thought disorder practice questions

A client with schizophrenia is prescribed second-generations antipsychotic. The client's mother asks, "About how long will it take until we see any changes in his symptoms?" Which response by the nurse would be most appropriate? 1. "Generally, it takes about one to two weeks to be effective in changing symptoms" 2. "You should see improvement in about 36 to 48 hours" 3. "His symptoms should subside almost immediately" 4. "It will take about 6 to 12 weeks until the drug is effective"

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

Positive symptoms of schizophrenia, specifically hallucinations and delusions, are thought to be caused by hyperactivity of which neurotransmitter? 1. Dopamine 2. Norepinephrine 3. Acetylcholine 4. Epinephrine

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

A nurse is assessing a client diagnosed with schizophrenia. The nurse suspects that the client may be experiencing water intoxication based on which finding? SATA 1. Emotional lability 2. Enhanced attention span 3. Muscle twitching 4. Increase in hallucinations 4. Irritability

1. Emotional lability 3. Muscle twitching 4. Increase in hallucinations 4. Irritability Findings associated with water intoxication include muscle twitching, irritability, increased psychotic symptoms such as hallucinations, and lability. Enhanced attention is not associated with water intoxication

A client with schizophrenia is prescribed clozapine (Clozaril). The nurse would monitor the client closely for specific signs of which of the following? 1. Infection 2. Hypotension 3. Nausea 4. Weight loss

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

Which of the following are key diagnostic criteria of schizophrenia? SATA 1. One or more major areas of social or occupational functioning markedly below previously achieved levels 2. Continuous signs for at least six months 3. Delusions present for a significant portion of time during a one-month period 4. Major depression occurring concurrently with active symptoms 5. A direct physiologic effect of a substance or medical condition

1. One or more major areas of social or occupational functioning markedly below previously achieved levels 2. Continuous signs for at least six months 3. Delusions present for a significant portion of time during a one-month period Key diagnostic criteria includes continuous signs for at least six months, one or more major areas of social or occupational functioning markedly below previously achieved levels, and delusions present for a significant portion of time during a one-month period. Other criteria include the absence, or insignificant duration, of major depressive, manic, or mixed episodes occurring concurrently with active symptoms, and that the disease is not a direct physiologic effect of a substance or medical condition

Which of the following is considered a first-generation antipsychotic drug used to treat psychosis in the United States? 1. fluphenazine (Proxlixin) 2. clozapine (Clozaril) 3. olanzapine (Zyprexa) 4. aripiprazole (Abilify)

1. fluphenazine (Proxlixin) Fluphenazine (Proxlixin) is a first-generation antipsychotic medication. Abilify, Clozaril, and Zyprexa are second-generation antipsychotics

When investigating biologic theories related to schizophrenia, which of the following neuroanatomic findings would be consistent with this mental health disorder? 1. Enlarged hippocampus 2. Enlarged lateral ventricle 3. Smaller third ventricle 4. Enlarged brain volume

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

A client diagnosed with schizophrenia is in anticholinergic crisis. The nurse would expect which finding to be noted upon assessment? 1. Bradycardia 2. Facial flushing 3. Incontinence 4. Hypothermia

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

Which of the following would the nurse expect to administer to a client with schizophrenia who is experiencing a dystonic reaction? 1. Risperidone (Risperdal) 2. Trihexyphenidyl (Artane) 3. Benztropine (Cogentin) 4. Aripiprazole (Abilify)

3. Benztropine (Cogentin) A client experiencing a dystonic reaction should receive immediate treatment with benztropine (Cogentin). Risperidone (Risperdal) and aripiprzole (Abilify) are antipsychotics that may cause dystonic reactions. Trihexyphenidyl (Artane) is used to treat Parkinsonism due to antipsychotic drugs

After teaching a group of nursing students about neurotransmitters associated with schizophrenia, the nursing instructor determines that the education was successful when the students verify which of the following as playing a role in the positive symptoms of schizophrenia? 1. Glutamate 2. Serotonin 3. Dopamine 4. Gamma-aminobutyric acid (GABA)

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

Clients diagnosed with schizophrenia may experience disordered water balance that may lead to water intoxication. Which of the following may occur as a result of water intoxication? 1. Oliguria 2. Hypernatremia 3. Hyponatremia 4. Weight loss

3. Hyponatremia Hyponatremia is a life-threatening complication of unknown cause. When a client ingests an unusually large volume of water, the kidneys' capacity to excrete water is overwhelmed, and serum sodium levels rapidly fall below the normal range of 135 to 145 mEq/L, to a neurological signs such as muscle twitching and irritability, and the client is at risk for seizures, coma or possible death. Polyuria and increased diurnal weight gain may occur.

A client with schizophrenia is experiencing delusions. The client states, "There's a huge apocalypse coming and an end of the world is near." The nurse interprets this statement as which type of delusion? 1. Somatic 2. Grandiose 3. Nihilistic 4. Persecutory

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

A client diagnosed with schizophrenia is having delusions that he is being plotted against by the government. This would be documented as which of the following types of delusion? 1. Somatic 2. Grandiose 3. Persecutory 4. Nihilistic

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

Which of the following is an anticholinergic side effect associated with some antipsychotic medications? 1. Increased tearing 2. Salivation 3. Photophobia 4. Diarrhea

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

A client has been prescribed clozapine (Clozaril) for treatment of schizophrenia. The patient must be taught to monitor which blood levels weekly while taking this drug? 1. Platelets 2. Hemoglobin 3. WBC 4. Hematocrit

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

When preparing a class presentation about schizophrenia, which of the following would the nurse most likely include? 1. Delusions are more commonly noted in younger children with schizophrenia 2. Schizophrenia is more commonly diagnosed in children than in adolescents 3. Very few individuals with schizophrenia reach older adulthood 4. Improvement in symptoms can occur as a client with a history of schizophrenia reaches older adulthood

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

Which of the following extrapyramidal side effects is noted by the client having bradykinesia and a shuffling gait? 1. Tardive dyskinesia 2. Akathisia 3. Acute dystonia 4. Pseudoparkinsonism

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

A family member asks you, "As both of my siblings have schizophrenia, why are my brother's symptoms so different from my sister's? He withdraws when there's a change in his environment or routine. She starts cursing and yelling about the Mafia and the CIA when I do something that's less than perfect." Based on your knowledge, your response should address: A The many differences in the presentation of schizophrenia. B The significance of paranoid content in the differential diagnosis of paranoid schizophrenia. C The typical progression of symptoms within an individual over time. D The effect of gender on clinical presentation in schizophrenia.

A

If clozapine (Clozaril) therapy is being considered, the nurse should evaluate which laboratory test to establish a baseline for comparison in order to recognize a potentially life-threatening side effect? A. White blood cell count B. Liver function studies C. Creatinine clearance D. Blood urea nitrogen

ANS: A The nurse should establish a baseline white blood cell count to evaluate a potentially life-threatening side effect if clozapine (Clozaril) is being considering as a treatment option. Clozapine can have a serious side effect of agranulocytosis in which a potentially fatal drop in white blood cells can occur.

After taking chlorpromazine (Thorazine) for 1 month, a client presents to an emergency department (ED) with severe muscle rigidity, tachycardia, and a temperature of 105oF (40.5C). The nurse expects the physician to recognize which condition and implement which treatment? A. Neuroleptic malignant syndrome and treat by discontinuing Thorazine and administering dantrolene (Dantrium) B. Neuroleptic malignant syndrome and treat by increasing Thorazine dosage and administering an antianxiety medication C. Dystonia and treat by administering trihexyphenidyl (Artane) D. Dystonia and treat by administering bromocriptine (Parlodel)

ANS: A The nurse should expect that an ED physician would diagnose the client with neuroleptic malignant syndrome and treat the client by discontinuing chlorpromazine (Thorazine) and administering dantrolene (Dantrium). Neuroleptic malignant syndrome is a potentially fatal condition characterized by muscle rigidity, fever, altered consciousness, and autonomic instability. The use of typical antipsychotics is largely being replaced by atypical antipsychotics due to fewer side effects and lower risks.

A 16-year-old-client diagnosed with paranoid schizophrenia experiences command hallucinations to harm others. The client's parents ask a nurse, "Where do the voices come from?" Which is the appropriate nursing reply? A. "Your child has a chemical imbalance of the brain which leads to altered thoughts." B. "Your child's hallucinations are caused by medication interactions." C. "Your child has too little serotonin in the brain causing delusions and hallucinations." D. "Your child's abnormal hormonal changes have precipitated auditory hallucinations."

ANS: A The nurse should explain that a chemical imbalance of the brain leads to altered thought processes. Hallucinations, or false sensory perceptions, may occur in all five senses. The client who hears voices is experiencing an auditory hallucination.

A client diagnosed with schizophrenia is prescribed clozapine (Clozaril). Which client symptoms related to the side effects of this medication should prompt a nurse to intervene immediately? A. Sore throat, fever, and malaise B. Akathisia and hypersalivation C. Akinesia and insomnia D. Dry mouth and urinary retention

ANS: A The nurse should intervene immediately if the client experiences a sore throat, fever, and malaise when taking the atypical antipsychotic drug clozapine (Clozaril). Clozapine can have a serious side effect of agranulocytosis, in which a potentially fatal drop in white blood cells can occur. Symptoms of infectious processes would alert the nurse to this potential.

Which statement should indicate to a nurse that an individual is experiencing a delusion? A. "There's an alien growing in my liver." B. "I see my dead husband everywhere I go." C. "The IRS may audit my taxes." D. "I'm not going to eat my food. It smells like brimstone."

ANS: A The nurse should recognize that a client who claims that an alien is inside his or her body is experiencing a delusion. Delusions are false personal beliefs that are inconsistent with the person's intelligence or cultural background.

3. A patient with paranoid schizophrenia is hospitalized after arguing with co-workers and threatening to harm them. The patient is aloof and suspicious and says, "Two staff members I saw talking were plotting to kill me." Based on data gathered at this point, which nursing diagnoses relate? Select all that apply.

ANS: A, B a. Risk for other-directed violence b. Disturbed thought processes

Laboratory results reveal decreased levels of prolactin in a client diagnosed with schizophrenia. When assessing the client, which symptoms should a nurse expect to observe?(Select all that apply.) A. Apathy B. Social withdrawal C. Anhedonia D. Auditory hallucinations E. Delusions

ANS: A, B, C The nurse should expect that a client with decreased levels of prolactin would experience apathy, social withdrawal, and anhedonia. Decreased levels of prolactin can cause depression which would result in the above symptoms.

Which of the following components should a nurse recognize as an integral part of a rehabilitative program when planning care for clients diagnosed with schizophrenia? (Select all that apply.) A. Group therapy B. Medication management C. Deterrent therapy D. Supportive family therapy E. Social skills training

ANS: A, B, D, E The nurse should recognize that group therapy, medication management, supportive family therapy, and social skills training all play an integral part in rehabilitative programs for clients diagnosed with schizophrenia. Schizophrenia results from various combinations of genetic predispositions, biochemical dysfunctions, physiological factors, and psychological stress. Effective treatment requires a comprehensive, multidisciplinary effort.

A nurse is administering risperidone (Risperdal) to a client diagnosed with schizophrenia. The therapeutic effect of this medication would most effectively address which of the following symptoms? (Select all that apply.) A. Somatic delusions B. Social isolation C. Gustatory hallucinations D. Flat affect E. Clang associations

ANS: A, C, E The nurse should expect that risperidone (Risperdal) would be effective treatment for somatic delusions, gustatory hallucinations, and clang associations. Risperidone is an atypical antipsychotic that has been effective in the treatment of the positive symptoms of schizophrenia and in maintenance therapy to prevent exacerbation of schizophrenic symptoms.

1. The family members of a patient newly diagnosed with paranoid schizophrenia state that they do not understand what has caused the illness. The nurse's response should be based on which models? Select all that apply.

ANS: A, D a. Neurobiological d. Genetic

Which nursing behavior will enhance the establishment of a trusting relationship with a client diagnosed with schizophrenia? A. Establishing personal contact with family members. B. Being reliable, honest, and consistent during interactions. C. Sharing limited personal information. D. Sitting close to the client to establish rapport.

ANS: B The nurse can enhance the establishment of a trusting relationship with a client diagnosed with schizophrenia by being reliable, honest, and consistent during interactions. The nurse should also convey acceptance of the client's needs and maintain a calm attitude when dealing with agitated behavior.

During an admission assessment, a nurse asks a client diagnosed with schizophrenia, "Have you ever felt that certain objects or persons have control over your behavior?" The nurse is assessing for which type of thought disruption? A. Delusions of persecution B. Delusions of influence C. Delusions of reference D. Delusions of grandeur

ANS: B The nurse is assessing the client for delusions of influence when asking if the client has ever felt that objects or persons have control of the client's behavior. Delusions of control or influence are manifested when the client believes that his or her behavior is being influenced. An example would be if a client believes that a hearing aid receives transmissions that control personal thoughts and behaviors.

A client diagnosed with schizophrenia tells a nurse, "The 'Shopatouliens' took my shoes out of my room last night." Which is an appropriate charting entry to describe this client's statement? A. "The client is experiencing command hallucinations." B. "The client is expressing a neologism." C. "The client is experiencing a paranoid delusion." D. "The client is verbalizing a word salad."

ANS: B The nurse should describe the client's statement as experiencing a neologism. A neologism is when a client invents a new word that is meaningless to others but may have symbolic meaning to the client. Word salad refers to a group of words that are put together randomly.

A client has been recently admitted to an inpatient psychiatric unit. Which intervention should the nurse plan to use to reduce the client's focus on delusional thinking? A. Present evidence that supports the reality of the situation B. Focus on feelings suggested by the delusion C. Address the delusion with logical explanations D. Explore reasons why the client has the delusion

ANS: B The nurse should focus on the client's feelings rather than attempt to change the client's delusional thinking by the use of evidence or logical explanations. Delusional thinking is usually fixed, and clients will continue to have the belief in spite of obvious proof that the belief is false or irrational.

A paranoid client presents with bizarre behaviors, neologisms, and thought insertion. Which nursing action should be prioritized to maintain this client's safety? A. Assess for medication noncompliance B. Note escalating behaviors and intervene immediately C. Interpret attempts at communication D. Assess triggers for bizarre, inappropriate behaviors

ANS: B The nurse should note escalating behaviors and intervene immediately to maintain this client's safety. Early intervention may prevent an aggressive response and keep the client and others safe.

A nurse is caring for a client who is experiencing a flat affect, paranoid delusions, anhedonia, anergia, neologisms, and echolalia. Which statement correctly differentiates the client's positive and negative symptoms of schizophrenia? A. Paranoid delusions, anhedonia, and anergia are positive symptoms of schizophrenia. B. Paranoid delusions, neologisms, and echolalia are positive symptoms of schizophrenia. C. Paranoid delusions, anergia, and echolalia are negative symptoms of schizophrenia. D. Paranoid delusions, flat affect, and anhedonia are negative symptoms of schizophrenia.

ANS: B The nurse should recognize that positive symptoms of schizophrenia include paranoid delusions, neologisms, and echolalia. The negative symptoms of schizophrenia include flat affect, anhedonia, and anergia. Positive symptoms reflect an excess or distortion of normal functions. Negative symptoms reflect a decrease or loss of normal functions.

A college student has quit attending classes, isolates self due to hearing voices, and yells accusations at fellow students. Based on this information, which nursing diagnosis should the nurse prioritize? A. Altered thought processes R/T hearing voices AEB increased anxiety B. Risk for other-directed violence R/T yelling accusations C. Social isolation R/T paranoia AEB absence from classes D. Risk for self-directed violence R/T depressed mood

ANS: B The nursing diagnosis that must be prioritized in this situation should be risk for other-directed violence R/T yelling accusations. Hearing voices and yelling accusations indicates a potential for violence, and this potential safety issue should be prioritized.

2. A nurse at the mental health clinic plans a series of psychoeducational groups for persons with schizophrenia. Which two topics would take priority?

ANS: B, E b. The importance of correctly taking your medication e. Ways to quit smoking

A newly admitted client has taken thioridazine (Mellaril) for 2 years with good symptom control. Symptoms exhibited on admission included paranoid delusions and hallucinations. The nurse should recognize which potential cause for the return of these symptoms? A. The client has developed tolerance to the antipsychotic medication. B. The client has not taken the medication with food. C. The client has not taken the medication as prescribed. D. The client has combined alcohol with the medication.

ANS: C Altered thinking can affect a client's insight into the necessity for taking antipsychotic medications consistently. When symptoms are no longer bothersome, clients may stop taking medications that cause disturbing side effects. Clients may miss the connection between taking the medications and an improved symptom profile.

A client states, "I hear voices that tell me that I am evil." Which outcome related to these symptoms should the nurse expect this client to accomplish by discharge? A. The client will verbalize the reason the voices make derogatory statements. B. The client will not hear auditory hallucinations. C. The client will identify events that increase anxiety and illicit hallucinations. D. The client will positively integrate the voices into the client's personality structure.

ANS: C It is unrealistic to expect the client to completely stop hearing voices. Even when compliant with antipsychotic medications, clients may still hear voices. It would be realistic to expect the client to associate stressful events with an increase in auditory hallucinations. By this recognition the client can anticipate symptoms and initiate appropriate coping skills.

A client diagnosed with schizophrenia states, "Can't you hear him? It's the devil. He's telling me I'm going to hell." Which is the most appropriate nursing reply? A. "Did you take your medicine this morning?" B. "You are not going to hell. You are a good person." C. "I'm sure the voices sound scary. The devil is not talking to you. This is part of your illness." D. "The devil only talks to people who are receptive to his influence."

ANS: C The most appropriate reply by the nurse is to reassure the client with an accepting attitude while not reinforcing the hallucination. Reminding the client that "the voices" are a part of his or her illness is a way to help the client accept that the hallucinations are not real.

Parents ask a nurse how they should reply when their child, diagnosed with paranoid schizophrenia, tells them that voices command him to harm others. Which is the appropriate nursing reply? A. "Tell him to stop discussing the voices." B. "Ignore what he is saying, while attempting to discover the underlying cause." C. "Focus on the feelings generated by the hallucinations and present reality." D. "Present objective evidence that the voices are not real."

ANS: C The most appropriate response by the nurse is to instruct the parents to focus on the feelings generated by the hallucinations and present reality. The parents should maintain an attitude of acceptance to encourage communication but should not reinforce the hallucinations by exploring details of content. It is inappropriate to present logical arguments to persuade the client to accept the hallucinations as not real.

An aging client diagnosed with chronic schizophrenia takes an antipsychotic and a beta-adrenergic blocking agent (propranolol) for hypertension. Understanding the combined side effects of these drugs, which statement by a nurse is most appropriate? A. "Make sure you concentrate on taking slow, deep, cleansing breaths." B. "Watch your diet and try to engage in some regular physical activity." C. "Rise slowly when you change position from lying to sitting or sitting to standing." D. "Wear sunscreen and try to avoid midday sun exposure."

ANS: C The most appropriate statement by the nurse is to instruct the client to rise slowly when changing positions. Antipsychotic medications and beta blockers cause a decrease in blood pressure. When given in combination, this side effect places the client at risk for developing orthostatic hypotension.

A client diagnosed with paranoid schizophrenia states, "My psychiatrist is out to get me. I'm sad that the voice is telling me to stop him." What symptom is the client exhibiting, and what is the nurse's legal responsibility related to this symptom? A. Magical thinking; administer an antipsychotic medication B. Persecutory delusions; orient the client to reality C. Command hallucinations; warn the psychiatrist D. Altered thought processes; call an emergency treatment team meeting

ANS: C The nurse should determine that the client is exhibiting command hallucinations. The nurse's legal responsibility is to warn the psychiatrist of the potential for harm. A client who is demonstrating a risk for violence could potentially become physically, emotionally, and/or sexually harmful to others or to self.

A client diagnosed with schizophrenia is slow to respond and appears to be listening to unseen others. Which medication should a nurse expect a physician to order to address this type of symptom? A. Haloperidol (Haldol) to address the negative symptom B. Clonazepam (Klonopin) to address the positive symptom C. Risperidone (Risperdal) to address the positive symptom D. Clozapine (Clozaril) to address the negative symptom

ANS: C The nurse should expect the physician to order risperidone (Risperdal) to address the positive symptoms of schizophrenia. Risperidone (Risperdal) is an atypical antipsychotic used to reduce positive symptoms, including disturbances in content of thought (delusions), form of thought (neologisms), or sensory perception (hallucinations).

A client diagnosed with schizoaffective disorder is admitted for social skills training. Which information should be taught by the nurse? A. The side effects of medications B. Deep breathing techniques to decrease stress C. How to make eye contact when communicating D. How to be a leader

ANS: C The nurse should plan to teach the client how to make eye contact when communicating. Social skills, such as making eye contact, can assist clients in communicating needs and maintaining connectedness.

A client diagnosed with psychosis NOS (not otherwise specified) tells a nurse about voices telling him to kill the president. Which nursing diagnosis should the nurse prioritize for this client? A. Disturbed sensory perception B. Altered thought processes C. Risk for violence: directed toward others D. Risk for injury

ANS: C The nurse should prioritize the diagnosis risk for violence: directed toward others. A client who hears voices telling him to kill someone is at risk for responding and reacting to the command hallucination. Other risk factors for violence include aggressive body language, verbal aggression, catatonic excitement, and rage reactions.

A client is diagnosed with schizophrenia. A physician orders haloperidol (Haldol) 50 mg bid, benztropine (Cogentin) 1 mg prn, and zolpidem (Ambien) 10 mg HS. Which client behavior would warrant the nurse to administer benztropine? A. Tactile hallucinations B. Tardive dyskinesia C. Restlessness and muscle rigidity D. Reports of hearing disturbing voices

ANS: C The symptom of tactile hallucinations and reports of hearing disturbing voices would be addressed by an antipsychotic medication such as haloperidol. Tardive dyskinesia, a potentially irreversible condition, would warrant the discontinuation of an antipsychotic medication such as haloperidol. An anticholinergic medication such as benztropine would be used to treat the extrapyramidal symptoms of restlessness and muscle rigidity.

A client diagnosed with schizophrenia takes an antipsychotic agent daily. Which assessment finding should a nurse immediately report to the client's attending psychiatrist? A. Respirations of 22 beats/minute B. Weight gain of 8 pounds in 2 months C. Temperature of 104F (40C) D. Excessive salivation

ANS: C When assessing a client diagnosed with schizophrenia who takes an antipsychotic agent daily, the nurse should immediately address a temperature of 104F (40C). A temperature this high can be a symptom of the rare but life-threatening neuroleptic malignant syndrome.

Which nursing intervention would be most appropriate when caring for an acutely agitated client diagnosed with paranoid schizophrenia? A. Provide neon lights and soft music. B. Maintain continual eye contact throughout the interview. C. Use therapeutic touch to increase trust and rapport. D. Provide personal space to respect the client's boundaries.

ANS: D The most appropriate nursing intervention is to provide personal space to respect the client's boundaries. Providing personal space may serve to reduce anxiety and thus reduce the client's risk for violence.

A nurse is assessing a client diagnosed with paranoid schizophrenia. The nurse asks the client, "Do you receive special messages from certain sources, such as the television or radio?" Which potential symptom of this disorder is the nurse assessing? A. Thought insertion B. Paranoid delusions C. Magical thinking D. Delusions of reference

ANS: D The nurse is assessing for the potential symptom of delusions of reference. A client who believes that he or she receives messages through the radio is experiencing delusions of reference. When a client experiences these delusions, he or she interprets all events within the environment as personal references.

A client diagnosed with chronic schizophrenia presents in an emergency department (ED) with uncontrollable tongue movements, stiff neck, and difficulty swallowing. The nurse would expect the physician to recognize which condition and implement which treatment? A. Neuroleptic malignant syndrome and treat by discontinuing antipsychotic medications B. Agranulocytosis and treat by administration of clozapine (Clozaril) C. Extrapyramidal symptoms and treat by administration of benztropine (Cogentin) D. Tardive dyskinesia and treat by discontinuing antipsychotic medications

ANS: D The nurse should expect that an ED physician would diagnose the client with tardive dyskinesia and discontinue antipsychotic medications. Tardive dyskinesia is a condition of abnormal involuntary movements of the mouth, tongue, trunk, and extremities that can be an irreversible side effect of typical antipsychotic medications.

During an admission assessment, a nurse notes that a client diagnosed with schizophrenia has allergies to penicillin, prochlorperazine (Compazine), and bee stings. Based on this assessment data, which antipsychotic medication would be contraindicated? A. Haloperidol (Haldol), because it is used only in elderly patients B. Clozapine (Clozaril), because of a cross-sensitivity to penicillin C. Risperidone (Risperdal), because it exacerbates symptoms of depression D. Thioridazine (Mellaril), because of cross-sensitivity among phenothiazines

ANS: D The nurse should know that thioridazine (Mellaril) would be contraindicated because of cross-sensitivity among phenothiazines. Prochlorperazine (Compazine) and thioridazine are both classified as phenothiazines.

29. A patient with schizophrenia has been stable for a year; however, the family now reports the patient is tense, sleeps 3 to 4 hours per night, and has difficulty concentrating. The patient says, "Volmers are hiding in the house." The nurse can correctly assess this information as an indication of:

ANS: D) relapse

18. A patient with schizophrenia is acutely disturbed and violent. After several doses of haloperidol (Haldol), the patient is calm. Two hours later the nurse sees the patient's head rotated to one side in a stiff position; the lower jaw is thrust forward, and the patient is drooling. Which problem is most likely?

ANS: a. Acute dystonic reaction

19. An acutely violent patient with schizophrenia receives several doses of haloperidol (Haldol). Two hours later the nurse notices the patient's head rotated to one side in a stiffly fixed position; the lower jaw is thrust forward, and the patient is drooling. Which intervention by the nurse is indicated?

ANS: a. Administer diphenhydramine (Benadryl) 50 mg IM from the PRN medication administration record.

13. A patient with delusions of persecution about being poisoned has refused all hospital meals for 3 days. Which intervention is most likely to be acceptable to the patient?

ANS: a. Allowing the patient to have supervised access to food vending machines

28. The family of a patient with undifferentiated schizophrenia is unfamiliar with the illness and the family's role in recovery. Which type of therapy should the nurse recommend?

ANS: a. Psychoeducational

4. When a patient with paranoid schizophrenia was discharged 6 months ago, haloperidol (Haldol) was prescribed. The patient now says, "I stopped taking those pills. They made me feel like a robot." What common side effects should the nurse validate with the patient?

ANS: a. Sedation and muscle stiffness

5. A nurse works with a patient with paranoid schizophrenia regarding the importance of medication management. The patient repeatedly says, "I don't like taking pills." Family members say they feel helpless to foster compliance. Which treatment strategy should the nurse discuss with the health care provider?

ANS: a. Use of a long-acting antipsychotic preparation

14. A community mental health nurse wants to establish a relationship with a very withdrawn patient diagnosed with schizophrenia. The patient lives at home with a supportive family. Select the nurse's best plan.

ANS: a. Visit daily for 4 days, then visit every other day for 1 week; stay with the patient for 20 minutes; accept silence; state when the nurse will return.

23. What assessment findings mark the prodromal stage of schizophrenia?

ANS: a. Withdrawal, misinterpreting, poor concentration, & preoccupation with religion

30. A patient with schizophrenia begins to talks about "volmers" hiding in the warehouse at work. The term "volmers" should be documented as:

ANS: a. neologism

1. A person has had difficulty keeping a job because of arguing with co-workers and accusing them of conspiracy. Today the person shouts, "They're all plotting to destroy me. Isn't that true?" Select the nurse's most therapeutic response.

ANS: b. "Feeling that people want to destroy you must be very frightening."

3. A patient diagnosed with paranoid schizophrenia says, "My co-workers are out to get me. I also saw two doctors plotting to kill me." How does this patient perceive the environment?

ANS: b. Dangerous

6. A patient's care plan includes monitoring for auditory hallucinations. Which assessment findings suggest the patient may be hallucinating?

ANS: b. Darting eyes, tilted head, mumbling to self

9. A patient with catatonic schizophrenia exhibits little spontaneous movement and demonstrates waxy flexibility. Which patient needs are of priority importance?

ANS: b. Physiologic

22. Which symptoms are expected for a patient with disorganized schizophrenia?

ANS: b. Social withdrawal and ineffective communication

20. A patient has taken trifluoperazine (Stelazine) 30 mg/day orally for 3 years. The clinic nurse notes that the patient grimaces and constantly smacks both lips. The patient's neck and shoulders twist in a slow, snakelike motion. Which problem would the nurse suspect?

ANS: b. Tardive dyskinesia

11. A nurse observes a patient who is in a catatonic state and standing immobile, facing the wall with one arm extended in a salute. The patient remains immobile in this position for 15 minutes, moving only when the nurse gently lowers the arm. What is the name of this phenomenon?

ANS: b. Waxy flexibility

34. A patient with schizophrenia begins a new prescription for lurasidone HCl (Latuda). The patient is 5', 6" tall and currently weighs 204 pounds. Which topic is most important for the nurse to include in the teaching plan related to this medication?

ANS: b. Weight management strategies

2. A newly admitted patient diagnosed with paranoid schizophrenia is hypervigilant and constantly scans the environment. The patient states, "I saw two doctors talking in the hall. They were plotting to kill me." The nurse may correctly assess this behavior as:

ANS: b. idea of reference

27. A patient with schizophrenia has taken a conventional antipsychotic medication for a year. Hallucinations are less intrusive, but the patient continues to have apathy, poverty of thought, and social isolation. The nurse expects a change to which medication?

ANS: b. olanzapine (Zyprexa)

10. A patient with catatonic schizophrenia is semistuporous, demonstrates little spontaneous movement, and has waxy flexibility. The patient's activities of daily living are severely compromised. An appropriate outcome is that the patient will:

ANS: b. perform self-care activities with coaching by the end of day 3.

16. A newly admitted patient with schizophrenia says, "The voices are bothering me. They yell and tell me I'm bad. I have got to get away from them." Select the nurse's most helpful reply.

ANS: c. "I'll stay with you. Focus on what we are talking about, not the voices."

35. A patient with schizophrenia has auditory hallucinations, delusions of grandeur, poor personal hygiene, and motor agitation. Which assessment finding would the nurse regard as a negative symptom of schizophrenia?

ANS: c. Poor personal hygiene

17. A patient with schizophrenia has taken fluphenazine (Prolixin) 5 mg orally twice daily for 3 weeks. The nurse now assesses a shuffling propulsive gait, a masklike face, and drooling. Which term applies to these symptoms?

ANS: c. Pseudoparkinsonism

8. A patient with schizophrenia tells the nurse, "I eat skiller. Tend to end. Easter. It blows away. Get it?" Select the nurse's best response.

ANS: d. "I am having difficulty understanding what you are saying."

32. A patient with schizophrenia and auditory hallucinations anxiously tells the nurse, "The voice is telling me to do things." Select the nurse's priority assessment question.

ANS: d. "What is the voice telling you to do?"

21. A nurse sits with a patient diagnosed with disorganized schizophrenia. The patient starts to laugh uncontrollably, although the nurse has not said anything funny. Select the nurse's best response.

ANS: d. "You're laughing. Tell me what's happening."

12. Which patient with schizophrenia would be expected to have the lowest score in global assessment of functioning?

ANS: d. 40 years old; disorganized schizophrenia since age 18; frequent relapses

26. A patient diagnosed with disorganized schizophrenia says, "It's beat. Time to eat. No room for the cat." What type of verbalization is evident?

ANS: d. Associative looseness

15. Withdrawn patients with schizophrenia:

ANS: d. Avoid relationships because they become anxious with emotional closeness.

33. A patient receiving risperidone (Risperdal) reports severe muscle stiffness at 10:30 AM. By noon, the patient has difficulty swallowing and is drooling. By 4:00 PM, vital signs are body temperature, 102.8° F; pulse, 110 beats per minute; respirations, 26 breaths per minute; and blood pressure, 150/90 mm Hg. The patient is diaphoretic. Select the nurse's best analysis and action.

ANS: d. Neuroleptic malignant syndrome. Immediately notify the health care provider.

24. A patient with schizophrenia says, "Contagious bacteria are everywhere. When they get in your body, you will be locked up with other infected people." Which problem is evident?

ANS: d. Paranoia

7. A health care provider considers which antipsychotic medication to prescribe for a patient with schizophrenia who has auditory hallucinations and poor social functioning. The patient is also overweight and has hypertension. Which drug should the nurse advocate?

ANS: d. aripiprazole (Abilify)

31. A patient with schizophrenia anxiously says, "I can see the left side of my body merging with the wall, then my face appears and disappears in the mirror." While listening, the nurse should:

ANS: d. maintain a normal social interaction distance from the patient.

25. A patient diagnosed with paranoid schizophrenia angrily tells a nurse, "You act like a homosexual. No one trusts you or wants to be around you." Select the most likely analysis. The patient:

ANS: d. may be projecting homosexual urges.

Which family member statements demonstrate recognition of the effects of social pressures associated with schizophrenia? (Select all that apply.) A "If my family member would just move in with me, it would be a lot easier for me to maintain my household and care for my children." B "It would be great if my family member could identify somebody to trust and believe when that person says, 'Your symptoms are worse. Let's go to the psychiatrist.'" C "I'll attend a support group, but I'm afraid my family member will not go...s/he would rather try to 'pass' as not mentally ill." D "I'm going to help my family member figure out what to tell other family members, friends, and business associates about why he's been on medical leave." E "I used to protect my family member from a lot of the interpersonal conflicts in the family, but we need to express our emotions more openly."

B, C, D

A peer approaches you and shares her frustration with her older brother, who has had multiple hospitalizations with schizophrenia. "He used to show interest in me, but since his discharge 5 days ago, he just stares into space. I cannot get a reaction out of him." Which of the following statements impart accurate information? (Select all that apply.) A "Have you confronted him with this?" B "He may be demonstrating flattening of affect and anhedonia." C "He may have sedation or masked facial expressions from his medications." D "Maybe he's depressed about having a chronic illness." E "It's sad when a loved one does not have any feelings."

B,C, D

Which client statements demonstrate acknowledgment of the effects of psychological pressures associated with schizophrenia? (Select all that apply.) A "I just want to get back to what I was doing and put this whole episode behind me." B "If I can't stand the side effects, how will I ask my prescriber to change my medication?" C "I'm going to look for a job where I can use my college degree but have less day-to-day stress." D "Next month, my sister and I are going to write a grant proposal for a psychiatric day treatment/social center." E "I have designed a weekly schedule so that I can get tasks done and have planned time to relax."

B,C,E

A nurse is designing a relapse-prevention inpatient group for clients with schizophrenia. Which statement addresses a main category of nursing activities? A "We're going to discuss current events." B "Let's go around the room and have each person say something positive about our group." C "If you can increase your self-assessment skills, you'll be able to tell when you're getting more stressed." D "We will go around the room and each person will state a personal goal for today."

C

The client with schizophrenia is preparing for discharge. To minimize relapse, what is the most important feature of planning the client's aftercare? A Identification of two new ways to bolster self-esteem B Ensuring that the client lists three potential sources of social support C An accurate description of the medication regimen with a specific plan for obtaining refills D Identification of three new methods of spending leisure time

C

Which of the following client statements demonstrates the major symptoms of schizophrenia? A "I had too much to drink last night, started feeling all-powerful, and stupidly drove my truck into a tree." B "I've been depressed ever since our house was destroyed by fire." C "'A stitch in time saves nine' means that prevention is easier than fixing a real problem." D "You can read my mind. This light of mine will shine, fine; blinding world will end at nine."

D

While you are employed as a charge nurse on an inpatient psychiatric unit, you recognize that you are choosing to spend less time interacting with the clients with schizophrenia. Your first action is: A Discussing your observation with your clinical supervisor. B Requesting a transfer to another unit. C Forcing yourself to interact with the clients with schizophrenia. D Reflecting on your behavior.

D

You have presented your client with written aftercare medication directions: "Take one capsule three times per day." Your client informs you that she has reviewed the material. Which response specifically addresses your concerns about adherence? A "If you forget one dose, you can double the next one." B "Do you understand everything?" C "This medication really works best if you take one capsule three times per day." D "What might get in the way of your taking your medications?"

D

You overhear a family member discussing medication adherence with your client. Which of the following statements do you want to encourage the family member to reiterate? A "Your children are getting tired of watching you get sick every time you stop your meds." B "If you stop taking your medication, I'll take custody of your children." C "You should let these health care providers get you well. Why do you fight that?" D "Your support group encourages you to make healthy choices. Taking your meds is a healthy thing you can do every day, just like brushing your teeth."

D