Chapter 16

The nurse is working with a client with schizophrenia who has cognitive deficits. It is time for the client to get up and eat breakfast. Which statement by the nurse would be most effective in helping the client prepare for breakfast? "I'll expect you in the dining room in 20 minutes." "First, wash your face and brush your teeth. Then put your clothes on." "Stay right there and I'll get your clothes." "Why don't you stay here and I'll get your tray for you."

"First, wash your face and brush your teeth. Then put your clothes on."

A client tells the nurse that the client has bugs in the client's brain and asks the nurse if the nurse can see them. Which response by the nurse is most therapeutic? "No, I don't see any bugs. You seriously can't have any bugs in your brain." "No, I don't see any bugs. That sounds scary for you." "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?" "You have a thought 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."

"No, I don't see any bugs. That sounds scary for you."

The nurse is teaching a client with schizoaffective disorders (SAD) about the client's prescribed medication therapy. The nurse determines that additional education is needed when the client states what? "One day, I won't have to worry about taking any medication." "I need to change my position slowly when getting up from lying down." "I need to make sure that I drink enough fluids throughout the day." "If I notice any strange muscle movements, I should call my provider."

"One day, I won't have to worry about taking any medication."

The nurse working with a client who is newly diagnosed with schizophrenia would include which in the client's education? "Schizophrenia is an illness that involves neurotransmitters, more specifically dopamine." "Schizophrenia is caused by pathology in the cerebellum, and there are medications that are helpful in this area." "Schizophrenia has been found to be nonresponsive to medications, and we will work mostly on helping you with daily activities." "Schizophrenia is curable if the correct medication and dosages are achieved."

"Schizophrenia is an illness that involves neurotransmitters, more specifically dopamine."

After assessing a client with schizophrenia, the nurse notes that the client exhibits signs and symptoms related to being unable to experience pleasure. The nurse documents this finding as what? Diminished emotional expression Alogia Avolition Anhedonia

Anhedonia

A client was admitted to the psychiatric intensive care unit with schizophrenia. The client exhibits primarily disorganized behavior. In addition to hallucinations and delusions, other assessments that the nurse would expect to find include what? Blunted inappropriate affect, withdrawal, incoherence, and confusion Abnormal, bizarre posturing; stupor; echolalia; and negativism Hostility, aggression, persecutory hallucinations, and argumentativeness Depression, elation, hyperactivity, and pressure of speech

Blunted inappropriate affect, withdrawal, incoherence, and confusion

A client with schizoaffective disorder is engaging in an extremely long conversation about a current affairs in the world. The client goes on to provide the nurse with minute details. The nurse interprets this as suggesting what? Circumstantiality Neologism Verbigeration Clang association

Circumstantiality

The psychiatric nurse recognizes that a client's cultural background can contribute to the misdiagnosis of schizophrenia primarily for which reason? Clinicians diagnose culturally accepted beliefs as psychotic thinking Clients fail to communicate effectively as a result of language barriers Clients are often educationally disadvantaged Clinicians often lack knowledge of cultural psychiatric beliefs

Clinicians diagnose culturally accepted beliefs as psychotic thinking

Assessment of a client with schizophrenia reveals that the client is hearing voices that tell the client that people are staring at the client and that the client is seeing illusions. When developing the plan of care for this client, which nursing diagnosis would be most appropriate? Impaired memory Risk for self-directed violence Disturbed sensory perception Ineffective coping

Disturbed sensory perception

A client with schizophrenia is exhibiting hallucinations and delusions. The mental health nurse knows that these symptoms are associated with hyperactivity of which neurotransmitter? Dopamine Serotonin Gamma-aminobutyric acid (GABA) Norepinephrine

Dopamine

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

Dopamine

A client has been taking haloperidol for 5 years when the client is admitted to the inpatient unit for relapse of symptoms of schizophrenia. Upon assessment, the client demonstrates akathisia, dystonia, a stiff gait, and rigid posture. The nurse correctly identifies these symptoms are indicative of what? Psychosis Tardive dyskinesia Extrapyramidal side effects Progressed schizophrenia

Extrapyramidal side effects

A client with schizophrenia believes that the client has discovered how to jump to the moon. The nurse would document this belief as what? High self-esteem Grandiose delusion Paradoxical conduct Inappropriate affect

Grandiose delusion

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

Hyponatremia

A client with delusions presents with strong defensiveness, even when watching the news or listening to the radio. The nurse would document this finding in the health history as what? Ambivalence Ideas of reference Flight of ideas Echolalia

Ideas of reference

Catatonia as seen in clients with schizophrenia is unique in the existence of which feature? Immobility like being in a trance Preoccupation with a delusion Presence of negative symptoms Disorganized speech patterns

Immobility like being in a trance

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

Injustice that must be remedied by legal action

The nurse is providing teaching to a client diagnosed with schizoaffective disorder. The nurse should explain to the client that which is true about this disorder? It is more common than schizophrenia. It is usually diagnosed in late adulthood. It is most common with somatoform disorders. It is a mix of psychotic and mood symptoms.

It is a mix of psychotic and mood symptoms.

A student nurse has been assigned to provide care for an inpatient psychiatric-mental health client who has a diagnosis of schizophrenia. The student nurse is apprehensive about interacting with the client. The client's detailed explanations of the client's delusions accompanied by unpredictable movements have prompted fear in the student. How should this nursing student interpret such feelings? Despite their unusual behavior, clients with schizophrenia do not pose a safety risk to care providers. Being afraid of a client who has schizophrenia is a result of stereotyping. It is natural to feel fear when a client exhibits unpredictable behavior, and this can cause the student to be reasonably cautious. These feelings are best disclosed to the client, and doing so can foster the openness that promotes a therapeutic relationship.

It is natural to feel fear when a client exhibits unpredictable behavior, and this can cause the student to be reasonably cautious.

Schizoaffective disorder has symptoms typical of both schizophrenia and which type of disorder? Mood disorders Anxiety disorders Substance use disorders Eating disorders

Mood disorders

A client had been withdrawn in the client's room for 3 days, not eating or sleeping, prior to his admission to the inpatient unit. Upon interview, the client demonstrates difficulty answering questions, appears to have no facial expressions, and cannot follow simple instructions. This cluster of symptoms can be described as what? Negative symptoms Delusions Thought disorder Positive symptoms

Negative symptoms

A client has been prescribed quetiapine for delusional disorder. In teaching the client about this medication, the nurse must be certain to include which information? Quetiapine can cause breast milk production. One of the common side effects is dry mouth. If dizziness is experienced, the client must call the doctor immediately. Quetiapine can cause one to crave sugar.

One of the common side effects is dry mouth.

While conducting a mental status examination, the client accuses the nurse of recording the interview so that it can be sent to the Federal Bureau of Investigation. What type of delusion is this client experiencing? Grandiose Paranoid Erotomanic Somatic

Paranoid

A client with schizoaffective disorder (SAD) is prescribed clozapine. The nurse understands that in addition to the drug's antipsychotic effects, it is also effective in which area? Limiting the risk for extrapyramidal adverse effects Reducing the risk for suicide Eliminating the need for additional medications Requiring no physiological monitoring

Reducing the risk for suicide

A 24-year-old with schizophrenia and paranoid delusions is admitted to the hospital. The student nurse asks the charge nurse about what approach to take with the client, who has been exhibiting hostility and isolation. Which approach would be the most appropriate direction from the charge nurse? Inform the client that the client must receive care and you will assist the client. Greet the client by gently touching the client's arm and telling the client that the client can trust you. Respect the client's need for personal space and avoid physical contact. Tell the client that if the client does not comply with the rules, you will inform the doctor.

Respect the client's need for personal space and avoid physical contact.

A nurse is assessing a client who is reporting the sensation of "bugs crawling under the skin" and intense itching and burning. The client states, "I know bugs have invaded my body." There is no evidence to support the client's report. The nurse interprets this as which type of delusion? Nihilistic Grandiose Somatic Persecutory

Somatic

Which treatment would be inappropriate for a client with delusional disorder? Cognitive-behavioral therapy Individual therapy Somatic therapy Psychopharmacology

Somatic therapy

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)? Tardive dyskinesia Dystonia Neuroleptic malignant syndrome Akathisia

Tardive dyskinesia

Which assessment findings in a client who is suspected of having a delusional disorder would be suggestive of a diagnosis of schizophrenia? The client's beliefs are considered delusional but nonbizarre. The client experiences frequent and sustained hallucinations. The client does not have insight into his or her delusions. The client responds to group psychotherapy.

The client experiences frequent and sustained hallucinations.

A client with schizophrenia is prescribed an antipsychotic medication. Which immediate side effects would the nurse include in the education plan for this medication? Risk for hypertension Risk for hypoprolactinemia The potential for weight loss The potential for sedation

The potential for sedation

Which data support a nursing diagnosis of impaired verbal communication? Ambivalence, delusional thinking, and avolition The presence of neologism, echolalia, and clanging The presence of neologism, delusions, and anergia Rapid pacing and running

The presence of neologism, echolalia, and clanging

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

They could be a real-life situation.

Which statements characterizes the major difference between the typical and atypical antipsychotic medications? Typical antipsychotics most often relieve positive symptoms but do not have a significant impact on negative symptoms. Atypical antipsychotics relieve only negative symptoms. Atypical antipsychotics tend to cause many more extrapyramidal side effects than do the typical antipsychotics. Typical antipsychotics cause blood dyscrasias, whereas atypical ones do not.

Typical antipsychotics most often relieve positive symptoms but do not have a significant impact on negative symptoms.

Which is a nonneurologic side effect of antipsychotic medications? Weight gain Akathisia Dystonia Seizures

Weight gain

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

atypical antipsychotics

A nursing instructor is preparing a class lecture about schizophrenia and outcomes focusing on recovery. Which would the instructor include as a major goal? continuity of care shorter inpatient stays immediate crisis stabilization social engagement

continuity of care

A nurse is caring for a client in an inpatient mental health setting. The nurse notices that when the client is conversing with other clients, the client repeats what they are saying word for word. The nurse interprets this finding and documents it as: echopraxia. neologisms. tangentiality. echolalia.

echolalia.

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

infection.

Which statement made by a client would indicate that the client has delusions of grandeur? "I am a magician, and my magic powers are good when the moon is full." "I let my baby die. I don't deserve to live." "I hear messages from aliens that tell me to steal cars." "I can't eat this food. It's poisoned."

"I am a magician, and my magic powers are good when the moon is full."

A client in an inpatient setting has a delusion that there are a multitude of undetectable noxious gases in circulation that have the potential to poison the client and others. Which of the nurse's responses is most therapeutic? "There are actually no poison gases in the atmosphere that we don't know about." "Why do you think that you keep insisting on this belief?" "I can assure you that you are actually very safe here." "If we detect a poison gas here, I promise that you'll be the first to know."

"I can assure you that you are actually very safe here."

A client is admitted to the psychiatric hospital with a diagnosis of schizophrenia. During the physical examination, the client's arm remains outstretched after the nurse obtains the pulse and blood pressure, and the nurse must reposition the arm. The nurse interprets this as what? Waxy flexibility Hypervigilance Retardation Echopraxia

Waxy flexibility

In working with the individual and family, which is the most accurate statement the nurse can make in order to teach the client and family about schizophrenia? "Individuals with schizophrenia do have differences in brain structure and function that cause a variety of symptoms such as lack of motivation and hearing voices." "Schizophrenia is being found to be related more closely to family dysfunction than to physiology, which is why family therapy is the most effective treatment for this disorder." "Medications for schizophrenia have not changed much since the early 1950s, although there are some medications that may be helpful." "It is more effective to treat the individual on a one-to-one basis than to involve the family in treatment because it is a very complicated process."

"Individuals with schizophrenia do have differences in brain structure and function that cause a variety of symptoms such as lack of motivation and hearing voices."

Which client exhibits the characteristics that are typical of the prodromal phase of schizophrenia? A 25-year-old does not express any of the symptoms of schizophrenia. A 20-year-old is experiencing a gradual decrease in the ability to concentrate, be productive, and sleep restfully. A 30-year-old has experienced a relapse after deciding that the client's atypical antipsychotic is unnecessary. A 28-year-old has been displaying the behaviors characteristic of schizophrenia for many months and has just been diagnosed with the disease.

A 20-year-old is experiencing a gradual decrease in the ability to concentrate, be productive, and sleep restfully.

When assuming the management of the care of a delusional client, which should be the nurse's priority intervention? Assure the client that he or she is safe in this milieu Acknowledge that there may be some truth in the delusion Encourage the client to talk about the reasoning behind his or her delusion Identify what triggers the delusion

Assure the client that he or she is safe in this milieu

A client diagnosed with schizophreniform disorder must have symptoms present for at least 1 month but with a duration of less than how long? 2 weeks 4 weeks 6 months 12 months

6 months

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

6 months.

The nurse expects psychiatric hospitalization for which of the clients diagnosed with schizoaffective disorder experiencing delusional thoughts? Select all that apply. A 76-year-old person whose symptoms are acute in nature A 25-year-old person who is having a first delusional experience A 45-year-old person who was arrested for assaulting a policeman A 30-year-old person who also has a diagnosis of depression A 39-year-old person who reports minor side effects from the current medication

A 76-year-old person whose symptoms are acute in nature A 25-year-old person who is having a first delusional experience A 45-year-old person who was arrested for assaulting a policeman A 30-year-old person who also has a diagnosis of depression

A nurse teaching a client about prescribed antipsychotic medication informs the client to contact a health care provider immediately if the client notices: An increase in weight of 2 lbs in 1 month. A feeling of dizziness when the client stands up. An increase in thirst. A dramatic change in temperature.

A dramatic change in temperature.

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

Behavior is relatively normal except when focused on the delusion.

A nurse is assessing a client diagnosed with schizophrenia. When documenting the findings, which would the nurse identify as a positive symptom? Select all that apply. Delusions Hallucinations Alogia Anhedonia Avolition

Delusions Hallucinations

A client with schizophrenia walks up to the nurse with the client's arm outstretched and says, "My arm went away. Dog, dog, dog." How should the nurse respond? Ignore the comments and redirect the client's attention. Ask the client if the client is trying to say that something is wrong with the client's arm. Ask the client if the client is having visual hallucinations. Tell the client that he or she can see the arm, and no dogs are around.

Ask the client if the client is trying to say that something is wrong with the client's arm.

A client has been diagnosed with schizophrenia. Assessment reveals that the client lives alone. The client's clothing is disheveled, the client's hair is uncombed and matted, and the client's body has a strange odor. During an interview, the client's family members voice a desire for the client to live with them when the client is discharged. Based on the assessment findings, which nursing diagnosis would be the priority? Ineffective role performance related to symptoms of schizophrenia Social isolation related to auditory hallucinations Dysfunctional family processes related to psychosis Bathing self-care deficit related to symptoms of schizophrenia

Bathing self-care deficit related to symptoms of schizophrenia

Which medication is used to control the extrapyramidal effects associated with antipsychotic medications? Benztropine Chlorpromazine Haloperidol Thioridazine

Benztropine

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

Benztropine

A nurse provides care to a client with schizoaffective disorder during hospitalization for acute psychosis. Nursing interventions to help the client to establish trust with the health care team is best accomplished by what? Offering reassurance in a soft, nonthreatening voice Reminding the client that delusions are not real Encouraging the client to participate in group therapy daily Decrease stressful situations by controlling the client's symptoms

Offering reassurance in a soft, nonthreatening voice

A client with a diagnosis of schizophrenia believes that the client is an undercover operative for the Central Intelligence Agency and that voices of various representatives of the organization give the client regular updates on the client's missions. The client is unwilling to participate in many interventions because the client is "too busy with things that are more important than you could possibly understand." The primary theme of the client's delusions is consistent with what? Paranoia Catatonia Disorganization Undifferentiation

Paranoia

A 44-year-old client has been experiencing intense job stress. In recent weeks, the client has confided in the client's spouse that the client believes the client's firm monitors every aspect of the client's personal performance and that the firm is engaged in deception and cover-up of its "true purpose." A nurse would recognize that the primary theme of the client's delusional disorder is what? Grandiose Somatic Conjugal Persecutory

Persecutory

After teaching a class of nursing students about the different types of delusions, the instructor determines that the education was successful when the class identifies which type as most common? Persecutory Somatic Grandiose Erotomanic

Persecutory

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

Persecutory

A client with a diagnosis of schizophrenia has a history of auditory and visual hallucinations. Which intervention is most likely to minimize the client's hallucinations? Ensuring that the client does not sleep more than 7 hours in any 24-hour period Clustering the client's medications at 0800 hours Providing a vivid, bright environment that provides distractions from hallucinations Provide frequent contact and communication with the client

Provide frequent contact and communication with the client

Which extrapyramidal side effect is noted by a client who has bradykinesia and a shuffling gait? Pseudoparkinsonism Akathisia Acute dystonia Tardive dyskinesia

Pseudoparkinsonism

A client has been prescribed clozapine for schizoaffective disorder (SCA) with depression. The nurse should explain to the client that one advantage of clozapine is that it can provide what? Cost savings Weight loss Reduction of hospitalizations and risk for suicide Combination with lithium for greater effect

Reduction of hospitalizations and risk for suicide

A client begins to exhibit hallucinations and delusions along with disorganized speech after forgetting to take antipsychotic medication. The nurse suspects that the client is at which point in the clinical course of the disorder? Prodromal phase Acute illness Stabilization Relapse

Relapse

A client who has a major depressive episode tells the nurse that, for the past 2 weeks, the client has been hearing voices and at times thinks that someone is following the client. A history reveals that the client has had these alternating symptoms before. The client also has experienced time with neither of these symptoms and has been able to function adequately. The nurse interprets these findings as suggesting: Paranoid schizophrenia Undifferentiated schizophrenia Brief psychotic disorder Schizoaffective disorder

Schizoaffective disorder

A nurse is caring for a client diagnosed with schizophreniform disorder. The nurse demonstrates understanding of this disorder when identifying that the client is at risk for developing what? Schizophrenia Personality disorder Major depression Substance abuse

Schizophrenia

Some research has suggested that schizophreniform disorder may be an early manifestation of which other mental health condition? Delusional disorder Schizophrenia Bipolar affective disorder Schizoaffective disorder

Schizophrenia

What are the signs and symptoms of schizophrenia according to the Diagnostic and Statistical Manual of Mental Disorders? Schizophrenia can be diagnosed as soon as an individual states he or she is hearing voices. Schizophrenia lasts at least 6 months and includes at least 1 month of 2 or more active-phase symptoms. Schizophrenia lasts at least 1 month and must include the symptom of hallucinations. Schizophrenia can be diagnosed as soon as an individual states he or she is hallucinating and delusional.

Schizophrenia lasts at least 6 months and includes at least 1 month of 2 or more active-phase symptoms.

A client diagnosed with schizophrenia states to the nurse, "My intestines are being eaten by snakes." This statement represents which type of delusion? Somatic delusion Persecutory delusion Grandiose delusion Referential delusion

Somatic delusion

The nurse should consider which during a psychiatric assessment of a newly immigrated client who is being evaluated for possible religious delusions? Some cultures hold religious beliefs that might be confused with delusional thought Most cultures contain well-accepted religious beliefs Delusions are often focused on the client's cultural religious beliefs The nurse's cultural religious beliefs may differ from those of the client's

Some cultures hold religious beliefs that might be confused with delusional thought

When developing the plan of care for a client with schizophrenia who is in the acute phase of illness, the nurse understands that the client is at high risk for what? Depression Mania Suicide Water intoxication

Suicide

Although a psychotic episode can be brief, the client impact can last a long time. For this reason, the nurse is aware of what? The best outcomes are achieved on an outpatient basis Family supports are required Supervision may be required to protect the person Cognitive therapy is indicated

Supervision may be required to protect the person

A nurse is caring for a hospitalized client who has schizophrenia. The client has been taking antipsychotic medications for 1 week when the nurse observes that the client's eyes are fixed on the ceiling. The nurse interprets this finding as: akathisia. oculogyric crisis. retrocollis. tardive dyskinesia.

oculogyric crisis.

While caring for a hospitalized client with schizophrenia, a nurse observes that the client is listening to the radio. The client tells the nurse that the radio commentator is speaking directly to the client. The nurse interprets this finding as: autistic thinking. concrete thinking. referential thinking. illusional thinking.

referential thinking.

A client diagnosed with delusional disorder who uses excessive health care resources most likely has which type of delusions? somatic jealous erotomanic grandiose

somatic

While being interviewed, a client diagnosed with a delusional disorder states, "I have this really strange odor coming out of my mouth. I stop to brush my teeth almost every hour and then rinse with mouthwash every half hour to get rid of this smell. I've seen so many doctors, and they can't tell me what's wrong." The nurse interprets the client's statement as reflecting which type of delusion? erotomanic grandiose somatic jealous

somatic

A nurse is caring for a client who has been receiving treatment for schizophrenia with chlorpromazine for the past year. It would be essential for the nurse to monitor the client for: weight loss. torticollis. hypoglycemia. tardive dyskinesia.

tardive dyskinesia.

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

white blood cells