Mental health Chapter 16

A client diagnosed with schizophrenia states, "I want to go home, go home, go home." This is an example of which speech pattern? Verbigeration Word salad Neologisms Clang association

Verbigeration

The nurse is conducting an interview with an adult client who is being treated for major depression. What question should the nurse prioritize in an effort to determine the client's risk for suicide? "Do you ever feel like your situation is hopeless?" "Do you feel like your antidepressant is helping your mood?" "How would you describe your relationship with your parents?" "What are your plans for the next few days?"

"Do you ever feel like your situation is hopeless?"

A client with schizophrenia is prescribed clozapine because other prescribed medications have been ineffective. After educating the client and family about the drug, the nurse determines that the education was successful when they state: "The client needs to have an electrocardiogram periodically when taking this drug." "We'll need to make sure that the client has the client's blood count checked at least weekly." "We need to watch to make sure that the client doesn't lose too much weight." "The client might develop toxic levels of the drug if the client smokes cigarettes."

"We'll need to make sure that the client has the client's blood count checked at least weekly."

The parent of a client who has a delusional disorder spends a great deal of time and energy trying to convince the client that the client is not actually the focus of a nationwide, secret plot to track the client's activities. Which of the client's responses is most typical of an individual with a delusional disorder? "I know I've got delusions, but you would too if you had to live my life." "You're so naïve. You just don't understand what's really happening out there." "I'll consider what you think, but this is something I really, really need." "I've told you before that I can't just snap my fingers and change the way I think."

"You're so naïve. You just don't understand what's really happening out there."

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

A dramatic change in temperature.

During an admission assessment with a psychiatric-mental health nurse, a client states that the client hears the voice of God in the client's head and the voice is telling the client that the client is worthless. How should the nurse document this symptom? Thought broadcasting A hallucination Thought insertion A delusion

A hallucination

A client diagnosed with schizophrenia has been prescribed clozapine. Which is a potentially fatal side effect of this medication? Tardive dyskinesia Dystonia Neuroleptic malignant syndrome Agranulocytosis

Agranulocytosis

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

Aripiprazole

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 Identify what triggers the delusion Acknowledge that there may be some truth in the delusion Encourage the client to talk about the reasoning behind his or her delusion

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

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 Bathing self-care deficit related to symptoms of schizophrenia Dysfunctional family processes related to psychosis Social isolation related to auditory hallucinations

Bathing self-care deficit related to symptoms of schizophrenia

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

Benztropine

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 Clang association Neologism Verbigeration

Circumstantiality

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. Anhedonia Delusions Avolition Hallucinations Alogia

Delusions Hallucinations

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 Disturbed sensory perception Risk for self-directed violence Ineffective coping

Disturbed sensory perception

The nurse is developing a care plan for a client with somatic delusions. Which would be an appropriate nursing diagnosis for this client? Chronic low self-esteem Risk for self-directed violence Disturbed sleep pattern Disturbed thought process

Disturbed thought process

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

Dopamine

How often must clients receiving clozapine get white blood cell counts drawn? Every 6 months Every 3 months Every week for the first 6 months Every year

Every week for the first 6 months

On admission to the psychiatric unit, a client is dressed in a red leotard and exercise bra, with an assortment of chains and brightly colored scarves on the client's head, waist, wrists, and ankles. The client's first words to the nurse are, "I'll punch you, munch you, crunch you," as the client dances into the room, shadow boxing. The client shakes the nurse's hand and says cheerfully, "We need to become better acquainted. I have the world's greatest intellect, and you are probably an intellectual midget." How can the nurse document the client's mood? Belligerent and blunted. Anxious and unpredictable. Expansive and grandiose. Suspicious and paranoid.

Expansive and grandiose.

Anhedonia

Feeling no joy or pleasure from life or any activities or relationships

During a client interview, a client states that "God has sent me a special message. I'm the only one who can carry out his plan." The nurse interprets this statement as suggesting which type of delusion? Mixed Grandiose Somatic Erotomanic

Grandiose

A client with delusional disorder tells the nurse that the client has discovered how to jump to the moon. The nurse would document this belief as what? Somatic delusion Jealous delusion Erotomanic delusion Grandiose delusion

Grandiose delusion

During an admission assessment, a client with schizoaffective disorder states that the client hears the voice of God in the client's head and the voice is telling the client that the client is worthless. What would the nurse document this symptom as? Delusion Avolition Alogia Hallucination

Hallucination

Which behavior is the priority concern as the nurse begins a care plan for a client in the manic phase of bipolar disorder? Bizarre, colorful, inappropriate dress Insulting, provocative behavior directed at staff Grandiose thinking and poor concentration Hyperactivity, dismissing meals, and sleep disturbance

Hyperactivity, dismissing meals, and sleep disturbance

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

Hyponatremia

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

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 A great, unrecognized talent Unfaithfulness

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 most common with somatoform disorders. It is a mix of psychotic and mood symptoms. It is more common than schizophrenia. It is usually diagnosed in late adulthood.

It is a mix of psychotic and mood symptoms.

A client who has been taking lithium for bipolar disorder is admitted to the hospital with the following symptoms: dry mouth, nausea and vomiting, blurred vision, dizziness, and muscle twitching. What should the nurse suspect? Interaction of lithium with another medication Common side effects of the drug Moderate lithium toxicity Need for an increased dose of medication

Moderate lithium toxicity

A nursing instructor is developing an education plan for a group of students about schizophrenia and schizoaffective disorders. The instructor identifies that in addition to psychosis, what other condition must be present at the same time for a diagnosis of schizoaffective disorder? Anxiety Mood disturbance Substance abuse Delirium

Mood disturbance

A comprehensive nursing assessment for neuroleptic malignant syndrome (NMS) should include checking for which in a client taking an antipsychotic medication? Dry mouth, flushing, and urinary retention Headache, muscle aches, and paresthesias Muscular rigidity, tremors, and difficulty swallowing Confusion, giddiness, and hyperalertness

Muscular rigidity, tremors, and difficulty swallowing

The nurse must be aware that individuals from diverse ethnic groups might describe troubling experiences in terms of physical problems or specific culture-bound syndromes. The syndrome of ghost sickness is exhibited by which culture? Chinese Indian Native American West African

Native American

The experience of delusions that are plausible in the context of a client's ethnic background are reflective of what? Fixed delusions Nonbizarre delusions Delusions of persecution Delusions of grandeur

Nonbizarre delusions

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? Erotomanic Somatic Persecutory Grandiose

Persecutory

The primary nursing goal for a client who is admitted for suicidal ideation or attempt would be what? Assess the cause of his or her depression. Assist him or her in the expression of sad and helpless feelings. Prevent self-destructive behavior. Develop rapport based on trust and understanding.

Prevent self-destructive behavior.

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?

Provide frequent contact and communication with the client

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

The potential for sedation

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? Reduction of hospitalizations and risk for suicide Combination with lithium for greater effect Weight loss Cost savings

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? Stabilization Relapse Prodromal phase Acute illness

Relapse

blunted affect

Restricted range of emotional feeling, tone, or mood

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

Schizophrenia

When reviewing the diagnostic criteria for schizophrenia based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V), which would be most accurate? 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 two or more characteristic symptoms. 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 two or more characteristic symptoms.

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

Somatic therapy

The nurse should consider which during a psychiatric assessment of a newly immigrated client who is being evaluated for possible religious delusions? Most cultures contain well-accepted 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 Delusions are often focused on the client's cultural religious beliefs

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 Water intoxication Mania Suicide

Suicide

A 55-year-old client was admitted to the psychiatric unit after an incident in a department store in which the client accused a sales clerk of following the client around the store and stealing the client's keys. The client was subdued by the police after destroying a window display because voices had told the client that it was evil. As the nurse approached the client, the client says, "You're all out to get me, and you're one of them. They're Rostoputians and grog babies here." This demonstrates what? Echolalia and echopraxia Suspiciousness and neologisms Illusions and loss of ego boundaries Loose associations and flight of ideas

Suspiciousness and neologisms

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)? Neuroleptic malignant syndrome Dystonia Tardive dyskinesia Akathisia

Tardive dyskinesia

The client's diagnosis of schizoaffective disorder is supported when the nurse documents what? Diagnosis testing confirmed a right parietal brain lesion The client reports "hearing voices" for the last 3 months The client's spouse reported that the client "repeated everything I said" for 48 hours The client's mother shares that "the client never missed work" even with the disorde

The client reports "hearing voices" for the last 3 months

A client with a delusional disorder has been undergoing individual psychotherapy. The therapy would be deemed ultimately successful when the client meets which outcome? The client will describe problems relating to others. The client will differentiate between reality and fantasy. The client will identify situations that evoke anxiety. The client will identify alternatives to present coping patterns.

The client will differentiate between reality and fantasy.

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

The presence of neologism, echolalia, and clanging

When assessing a client with a delusional disorder who is experiencing somatic delusions, which would the nurse expect as within normal parameters? Select all that apply. Sleep patterns Attention Orientation Thinking Self-care patterns

Thinking Orientation Attention

A client is diagnosed with a delusional disorder. While providing care to the client, the nurse assesses the client's delusions. Which would be least appropriate for the nurse to do? Try to change the client's delusional belief Determine the impact of the delusion on the client's safety Evaluate the significance to the client Avoid dwelling on the delusion

Try to change the client's delusional belief

Assessment of genetic predisposition supports asking a client who is exhibiting symptoms of a delusional disorder what? If any family member shows symptoms of depression When the delusion first began If the client has complied with the treatment plan Whether any family members have been diagnosed with schizophrenia

Whether any family members have been diagnosed with schizophrenia

flat affect

absence of any facial expression that would indicate emtions or mood

Avolition or lack of volition

absence of will, ambition, or drive to take action or accomplish tasks

Which 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?"

clang association

A client with schizophrenia states that the client is God's messenger and the client's mission is to become president. The nurse documents these comments as evidence of what? Delusional thinking Bizarre behavior Hallucinatory experiences Formal thought disorder

delusional thinking

Positive symptoms of schizophrenia, specifically hallucinations and delusions, are thought to be caused by hyperactivity of which neurotransmitter? Dopamine Acetylcholine Epinephrine Norepinephrin

dopamine

When investigating biologic theories related to schizophrenia, which neuroanatomic findings would be consistent with this mental health disorder? enlarged lateral ventricle smaller third ventricle enlarged hippocampus enlarged brain volume

enlarged lateral ventricle

apathy

feeling of indifference toward people, activites or relationships

inattention

inability to concentrate or focus on a topic or activity, regardless or its importance

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

infection

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.

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? Catatonia Disorganization Paranoia Undifferentiation

paranoia

A client diagnosed with schizophrenia is having delusions that the client is being plotted against by the government. This would be documented as which type of delusion? persecutory grandiose nihilistic somatic

persecutory

cataonia

psychologically induced immobility occasionally marked by periods of agitation or excitement; the client seems motionless as if in a trance

Asociality

social withdrawal, few or no relationships, lack of closeness

A client diagnosed with delusional disorder who uses excessive health care resources most likely has which type of delusions? Somatic Nihilistic Grandiose Jealous

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?

somatic

Alogia

tendency to speak little or to convey little subtance of meaning (poverty of content)

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

the client experiences frequent and sustained hallucinations