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13. All of the following are included in the plan of care for a client with schizophrenia. Which nursing intervention should the nurse perform first when caring for this client? A) Observe for signs of fear or agitation B) Maintain reality through frequent contact C) Encourage to participate in the treatment milieu D) Assess community support systems

Ans: A Feedback: Safety for both the client and the nurse is the priority when providing care for the client with schizophrenia. The nurse must observe for signs of building agitation or escalating behavior such as increased intensity of pacing, loud talking or yelling, and hitting or kicking objects. The nurse must then institute interventions to protect the client, nurse, and others in the environment.

A client diagnosed with schizophrenia insists on stopping her medication because it causes her to gain weight. The client is exercising which ethical principle? a) Veracity b) Justice c) Autonomy d) Beneficence

C The client is exercising autonomy and is making her own decision to stop taking the medication. Although it is probably not in her best interest, she does have that right. According to the principle of beneficence, the health care provider uses knowledge of science and incorporates the art of caring to develop an environment in which individuals achieve their maximal health care potential. Justice is the duty to treat all fairly, distributing the risk and benefits equally. Veracity is faithfulness to obligation and duties.

A nurse is teaching about assisted outpatient treatment to the caregivers of the client in the psychiatric facility. What are the benefits of this treatment program? Select all that apply. a) The client would require shorter inpatient stays. b) The client would adapt better to the society. c) The client would respond better to psychotropic drugs. d) The client's risk of self-harm would be reduced. e) The client would be protected from criminal victimization of others.

A, D, E The benefits of the assisted outpatient treatment include shorter inpatient stays, reduced risk of self-harm and protection of the client from criminal victimization of others. The client is not likely to develop more social skills with the assisted outpatient treatment. The client's response to drugs doesn't depend on the client being involved in the assisted outpatient program.

When it is discovered that a nurse did not act reasonably when providing care that is compatible with the standard of nursing care, the remaining factor that would confirm that the nurse acted negligently is whether ... a) The nurse was responsible for client injury b) The client's actions played a part in the nurse's reaction c) The injury results in permanent disability d) The client's injury was serious

A After it is determined that the nurse did not act responsibly in providing care in accordance with established standards of care, the remaining issue is to confirm that injury occurred as a result of the nurse's actions. That the client's injury was serious, resulted in permanent disability, and is the result of the client's actions are not part of the decision.

Dr. Smith, a psychotherapist, hears her client state, "I have had it with this marriage. I'm telling you, and not that I ever would do it, but I feel like hiring a hit man to kill the woman!" Dr. Smith ... a) must warn the client's wife, based on the Tarasoff rule. b) may be anxious, but since the client did not say he would kill his wife, must hold the client's statements in confidence. c) is bound to hold all psychotherapeutic content under strict confidence. d) must keep this confidential because the client made a disclaimer that he would never do it.

A Confidentiality must be broken if there are viable threats made against another person's safety.

A client 22 years of age with schizophrenia is refusing his antipsychotic medication. He states, "I don't like the dopey way it makes me feel. I feel like I'm walking underwater when I take it." The nurse explains to him, "Your schizophrenia is caused by a chemical imbalance in your brain, and this medication helps fix that chemical imbalance. You need to take it so your symptoms will get better." This conversation reflects a conflict between which two types of ethical principles? a) Autonomy and beneficence b) Justice and nonmaleficence c) Paternalism and veracity d) Autonomy and justice

A Ethical conflicts can occur when the client is being guided by the principle of autonomy and the nurse by the principle of beneficence. According to the principle of autonomy, each person has the fundamental right of self-determination. According to the principle of beneficence, the health care provider uses knowledge of science, and incorporates the art of caring, to develop an environment in which individuals achieve their maximal health care potential. Justice involves a duty to treat all fairly. Paternalism is the belief that knowledge and education authorize professionals to make decisions for the good of the client. Veracity is the duty to tell the truth. Nonmaleficence is the duty to cause no harm.

Which of the following rights could the psychiatric client lose when admitted to a locked, inpatient psychiatric treatment facility? a) Right to schedule his or her own time b) Right to safety from harm c) Right to send and receive mail without censorship d) Right to communicate with an attorney

A If a client is admitted to a locked unit, he or she is deemed of harm to self or others. In the case of potential harm to self or others, the client loses the rights to refuse treatment, including attending scheduled activities.

The nurse is caring for a client who has been physically restrained for aggressive behavior. The nurse tells the client's caregiver to remove the restraints temporarily from the limbs after every hour. What is the most appropriate reason for this? a) Removing the restraints will facilitate blood supply. b) Removing the restraints will increase client comfort c) Removing the restraints would reduce the aggression in the client. d) Removing the restraints will increase client activity.

A If a client is physically restrained, the restraints are removed hourly to exercise the limbs. This will facilitate the blood supply of the limb which may have been impeded because of using restraints. The purpose of removing the physical restraints is not to make the client comfortable. Removal of restraints would not be useful to reduce the aggression in the client. The restraints are applied because of the client's hyperactivity (aggression) thus removing the restraints is not useful to increase client activity.

As a result of the increasing severity of her delusions and consequent unsafe behavior, a client has been admitted to a psychiatric facility and judged incompetent to make decisions. Who will now make decisions for the client? a) A guardian appointed by the court b) The client's primary nurse c) A hospital-appointed interdisciplinary committee d) The client's psychiatrist

A If individuals admitted to a psychiatric facility are judged to be incompetent to make decisions, the court will appoint a guardian to make decisions for them.

All but which of the following states have abolished the insanity defense? a) Iowa b) Utah c) Idaho d) Montana

A Iowa has not abolished the insanity defense. Idaho, Montana, and Utah have abolished this defense.

What is provided in the Code of Ethics for Nurses of the American Nurses Association (ANA)? a) A guideline for nurses regarding ethical conduct b) Information about what to do when confronted with an ethical dilemma c) A description of case studies featuring ethical dilemmas d) Definitions of ethical principles and how they relate to nursing practice

A The ANA's Code of Ethics for Nurses guides ethical decision-making.

While performing the admission assessment of a new client, the nurse observed that the client brought a bottle of over-the-counter pain medication to the hospital. The nurse failed to document this or remove the medication from the room. Subsequently, the client experienced a serious adverse drug reaction as a result of the interaction between this drug and one of the drugs that she was prescribed in the hospital. This nurse may be guilty of what? a) Malpractice b) Assault c) Failure of duty to warn d) Incompetence

A The four elements of nursing malpractice are evident in this scenario. Assault is an act that puts another person in apprehension of being touched (or of bodily harm without consent), and failure of duty to warn surrounds a client's threat to harm another person. Incompetence, in the legal sense, surrounds a client's right to autonomy.

The goal of seclusion is to a) Give the client the opportunity to gain self-control b) Allow the nurse to monitor for side effects of medications c) Promote thoughtful reflection regarding behavior d) Punish the client for bad behavior

A The goal of seclusion is to give the client an opportunity to regain physical and emotional self-control.

The insanity defense is used in approximately how many criminal cases? a) 1% b) 50% c) 20% d) 10%

A The insanity defense is used approximately in 1% of criminal cases.

The nurse is acting in accordance with the American Nurses Association principles when she does what? Select all that apply a) Shares with the client that discharge is not likely to occur this week b) Makes sure to take the client to the recreation room as promised c) Gets the client extra dessert when she reports that it is her birthday d) Encourages the client to choose when she will call her family e) Notifies the physician when a prescribed medication is not managing the client's anxiety effectively

A, B, D, E The nurse is acting in accordance with the American Nurses Association principles when he or she notifies the physician when a prescribed medication is not managing the client's anxiety effectively; shares with the client that discharge is not likely to occur this week; encourages the client to choose when she will call her family; and takes the client to the recreation room as promised. Getting the client extra dessert when she reports that it is her birthday has nothing to do with the ANA. (less)

7. A person suffering from schizophrenia has little emotional expression when interacting with others. The nurse would document the client's affect as which of the following? Select all that apply. A) Flat B) Blunt C) Bright D) Inappropriate E) Pleasant

Ans: A, B Feedback: Clients with schizophrenia are often described as having blunted affect (few observable facial expressions) or flat affect (no facial expression). The client may exhibit an inappropriate expression or emotions incongruent with the context of the situation. It is not likely that the affect of a person with schizophrenia would be pleasant.

Videbeck Ch.16 Chapter Study Guide pg.293-294 Clinical Example John Jones, 33, has been admitted to the hospital for the third time with a diagnosis of paranoid schizophrenia. John had been taking haloperidol (Haldol) but stopped taking it weeks ago, telling his case manager it was "the poison that is making me sick." Yesterday, John was brought to the hospital after neighbors called the police because he had been up all night yelling loudly in his apartment. Neighbors reported him saying, "I can't do it! They don't deserve to die!" and similar statements. John appears guarded and suspicious and has very little to say to anyone. His hair is matted, he has a strong body odor, and he is dressed in several layers of heavy clothing even though the temperature is warm. So far, John has been refusing any offers of food or fluids. When the nurse approached John with a dose of haloperidol, he said, "Do you want to to die?" 1. What additional assessment data dose the nurse need to plan care for John?

Additional assessment data (examples): discover the content of any command hallucinations; ask about preferences for hygiene (e.g., shower or bath); and determine whether there is a thing or place that makes him feel safe and secure.

14. The nursing supervisor in an extended care facility is managing the environment to best help the clients with dementia. Which should the nurse include in planning the living environment? A) Plan for the same caregivers to provide care to individuals as much as possible. B) Open the windows and doors to allow fresh air to circulate through the environment. C) Provide a buffet-style menu with many food choices. D) Assign peer-led exercise activates on a daily basis.

Ans: A Feedback: A structured environment and established routines can reassure clients with dementia. Familiar surroundings and routines help to eliminate some confusion and frustration from memory loss. Providing the same caregiver establishes familiarity and routine. Safety considerations involve protecting against injury, meeting physiologic needs, and managing risks posed by the environment. Open doors pose a safety risk of wandering away. Buffet-style meals require the client to make too many choices, thus adding to frustration. The nurse encourages clients to engage in physical activity because they may not initiate such activities independently; many clients tend to become sedentary as cognitive abilities diminish. Clients often are quite willing to participate in physical activities but cannot initiate, plan, or carry out those activities without assistance.

24. One evening, a client with schizophrenia leaves his room and begins marching in the hall. When approached by the nurse, the client says, ìGod says I'm supposed to guard the area.î Which of the following responses would be best? A) ìI understand you hear a voice. You and I are the only ones in the hall, and I don't hear a voice.î B) ìThe voices are part of your illness, and they will leave in time.î C) ìThis guarding responsibility can make you tired. You rest for now, and I'll guard a while.î D) ìYou are just imagining these things. Do not pay any attention to the voices.î

Ans: A Feedback: Acknowledging that the client hears a voice validates that the client's experience is real to him, while presenting reality. ìThe voices are part of your illness, and they will leave in time,î is not appropriate to the client's statement. ìThis guarding responsibility can make you tired. You rest for now, and I'll guard a while,î reinforces the client's delusion. ì'You are just imagining these things. Do not pay any attention to the voices,î does not deal with the patient in a serious manner.

5. A client with dementia is unable to recognize ordinary objects, such as a pen or notebook. Which would this be a symptom of? A) Agnosia B) Amnesia C) Apraxia D) Aphasia

Ans: A Feedback: Agnosia is the inability to recognize familiar objects. Amnesia is failure to remember past events. Apraxia is impairment in the ability to execute motor functions despite intact motor abilities. Aphasia is a deterioration of language function.

3. Which is believed to be a risk factor specific to the development of delirium? A) Increased severity of physical illness B) Older age C) Baseline cognitive impairment D) Gradual decline in functioning

Ans: A Feedback: An estimated 10% to 15% of people in the hospital for general medical conditions are delirious at any given time. Onset is sudden. Delirium is common in older, acutely ill clients. Risk factors for delirium include increased severity of physical illness, older age, and baseline cognitive impairment such as that seen in dementia. Children may be more susceptible to delirium, especially that related to a febrile illness or certain medications such as anticholinergics. Delirium usually develops over a short period, sometimes a matter of hours, and fluctuates, or changes, throughout the course of a day. Prevalence of dementia also rises with age, and progression is gradual.

21. The nurse observes a client with schizophrenia sitting alone, laughing occasionally, and turning his head as if listening to another person. The nurse assesses this behavior to indicate that the client is experiencing auditory hallucinations and says, A) ìAre you hearing something?î B) ìIt's a beautiful day, isn't it?î C) ìWould you like to go to your room to talk?î D) ìWould you like to take some of your PRN medication?î

Ans: A Feedback: Asking the client if he is hearing something validates the nurse's assessment and focuses on the client's experience. The other choices do not address the situation of the client experiencing auditory hallucinations at the present time.

19. A client who has suspicion has been placed in a room with a roommate. The night nurse reports that this client has been awake for the past 3 nights. The likely explanation for his wakefulness is which of the following? A) He is fearful of what his roommate might do to him while he sleeps. B) He is a light sleeper and unaccustomed to a roommate. C) He is watching for an opportunity to escape. D) He is worrying about his family problems.

Ans: A Feedback: Clients who have suspicion trust no one and believe others are going to harm them. Being fearful of his roommate, being a light sleeper and unaccustomed to a roommate, and worrying about family problems would not be the most likely reasons why this client has been awake for the past three nights. The other explanations are not as likely.

28. The caregiver of a client with Alzheimer's disease reports to the nurse that often the client will suddenly become angry during meals and nothing seems to calm him down. The nurse teaches the caregiver to use distraction techniques. Which response would be best to teach as an example of this technique? A) ìLet's look at what is on television.î B) ìIf you stop yelling, I will get your dessert.î C) ìDon't you want to finish your meal?î D) ìI don't understand what you are saying.î

Ans: A Feedback: Distraction involves shifting the client's attention and energy to a more neutral topic. For example, the client may display a catastrophic reaction to the current situation, such as jumping up from dinner and saying, ìMy food tastes like poison!î The nurse might intervene with distraction by saying, ìCan you come to the kitchen with me and find something you'd like to eat?î or ìYou can leave that food. Can you come and help me find a good program on television?î (redirection/distraction). Influencing behavior with a reward is a behavioral technique. Asking a direct question is ineffective. Clarification is used to try to determine meaning behind the client's message.

4. Which patient is most likely suffering from dementia? A) A 90-year-old male who has experienced progressive mental decline that started with forgetfulness B) An 80-year-old female who has been in excellent health until she was admitted through the emergency department with a severe urinary tract infection and is now very anxious and is threatening staff C) A 6-year-old child who has just been administered conscious sedation for a closed reduction of a fractured wrist and says that her parents have three sets of eyes D) A 22-year-old male who was involved in a motorcycle crash without wearing a helmet now unable to remember where he is

Ans: A Feedback: Memory impairment is the prominent early sign of dementia. The course of dementia is usually progressive. A 90-year-old gentleman who has experienced progressive mental decline that started with forgetfulness is most likely suffering from dementia. An 80- year-old lady who has been in excellent health until she was admitted through the emergency department with a severe urinary tract infection is likely experiencing delirium. Delirium almost always results from an identifiable physiologic, metabolic, or cerebral disturbance or from drug intoxication or withdrawal. The 6-year-old who has just been administered conscious sedation is likely delirious. A 22-year-old male who was involved in a motorcycle crash without wearing a helmet and now cannot remember where he is likely experiencing an amnestic disorder.

17. A college freshman is admitted to the hospital with a diagnosis of schizophrenia. Friends reported that she had been in her room for 2 days in a trance-like state, not eating nor speaking to anyone. Which of the following is the highest priority for this client? A) Assessing fluid intake and output B) Completing an assessment of mental status C) Obtaining more data about her college experiences D) Providing for adequate rest

Ans: A Feedback: Physiologic homeostasis is a priority for this client. Completing an assessment of mental status, obtaining data about college experiences, and providing adequate rest are not the highest priority

10. A client with schizophrenia reads the advice column in the newspaper daily. When asked why the client is so interested in the advice column, the client replies, ìThis person is my guide and tells me what I must do every day.î The nurse would best describe this type of thinking as which of the following? A) Referential delusion B) Grandiose delusion C) Thought insertion D) Personalization

Ans: A Feedback: Referential delusions or ideas of reference involve the client's belief that television broadcasts, music, or newspaper articles have special meaning for him or her. Grandiose delusions are characterized by the client's claim to association with famous people or celebrities, or the client's belief that he or she is famous or capable of great feats. Thought insertion is the belief that others are placing thoughts in their mind against their will. Personalization is not a psychotic characteristic of schizophrenia.

16. The nurse caring for an elderly woman with dementia has asked the woman's children to bring old photo albums when they visit. Which best describes the usefulness of viewing photos when caring for the dementia client? A) Viewing photos is a form of reminiscence therapy for the client. B) Sharing photos will encourage interaction with other clients. C) This can help the children to correctly identify old photographs. D) Talking about the photos will encourage the client to live in the past.

Ans: A Feedback: Reminiscence therapy (thinking about or relating personally significant past experiences) is an effective intervention for clients with dementia. Rather than lamenting that the client is ìliving in the past,î this therapy encourages family and caregivers also to reminisce with the client. Reminiscing uses the client's remote memory, which is not affected as severely or quickly as recent or immediate memory. Photo albums may be useful in stimulating remote memory, and they provide a focus on the client's past.

13. A client with dementia is starting pharmacotherapy to slow the progression of cognitive decline. The client has a history of moderate but steady alcohol use over the past 45 years. Which medication should the nurse question as least suitable for this client? A) Tacrine (Cognex) B) Memantine (Namenda) C) Donepezil (Aricept) D) Rivastigmine (Exelon)

Ans: A Feedback: Tacrine (Cognex) is a cholinesterase inhibitor; however, it elevates liver enzymes in about 50% of clients using it. Lab tests to assess liver function are necessary every 1 to 2 weeks; therefore, tacrine is rarely prescribed. Memantine (Namenda) is an NMDA receptor antagonist that can slow the progression of Alzheimer's in the moderate or severe stages. Donepezil (Aricept), rivastigmine (Exelon), and galantamine (Reminyl) are cholinesterase inhibitors and have shown modest therapeutic effects and temporarily slow the progress of dementia.

18. The client with schizophrenia tells the nurse that rats have started to eat his brain. The best response by the nurse would be, A) ìHave you discussed this with your physician?î B) ìHow could that be possible?î C) ìYou cannot have rats in your brain.î D) ìYou look OK to me.î

Ans: A Feedback: This sounds like a new symptom, so talking with the physician is important; the client may need to have his medication reevaluated. ìHow could that be possible,î puts the client on the defensive. ìYou cannot have rats in your brain,î refers to the response as being unbelievable. ìYou look OK to me,î is inappropriate and not therapeutic.

7. The nurse is caring for a client with cognitive impairment. To determine whether the client is suffering from delirium or dementia, the nurse reviews the symptoms and course of each disorder. Place the letter ìAî beside terms describing delirium and the letter ìBî beside terms describing dementia. ____ Rapid onset ____ Progressive decline ____ Long-term memory impairment ____ Slurred speech ____ Hallucinations

Ans: A, B, B, A, A Feedback: Onset of delirium is rapid, but of dementia is gradual. Duration of delirium is brief, but of dementia is progressing. Delirium affects only short-term memory. Dementia begins with short-term memory loss and progresses to long-term memory loss. Slurred speech is characteristic of delirium. Speech with dementia is unchanged until the client begins to develop aphasia. Visual and tactile hallucinations are common with delirium, but rarely experienced with dementia.

27. Which of the following questions would best help the nurse to evaluate the effectiveness of antipsychotic medications for a client who has schizophrenia? Select all that apply. A) Have the symptoms you were experiencing disappeared? B) If the symptoms have not disappeared, are you able to carry out your daily life despite the persistence of some psychotic symptoms? C) Are you committed to taking the medication as prescribed? D) Are you satisfied with your quality of life? E) Do you have access to community agencies that will help you to live successfully in this community?

Ans: A, B, C, D Feedback: The client's perception of the success of treatment plays a part in evaluation. In a global sense, evaluation of the treatment of schizophrenia is based on the following: ï Have the client's psychotic symptoms disappeared? If not, can the client carry out his or her daily life despite the persistence of some psychotic symptoms? ï Does the client understand the prescribed medication regimen? Is he or she committed to adherence to the regimen? ï Does the client believe that he or she has a satisfactory quality of life? The question, ìDo you have access to community agencies that will help you to live successfully in this community?î is an appropriate question to ask to evaluate the plan of care but does not directly relate to antipsychotic medications.

11. The nurse is performing a health history with a client exhibiting signs of delirium. The nurse asks the client and family members about possible causes of the delirious state. Which would the nurse likely attribute as underlying causes for the client's delirium? Select all that apply. A) Recent alcohol use B) Dehydration C) Use of antihistamines D) Sleep disturbances E) Use of megadoses of vitamins F) Exposure to paint or gasoline

Ans: A, B, C, D, F Feedback: Because the causes of delirium are often related to medical illness, alcohol, or other drugs, the nurse obtains a thorough history of these areas. The nurse may need to obtain information from family members if a client's ability to provide accurate data is impaired. Information about drugs should include prescribed medications, alcohol, illicit drugs, and over-the-counter medications. Physiologic or metabolic causes include hypoxemia, electrolyte disturbances, renal or hepatic failure, hypoglycemia or hyperglycemia, dehydration, sleep deprivation, thyroid or glucocorticoid disturbances, thiamine or vitamin B12 deficiency, vitamin C, niacin, or protein deficiency, cardiovascular shock, brain tumor, head injury, and exposure to gasoline, paint solvents, insecticides, and related substances. Infectious processes include sepsis, urinary tract infection, pneumonia, meningitis, encephalitis, HIV, and syphilis.

32. Which are possible sources of frustrations for nurses caring for persons with dementia? Select all that apply. A) The clients do not retain explanations or instructions, so the nurse must repeat the same things continually. B) The nurse may get little or no positive response or feedback from clients with dementia. C) It can be difficult to remain positive and supportive to clients and family because the outcome is so bleak. D) It can be helpful for the nurse to talk to colleagues or even a counselor about personal feelings of depression and grief as the dementia progresses. E) The clients may seem not to hear or respond to anything the nurse does.

Ans: A, B, C, E Feedback: Working with and caring for clients with dementia can be exhausting and frustrating for both the nurse and caregiver. Teaching is a fundamental role for nurses, but teaching clients who have dementia can be especially challenging and frustrating. These clients do not retain explanations or instructions, so the nurse must repeat the same things continuously. The nurse may begin to feel that repeating instructions or explanations does not good because clients do not understand or remember them. The nurse may get little or no positive response or feedback from clients with dementia. It can be difficult to deal with feelings about caring for people who will never get better and go home. As dementia progresses, clients may seem not to hear or respond to anything the nurse says or does. Remaining positive and supportive to clients and family can be difficult when the outcome is so bleak. The nurse may need to deal with personal feelings of depression and grief as the dementia progresses; he or she can do so by discussing the situation with colleagues or even a counselor, but this is an intervention instead of a source of frustration for the nurse.

25. When performing discharge planning for a client who has schizophrenia, the nurse anticipates barriers to adhering to the medication regimen. The nurse assesses which of the following as improving the likelihood that the client will follow the prescribed medication regimen? Select all that apply. A) Short-term memory intact B) History of missing appointments C) Receives monthly disability checks D) Walking is primary mode of transportation E) States location of pharmacy nearest his residence

Ans: A, C, E Feedback: Sometimes clients intend to take their medications as prescribed but have difficulty remembering when and if they did so. They may find it difficult to adhere to a routine schedule for medications. Clients may have practical barriers to medication compliance, such as inadequate funds to obtain expensive medications, lack of transportation or knowledge about how to obtain refills for prescriptions, or inability to plan ahead to get new prescriptions before current supplies run out.

28. A client with schizophrenia has returned to the clinic because of an increase in symptoms. The client reports he stopped taking his meds because he did not like the side effects. The nurse educates the client about managing uncomfortable side effects. Which of the following is included in the teaching plan? Select all that apply. A) Suck on hard candy as desired B) Spend at least 30 minutes outside in the sun daily C) Use stool softeners as needed D) Decrease the amount of daily fluid intake E) Maintain a balanced calorie-controlled diet

Ans: A, C, E Feedback: Unwanted side effects are frequently reported as the reason clients stop taking medications. Interventions, such as eating a proper diet and drinking enough fluids, using a stool softener to avoid constipation, sucking on hard candy to minimize dry mouth, or using sunscreen to avoid sunburn, can help to control some of these uncomfortable side effects.

9. During the nursing assessment, a client describes constantly hearing voices mumbling in the background. The client denies that the voices are telling him to do anything harmful. The nurse documents that the client is experiencing which of the following? A) Command hallucinations B) Auditory hallucinations C) Olfactory hallucinations D) Gustatory hallucinations

Ans: B Feedback: Auditory hallucinations, the most common type, involve hearing sounds, most often voices, talking to or about the client. Command hallucinations are voices demanding that the client take action, often to harm self or others, and are considered dangerous. Olfactory hallucinations involve smells or odors. Gustatory hallucinations involve a taste lingering in the mouth or the sense that food tastes like something else

19. Which is the most effective intervention for clients with delirium? A) Giving detailed explanations B) Managing environmental stimuli C) Promoting rest with PRN medications D) Providing activities for distraction

Ans: B Feedback: Clients with delirium become overstimulated easily; their ability to process environmental stimuli is impaired.

29. The nurse is working with a client with schizophrenia, disorganized type. It is time for the client to get up and eat breakfast. Which of the following statements by the nurse would be most effective in helping the client prepare for breakfast? A) ìI'll expect you in the dining room in 20 minutes.î B) ìIt's time to put your dress on now.î C) ìStay right there and I'll get your clothes for you.î D) ìWhy don't you stay here and I'll get your tray for you.î

Ans: B Feedback: Clients with schizophrenia may have significant self-care deficits. The client needs clear direction, with tasks broken into small steps, to begin to participate in her own self-care. The other choices do not support the client effectively. ìI'll expect you in the dining room in 20 minutes,î is authoritarian and does not allow the client dignity. ìStay right here, and I'll get your clothes for you,î is also authoritarian and does not allow the client dignity. ìWhy don't you stay here and I'll get your tray for you,î is kinder but it robs the client of the opportunity to do for himself or herself as much as possible.

5. The client with schizophrenia believes the student nurses are there to spy on the clients. The client is suffering from which of the following symptoms? A) Hallucinations B) Delusions C) Anhedonia D) Ideas of reference

Ans: B Feedback: Delusions are fixed false beliefs that have no basis in reality. Hallucinations are false sensory perceptions or perceptual experiences that do not exist in reality. Ideas of reference are false impressions that external events have special meaning for the person. Anhedonia is feeling no joy or pleasure from life or any activities or relationships.

2. A nurse working in an assisted living facility is holding an in-service for the nursing assistants. The nurse reviews common behaviors associated with cognitive deterioration associated with dementia. Which would cause the nurse to know that the assistants correctly understood if it were expressed during a posttest? A) The clients should be able to ask us for items they need. B) The clients may not recognize their family when they come to visit. C) The clients who are ambulatory can still carry out activities of daily living independently. D) The clients should know when to come to the dining room for meals

Ans: B Feedback: Dementia is a mental disorder that involves multiple cognitive deficits, primarily memory impairment, and at least one of the following cognitive disturbances: (1) aphasia, which is deterioration of language function; (2) apraxia, which is impaired ability to execute motor functions despite intact motor abilities; (3) agnosia, which is inability to recognize or name objects despite intact sensory abilities; and (4) disturbance in executive functioning, which is the ability to think abstractly and to plan, initiate, sequence, monitor, and stop complex behavior.

29. The adult son of a client with dementia asks the nurse how he should respond when his mother repeatedly says she has had a busy day at work. The mother has not worked in over 20 years. Which is the best guidance that the nurse could offer? A) Ask her to explain what she did at work today that kept her busy. B) Go along with her thought of it having been a busy day, but do not refer to her work. C) Reorient her that she is at home and did not go to work. D) Give her 5 to 10 minutes of rest, and she will have no memory of the incident.

Ans: B Feedback: Going along means providing emotional reassurance to clients without correcting their misperception or delusion. The nurse does not engage in delusional ideas or reinforce them, but he or she does not deny or confront their existence. For example, a client is fretful, repeatedly saying, ìI'm so worried about the children. I hope they're okayî and speaking as though his adult children were small and needed protection. The nurse could reassure the client by saying, ìThere's no need to worry; the children are just fineî (going along). Time away is an effective technique for aggression.

14. A client with schizophrenia is seen sitting alone and talking out loud. Suddenly, the client stops and turns as if listening to someone. The nurse approaches and sits down beside the client. Which of the following is the best initial response by the nurse? A) ìYou must be pretty bored to be sitting here talking to an invisible person.î B) ìI don't hear or see anyone else; what are you hearing and seeing?î C) ìI can tell you are hearing voices, but they are not real.î D) ìHow long have you known the person you are talking to?î

Ans: B Feedback: Intervening when the client experiences hallucinations requires the nurse to focus on what is real and to help shift the client's response toward reality. Initially, the nurse must determine what the client is experiencingóthat is, what the voices are saying or what the client is seeing. In command hallucinations, the client hears voices directing him or her to do something, often to hurt self or someone else. For this reason, the nurse must elicit a description of the content of the hallucination so that health-care personnel can take precautions to protect the client and others as necessary. The nurse might say, ìI don't hear any voices; what are you hearing?î ìHow long have you known the person you are talking to?î would reinforce the client's hallucination.

17. The nurse is encouraging a group of clients with dementia to join in upper body range of motion exercises using light dumbbells. Which technique will most likely result in the greatest amount of participation? A) Show an instructional video just prior to the activity. B) Describe the exercise immediately before performing it. C) Demonstrate the exercises while clients simultaneously perform them. D) Perform the same routine daily to avoid the need for repeated instruction.

Ans: C Feedback: The nurse encourages clients to engage in physical activity because they may not initiate such activities independently; many clients tend to become sedentary as cognitive abilities diminish. Clients often are quite willing to participate in physical activities but cannot initiate, plan, or carry out those activities without assistance.

31. A new nurse has been working with clients with Alzheimer's disease for almost 6 months. During a staff meeting, the nurse expresses frustration because the same instructions have to be given to clients on a daily basis. The nurse states, ìI feel like all my work doesn't do them any good.î Which should the nurse's supervisor encourage the nurse to do? A) Cease giving instructions because the clients will not remember them anyway. B) Try to stay supportive and meet the clients' needs at the current moment. C) Seek counseling if personal feelings get in the way of client care. D) Consider transferring to a different client care specialty area.

Ans: B Feedback: Teaching is a fundamental role for nurses, but teaching clients who have dementia can be especially challenging and frustrating. These clients do not retain explanations or instructions, so the nurse must repeat the same things continually. The nurse must be careful not to lose patience and not to give up on these clients. Discussing these frustrations with others can help the nurse to avoid conveying negative feelings to clients and families or experiencing professional and personal burnout. The nurse must remain positive and supportive to clients and family.

23. The nurse enters the room of a client with schizophrenia the day after he has been admitted to an inpatient setting and says, ìI would like to spend some time talking with you.î The client stares straight ahead and remains silent. The best response by the nurse would be, A) ìI can see you want to be alone. I'll come back another time.î B) ìYou don't need to talk right now. I'll just sit here for a few minutes.î C) ìI've got some other things I can do now. I hope you'll feel like talking later.î D) ìYou would feel better if you would tell me what you're thinking.î

Ans: B Feedback: This response indicates acceptance of the client and shows genuine interest in him, building rapport and trust. Initially, the client may tolerate only 5 or 10 minutes of contact at one time. Establishing a therapeutic relationship takes time, and the nurse must be patient. The nurse must maintain nonverbal communication with the client, especially when verbal communication is not very successful. This involves spending time with the client, perhaps through fairly length periods of silence. The presence of the nurse is a contact with reality for the client and also can demonstrate the nurse's genuine interest and caring to the client. The other choices are not consistent with what is therapeutic for the client.

6. Which client would have an increased risk for delirium? A) An elderly woman with abdominal pain B) A 3-year-old child with a temperature of 103.2∞F C) A middle-aged woman newly diagnosed with multiple sclerosis D) A young adult male with gastroenteritis and dehydration

Ans: B Feedback: Young children with high fever are at risk for delirium. The other choices would not be the most likely candidates for increased risk for delirium.

23. The nurse is developing interventions to promote socialization in a client with moderate dementia. Which would provide a safe and secure environment for the client? A) A card game with other clients B) An activity with the nurse C) Decorating a bulletin board with the group D) Morning stretch group with music

Ans: B Feedback: The client has to interact only with the nurse, who will behave in a predictable way and will focus on the client's needs, without undue or unexpected disruptions. Group activities do not provide a safe and secure environment like an activity done with the nurse does.

32. Which of the following are central components of a psychiatric rehabilitation and recovery program? Select all that apply. A) Working with clients to have an improved quality of life according to society's point of view B) Working with clients to manage their own lives C) Working with clients to make effective treatment decisions D) Working with clients to have an improved quality of life according to his or her point of view. E) Working with clients to diagnose their problem early

Ans: B, C, D Feedback: Psychiatric rehabilitation has the goal of recovery for clients with major mental illness that goes beyond symptom control and medication management. Working with clients to manage their own lives, make effective treatment decisions, and have an improved quality of lifeófrom the client's point of viewóare central components of such programs.

2. The nurse reviews current literature and identifies that which of the following are included in current studies of biologic theories regarding the etiology of schizophrenia? Select all that apply. A) That there is a particular pathologic structure associated with the disease. B) That genetics is the cause of schizophrenia. C) Persons with schizophrenia have decreased brain volume and abnormal brain function in the frontal and temporal areas of persons with schizophrenia. D) The brain activity of persons with schizophrenia differs from people who do not have schizophrenia. E) That the etiology of schizophrenia may be related to the body's response to exposure of a virus.

Ans: B, C, D, E Feedback: In the first half of the 20th century, studies focused on trying to find a particular pathologic structure associated with the disease, largely through autopsy. Such a site was not discovered. The biologic theories of schizophrenia focus on genetic factors, neuroanatomic and neurochemical factors (structure and function of the brain), and immunovirology (the body's response to exposure to a virus).

30. The parents of a young adult male who has schizophrenia ask how they can recognize when their son is beginning to relapse. The nurse teaches the family to look for which of the following? Select all that apply. A) Excessive sleeping B) Fatigue C) Irritability D) Increased inhibition E) Negativity

Ans: B, C, E Feedback: Teaching the client and family members to prevent or manage relapse is an essential part of a comprehensive plan of care. This includes providing facts about schizophrenia, identifying the early signs of relapse, and teaching health practices to promote physical and psychological well-being. Early signs of relapse include impaired cause-and-effect reasoning, impaired information processing, poor nutrition, lack of sleep, lack of exercise, fatigue, poor social skills, social isolation, loneliness, interpersonal difficulties, lack of control, irritability, mood swings, ineffective medication management, low self- concept, looking and acting different, hopeless feelings, loss of motivation, anxiety and worry, disinhibition, increased negativity, neglecting appearance, and forgetfulness.

4. The nurse is assessing for negative symptoms of schizophrenia in a newly admitted client. The nurse would note which behavior as indicative of a negative symptom? A) Difficulty staying on subject when responding to assessment questions B) Belief of owning a transportation device allowing for travel to the center of the Earth C) Hesitant to answer the nurse's questions during the assessment interview D) Mimicking the postural changes made by the nurse during the assessment interview

Ans: C Feedback: A negative symptom of schizophrenia is alogia, or the tendency to speak very little or to convey little substance of meaning (poverty of content). Associative looseness (fragmented or poorly related thoughts and ideas), delusions (fixed false beliefs that have no basis in reality), and echopraxia (imitation of the movements and gestures of another person whom the client is observing) are all positive symptoms.

30. The grown daughter of a woman with Alzheimer's disease reports to the nurse that she is trying to keep her mother's condition from worsening by asking her questions whenever they are together. Which will be accomplished by this intervention? A) Decrease environmental misinterpretation B) Improve memory retention C) Increase frustration D) Slow the progress of the disease

Ans: C Feedback: Alzheimer's disease is progressive; clients do not learn new information, and they become frustrated when asked to perform tasks they are not capable of doing.

20. A client with schizophrenia is reluctant to take his prescribed oral medication. The most therapeutic response by the nurse to this refusal is, A) ìI can see that you're uncomfortable now, so we can wait until tomorrow.î B) ìIf you refuse these pills, you'll have to get an injection.î C) ìWhat is it about the medicine that you don't like?î D) ìYou know you have to take this medicine for your own good.

Ans: C Feedback: Asking the client why he does not like his medication explores the client's reason for refusal, which is the first step in resolving the issue. The nurse must determine the barriers to compliance for each client. Threatening the client with an injection is assault. Waiting until tomorrow puts off the inevitable. Telling him it is for his own good is not the most therapeutic response in order to get the client to take his medication.

10. Which distinguishes delirium from dementia? A) Delirium has an acute onset and is progressive in course. B) Delirium has a gradual onset and can be resolved. C) Dementia has a gradual onset and is progressive in course. D) Dementia has an acute onset and can be resolved.

Ans: C Feedback: Delirium has a sudden onset, and the underlying cause is treatable; by contrast, dementia has a gradual onset and is progressive rather than treatable.

16. A client diagnosed with schizophrenia is laughing and talking while sitting alone. Which of the following is the best response by the nurse? A) State, ìCan you share your joke with me?î B) To sit with the client quietly until the client is ready to talk C) State, ìTell me what's happening.î D) State, ìYou look lonely here. Let's join the others in the day room.î

Ans: C Feedback: Having the client tell the nurse what is happening explores what the client is experiencing and engages the client in reality interaction. Answer choices A, B, and C are not appropriate responses by the nurse in this situation.

11. The nurse is preparing a client with schizophrenia for discharge. The nurse asks the client, ìHow are you going to care for yourself at home?î The purpose of the nurse's question is to assess the client's A) self concept. B) judgment. C) insight. D) social support system.

Ans: C Feedback: Insight refers to the client's degree of self-awareness and realistic view of life. It can be severely impaired in schizophrenia. Over time, some clients can learn about the illness, anticipate problems, and seek appropriate assistance as needed. Judgment refers to appropriate decision-making ability and is based on the ability to interpret the environment correctly. At times, lack of judgment is so severe that clients cannot meet their needs for safety and protection and place themselves in harm's way.

34. Which of the following attitudes would be best for the nurse when the client who has schizophrenia acts as though the nurse is not trustworthy or that his or her integrity is being questioned? A) That the client is correct and the nurse is not trustworthy B) That the client wants to insult the nurse C) That the client's behavior is a part of the illness D) That the nurse's actions have failed

Ans: C Feedback: Suspicious or paranoid behavior on the client's part may make the nurse feel as though he or she is not trustworthy or that his or her integrity is being questioned. The nurse must recognize this type of behavior as part of the illness and not interpret or respond to it as a personal affront. The nurse must not take responsibility for the success or failure of treatment efforts or view the client's status as a personal success or failure.

33. A student nurse is having a first experience in an inpatient psychiatric unit and is frightened by the behaviors of the clients with schizophrenia. The student should take which of the following actions to deal with fear? A) Express fear to the psychiatrist during rounds B) Pretend to not be afraid C) Stay in an open area while talking with the clients D) Insist that the instructor accompanies the student at all times.

Ans: C Feedback: The nurse also may be genuinely frightened or threatened if the client's behavior is hostile or aggressive. The nurse must acknowledge these feelings and take measures to ensure his or her safety. This may involve talking to the client in an open area rather than in a more isolated location or having an additional staff person present rather than being alone with the client. If the nurse pretends to be unafraid, the client may sense the fear anyway and feel less secure, leading to a greater potential for the client to lose personal control. It is not possible for the instructor to accompany the student at all times.

8. A client who has schizophrenia is having a conversation with the nurse suddenly stops talking in the middle of a sentence. The client is experiencing which type of thought disruption? A) Thought withdrawal B) Thought insertion C) Thought blocking D) Thought broadcasting

Ans: C Feedback: The nurse can assess thought content by evaluating what the client actually says. For example, clients may suddenly stop talking in the middle of a sentence and remain silent for several seconds to 1 minute (thought blocking). They also may state that they believe others can hear their thoughts (thought broadcasting), that others are taking their thoughts (thought withdrawal), or that others are placing thoughts in their mind against their will (thought insertion).

8. The daughter of a woman with dementia asks the nurse if her mother will ever be able to live independently again. Which would be the most appropriate response by the nurse? A) ìYou sound like you aren't ready for her to be dependent on caregivers.î B) ìHer confusion is a temporary complication of her physical illness and should subside when the illness gets better.î C) ìSymptoms of dementia gradually get worse. Unfortunately she will not be independent again.î D) ìWith early treatment, mild dementia can be reversed. It may be possible.î

Ans: C Feedback: The prognosis for dementia involves progressive deterioration of physical and mental abilities until death. Typically, in the later stages, clients have minimal cognitive and motor function, are totally dependent on caregivers, and are unaware of their surroundings or people in the environment. They may be totally uncommunicative or make unintelligible sounds or attempts to verbalize. Delirium secondary to physical illness will subside with physical recovery.

21. The nurse is working with a client who has hallucinations and delusions. The client tells the nurse she cannot take a shower because she is waiting for her husband to take her home. Which response by the nurse is best in this situation? A) ìIt would be best if you just took your shower now.î B) ìYou seem anxious and upset.î C) ìYou have plenty of time to shower before it's time to go home.î D) ìWhy are you thinking you're going home?î

Ans: C Feedback: This is an example of going along with, rather than correcting, the client's misperception so that she can get on with her daily activities and not focus on being upset about not going home. The other choices are not the best responses in this situation.

18. A client with dementia gets angry and begins to yell at the nurse during mealtime. The nurse leaves the client's side for 5 to 10 minutes and then returns. Which of the following best explains the nurse's behavior? A) The nurse was unsure of how to calm the client. B) The nurse was frustrated and needed to take a ìtime-out.î C) The nurse gave the client a chance to calm down before resuming the meal. D) The nurse stepped away to verify the safety of other clients.

Ans: C Feedback: Time away involves leaving clients for a short period and then returning to them to reengage in interaction. For example, the client may get angry and yell at the nurse for no discernible reason. The nurse can leave the client for about 5 or 10 minutes and then return without referring to the previous outburst. The client may have little or no memory of the incident and may be pleased to see the nurse on his or her return.

20. The nurse is assessing a client with early signs of dementia. What is the nurse trying to determine when the nurse asks the client what he ate for breakfast that morning? A) Orientation B) Food preferences C) Recent memory D) Remote memory

Ans: C Feedback: The initial sign of dementia is memory loss for recent events that exceeds normal forgetfulness. Asking what the client ate for breakfast is not determining orientation, food preferences, or remote memory.

26. A client with moderate Alzheimer's disease is living with her grown daughter. Which statement by the daughter would indicate the need for intervention by the nurse? A) ìIt's distressing when my mother forgets my name.î B) ìI wish my sister would come to visit more often.î C) ìMother won't let anyone else do anything for her.î D) ìTaking care of my mother is a big responsibility.î

Ans: C Feedback: When the caregiver feels as though no one else can provide care, the risk for role strain is markedly increased. The other choices do not require intervention by the nurse.

6. The client with schizophrenia makes the following statement, ìI just don't know how to count. The sky turned to fire. I have a ball in my head.î The nurse documents this entire statement as an example of A) flight of ideas. B) ideas of reference. C) delusional thinking. D) associative looseness.

Ans: D Feedback: Associative looseness is demonstrated through fragmented or poorly related thoughts and ideas. The series of disconnected thoughts best exemplifies this concept. Some of the statements contain delusions, or fixed false beliefs that have no basis in reality. Flight of ideas refers to rapidly flowing thoughts that are more connected than the client's statement. Ideas of reference are false impressions that external events have special meaning for the person.

24. The daughter of a client with dementia has been the primary caregiver for 5 months. The daughter expresses to the nurse, ìAt times it is so overwhelming! I feel I do not have a life anymore!î Which is the most helpful response by the nurse? A) ìAre you saying you don't want to care for your mother anymore?î B) ìI know it is really hard. It takes a lot of work and you are doing such a good job.î C) ìYour mother really appreciates what you do for her. You are the best one to care for her.î D) ìHere is the number of a caregivers' support group. How do you think you would feel talking with others in the same situation?î

Ans: D Feedback: Caregivers need outlets for dealing with their own feelings. Support groups can help them to express frustration, sadness, anger, guilt, or ambivalence; all these feelings are common. Attending a support group regularly also means that caregivers have time with people who understand the many demands of caring for a family member with dementia. The client's physician can provide information about support groups, and the local chapter of the National Alzheimer's Disease Association is listed in the phone book. Area hospitals and public health agencies also can help caregivers to locate community resources. The nurse should understand that the caregiver is asking for help when expressing frustration. The nurse should not dismiss the caregiver's feelings or in any way induce additional guilt.

22. The nurse is caring for a client with Alzheimer's disease. The nurse observes that the client's pacing and mumbling to himself increase at mealtime and shift change. Which intervention should the nurse implement first? A) Administer an antianxiety drug such as lorazepam (Ativan) at these times. B) Explain the unit routine and the reasons for increased activity to the client. C) Keep unit activity to a minimum. D) Move the client to a quieter area during these times

Ans: D Feedback: The nurse must alter the environment because the client will not learn new coping skills for frustrating or overly stimulating situations. Administering an antianxiety agent or explaining the routine of the unit and reasons for increased activity to the client may be done but would not be the initial intervention. The unit activity does not need to be kept to a minimum.

25. Which statement by the nurse would be most appropriate to the family member who is the primary caregiver to a client with dementia? A) ìMost people seek help when they really need it.î B) ìWhat is wrong with your family? Can't they see you need help?î C) ìYou should be grateful that you still have your family member around.î D) ìYes, it is important for you to spend some time relaxing and doing what you like to do. This will help you to be better prepared to manage the demands of the caregiver role.î

Ans: D Feedback: Caregivers need support to maintain personal lives. They need to continue to socialize with friends and to engage in leisure activities or hobbies rather than focus solely on the client's care. Caregivers who are rested, are happy, and have met their own needs are better prepared to manage the rigorous demands of the caregiver role. Most caregivers need to be reminded to take care of themselves; this act is not selfish but really is in the client's best long-term interests. Many times caregivers will say they will seek help when they really need it. However, they must maintain their own well-being and not wait until they are exhausted before seeking relief. The primary caregiver may believe other family members should volunteer to help without being asked, but other family members may believe that the primary caregiver chose to take on the responsibility and do not feel obligated to help out regularly. It is important for the family to express their feelings and ideas and to participate in caregiving according to their own expectations. Many families need assistance to reach this type of compromise. Asking the caregiver what is wrong with his or her family and pointing out that the caregiver needs help are not helpful to the caregiver. It would be better for the nurse to encourage family members to share their feelings and to compromise for the best interests of the client. Telling the caregiver that he or she should be grateful will only increase the caregiver's sense of guilt, which is not productive.

1. The most commonly supported neuroanatomic theory of schizophrenia suggests which etiology? A) Excessive amounts of dopamine and serotonin in the brain B) Ineffective ability of the brain to use dopamine and serotonin C) Insufficient amounts of dopamine in the brain D) Decreased brain tissue in the frontal and temporal regions of the brain

Ans: D Feedback: Decreased brain tissue in the frontal and temporal regions of the brain is the most commonly supported neuroanatomic theory that suggests the etiology of schizophrenia. The other theories are neurochemical.

1. During the change of shift report in the intensive care unit, the nurse learns that a client has developed signs of delirium over the past 8 hours. Which behavior documented in the nursing notes would be consistent with delirium? A) Unable to identify a water pitcher B) Unable to transfer to sitting position C) Difficulty with verbal expression D) Disoriented to person

Ans: D Feedback: Delirium usually develops over a short period, sometimes a matter of hours, and fluctuates, or changes, throughout the course of the day. Clients with delirium have difficulty paying attention, are easily distracted and disoriented, and may have sensory disturbances such as illusions, misinterpretations, or hallucinations. Dementia symptoms include aphasia (deterioration of language function), apraxia (impaired ability to execute motor functions despite intact motor abilities), and agnosia (inability to recognize or name objects despite intact sensory abilities).

31. A client asks the nurse upon discharge, ìWhat should I do if I forget to take my medicine?î The nurse should explain to the client which of the following? A) ìJust double the dose next time it is scheduled.î B) ìSkip that dose and resume your regular with the next dose.î C) ìDon't miss doses, or you will not maintain therapeutic drug levels.î D) ìIf you remember within 3 to 4 hours later than it is due, take it then. If you remember more than 4 hours after it was due, do not take that dose.î

Ans: D Feedback: If a client forgets a dose of antipsychotic medication, advise the client to take it if the dose is only 3 to 4 hours late. If the missed dose is more than 4 hours late or the next dose is due, ask the client to omit the forgotten dose.

12. All of the following are nursing diagnoses identified for a client with schizophrenia. The student nurse correctly anticipates which diagnosis will resolve when the client's negative symptoms improve? A) Impaired verbal communication B) Risk for other-directed violence C) Disturbed thought processes D) Social isolation

Ans: D Feedback: NANDA diagnoses commonly established based on the assessment of psychotic symptoms or positive signs are as follows: - Risk for other-directed violence - Risk for suicide - Disturbed thought processes - Disturbed sensory perception - Disturbed personal identity - Impaired verbal communication NANDA diagnoses based on the assessment of negative signs and functional abilities include the following: - Self-care deficits - Social isolation - Deficient diversional activity - Ineffective health maintenance - Ineffective therapeutic regimen management

27. A nurse is educating a group of elderly community members about cognitive disorders. Which would the nurse include as a measure most likely to prevent Alzheimer's disease and other dementias? A) Crafts B) Cooking C) Watching television D) Reading

Ans: D Feedback: People who regularly participate in brain-stimulating activities such as reading books and newspapers or doing crossword puzzles are less likely to develop Alzheimer's disease than those who do not. Engaging in leisure-time physical activity during midlife and having a large social network are associated with a decreased risk for Alzheimer's disease in later life.

26. A client with schizophrenia is attending a follow-up appointment at the community mental health clinic. The client reports to the nurse, ìI stopped taking the antipsychotic medication because I can't get a hard-on with my girlfriend anymore.î Which of the following should the nurse recommend to enhance the client's well-being? A) ìIt sounds like that is a problem for you. Don't you still find her to be sexy enough?î B) ìSexual dysfunction is a temporary side effect and should get better once your body is used to the medication.î C) ìYou should avoid having sex with your girlfriend anyway. Do you really want her to get pregnant?î D) ìIt is important for you to take an antipsychotic medication. You may need a different type that will be less likely to affect your sexual functioning. I would like to call your physician about this.î

Ans: D Feedback: Some side effects, such as those affecting sexual functioning, are embarrassing for the client to report, and the client may confirm these side effects only if the nurse directly inquires about them. This may require a call to the client's physician or primary provider to obtain a prescription for a different type of antipsychotic.

22. A client with schizophrenia is admitted to the inpatient unit. He does not speak when spoken to but has been observed talking to himself on occasion. What would be the priority objective at this time? A) The client will begin talking with other clients B) The client will express his feelings freely C) The client will increase his socialization with others D) The client will increase his reality orientation

Ans: D Feedback: The client needs to be oriented to reality before he can participate in other therapeutic activities. The other choices would not be priority goals for this patient right now.

12. A client voluntarily admitted to the inpatient psychiatric unit is currently experiencing mild delirium. The client approaches the nurse and states, ìI'm going to take walk outside. I'll be back in about 10 minutes.î Which is the most appropriate nursing action? A) Further assess the client's motives for wanting to walk. B) Give the client permission to go on a walk on the grounds. C) Tell the client the walk is not allowed and restrict him to the unit. D) Designate a staff member to accompany the client on the walk.

Ans: D Feedback: The nurse teaches clients to request assistance for activities such as getting out of bed or going to the bathroom. If clients cannot request assistance, they require close supervision to prevent them from attempting activities they cannot perform safely alone. The nurse responds promptly to calls from clients for assistance and checks clients at frequent intervals.

9. Which statement made by the nurse would be most appropriate to an 89-year-old patient who is confused but has no history of dementia and is hospitalized for an acute urinary tract infection? A) ìYou are likely to become progressively more confused now.î B) ìThis should be just a temporary situation.î C) ìDon't worry about it; everyone is confused when they are in the hospital.î D) ìI know things are upsetting and confusing right now, but your confusion should clear as you get better.î

Ans: D Feedback: ìI know things are upsetting and confusing right now, but your confusion should clear as you get better,î would be validating and giving information and would provide realistic reassurance to the client who has delirium as this is often an acute and temporary situation in elderly people who are acutely ill and have other risk factors such as medications and illness and age. ìYou are likely to become progressively more confused now,î is inaccurate as the person likely has delirium, and this will be an acute and temporary situation. ìThis should be just a temporary situationî provides some reassurance but no validation. ìDon't worry about it; everyone is confused when they are in the hospitalî is inaccurate.

15. The nurse encourages the client with dementia to meet nutritional needs. Which is the best approach to assist in meeting adequate dietary intake? A) Sit with the client as long as necessary to complete the meal. B) Provide entertainment during meals such as television or music. C) Avoid between-meal snacks to encourage appetite. D) Serve meals in small, bite-size pieces.

Ans: D Feedback: Clients may eat poorly because of limited appetite or distraction at mealtimes. The nurse addresses this problem by providing foods clients like, sitting with clients at meals to provide cues to continue eating, having nutritious snacks available whenever clients are hungry, and minimizing noise and undue distraction at mealtimes. Clients who have difficulty manipulating utensils may be unable to cut meat or other foods into bite-sized pieces. The food should be cut up when it is prepared, not in front of clients, to deflect attention from their inability to do so. Food that can be eaten without utensils, or finger foods such as sandwiches and fresh fruits, may be best.

3. The student nurse correctly recognizes that which one of the following findings is best supported by genetic studies in the etiology of schizophrenia? A) If a person has schizophrenia, distant relatives are also at risk. B) That there is no relationship at all between schizophrenia and genetics. C) That there is a weak correlation between genetics and schizophrenia. D) That schizophrenia is at least partially inherited.

Ans: D Feedback: The most important studies have centered on twins; these findings have demonstrated that if one identical twin has schizophrenia, the other twin has a 50% chance of developing it as well. Fraternal twins have only a 15% risk. This finding indicates that schizophrenia is at least partially inherited.

15. A client states, ìI am dead. I have come back from the dead.î An appropriate response by the nurse is, A)"what is it like to feel dead" B)"No you did not die. People don't come back from the dead." C)"Show me what you did in art therapy this morning" D)"Ill get your medicine and you'll feel better"

Ans:C Feedback: The client experiencing delusions utterly believes them and cannot be convinced they are false or untrue. It is the nurse's responsibility to present and maintain reality by making simple statements. The nurse must avoid openly confronting the delusion or arguing with the client about it. The nurse also must avoid reinforcing the delusional belief by ìplaying alongî with what the client says.

A nurse working on the psychiatric unit receives a telephone call from the employer of one of the clients on the unit. The employer asks to be sent a copy of Mr. Murray's latest laboratory work and psychological testing results so Mr. Murray's medical records in employee health can be kept up-to-date. Based on the nurse's knowledge about issues surrounding breach of confidentiality, which response would be the most appropriate? a) "Sure, give me your address, and I will see that the information is sent to you." b) "I am unable to acknowledge whether or not a Mr. Murray is a client on this unit." c) "I'm sorry; we're not allowed to give out that information about our client." d) "I'll have to get the client's signed consent before we can send that information to you."

B A breach of confidentiality is the release of client information without the client's consent in the absence of legal compulsion or authorization to release information. Acknowledging that Mr. Murray is a client on the unit would be such a breach. Even if the nurse explains that he or she cannot give the information without the client's consent, the explanation lets the employer know that Mr. Murray is receiving care in a psychiatric hospital.

Which of the following practices places a nurse at risk for being charged with malpractice? a) Constantly working to improve communication skills b) Always attempting to provide the most economically sensitive client care c) Documenting all reasons for any deviation from the applicable standard of care d) Always treating clients with compassion and respect

B Always focusing on economically sensitive care may come into conflict with providing care required by the applicable standard of care; as such, this places a nurse at risk for being charged with malpractice. A diligent and reflective nurse can reduce the risks of malpractice by incorporating several elements into his or her practice: exhibiting excellent communication skills, treating clients with compassion and respect, and documenting reasons for deviating from applicable standards of care.

The nurse recognizes that the difference between a voluntary and an involuntary commitment is that ... a) An involuntarily committed client may refuse treatment b) An involuntarily committed client may not initiate their own discharge c) The voluntarily committed client usually has good insight into his or her mental health problem d) The voluntarily committed client is usually less aggressive

B An involuntary commitment prevents a client from initiating his or her own discharge, so this is the correct answer. A voluntarily committed client is not necessarily less aggressive than a client committed involuntarily. Both voluntarily and involuntarily committed clients may refuse treatment. And, while insight may be a factor that leads to a voluntary commitment, the voluntarily committed client may or may not possess this.

A nurse tells a client that she will bring him his pain medicine in 5 minutes after she checks on another client. The nurse returns in 5 minutes and administers the medication as planned. The nurse is practicing which of the following principles by returning as promised? a) Autonomy b) Fidelity c) Nonmaleficence d) Paternalism

B Fidelity is faithfulness to obligations and duties. It is keeping promises and is important in establishing trusting relationships.

A client's plan of care includes revoking privileges for inappropriate behavior, based on a contract between the client and the nurse who wrote the plan. Another nurse decides to ignore this, because the client promises that she will adhere to the contract in the future. The second nurse's behavior may have violated which ethical principle? a) Veracity b) Fidelity c) Autonomy d) Beneficence

B Fidelity is the nurse's faithfulness to duties, obligations, and promises. Autonomy is the client's right to make decisions for himself or herself. Veracity is a systematic behavior of honesty and truthfulness in speech. Beneficence is the principle of doing good, not harm.

Which of the following occurs when staff members physically control the client and move him or her to a seclusion room? a) Mechanical restraint b) Human restraint c) Battery d) Abuse

B Human restraint is when staff members physically control the client and move him or her to a seclusion room. A mechanical restraint is a device, usually ankle or wrist restraints, fastened to a bed frame to curtail the client's physical aggression. Battery involves harmful or unwarranted contact with the client.

A new nursing student correctly identifies which of the following as most essential for guiding psychiatric-mental health nursing actions? a) Federal laws b) Code of Ethics for Nurses c) Personal beliefs d) State laws

B Psychiatric-mental health nursing actions are guided by the Code of Ethics for Nurses.

The depressed client is deciding which type of treatment would be beneficial for him. The nurse would document that the client is utilizing which of the following ethical principles in this situation? a) Justice b) Autonomy c) Beneficence d) Veracity

B The American Nurses Association identified four primary principles to guide ethical decisions. These principles include the client's right to autonomy, the right to beneficence (doing good) by the nurse, the right to justice or fair treatment, and the right to veracity (the truth) regarding the client's condition and treatment.

A psychiatric client informs the nurse that he is feeling better and does not want to take his antidepressive medication. This client is exhibiting which of the following when making this decision? a) Beneficence b) Autonomy c) Veracity d) Justice

B The client is practicing autonomy and the principle that each client has the fundamental right of self-determination.

Which client would the nurse determine to be the most likely candidate for involuntary commitment? a) The client who refuses to participate in the planned therapy b) The client who is screaming in the street disturbing neighbors c) The client with a mental disorder who is homeless d) The client who refuses to take the prescribed medication

B The client who is screaming in the street is more likely to be judged as a danger to himself or to others. Clients have a right to refuse medications or to not participate in therapy in many states and provinces. Being homeless or refusing medication or therapy does not pose an immediate danger to oneself or others.

A client who was deemed to be at high risk for suicide was ordered visual checks every 15 minutes. Nurse K. had been performing these checks since the beginning of her shift but neglected to pass off this responsibility to a colleague before leaving the unit for her scheduled break. As a result, the client made a suicide attempt while Nurse K. was off the unit. Which ethical principle has Nurse K. most clearly violated? a) Beneficence b) Fidelity c) Autonomy d) Veracity

B The ethical principle of fidelity implies that the nurse is faithful to duties, obligations, and promises when providing care for the client. Autonomy is related to independence in decision making, while beneficence is doing good and veracity is telling the truth.

The psychiatric nurse is particularly concerned about securing informed consent for an invasive procedure from a ... a) 25-year-old Caucasian male who has just completed alcohol withdrawal therapy b) 45-year-old Asian male who is diagnosed with antisocial personality disorder c) 60-year-old female visiting from England who experienced a panic attack d) 21-year-old African American female with a history of both physical and sexual abuse

B Violations of the ethical principles of informed consent are committed when a consenting client is not fully informed of the details of the treatment; a 45-year-old Asian male who is diagnosed with antisocial personality disorder may not be able to fully understand the details, due both to his disorder and his possible inability to understand the language. The other clients do not face such barriers and should be fully able to understand all information provided to them.

The nurse is explaining the responsibilities to a client's legal guardian. Which statements by the nurse are correct? Select all that apply. a) "You are supposed to monitor the client all the time." b) "You have to make healthcare decisions for the client." c) "You are supposed to write checks for the client." d) "You, not the client, should sign legal documents." e) "You have to make the client stay with you."

B, C, D Clients with severe mental illness are usually appointed a legal guardian or a conservator. The functions of the legal guardian include writing checks for the client, giving informed consent (making healthcare decision for the client), and entering contracts. The legal guardian need not make the client stay with himself or herself. The legal guardians are not expected to monitor the client all the time.

The nurse has used wrist and ankle restraints for a client who was extremely aggressive. What assessments should the nurse perform on a regular basis after restraining the client? Select all that apply. a) Memory b) Emotional well-being c) Skin condition d) Side effects of medication e) Peripheral circulation

B, C, D, E The nurse should perform routine assessments for the client who has been physically restrained. The assessments should include the skin condition of the client and the circulation of the client. The use of restraints could impede the peripheral blood supply and cause skin breakdown. The client should be monitored for side effects of medication. The client's emotional well-being (stability) should also be assessed to determine if the restraints can be removed. The client is physically restrained thus it would be inappropriate to assess the memory.

A nurse is caring for a client in the healthcare facility. The client doesn't show signs of suicidal ideation or pose harm to others. The client wishes to leave the facility and go home. What is the most appropriate response of the nurse? a) "You could leave. I would inform the health care provider." b) "You inform the healthcare provider and leave the facility." c) "You could sign a written request for discharge." d) "The healthcare provider should assess you again before allowing your request."

C Clients admitted to a healthcare facility have the right to leave, provided they do not pose a danger to themselves or others. If the client wishes to leave the health-care facility, he or she can sign a written request for discharge. Informing the health-care provider before leaving is not sufficient to obtain a discharge. Advising the client to leave and stating that the nurse would inform the health-care provider is an inappropriate suggestion. According to the law, the client has the right to be discharged even against medical advice.

The inappropriate use of restraints or seclusion is considered ... a) Battery b) Assault c) False imprisonment d) Causation

C False imprisonment is defined as the unjustified detention of a client, such as the inappropriate use of restraint or seclusion. Battery involves harmful or unwarranted contact with the client. Assault involves any action that causes a person to fear being touched in a way that is offensive, insulting, or physically injurious without consent or authority. Causation occurs when a breach of duty was the direct cause of loss, damage, or injury.

A psychiatric nursing class is discussing current trends in mental health care. A student voices the opinion that there should be equitable access to mental health care and resources for those who live in rural areas, for those without health insurance, and for those with very little income. The student nurse's opinion most closely reflects which ethical principle? a) Paternalism b) Nonmaleficence c) Justice d) Veracity

C Justice is the duty to treat all fairly, distributing the risks and benefits equally. Justice becomes an issue when some portion of a population does not have access to health care. Nonmaleficence is the duty to cause no harm, both individually and for all. Paternalism is the belief that knowledge and education authorize professionals to make decisions for the good of clients. Veracity is the duty to tell the truth.

Which ethical principle focuses on the duty to do no harm? a) Autonomy b) Beneficence c) Nonmaleficence d) Justice

C Nonmaleficence is the requirement to do no harm to others either intentionally or unintentionally. Autonomy involves the right of the client to make his or her own decisions. Justice refers to fairness. Beneficence refers to one's duty to benefit or promote good for others.

A client with a psychiatric illness has become extremely aggressive and the nurse decides that the client needs to be restrained. Which action would be considered human restraint? a) The nurse ties the client's wrist using wrist restraints. b) The nurse asks the client to calm down. c) The nurse and a group of paramedics hold the client. d) The nurse sedates the client with morphine.

C Restraint is the direct application of physical force to restrict the client's freedom of movement. The nurse and a group of paramedics holding the client is an example of human restraint. The nurse does not apply force while telling the client to calm down. Sedating the client is an example of chemical restraint. Applying a wrist cuff to control the aggression of the client indicates the use of mechanical restraints.

One way that nurses can protect themselves against liability from malpractice is to do which of the following? a) Avoid documenting incriminating information. b) Carry individual malpractice insurance. c) Know the statutory and professional standards. d) Request legal consultation from the employer.

C To decrease their chances of liability for malpractice, psychiatric nurses must ensure that their professional practice is within the bounds of statutory and professional standards.

A client was admitted for electroconvulsive therapy (ECT). The physician performing the procedure failed to obtain informed consent before the ECT was administered. The physician could be charged with which of the following? a) Fidelity b) Beneficence c) Assault d) Battery

D All clients have the right to give informed consent before healthcare professionals perform interventions. Administration of treatments or procedures without a client's informed consent can result in legal action against the primary provider and the health care agency. In such lawsuits, clients will prevail, alleging battery (touching another without permission), if they can prove they did not consent to the procedure, providers did not give adequate information for a decision, or the treatment exceeded the scope of the consent.

An adolescent client has refused to wash or change his clothes for several days. He smells and looks filthy. Three male staff members approach him to escort him to the shower. The client resists and becomes combative when staff members insist. They place the client in seclusion and restraints and tell him that they will release him when he is calm and willing to shower. The client's rights have been ... a) Violated, primarily because he shouldn't be forced to shower b) Not violated, because his combative behavior warranted seclusion and restraint to protect others c) Not violated, because a degree of cleanliness is important d) Violated, primarily because of the inappropriate use of restraints

D Clients have the right to treatment in the least restrictive environment. No staff can confine a person with mental illness who is not a threat to self or others. Nurses must assess a client's condition and status constantly so that healthcare professionals can initiate more or less restrictive treatment alternatives based on the client's evolving needs.

A psychiatric-mental health client has an advance care directive on his medical record. A clinician provides treatment that disregards the client's directive. The clinician would be liable for which of the following? a) False imprisonment b) Battery c) Assault d) Medical battery

D Failure to respect a client's advance directive is considered medical battery. Assault is the threat of unlawful force to inflict bodily injury on another. Battery is the intentional and unpermitted contact with another. False imprisonment is the detention or imprisonment contrary to the provision of law.

Ensuring that the client has informed consent before agreeing to a treatment regimen displays which of the following ethical principles? a) Nonmaleficence b) Fidelity c) Justice d) Autonomy

D The nurse respects the client's autonomy through client's rights, informed consent, and encouraging the client to make choices about his or her health care. The nurse has a duty to take actions that promote the client's health (beneficence) and that do not harm the client (nonmaleficence). The nurse must treat all clients fairly (justice), be truthful and honest (veracity), and honor all duties and commitments to clients and families (fidelity).

From a legal standpoint, clients hospitalized as voluntary admissions differ from other types of admissions which of the following ways? a) They cannot refuse treatment. b) They can leave the hospital whenever they want. c) They are not considered a danger to themselves or others. d) They are considered competent.

D Voluntary clients have certain rights that differ from those of other hospitalized clients. Specifically, they are considered competent (unless otherwise adjudicated) and therefore have the absolute right to refuse treatment, including psychotropic medications, unless they are dangerous to themselves or others, as in a violent destructive episode within the treatment unit.

A nurse is explaining the distinction between confidentiality and privacy. Which of the following would the nurse include as reflecting privacy? a) Ethical duty for nondisclosure b) Involvement of two individuals c) Knowledge of treatment costs and benefits d) Part of personal life not governed by society's laws

D Privacy refers to that part of an individual's personal life that is not governed by society's laws and government intrusion. Confidentiality refers to an ethical duty of nondisclosure. Confidentiality also involves two people: the individual who discloses the information, and the person with whom the information is shared. Informed consent is a legal procedure to ensure that the client knows the benefits and costs of treatment.

Videbeck Ch.16 Chapter Study Guide pg.293-294 Clinical Example 3. Identify at least two nursing interventions for the three priorities listed above.

Disturbed thought process: engage client in present, here-and-now topics not related to delusional ideas; focus on client's emotions and feelings. Ineffective therapeutic regimen management: offer scheduled medications in a matter-of-fact manner; allow client to open unit-dose packets; assess for side effects, and give medications or provide nursing interventions to relieve side effects; provide factual information to the client: "This medication will decrease the voices you're hearing." Self-care deficit: provide supplies and privacy for hygiene activities; give feedback about body odor, dirty clothes, and so forth; help client store extra clothing where he has access to it and believes it is safe.

Videbeck Ch.16 Chapter Study Guide pg.293-294 Clinical Example 2. Identify the three priorities, nursing diagnoses, and expected outcomes for John's care, with your rationales for the choices.

Disturbed thought processes: client will have 5-minute interactions that are reality based; client will express feelings and emotions. Ineffective therapeutic regimen management (medication refusal): client will take medication as prescribed; client will verbalize difficulties in following medication regimen. Self-care deficit: client will shower or bathe, wash hair and clean clothes every other day; client will wear appropriate clothing for the weather or activity.

Videbeck Ch.16 Chapter Study Guide pg.293-294 Clinical Example 4. What community referrals or supports might be beneficial for John when he is discharged?

John might benefit from a case manager in the community and a community support program or a clinic for possible depot injections of his medication.

Videbeck Ch.16 NCLEX-Style Chapter Review Questions 4. A client with schizophrenia is hearing voices that tell him to kill himself. What term is used to identify this type of false sensory perception? a. Flight of ideas b. Hallucination c. Delusion d. Ideas of reference

b Hallucination A hallucination is a sensory perception, such as hearing voices and seeing objects, that only the client experiences. A delusion is a false belief. Flight of ideas refers to the mistaken belief that someone or something outside the client is controlling the client's ideas or behavior.

Videbeck Ch.16 NCLEX-Style Chapter Review Questions 14. A client diagnosed with schizophrenia tells the nurse, "I hear the voice of Elvis." Which of the following is the most therapeutic response by the nurse? a. "I don't hear the voice, but I know you hear what sounds like a voice." b. "You shouldn't focus on Elvis' voice." c. "You know that Elvis has been dead for years." d. "Don't worry about the voice as long as it doesn't belong to anyone real."

a "I don't hear the voice, but I know you hear what sounds like a voice." Acknowledging that the client hears what sounds like a voice states reality about the client's hallucination. The other options are judgmental and demeaning.

Videbeck Ch.16 NCLEX-Style Chapter Review Questions 17. The nurse notes that a client with schizophrenia sits in a chair rocking back and forth. What does the nurse recognizes this as? a. Catatonic excitement b. A sign of anxiety c. Catatonic stupor d A side effect of medication

a Catatonic excitement In catatonic excitement, clients may show uncontrolled and aimless motor activity. They may engage in in repetitive stereotypic movements with no apparent purpose, such as rocking back and forth for hours. Clients also may manifest normal mannerisms out of context, such as grimacing for no reason.

Videbeck Ch.16 NCLEX-Style Chapter Review Questions 15. Which of the following speech pattern is exhibited by the client stating, "I will take a pill if I go up the hill but not if my name is Jill, I don't want to kill?" a. Clang association b. Verbigeration c. Neologism d. Word salad

a Clang association Clang associations are ideas that are related to one another based on sound or rhyming rather than meaning. Neologisms are words invented by the client. A verbigeration is the stereotyped repetition of words or phrases that may or may not have meaning to the listener. A word salad is a combination of jumbled words and phrases that are disconnected or incoherent and make no sense to the listener.

Videbeck Ch.16 NCLEX-Style Chapter Review Questions 26. The client with delusional disorder may neglect hygiene because of which of the following delusions? a. Persecutory b. Grandiosity c. Somatic d. Erotomanic

a Persecutory A client may neglect personal hygiene as a result of deterioration in functional ability or delusions of persecution. If a client believes someone is trying to poison him, for example, he may be reluctant to use toothpaste, soaps, deodorants, and other hygiene products.

Videbeck Ch.16 Chapter Study Guide pg.293-294 Multiple Choice Questions 5. When the client describes fear of leaving his apartment as well as the desire to get out and meet others, it is called a. ambivalence b. anhedonia c. alogia d. avoidance

a ambivalence

Videbeck Ch.16 Chapter Study Guide pg.293-294 Multiple-Response Questions. Select all that apply. 1. A teaching plan for the client taking an antipsychotic medication will include which of the following? a. Apply sun block lotion before going outdoors. b. Drink sugar-free beverages for dry mouth. c. Have serum blood levels drawn once a month. d. Rise slowly from a sitting position. e. Skip any dose that is not taken on time. f. Take medication with food to avoid nausea.

a,b,d Apply sunblock lotion before going outdoors, Drink sugar-free beverages for dry mouth, Rise slowly from a sitting position

Videbeck Ch.16 NCLEX-Style Chapter Review Questions 27. A nurse who works in a psychiatry unit finds that young clients with schizophrenia have worse prognoses when compared with clients who are diagnosed later in life. Which of the following reasons should lead the nurse to make this observation? Select all that apply. a. Have less sense of personal identity b. Are less likely to have experiences of independent living c. Are less adherent to the treatment schedule d. Are inherently more susceptible to receive a poor prognosis e. Are not able to accurately communicate their issues and concerns.

a,b,d Have less sense of personal identity, Are less likely to have experiences of independent living, Are inherently more susceptible to receive a poor prognosis Young clients with schizophrenia have a poor prognosis when compared with older clients. Possibly reasons include that young clients have a less developed sense of personal identity and have not had experiences of successful independent living. Differences in treatment adherence are not related to age. Difficulty in communicating problems dose not depend on the age of the client. Age at onset appears to be an important factor in how well the client fares: those who develop the illness earlier show worse outcomes than those who develop it later.

Videbeck Ch.16 NCLEX-Style Chapter Review Questions 1. The nurse documents that the client is exhibiting negative symptoms of schizophrenia when observing the client doing what? Select all that apply. a. Repeatedly turning down invitations to join in unit activities b. Threatening to "slap anyone that bothers my stuff." c. Taking very quietly d. Walking in circles around the unit exhausted e. Being unable to explain the phrase, "raining like cats and dogs."

a,e Repeatedly turning down invitations to join in unit activities, Being unable to explain the phrase, "raining like cats and dogs." Emotional isolation and a lack of abstract thinking are negative symptoms since they represents a lack of a normal function.

Videbeck Ch.16 NCLEX-Style Chapter Review Questions 19. A client tells the nurse she has bugs in her brain and asks the nurse if she can see them. Which of the following responses by the nurse is most therapeutic? a. "You have a though disorder and only think you have bugs in your brain. There really aren't any. You don't have to worry because we would give you medicine for any medical problems." b. "No, I don't see any bugs. That sounds scary for you." c. "Your thinking is a little illogical. I wouldn't be able to see bugs if they were inside your brain. Would you like to talk more about this?" d. "No, I don't see any bugs. Are you seeing bugs or hearing unusual sounds or voices?"

b "No, I don't see any bugs. That sounds scary for you." The person who hallucinates is preoccupied and frightened by what he or she hears or sees. The hallucination is real to the client, and the nurse cannot argue away, dismiss, or ignore it. Although the hallucination is real to the client, nurses make it clear that they do not hear the voices or see the visual images. Nurses do, however, communicate concern that the client is bothered, upset, or frightened by the hallucination.

Videbeck Ch.16 NCLEX-Style Chapter Review Questions 12. Which of the following medications is used to control the extrapyramidal effects associated with antipsychotic medications? a. Thioridazine (Mellaril) b. Benzotropine (Cogentin) c. Haloperidol (Haldol) d. Chlopromazine (Thorazine)

b Benzotropine (Cogentin) Cogentin is an anticholinergic drug used to relieve drug-induced extrapyramidal adverse effects, such as muscle weakness, involuntary muscle movement, pseudoparkinsonism, and tardive dyskinesia.

Videbeck Ch.16 NCLEX-Style Chapter Review Questions 29. Which of the following statements best reflects schizoaffective disorder? a. Delusions are present but hallucinations are absent. b. Clients are often misdiagnosed as having schizophrenia. c. Mood symptoms must occur consistently positive symptoms d. The symptoms typically run a fairly constant course.

b Clients are often misdiagnosed as having schizophrenia. Mental health providers find schizoaffective (SAD) difficult to conceptualize, diagnose, and treat because of the variable clinical course. Clients are often misdiagnosed as having schizophrenia. 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 (e.g., diminished emotional expression, alogia, or avolition). In addition, the positive symptoms (delusions or hallucinations) must be present without the mood symptoms at some time during this period (for at least 2 weeks).

Videbeck Ch.16 NCLEX-Style Chapter Review Questions 16. What term is used to describe the speech pattern being used when the client imitates or repeats what the nurse is saying? a. Word salad b. Echolalia c. Neologisms d. Clang associations

b Echoliallia Echolalia is the client's imitation or repetition of what the nurse says. Neologisms are words invented by the client. Clang associations are ideas that are related to one another based on sound or rhyming rather than meaning. A word salad is a combination of jumbled words and phrases that are disconnected or incoherent and make no sense to the listener.

Videbeck Ch.16 NCLEX-Style Chapter Review Questions 10. The nurse is assigned to a client with catatonic schizophrenia. Which intervention should the nurse include in the client's care plan? a. Giving the client an opportunity to express concerns b. Meeting all of the client's physical needs c. Providing a quiet environment where the client can be alone d. Administering lithium carbonate (Lithonate) as prescribed.

b Meeting all of the client's physical needs Meeting all of the client's physiologic needs is most important because clients with catatonic schizophrenia cannot meet their own needs by themselves. Clients with catatonic schizophrenia are unable to express their concerns. Lithium is used for the manic phase of bipolar disorder. The nurse needs to give support to the client and be present for him or her as reassurance.

Videbeck Ch.16 Chapter Study Guide pg.293-294 Multiple Choice Questions 2. The nurse is planning discharge teaching for a client taking clozapine (Clozaril). Which of the following is essential to include? a. Caution the client not to be outdoors in the sunshine without protective clothing. b. Remind the client to go to the lab to have blood drawn for a white blood cell count. c. Instruct the client about dietary restrictions. d. Give the client a chart to record the daily pulse rate.

b Remind the client to go to the lab to have blood drawn for a white blood cell count.

Videbeck Ch.16 NCLEX-Style Chapter Review Questions 22. A client who has a major depressive episode tells the nurse that, for the past two weeks, he has been hearing voices and at times thinks that someone is following him. A history reveals that he has had these alternating symptoms before. He also has experienced time with neither of these symptoms and has been able to function adequately. The nurse interprets these findings as suggesting which of the following? a. Brief psychotic disorder b. Schizoaffective disorder c. Paranoid schizophrenia d. Undifferentiated schizophrenia

b Schizoaffective disorder Schizoaffective disorder is characterized by intervals of intense symptoms between quiescent periods. At times, there are symptoms of schizophrenia, and at other times, there seems to be a mood disorder. Because the symptoms alternate with quiet periods, schizophrenia, either paranoid or undifferentiated, would not apply. A brief psychotic episode involves symptoms of at least 1 day but less than 1 month, and the onset is sudden. The client generally experiences emotional turmoil or overwhelming confusion and rapid intense shifts affect.

Videbeck Ch.16 NCLEX-Style Chapter Review Questions 20. Which of the following is an appropriate intervention for a client having auditory hallucinations? a. Encourage the client to discuss the content of the hallucinations with staff as they occur. b. Tell the client to talk back to the voices and tell them to go away. c. Ask the client to keep a journal about what the voices tell him and to bring the journal to therapy sessions. d. Encourage the client to spend quiet time alone until hallucinations cease.

b Tell the client to talk back to the voices and tell them to go away. Interventions for managing hallucinations include dismissal intervention (i.e., telling the voices to go away), various coping strategies (e.g., jogging, telephoning, playing games, seeking out others, employing relaxation techniques), or competing stimuli (e.g., listening to music or another's or one's own voice to overcome auditory hallucinations, and visual stimuli to overcome visual hallucinations).

Videbeck Ch.16 NCLEX-Style Chapter Review Questions 9. A client diagnosed with schizophrenia states, "I want to go home, go home, go home." This is an example of which of the following speech patterns? a. Neologisms b. Verbigeration c. Clang association d. Word salad

b Verbigeration A verbigeration is the stereotyped repetition of words or phrases that may or may not have meaning to the listener. Clang associations are ideas that are related to one another based on sound or rhyming rather than meaning. Neologisms are words invented by the client. A word salad is a combination of jumbled words and phrases that are disconnected or incoherent and make no sense to the listener.

Videbeck Ch.16 NCLEX-Style Chapter Review Questions 7. Which of the following is a nonneurologic side effect of antipsychotic medications? a. Seizures b. Weight Gain c. Akathisia d. Dystonia

b Weight Gain Weight gain is a nonneurologic side effect of antipsychotic medications.

Videbeck Ch.16 Chapter Study Guide pg.293-294 Multiple Choice Questions 6. The client who hesitates 30 seconds before responding to any question is described as having a. blunted affect b. latency of response c. Paranoid delusions d. poverty of speech

b latency of response

Videbeck Ch.16 Chapter Study Guide pg.293-294 Multiple-Response Questions. Select all that apply. 2. Which of the following are considered to be positive signs of schizophrenia? a. Anhedonia b. Delusions c. Hallucinations d. Disorganized thinking e. Illusions f. Social withdrawal

b,c,d Delusions, Hallucinations, Disorganized thinking

Videbeck Ch.16 Chapter Study Guide pg.293-294 Multiple Choice Questions 4. Which of the following statements would indicate that family teaching about schizophrenia had been effective? a. "If our son takes his medication properly, he won't have another psychotic episode." b. "I guess we'll have to face the fact that our daughter will eventually be institutionalized." c. "It's a relief to find out that we did not cause our son's schizophrenia." d. "It is a shame our daughter will never be able to have children."

c "It's a relief to find out that we did not cause our son's schizophrenia."

Videbeck Ch.16 NCLEX-Style Chapter Review Questions 8. Which medication classification has been most effective in treating akathisia? a. Antimanics b. Antianxiety c. Beta-Blockers d. Sedatives

c Beta-Blockers Beta-Blockers, such as propranolol,, have been most effective in treating akathisia.

Videbeck Ch.16 NCLEX-Style Chapter Review Questions 30. A nurse is developing a plan of care for a client diagnosed with delusional disorder. Which of the following would the nurse need to keep in mind? a. Psychopharmacologic agents are quite helpful in alleviating the delusions. b. The delusions have probably just recently developed. c. Clients with delusional disorder typically have problems with medication adherence. d. Female clients with delusional disorder often act on their delusions.

c Clients with the delusional disorder typically have problems with medication adherence. By the time a client with a diagnosis of the delusional disorder is seen in a psychiatric setting, he or she has generally had the delusion for a long time. It is deeply ingrained and many times unshakable even with psychopharmacologic intervention. These clients rarely comply with medication regimens. Male clients who have the erotomanic subtype are more likely to require special care because they are more likely than other clients to act on their delusions (for example, by continued attempts to contact the loved object or stalking).

Videbeck Ch.16 NCLEX-Style Chapter Review Questions 21. A married couple arrives at the outpatient clinic. Upon assessment, the nurse finds that the couple believes that the police have been following them and tapping their phones for 2 months. This couple most likely suffers from which of the following disorders? a. Psychotic disorder NOS b. Conjugal delusion c. Folie a deux d. Delusional disorder, paranoid type

c Folie a deux Share psychotic disorder, or folie a deux, involves two individuals who have a close relationship and share the same delusion. This occurrence is attributed to the strong influence of the more dominant person. It is seen more frequently in women who are isolated by language, culture, or geography. Such persons are often related by blood or marriage and have lived together for an extended period of time. Contributing factors include old age, low intelligence, sensory impairment, cerebrovascular disease, and alcohol abuse. This disorder has been diagnosed in twins and individuals, both of whom had a chronic psychotic disorder. This disorder also has occurred in a group of individuals or in families in which the parent is the primary case (inducer).

Videbeck Ch.16 NCLEX-Style Chapter Review Questions 13. A client is being seen in the health clinic. The nurse observes a shuffling gait, drooling, and slowness of movement. The client is currently taking an antipsychotic for treatment of schizophrenia. The nurse knows that which of the following side effects is occurring? a. Dystonic movements b. Akathisia c. Pseudoparkinsonism d. Neuroleptic malignant syndrome

c Pseudoparkinsonism Pseudoparkinsonism is exhibited by a shuffling gait, drooling, and slowness of movement. Dystonia is characterized by cramps and rigidity of the tongue, face, neck, and back muscles. Akathisia causes restlessness, anxiety, and jitteriness. Neuroleptic malignant syndrome causes rigidity, fever, hypertension, and diaphoresis.

Videbeck Ch.16 NCLEX-Style Chapter Review Questions 23. When obtaining a client's history, a 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 at work. He also is exhibiting catatonic excitement, echopraxia, loose associations, and pressured speech. The nurse suspects which of the following? a. Schizoaffective disorder b. Schizophrenia c. Schizophreniform disorder d. Brief Psychotic disorder

c Schizophreniform disorder The essential features of the schizophreniform disorder are identical to those of criteria A for schizophrenia (delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms), with the exception of the duration of the illness, which can be less than 6 months but with symptoms present for at least 1 month. Schizophrenia would be as described, but the symptoms must persist for at least 6 months. In brief psychotic disorder, the length of the episode is at least 1 day but less than 1 month. With schizoaffective disorder, the 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, hallucination, disorganized speech, disorganized or catatonic behavior, or negative symptoms.

Videbeck Ch.16 NCLEX-Style Chapter Review Questions 11. A client diagnosed with schizophrenia states to the nurse, "My intestines are being eaten by snakes." This statement represents which type of delusion? a. Grandiose delusion b. Referential delusion c. Somatic delusion d. Persecutory delusion

c Somatic delusion Somatic delusions are generally vague and unrealistic beliefs about the client's health or bodily functions. Persecutory delusions involve the client's belief that "others" are planning to harm the client or are spying, following, or belittling the client in some way. Grandiose delusions are characterized by the client's claim to associated with famous people or celebrities or the client's belief that he or she is famous or capable of great feats. Referential delusions or ideas of reference involve the client's belief that television broadcasts, music, or newspaper articles have special meaning fro him or her.

Videbeck Ch.16 NCLEX-Style Chapter Review Questions 3. A client has been taking neuroleptic medications for many years as a treatment for schizophrenia. The client is exhibiting tongue protrusion, facial grimacing, and excessive blinking. These manifestations are characteristic of which extrapyramidal side effects (EPS). a. Neuroleptic malignant syndrome b. Dystonia c. Tardive Dyskinesia d. Akathisia

c Tardive Dyskinesia Unusual movements of the tongue, neck, and arms suggest tardive dyskinesia, an adverse reaction to neuroleptic medication. Dystonia is characterized by cramps and rigidity of the tongue, face, neck, and back muscles. Neuroleptic malignant syndrome causes rigidity, fever, hypertension, and diaphoresis. Akathisia causes restlessness, anxiety, and jitteriness.

Videbeck Ch.16 NCLEX-Style Chapter Review Questions 2. A client is watching the news and tells the nurse that the newscaster is sending a message to him. What term is used to identify this symptom? a. flight of idea b. hallucination c. idea of reference d. delusion

c idea of reference Ideas of reference refers to the mistaken belief that external events have special meaning to the individual, such as the television newscaster sending a message directly to the individual. A delusion is a false belief. A hallucination is a sensory perception, such as hearing voices and seeing objects, that only the client experiences. Flight of ideas is a speech pattern in which the client skips from one unrelated subject to another.

Videbeck Ch.16 NCLEX-Style Chapter Review Questions 31. The nurse suspects that a client is experiencing a brief psychotic pisode based on which of the following? Select all that apply. a. Gradual onset of symptoms b. Mild confusion c. Evidence of hallucinations d. Recent life stressor e. Intense changes in affect

c,d,e Evidence of hallucinations, Recent life stressor, Intense changes in affect In brief psychotic disorder, the length of the episode is at least 1 day but less than 1 month. The onset is sudden and includes at least one of the positive symptoms of criteria A for schizophrenia (delusions or hallucinations). The person generally experiences overwhelming confusion and rapid, intense shifts of affect (APA, 2013). Brief psychotic disorder can often occur in the context of a recent life stressor such as giving birth.

Videbeck Ch.16 NCLEX-Style Chapter Review Questions 5. A client diagnosed with schizophrenia has been prescribed clozapine (Clozaril). Which of the following is a potentially fatal side effect of this medication? a. Dystonia b. Tardive dyskinesia c. Neuroleptic malignant syndrome d. Agranulocytosis

d Agranulocytosis Agranulocytosis is manifested by a failure of the bone marrow to produce adequate white blood cells. Neuroleptic malignant syndrome is a life-threatening reaction to neuroleptic medication that requires immediate treatment. Tardive dyskinesia causes involuntary movements of the tongue, mouth, facial muscles, and arm and leg muscles. Dystonia is characterized by cramps and rigidity of the tongue, face, neck, and back muscles.

Videbeck Ch.16 Chapter Study Guide pg.293-294 Multiple Choice Questions 1. The family of a client with schizophrenia asks the nurse about the difference between conventional and atypical antipyschotic medications. The nurse's answer is based on which of the following? a. Atypical antipsychotics are newer medications but act in the same ways as conventional antipsychotics. b. Atypical antipsychotics are newer medications but act in the same ways as conventional antipsychotics. c. Conventional antipsychotics have serious side effects; atypical antipsychotics have virtually no side effects. d. Atypical antipsychotics are dopamine and serotonin antagonists; conventional antipsychotics are only dopamine antagonists.

d Atypical antipsychotics are dopamine and serotonin antagonists; conventional antipsychotics are only dopamine antagonists.

Videbeck Ch.16 Chapter Study Guide pg.293-294 Multiple Choice Questions 3. The nurse is caring for a client who has been taking fluphenazine (Prolixin) for 2 days. The client suddenly cries out, his neck twists to one side, and his eyes appear to roll back in the sockets. The nurse finds the following PRN medications ordered for the client. Which one should the nurse administer? a. Benztropine (Cogentin), 2 mg PO, bid, PRN b. Fluphenazine (Prolixin), 2 mg PO, tid, PRN c. Haloperidol (Haldol), 5 mg IM, PRN ectreme agitation d. Diphenhydramine (Benadryl), 25 mg IM, PRN

d Diphenhydramine (Benadryl), 25 mg IM, PRN

Videbeck Ch.16 NCLEX-Style Chapter Review Questions 28. A client with schizophrenia is exhibiting disorganized behavior. Which of the following would the nurse most likely observe? a. Neologism b. Tangentiality c. Echolalia d. Echopraxia

d Echopraxia Echopraxia, or the involuntary imitation of another person's movements and gestures, is a disorganized behavior. Neologism, echolalia, and tangeniality reflect disorganized thinking.

Videbeck Ch.16 NCLEX-Style Chapter Review Questions 24. 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 education was effective when they state that which of the following should be reported immediately? a. Tremor b. Weight gain c. Decreased blood pressure d. Elevated temperature

d Elevated temperature Clients receiving antipsychotic therapy need to be alerted to the potential for complications, including neuroleptic malignant syndrome, a life-threatening condition that can occur with antipsychotic agents. This syndrome is manifested by severe muscle rigidity and elevated temperature that can rapidly accelerate. The nurse should instruct the client to seek immediate care if an elevated temperature develops. Tremor also should be reported, but this is not a life-threatening manifestation. Decreased blood pressure and weight gain can occur with antipsychotic agents, but these are not life threatening.

Videbeck Ch.16 Chapter Study Guide pg.293-294 Multiple Choice Questions 7. The overall goal of psychiatric rehabilitation is for the client to gain a. control of symptoms b. freedom from hospitalization c. management of anxiety d. recovery from the illness

d Recovery from the illness

Videbeck Ch.16 NCLEX-Style Chapter Review Questions 18. The nurse is evaluating the plan of care for a client with schizophrenia. Which of the following observations best suggest that the plan has been effective? a. The client reports that she no longer has hallucinations. b. The client no longer believes that she has special powers. c. The client has been compliant with taking her medications and attending therapy session. d. The client has resumed employment had has been attending social functions at the community center.

d The client has resumed employment had has been attending social functions at the community center. Major goals for the care of a client with schizophrenia are to experience improved thought processes and fewer psychotic symptoms, to not engage in violent behavior, to acquire improved social skills and engage in satisfying social interaction, and to gain knowledge about the disease process and treatment.

Videbeck Ch.16 NCLEX-Style Chapter Review Questions 6. Cients receiving clozapine (Clozaril) must get white blood cell counts drawn every.. a. Year b. 3 months c. 6 months d. Week for the first 6 months

d Week for the first 6 months Clients taking this antipsychotic must have weekly white blood cell counts for the first 6 months of clozapine therapy and every 2 weeks thereafter.

Videbeck Ch.16 NCLEX-Style Chapter Review Questions 25. A client diagnosed with schizoaffective disorder and severe depression is being treated with antipsychotic medications. The client tells the nurse about difficulty with self-care activities. with which of the following interventions should the nurse respond? a. contact the physician for a change in medications b. gain assistance from family members c. outline the side effects of the medications d. establish a routine and set goals

d establish a routine and set goals The most useful approach for the nurse to try is to help the client establish a routine and set goals for accomplishing the activities of daily living.