, which finding would the nurse expect to assess? A. few, if any, psychological deficits B. High level of intelligence C. altered personality D. Changes in mental status

A. few, if any, psychological deficits Clients with delusional disorder show few, if any, psychological deficits. In these clients, average or marginally low intelligence is characteristic. Mental status is not generally affected. Thinking, orientation, affect, attention, memory, perception, and personality are generally intact. CH 22

A group of students are reviewing the events associated with the fight-or-flight response. They demonstrate understanding of the information when they identify which of the following results from sympathetic nervous stimulation? A) Hypoglycemia B) Tachycardia C) Hypotension D) Hypercoagulability

B CH 18

A nurse is providing care to a client just recently diagnosed with schizophrenia during an inpatient hospital stay. Throughout the day, the nurse observes the client drinking from the water fountain quite frequently as well as carrying cans of soda and bottles of water with him wherever he goes. Upon entering the clients room, the nurse sees numerous empty cups that had been filled with fluids on his table and in the trash can. The room has an odor of urine. The nurse suspects which of the following? A) Diabetes mellitus B) Disordered water balance C) Tardive dyskinesia D) Orthostatic hypotension

B) Disordered water balance CH 22

A nurse is providing an in-service presentation on coping and adaptation. Which of the following would the nurse most likely include? Select all that apply. A) Most coping strategies are similar in their approach. B) Coping when effective leads to adaptation. C) Reappraisal occurs simultaneously with coping. D) The same coping strategy is used in each situation. E) Coping is a deliberate and planned effort to mange stress.

B, E CH 18

A nurse is assessing a client diagnosed with schizophrenia. The nurse suspects that the client may be experiencing water intoxication based on which finding? Select all that apply. a) enhanced attention span b) increase in hallucinations c) Muscle twitching d) emotional lability e) irritability

B,C,D,E b) increase in hallucinations c) Muscle twitching d) emotional lability e) irritability Findings associated with water intoxication include muscle twitching, irritability, increased psychotic symptoms such as hallucinations, and lability. Enhanced attention is not associated with water intoxication. CH 22

A client diagnosed with schizophrenia is an anticholinergic crisis. The nurse would expect which finding to be noted upon assessment? A. Hypothermia B. Bradycardia C. Facial flushing D. Incontinence

C. Facial flushing Clinical manifestations of anticholinergic crisis include facial flushing, tachycardia, urinary retention, and hyperthermia (fever). CH 22

A nurse is working with a group of clients diagnosed with schizophrenia in a community setting. Which of the following would least likely be a priority? A) Improving the quality of life B) Instilling hope C) Managing psychosis D) Preventing relapse

C. Managing psychosis CH 22

A nurse is preparing to administer prescribed antipsychotic medication to a client with psychosis. The identifies the prescribed medication as a first-generation antipsychotic drug. Which drug would the nurse most likely be administering? A. Olanzapine B. Clozapine C. Aripiprazole D. Fluphenazine

D. Fluphenazine Fluphenazine is a first-generation antipsychotic medication. The other listed drugs are second-generation antipsychotics. CH 22

When developing the plan of care for a client diagnosed with delusional disorder, the nurse would anticipate treatment in which setting? A. Inpatient B. Partial hospitalization C. Residential treatment D. Outpatient

D. Outpatient Clients with delusional disorder are treated most effectively in outpatient setting with supportive therapy. Inpatient residential treatment, and partial hospitalization, would not be appropriate for this client population. CH 22

A psychiatric-mental health nurse is teaching a class about schizophrenia. When describing delusions, which information would the nurse most likely include? a) They are variable in nature b) They could be a real-life situation c) They are implausible within the person's ethnic background d) They are easily changed with conflicting evidence.

b) They could be a real-life situation Delusions are fixed, false beliefs that cannot be changed by conflicting evidence. They can be situations that could occur in real life and are plausible in the context of the person's ethnic and cultural background, or clearly impossible. They usually involve a misinterpretation of experience.

Which is the most common subtype of delusion? a) grandiose b) somatic c) persecutory d) jealous

c) persecutory Of all the subtypes, persecutory delusions are the most common. CH 22