NURS 302 Module 4: Bipolar, Schizophrenia & Psychotic disorder - practice questions

Karen, who has bipolar disorder, is being assessed by the nurse as she was recently started on lamotrigine. Which of the following statements would indicate that Karen is experiencing side effects of the medication? Select all that apply. A. "I had difficulty falling asleep last night and I keep getting a bad headache." B. "I feel like I'm getting a cold; I've had a fever and sore throat the last few days." C. "I noticed this red rash on my chest that started just a few days ago." D. "My thoughts feel like they have slowed down and I feel drowsy." E. "I've had an upset stomach with nausea and diarrhea over the last few days."

B. "I feel like I'm getting a cold; I've had a fever and sore throat the last few days." C. "I noticed this red rash on my chest that started just a few days ago."

A nursing instructor is teaching about the prevalence of bipolar disorder. Which student statement indicates that learning has occurred? A. "This disorder is equally prevalent in all socioeconomic groups." B. "This disorder is more prevalent in the higher socioeconomic groups." C. "This disorder's prevalence cannot be evaluated on the basis of socioeconomic groups." D. "This disorder is more prevalent in the lower socioeconomic groups."

B. "This disorder is more prevalent in the higher socioeconomic groups."

Which medication would the nurse prepare to administer to reverse extrapyramidal effects associated with antipsychotic therapy? A. Warfarin B. Amantadine C. Epinephrine D. Haloperidol

B. Amantadine

A nurse is assessing a client who is currently taking perphenazine. Which of the following findings should the nurse identify as an extrapyramidal symptom (EpS)? (Select all that apply.) A. Decreased level of consciousness B. Drooling C. Involuntary arm movements D. Urinary retention E. Continual pacing

B. Drooling C. Involuntary arm movements E. Continual pacing

The provider determines that Sarah's new antidepressant may have precipitated her manic episode. The nurse is now assessing to determine which stage of mania Sarah was in before admission. Based on the information the nurse has received until this point, which stage do you think best describes Sarah's symptoms? A. Stage I B. Stage II C. Stage IIIa D. Stage IIIb

B. Stage II

What is the main difference between an individual diagnosed with bipolar I and bipolar II? A. An individual diagnosed with bipolar II has never had a hypomanic episode. An individual diagnosed with bipolar I disorder has had at least one hypomanic episode. B. An individual diagnosed with bipolar I has never had a manic episode. An individual diagnosed with bipolar II disorder has had at least one manic episode. C. An individual diagnosed with bipolar II has never had a manic episode. An individual diagnosed with bipolar I disorder has had at least one manic episode. D. An individual diagnosed with bipolar I has never had a hypomanic episode. An individual diagnosed with bipolar II disorder has had at least one manic episode

C. An individual diagnosed with bipolar II has never had a manic episode. An individual diagnosed with bipolar I disorder has had at least one manic episode.

Which of the following patients with schizophrenia is at highest risk for injury to self or others? A. Has little to no family support B. Has a family history of mood disorders C. Has command hallucinations D. Has delusions of reference

C. Has command hallucinations

Which of the following patients would be diagnosed with schizophrenia according to the diagnostic criteria? Select all that apply. A. Jared has avolition, apathy, and lack of abstract thinking. B. Jimmy has delusions of persecution and suicidal ideation. C. Justin has auditory and visual hallucinations and flat affect. D. Jenny has neologisms and echopraxia. E. Jeremy has auditory hallucinations and delusions of reference.

C. Justin has auditory and visual hallucinations and flat affect. D. Jenny has neologisms and echopraxia. E. Jeremy has auditory hallucinations and delusions of reference.

The client hears the word "match." The client replies, "A match. I like matches. They are the light of the world. God will light the world. Let your light so shine." Which communication pattern does the nurse identify? A. Word salad B. Ideas of reference C. Loose association D. Clang association

C. Loose association

What are appropriate nursing interventions for the patient experiencing disturbed sensory perception: Auditory? Select all that apply. A. Attempt to understand incomprehensible speech B. Provide assistance with self-care needs C. Observe for signs of hallucinations D. Use distraction techniques E. Ask what voices are saying

C. Observe for signs of hallucinations D. Use distraction techniques E. Ask what voices are saying

A nurse is caring for a client who has schizophrenia and exhibits a lack of grooming and a flat affect. The nurse should expect a prescription for which of the following medications? A. Chlorpromazine B. Thiothixene C. Risperidone D. Haloperidol

C. Risperidone

A client is admitted with a diagnosis of brief psychotic disorder, with catatonic features. Which symptoms are associated with the catatonic specifier? A. Substance abuse and cachexia. B. Ataxia and akinesia. C. Stupor, muscle rigidity, and negativism. D. Strong ego boundaries and abstract thinking.

C. Stupor, muscle rigidity, and negativism.

A 68-year-old man is seen by a home care nurse. He has been taking chlorpromazine since 1969 for schizophrenia. Which of the following adverse effects are most commonly seen after use of chlorpromazine for long periods? A. lethargy B. amnesia C. tardive dyskinesia D. dystonia

C. tardive dyskinesia

A nurse is caring for a client who has schizophrenia and is reviewing discharge instructions which include a new prescription for risperidone. Describe at least three teaching points for client education

CLIENT EDUCATION: - Advise the client to follow a healthy, low‐calorie diet. - Recommend regular exercise. - Instruct the client to monitor weight. - Teach the client about adverse effects (agitation, dizziness, sedation, sleep disruption) and instruct the client to notify their provider if they are present.

A nurse is providing teaching to a client who has a new prescription for clozapine. COMPLICATIONS: Identify at least four adverse effects.

COMPLICATIONS - Weight gain - Diabetes mellitus - Dyslipidemia - Agranulocytosis - Sedation - Orthostatic hypotension - Anticholinergic effects

A nurse begins the intake assessment of a client diagnosed with bipolar I disorder. The client shouts, "You can't do this to me. Do you know who I am?" Which is the priority nursing action in this situation? A. To reorient the client to person, place, time, and situation. B. To redirect the client to the needed assessment information. C. To provide high-calorie finger foods to meet nutritional needs. D. To provide self and client with a safe environment.

D. To provide self and client with a safe environment.

Recent research on the RAISE approach to the treatment of schizophrenia incorporates which of the following elements as important to improving outcomes? (Select all that apply.) a. Early intervention at the first episode of psychosis b. Support for employment or educational pursuits c. Rapid high-dose loading with antipsychotic medication d. Court-ordered sanctions for treatment e. Recovery-focused psychotherapy

a. Early intervention at the first episode of psychosis b. Support for employment or educational pursuits e. Recovery-focused psychotherapy

Benson is not interested in attending groups, has not showered or changed his clothes, and has problems deciding what to pick for lunch when he goes to the dining room. What negative symptom of schizophrenia is the patient experiencing? apathy avolition anosognosia anergia anhedonia lack of abstract thinking

avolition Avolition is the lack of volition or the inability to initiate any goal-directed activity. This might look like lack of interest or motivation; neglect of activities of daily living, including personal hygiene and appearance; or the inability to choose a logical course of action in a situation.

A charge nurse is discussing manifestations of schizophrenia with a newly licensed nurse. Which of the following manifestations should the charge nurse identify as being effectively treated by first‐generation antipsychotics? (Select all that apply.) A. Auditory hallucinations B. Withdrawal from social situations C. Delusions of grandeur D. Severe agitation E. Anhedonia

A. Auditory hallucinations C. Delusions of grandeur D. Severe agitation

Which of the following are common side effects of antipsychotic medications? Select all that apply. A. Dry mouth and urinary retention B. Sedation and orthostatic hypotension C. Extrapyramidal symptoms D. Tardive dyskinesia G. Gynecomastia

A. Dry mouth and urinary retention B. Sedation and orthostatic hypotension C. Extrapyramidal symptoms D. Tardive dyskinesia G. Gynecomastia

After careful evaluation, the provider has given Sarah a diagnosis of bipolar disorder. Using the knowledge about the predisposing factors of bipolar disorders, which of the following would be priorities to screen for with Sarah? Select all that apply. A. Family history B. Current list of medications C. History of depression D. History of manic episodes E. History of ADHD

A. Family history B. Current list of medications C. History of depression D. History of manic episodes E. History of ADHD

A man is hospitalized because of a relapse of his psychotic disorder. He states, "I quit taking my medicines because I always forget to take them at least one time a day." Which of the following regimens for his antipsychotic medications will increase medication adherence? A. monthly injection by a home care nurse B. low-dose daily therapy C. daily visits to the clinic to receive his medications D. once-a-week drug therapy

A. monthly injection by a home care nurse

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

A. "Focus on the feelings generated by the hallucinations and present reality."

A nurse is caring for a client who has substance‐induced psychotic disorder and is experiencing auditory hallucinations. The client states, "The voices won't leave me alone!" Which of the following statements should the nurse make? (Select all that apply.) A. "When did you start hearing these things?" B. "The voices are not real, or else we would both hear them." C. "It must be scary to hear voices." D. "Are the voices you hear telling you to hurt yourself?" E. "Why are the voices talking to only you?"

A. "When did you start hearing these things?" C. "It must be scary to hear voices." D. "Are the voices you hear telling you to hurt yourself?"

An intake nurse is assessing a 22-year-old patient who presents with abnormally elevated mood, pressured speech, flight of ideas, and grandiosity, which has lasted for 10 days. The patient also states that he was recently fired from his job because of time issues. The patient admits to having experienced several depressive episodes in the past. This information is most consistent with which of the following diagnoses? A. Bipolar I Disorder B. Bipolar II Disorder C. Cyclothymic Disorder D. Substance-Induced Bipolar Disorder

A. Bipolar I Disorder

A nurse is assessing a client diagnosed with 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. Delusions of reference B. Paranoia C. Thought insertion D. Magical thinking

A. Delusions of reference

Which of the following is true with regard to the dopamine hypothesis of schizophrenia? Select all that apply. A. Excessive dopaminergic activity explains the positive and negative symptoms of schizophrenia. B. Symptoms of schizophrenia occur because of deficient dopaminergic activity in the mesolimbic tract. C. Deficient dopaminergic activity disrupts serotonin levels, which accounts for both positive and negative symptoms of schizophrenia. D. Excessive dopaminergic activity is the result of an excess of dopamine, too many dopamine receptors, or a receptor hypersensitivity to dopamine. E. Positive symptoms of schizophrenia occur because of increased amounts of dopamine receptors.

A. Excessive dopaminergic activity explains the positive and negative symptoms of schizophrenia. D. Excessive dopaminergic activity is the result of an excess of dopamine, too many dopamine receptors, or a receptor hypersensitivity to dopamine. E. Positive symptoms of schizophrenia occur because of increased amounts of dopamine receptors.

Which of the following patients is experiencing predominantly negative symptoms of schizophrenia? Select all that apply. A. Patient is isolating himself to the corner of the dayroom, has his hoodie pulled down over his face, and fails to participate in groups and make eye contact. B. Patient is mumbling to himself, occasionally paces the hallways and yells out "I am God - you will all pay!", and demonstrates a significant pause before responding to staff questions. C. Patient is sitting with his back toward the members of the group therapy session and laughs aloud and speaks incoherently when a client shares her history of childhood sexual abuse. D. Patient has not showered in several days, refuses to participate in groups, and has been medicated several times for seemingly unprovoked aggressive outbursts. E. Patient is not showering, is uninterested in talking to others on the unit, has a flat affect, and has decreased motor movements.

A. Patient is isolating himself to the corner of the dayroom, has his hoodie pulled down over his face, and fails to participate in groups and make eye contact. E. Patient is not showering, is uninterested in talking to others on the unit, has a flat affect, and has decreased motor movements.

The nurse is caring for a client with schizophrenia who reports auditory hallucinations. The nurse teaches the client to say, "Leave me alone," whenever the voices are speaking. What is the specific outcome of this nursing intervention? A. The client gains conscious control over the hallucinations. B. The client demonstrates trust over the surrounding environment. C. The client perceives fewer hallucinations and involves himself or herself in interpersonal activities. D. The client will show interest in discussing the content of hallucinations.

A. The client gains conscious control over the hallucinations.

While caring for a client with paranoia, the nurse implements family-style serving of food to the client. Which statement describes the nurse's expectation of this intervention? A. The client will have decreased suspiciousness. B. The client will have improved self-esteem. C. The client will have improved concrete thinking. D. The client will have an improved functional communication pattern.

A. The client will have decreased suspiciousness.

Which symptoms in a client indicate the persecutory type of delusional disorder? Select all that apply. A. The feeling of being spied on B. The feeling of being poisoned C. The feeling of being plotted against D. The feeling of a famous person being in love with him or her E. The feeling of being in a relationship with a religious leader

A. The feeling of being spied on B. The feeling of being poisoned C. The feeling of being plotted against

Schizophrenia has four phases. Which of the following accurately depicts a particular phase? Select all that apply. A. The patient has significant deterioration with depressive symptoms. B. The patient is experiencing visual hallucinations and no other symptoms. C. The patient's positive symptoms are improved, but negative symptoms may linger. D. The patient is experiencing grandiose delusions and anosognosia. E. The patient has signs that are hard to recognize, but include withdrawal, lack of peer relationships, and poor school performance.

A. The patient has significant deterioration with depressive symptoms. C. The patient's positive symptoms are improved, but negative symptoms may linger. D. The patient is experiencing grandiose delusions and anosognosia. E. The patient has signs that are hard to recognize, but include withdrawal, lack of peer relationships, and poor school performance.

Sarah has been diagnosed with bipolar disorder type II, most recent episode depressed. Which of the following etiological factors would the nurse expect to find during assessment? Select all that apply. A. The patient reports a maternal history of "mood issues." B. The patient has been taking a corticosteroid for her asthma since she was 12. C. The patient states that she was diagnosed with ADHD when she was 8. D. The patient discloses that when she was 6 she was "touched inappropriately" by an uncle. E. The patient reports that she started using heroin last year.

A. The patient reports a maternal history of "mood issues." B. The patient has been taking a corticosteroid for her asthma since she was 12. C. The patient states that she was diagnosed with ADHD when she was 8. D. The patient discloses that when she was 6 she was "touched inappropriately" by an uncle. E. The patient reports that she started using heroin last year.

Which anticholinergic side effect is associated with second generation (atypical) antipsychotic medications? A. Tremors B. Drowsiness C. Weight loss D. Bradycardia

A. Tremors

A man is taking chlorpromazine. He develops a high fever, respiratory depression, and diminished level of consciousness. What condition has the patient developed? A. neuroleptic malignant syndrome B. dystonia C. anhedonia D. akathisia

A. neuroleptic malignant syndrome

A nurse is speaking with a client who has schizophrenia when the client suddenly seems to stop focusing on the nurse's questions and begins looking at the ceiling and talking to themselves. Which of the following actions should the nurse take? A. Stop the interview at this point, and resume later when the client is better able to concentrate. B. Ask the client, "Are you seeing something on the ceiling?" C. Tell the client, "You seem to be looking at something on the ceiling. I see something there, too." D. Continue the interview without comment on the client's behavior.

B. Ask the client, "Are you seeing something on the ceiling?"

Sarah, a 21-year-old female, was just transferred to the behavioral unit from the ICU. She came in to the emergency department 2 days previously due to a recent overdose that was a suspected suicide attempt. Sarah has a diagnosis of major depressive disorder. You are completing a comprehensive assessment on Sarah. She tells you she was diagnosed with major depressive disorder when she was 16 years old. However, she states that right before she was admitted to the hospital she wasn't sleeping because she wasn't tired, she was irritable, she constantly felt like she was on the go but wasn't able to get her assignments done for school because she couldn't focus, and she had started hanging out with some new friends and had tried heroin for the first time, causing an overdose. What is the appropriate diagnosis for Sarah based on her report? A. Depressive Disorder B. Bipolar I Disorder C. Bipolar II Disorder D. Cyclothymia

B. Bipolar I Disorder

While reviewing the laboratory reports of a client with a psychotic disorder, the nurse finds abnormally high levels of prolactin in the blood. Which medication in the client's prescription might be the cause of this finding? A. Clozapine B. Haloperidol C. Lurasidone D. Risperidone

B. Haloperidol

A patient is prescribed ziprasidone (Geodon) for the treatment of schizophrenia. Which of the following would alert the healthcare provider that the patient is experiencing an adverse effect of the medication? Select all that apply. A. Seizure activity B. Pulmonary crackles C. Palpitations and syncope D. Rigidity and bradykinesia E. Increased temperature

B. Pulmonary crackles C. Palpitations and syncope D. Rigidity and bradykinesia E. Increased temperature

While caring for a client with schizophrenia, the nurse finds that the client has aggressive body language, catatonic excitement, and command hallucinations. Which interventions would the nurse implement to ensure the safety of this client? Select all that apply. A. Restrain and monitor the client closely. B. Use a calm attitude with the client. C. Engage the client in activities like punching a bag. D. Maintain a low level of lighting and simple decor in the client's room. E. Assess the client's understanding about the content of hallucinations.

B. Use a calm attitude with the client. C. Engage the client in activities like punching a bag. D. Maintain a low level of lighting and simple decor in the client's room.

The RAISE approach stands for Recovery After an Initial Schizophrenia Episode. What are the approaches used in RAISE? Select all that apply. A. Cognitive remediation B. Vocational support C. Personalized treatment plan D. Case management E. Family education and support

B. Vocational support C. Personalized treatment plan D. Case management E. Family education and support

A client with a psychiatric illness tells the nurse, "It is very cold. I am cold and bold. The gold has been sold." Which intervention would the nurse implement in this situation? A. Observe the client by leaving him or her alone. B. Ignore the client's statements. C. Seek clarification from the client. D. Notify the primary health-care provider.

C. Seek clarification from the client.

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

D. "Rise slowly when you change position from lying to sitting or sitting to standing."

A 16-year-old client diagnosed with 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's hallucinations are caused by medication interactions." B. "Your child's abnormal hormonal changes have precipitated auditory hallucinations." C. "Your child has too little serotonin in the brain, causing delusions and hallucinations." D. "Your child has a chemical imbalance of the brain, which leads to altered thoughts."

D. "Your child has a chemical imbalance of the brain, which leads to altered thoughts."

Which of the following is the primary goal in working with an actively psychotic, suspicious client? a. Promote interaction with others. b. Decrease his anxiety and increase trust. c. Improve his relationship with his parents. d. Encourage participation in therapy activities.

b. Decrease his anxiety and increase trust.

When a client suddenly becomes aggressive and violent on the unit, which of the following approaches would be best for the nurse to use first? a. Provide large motor activities to relieve the client's pent-up tension. b. Administer a dose of prn haloperidol to keep the patient calm. c. Call for adequate help to control the situation safely. d. Convey to the client that his behavior is unacceptable and will not be permitted.

c. Call for adequate help to control the situation safely.

The nurse asks his patient, Scott, "Did you shower this morning?" Scott states, "When did I shower? I love to take showers. I love to do a lot of things, like cook breakfast. Speaking of breakfast, it was great! Oh yeah, I took a shower after breakfast this morning." What positive symptom of schizophrenia is the patient experiencing? hallucinations delusions of persecution delusions of reference somatic delusions loose associations neologisms clang associations word salad circumstantiality tangentiality perseveration grandiose delusions echolalia echopraxia waxy flexibility

circumstantiality With circumstantiality, the patient is delayed in reaching the point of communication because of unnecessary and over-the-top details. The patient will eventually answer the question but with numerous interruptions by the nurse to keep the person on track.

The nurse asks Julie how she slept last night. Julie responds by saying, "I slept in a bed. My head was dead. It felt like it was full of lead. I wish I had read instead." What positive symptom of schizophrenia is the patient experiencing? hallucinations delusions of persecution delusions of reference somatic delusions loose associations neologisms clang associations word salad circumstantiality tangentiality perseveration grandiose delusions echolalia echopraxia waxy flexibility

clang associations

Jamie pulls the nurse aside to let her know that, "The other patients are out to get me and I am worried for my safety. I know they have planned something. You have to help me!" What positive symptom of schizophrenia is the patient experiencing? hallucinations delusions of persecution delusions of reference somatic delusions loose associations neologisms clang associations word salad circumstantiality tangentiality perseveration grandiose delusions echolalia echopraxia waxy flexibility

delusion of persecution

Sarah has responded well to the lithium and is within the therapeutic range. She is now ready for discharge. However, her provider wants her to see a cognitive therapist. What should the nurse tell Sarah to expect from the cognitive therapist? Select all that apply. A. "You will work on controlling cognitive distortions." B. "The therapist will help you with getting relief as soon as possible." C. "The therapist will focus on changing automatic thoughts." D. "You will work on childhood traumas that may have contributed to the bipolar." E. "Your family will be an instrumental part of cognitive therapy."

A. "You will work on controlling cognitive distortions." B. "The therapist will help you with getting relief as soon as possible." C. "The therapist will focus on changing automatic thoughts."

A nurse is discussing routine follow‐up needs with a client who has a new prescription for valproate. The nurse should inform the client of the need for routine monitoring of which of the following? A. AST/ALT and LDH B. Creatinine and BUN C. WBC and granulocyte counts D. Blood sodium and potassium

A. AST/ALT and LDH

A nurse is caring for a client who is experiencing extreme mania due to bipolar disorder. prior to administration of lithium carbonate, the client's lithium blood level is 1.2 mEq/L. Which of the following actions should the nurse take? A. Administer the next dose of lithium carbonate as scheduled. B. Prepare for administration of aminophylline. C. Notify the provider for a possible increase in the dosage of lithium carbonate. D. Request a stat repeat of the client's lithium blood level.

A. Administer the next dose of lithium carbonate as scheduled.

With Sarah's recent overdose, which was determined to be accidental, and diagnosis of bipolar disorder, the nurse is developing a plan of care for Risk for Self-directed Violence. Which of the following would be appropriate interventions for this nursing diagnosis? Select all that apply. A. Assess substance use B. Set limits on manipulative behavior C. Remove all dangerous objects D. Maintain a calm attitude E. Do not argue with patient

A. Assess substance use C. Remove all dangerous objects D. Maintain a calm attitude

The provider has prescribed lithium carbonate for Sarah's bipolar disorder. Which of the following are important teaching points to include about lithium when educating the patient? Select all that apply. A. Eat a variety of healthy foods and maintain sodium intake. B. Make sure to get monthly lithium testing in the first few months. C. Avoid drinking too much caffeine, such as coffee and sodas. D. Report skin rash or unusual bruising immediately. E. Make sure to drink 8 glasses of water per day.

A. Eat a variety of healthy foods and maintain sodium intake. B. Make sure to get monthly lithium testing in the first few months. C. Avoid drinking too much caffeine, such as coffee and sodas. E. Make sure to drink 8 glasses of water per day.

Which of the following patients would meet criteria for a bipolar disorder? Select all that apply. A. Lauren has a long history of depression, but is complaining of irritability, her thoughts being all over the place, not being able to focus, has started a lot of home projects, and spending a lot of time online lately. B. Stacey was admitted with labile mood and irritability, rapid speech, inability to focus attention, and impairment in functioning. C. Kelly presents with a history of depression and elevated mood, getting fired from her job, and delusions of grandeur. D. Brandon presents with euphoria and increased sexual inhibition and a history of depression. E. Jeremy complains of history of depression, but now presents with decreased need for sleep, irritability, distractibility, flight of ideas, and pressured speech.

A. Lauren has a long history of depression, but is complaining of irritability, her thoughts being all over the place, not being able to focus, has started a lot of home projects, and spending a lot of time online lately. E. Jeremy complains of history of depression, but now presents with decreased need for sleep, irritability, distractibility, flight of ideas, and pressured speech.

The provider wants to prescribe a medication to help with Sarah's bipolar II disorder. Which medication(s) would the nurse expect to see prescribed? Select all that apply. A. Lithium carbonate B. Lamotrigine C. Lurasidone D. Lorazepam E. Lexapro

A. Lithium carbonate B. Lamotrigine

Bipolar disorder can also be medication induced. Which of the following medications would be important to assess for in a patient who presents with acute mania? Select all that apply. A. Steroids B. Anticoagulants C. Anxiolytics D. Oral contraceptives E. Anticonvulsants

A. Steroids C. Anxiolytics D. Oral contraceptives E. Anticonvulsants

The nurse is caring for a client who is at high risk for violence. While caring, the nurse offers an empathetic response to the client's feelings. Which outcome does the nurse expect from this intervention? A. The client develops trust. B. The client develops self-esteem. C. The client develops a less anxious nature. D. The client develops a feeling of some control.

A. The client develops trust.

The nurse is caring for a client who is diagnosed with hypomania. Which behavior does the nurse find in the client? Select all that apply. A. The client is cheerful and expansive with an underlying irritability. B. The client shows extreme fluctuating emotions. C. The client tries to maintain a close friendship with the nurse. D. The client neglects personal hygiene and grooming. E. The client talks and laughs very loudly while communicating with the nurse.

A. The client is cheerful and expansive with an underlying irritability. E. The client talks and laughs very loudly while communicating with the nurse.

Which of the following would the nurse include on the care plan for a patient in regard to Risk for Self-directed Violence? Select all that apply. A. The nurse will assess for substance use. B. The patient will not harm self. C. The nurse will assess level of anxiety. D. The patient will able to recognize signs of increasing anxiety. E. The patient will not argue with the nurse.

A. The nurse will assess for substance use. B. The patient will not harm self. C. The nurse will assess level of anxiety. D. The patient will able to recognize signs of increasing anxiety.

Lithium is used to treat bipolar disorder. Which side effects would you expect to see in a patient with lithium toxicity? Select all that apply. A. Tremors B. Skin rash C. Nausea and vomiting D. Bruising E. Blurred vision

A. Tremors C. Nausea and vomiting E. Blurred vision

Which medication regulates the influx and outflow of calcium from the cells through the expression of CACNA1C protein? A. Verapamil B. Bupropion C. Atomoxetine D. Lithium carbonate

A. Verapamil

A patient is beginning a new drug regimen of escitalopram for depression. Before administering this medication, it is necessary to assess for which of the following? A. prior recent use of monoamine oxidase (MAO) inhibitors B. prior diet high in tyramine-containing foods C. history of cigarette use D. history of seizure disorders

A. prior recent use of monoamine oxidase (MAO) inhibitors

A nurse in an acute mental health facility is caring for a client who is experiencing acute mania. ALTERATION IN HEALTH (DIAGNOSIS)

ALTERATION IN HEALTH (DIAGNOSIS): - An abnormally elevated mood, which can also be described as expansive or irritable; usually requires hospitalization

Which symptoms does the nurse expect to appear in the client whose serum concentration of lithium is 1.8 mEq/L? A. Mental alertness B. Decreased urine output C. Persistent vomiting D. Constipation

C. Persistent vomiting

What tool should a nurse use to differentiate occasional spontaneous behaviors of children from behaviors associated with bipolar disorder? A. "Monotherapy" tool B. "FIND" tool C. "Risky Activity" tool D. "Consensus Committee" tool

B. "FIND" tool

A nurse is caring for a client who has bipolar disorder. The client states, "I am very rich, and I feel I must give my money to you." Which of the following responses should the nurse make? A. "Why do you think you feel the need to give money away?" B. "I am here to provide care and cannot accept this from you." C. "I can request that your case manager discuss appropriate charity options with you." D. "You should know that giving away your money is inappropriate."

B. "I am here to provide care and cannot accept this from you."

A man has been taking imipramine for 1 week for depression. He tells the nurse that he is going to stop taking this medication because it is not working. The best response is which of the following? A. "Contact your prescriber about taking a different antidepressant medication." B. "It may take up to 4 weeks before this medication makes you feel better." C. "You should slowly taper rather than suddenly discontinue this medication." D. "You should take an extra dose today to build up your blood level and get faster results."

B. "It may take up to 4 weeks before this medication makes you feel better."

A nurse is caring for a client who is prescribed lithium therapy. The client tells of the plan to take ibuprofen for osteoarthritis pain relief. Which of the following statements should the nurse make? A. "That is a good choice. Ibuprofen does not interact with lithium." B. "Regular aspirin would be a better choice than ibuprofen." C. "Lithium decreases the effectiveness of ibuprofen." D. "The ibuprofen will make your lithium level fall too low."

B. "Regular aspirin would be a better choice than ibuprofen."

A client with mania reports an inability to sleep. Which appropriate actions does the nurse take to promote sleep? Select all that apply. A. Provide a low-protein diet B. Administer sedative agents as prescribed C. Reduce lighting in the room D. Provide tea or coffee before sleep E. Help perform relaxation exercises before sleep

B. Administer sedative agents as prescribed C. Reduce lighting in the room E. Help perform relaxation exercises before sleep

Which of the following symptoms would the nurse expect to find in a patient with Bipolar I Disorder, most recent episode manic? Select all that apply. A. Decreased appetite B. Decreased need for sleep C. Impairment in functioning D. Irritability E. Distractible

B. Decreased need for sleep D. Irritability E. Distractible

A nurse is discussing relapse prevention with a client who has bipolar disorder. Which of the following information should the nurse include in the teaching? (Select all that apply.) A. Use caffeine in moderation to prevent relapse. B. Difficulty sleeping can indicate a relapse. C. Begin taking your medications as soon as a relapse begins. D. Participating in psychotherapy can help prevent a relapse. E. Anhedonia is a clinical manifestation of a depressive relapse.

B. Difficulty sleeping can indicate a relapse. D. Participating in psychotherapy can help prevent a relapse. E. Anhedonia is a clinical manifestation of a depressive relapse.

A nurse is planning care for a client who has bipolar disorder and is experiencing a manic episode. Which of the following interventions should the nurse include in the plan of care? (Select all that apply.) A. Provide flexible client behavior expectations. B. Offer concise explanations. C. Establish consistent limits. D. Disregard client concerns. E. Use a firm approach with communication.

B. Offer concise explanations. C. Establish consistent limits. E. Use a firm approach with communication.

A client with bipolar disorder is at high risk of self-harm. The nurse finds that the client perceives actions of others as threatening. Which actions does the nurse take to ensure the safety of this client? Select all that apply. A. Uses mechanical restraints B. Removes dangerous objects from the client's room C. Provides additional care by adding new staff D. Maintains low level of stimuli in the client environment E. Notifies the primary health-care provider

B. Removes dangerous objects from the client's room D. Maintains low level of stimuli in the client environment

The parent of an adolescent client says, "My child keeps talking about calling the U.S. president to give him suggestions." The nurse also finds that the client has increased libido. Which does the nurse interpret from these findings? A. The client is experiencing psychosis. B. The client is experiencing hypomania. C. The client is experiencing acute mania. D. The client is experiencing delirious mania.

B. The client is experiencing hypomania.

A nurse is teaching the importance of proper diet to a patient taking the MAO inhibitor tranylcypromine for depression. Which of the following food selections by the patient indicates that further teaching is needed? A. a tossed salad and a bowl of vegetable soup B. a salami and Swiss cheese sandwich and a banana C. a hamburger and French fries D. a cold plate with cottage cheese, chicken salad, and grapes

B. a salami and Swiss cheese sandwich and a banana

A nurse is discussing early indications of toxicity with a client who has a new prescription for lithium carbonate for bipolar disorder. The nurse should include which of the following manifestations in the teaching? (Select all that apply.) A. Constipation B. polyuria C. Rash D. Muscle weakness E. Tinnitus

B. polyuria D. Muscle weakness

A nurse is teaching a newly licensed nurse about the use of electroconvulsive therapy (ECT) for the treatment of bipolar disorder. Which of the following statements by the newly licensed nurse indicates understanding? A. "ECT is the recommended initial treatment for bipolar disorder." B. "ECT is contraindicated for clients who have suicidal ideation." C. "ECT is effective for clients who are experiencing severe mania." D. "ECT is prescribed to prevent relapse of bipolar disorder."

C. "ECT is effective for clients who are experiencing severe mania."

Which does the catatonia specifier stupor indicate? A. Absence of verbal response B. No response to external stimuli C. Absence of psychomotor activity D. No influence of external stimuli

C. Absence of psychomotor activity

Which intervention would the nurse perform to help the client who is on verapamil, a calcium channel-blocker therapy, understand how to mitigate the effects of drowsiness and dizziness? A. Encourage the client to eat a fiber-rich diet. B. Advise the client to take verapamil along with food. C. Instruct the client not to operate heavy machinery. D. Record the client's blood pressure before administration of the medication.

C. Instruct the client not to operate heavy machinery.

The nurse has assigned a client a diagnosis of "imbalanced nutrition: less than body requirements related to hyperactivity as evidenced by weight loss." The nurse would like the client to gain 1 pound by discharge. Which intervention would be appropriate for the client to meet this goal? A. Place the client on a low-calorie, low-fat diet. B. Encourage the client to sit in the dining hall with other clients during meals. C. Provide the client with high-calorie, high-protein finger foods. D. Encourage the client to consume drinks high in caffeine .

C. Provide the client with high-calorie, high-protein finger foods.

The nurse is caring for a client with impaired social interaction. The nurse sets limits on the manipulative behavior of the client. Which outcome in the client does the nurse expect from this intervention? A. The client develops self-esteem. B. The client develops a feeling of security. C. The client develops appropriate interaction skills. D. The client accepts responsibility for his or her own behavior.

C. The client develops appropriate interaction skills.

The specifier supplied for a client diagnosed with bipolar I disorder is "single manic episode." Which meaning would the nurse attribute to this specifier? A. The individual has recurrent episodes of depression. B. This is the current or most recent behavior experienced. C. This is the individual's first episode of mania. D. The individual has had a catatonic episode.

C. This is the individual's first episode of mania.

A woman who is stable on lithium therapy for her bipolar disorder is shortly going to be receiving a drug for her hypertension. Which drug would be of greatest concern if added to the treatment regimen? A. a vasodilator B. an angiotensin-converting enzyme inhibitor C. a diuretic D. a calcium channel blocker

C. a diuretic

Fluoxetine achieves its effects by A. blocking the uptake of monoamines B. inhibiting monoamine oxidase A (MAO-A) enzyme in nerve terminals C. selectively inhibiting serotonin reuptake D. directly stimulating serotonin receptors

C. selectively inhibiting serotonin reuptake

A nurse in an acute mental health facility is caring for a client who is experiencing acute mania. CLIENT EDUCATION: Identify two client outcomes.

CLIENT EDUCATION: Client outcomes - The client will refrain from self‐harm. - The client will sleep 6 to 8 hr each night. - The client will maintain adequate fluid and food intake. - The client will use appropriate communication skills to meet needs. - The client will participate in self‐care.

A nurse is providing teaching to a client who has rapid cycling bipolar disorder and a new prescription for carbamazepine. COMPLICATIONS: Identify at least four adverse effects.

COMPLICATIONS - CNS effects - Nystagmus - Diplopia - Vertigo - Staggering gait - Headache - Blood dyscrasias - Teratogenesis - Hypoosmolarity - Dermatitis - Rash

Which statement made by the registered nurse regarding bipolar disorder is true? A. "Bipolar disorder tends to occur among those in lower socioeconomic groups." B. "The onset of bipolar disorder is around age 40." C. "Bipolar is the third leading cause of disability in the middle-age group." D. "Bipolar is completely treatable, but many individuals go years without a diagnosis."

D. "Bipolar is completely treatable, but many individuals go years without a diagnosis."

A nurse is admitting a client who has a new diagnosis of bipolar disorder and is scheduled to beginlithium therapy. When collecting a medical history from the client's caregiver, which of the following statements is the priority to report to the provider? A. "Current medical conditions include diabetes that is controlled by diet." B. "Recent medications include a course of prednisone for acute bronchitis." C. "Current vaccinations include a flu vaccine last month." D. "Current medications include furosemide for congestive heart failure."

D. "Current medications include furosemide for congestive heart failure."

At which age would the nurse expect to begin documenting manic episodes in a client diagnosed with bipolar disorder? A. 19 B. 21 C. 23 D. 25

D. 25

When assessing a patient diagnosed with schizophrenia, which of the following will the healthcare provider identify as a negative symptom? A. Delusions B. Disorganized speech C. Hallucinations D. Anhedonia

D. Anhedonia

A client with bipolar disorder is diagnosed with migraine. Which medication is effective when the primary health-care provider prefers a single medication for the treatment of both conditions? A. Clonazepam B. Lamotrigine C. Aripiprazole D. Chlorpromazine

D. Chlorpromazine

The nurse is caring for a client with mania who is on lithium carbonate therapy. The nurse monitors the client's skin turgor daily. Which sign or symptom observed in the client supports this nursing intervention? A. Polyuria B. Dizziness C. Dry mouth D. Dehydration

D. Dehydration

A nurse is caring for a client who has bipolar disorder. Which of the following is the priority nursing action? A. Set consistent limits for expected client behavior. B. Administer prescribed medications as scheduled. C. Provide the client with step‐by‐step instructions during hygiene activities. D. Monitor the client for escalating behavior.

D. Monitor the client for escalating behavior.

Which side effect associated with antipsychotics occurs due to the blockade of alpha1-adrenergic receptors? A. Dry mouth B. Constipation C. Urinary retention D. Orthostatic hypotension

D. Orthostatic hypotension

A patient taking lithium is having problems with coordination and unstable gait. The patient's lithium level is 2.3 mEq/L. The nurse should do which of the following? A. Continue to administer the lithium three times per day. B. Skip a dose of lithium and then resume the regular medication schedule. C. Administer an extra dose of lithium. D. Withhold the lithium, offer fluids, and notify the prescriber of the lithium level.

D. Withhold the lithium, offer fluids, and notify the prescriber of the lithium level.

Monoamine oxidase (MAO) inhibitors are indicated in which of the following? A. in patients who have previously developed serotonin syndrome B. in patients who are first beginning treatment of depression C. in patients who are having trouble sleeping D. in patients who have not responded successfully to selective serotonin reuptake inhibitors and tricyclic antidepressants

D. in patients who have not responded successfully to selective serotonin reuptake inhibitors and tricyclic antidepressants

Which of the following adverse effects of the imipramine is considered the most serious? A. dry mouth B. constipation C. urinary retention D. orthostatic hypotension

D. orthostatic hypotension

A nurse practitioner plans to order lithium for a patient with bipolar disorder. Lithium is contraindicated in a patient with an impairment of which of the following systems? A. respiratory system B. cardiac system C. endocrine system D. renal system

D. renal system

A nurse in an acute mental health facility is caring for a client who is experiencing acute mania. EXPECTED FINDINGS: Identify four expected findings.

EXPECTED FINDINGS - Agitation and irritability - Intolerance of interference or criticism - Increase in talking and activity - Flight of ideas - Grandiosity - Impulsivity - Demanding and manipulative behavior - Distractibility - Poor judgment - Attention‐seeking behavior - Impairment in social and occupational functioning - Decreased sleep - Neglect of ADLs - Possible delusions and hallucinations - Denial of illness

A nurse in an acute mental health facility is caring for a client who is experiencing acute mania. NURSING CARE: Identify two nursing actions.

NURSING CARE - Focus on safety as the priority of care. - Maintain client's physical health and self‐care needs. - Provide a safe environment. - Assess for suicidal thoughts, intentions, and escalating behavior. - Decrease stimulation. - Provide client protection with restraints, seclusion, or one‐to‐one observation if necessary. - Implement frequent rest periods. - Provide appropriate outlets for physical activity. - Use calm and concise communication.

A nurse is providing teaching to a client who has rapid cycling bipolar disorder and a new prescription for carbamazepine. NURSING INTERVENTIONS: Describe at least four nursing interventions or client education points.

NURSING INTERVENTIONS - Advise the client that CNS effects should subside within a few weeks. - Administer carbamazepine at bedtime to minimize CNS effects. - Advise the client of the need for routine monitoring of CBC, platelets, and blood sodium levels. - Monitor for indications of bleeding. - Advise the client to avoid use in pregnancy. - Monitor the client for indications of fluid retention. - Advise the client to wear sunscreen. - Instruct the client to notify the provider if a rash occurs.

A nurse is providing teaching to a client who has rapid cycling bipolar disorder and a new prescription for carbamazepine. THERAPEUTIC USES: Discuss the use of carbamazepine as it relates to bipolar disorder.

THERAPEUTIC USES: - Carbamazepine is used to treat manic and depressive episodes, as well as to prevent relapse of mania and depressive episodes of bipolar disorder. - This type of medication is particularly useful for clients who have mixed mania and rapid cycling bipolar disorders.

The physician orders lithium carbonate 600 mg tid for a newly diagnosed patient with bipolar I disorder. There is a narrow margin between the therapeutic and toxic levels of lithium. The therapeutic range for acute mania is: a. 0.5 to 1.5 mEq/L b. 10 to 15 mEq/L c. 0.5 to 1.0 mEq/L d. 5 to 10 mEq/L

a. 0.5 to 1.5 mEq/L

Although historically lithium has been the medication of choice for mania, several others have been used with good results. Which of the following are used in the treatment of bipolar disorder? (Select all that apply.) a. Olanzapine (Zyprexa) b. Oxycodone (OxyContin) c. Carbamazepine (Tegretol) d. Gabapentin (Neurontin) e. Tranylcypromine (Parnate)

a. Olanzapine (Zyprexa) c. Carbamazepine (Tegretol) d. Gabapentin (Neurontin)

The nurse is providing medication education to a cliient on lithium. Which of the following are important points to include? (Select all that apply.) a. Significant reductions in sodium intake increase the risk for lithium toxicity. b. Weight loss is a common side effect of lithium. c. Serum lithium levels will need to be checked at regular intervals throughout treatment. d. Lithium therapy should be continued even during periods when the patient feels well.

a. Significant reductions in sodium intake increase the risk for lithium toxicity. c. Serum lithium levels will need to be checked at regular intervals throughout treatment. d. Lithium therapy should be continued even during periods when the patient feels well.

A client who is experiencing a manic episode is admitted to the psychiatric unit after being brought to the emergency department by a family member. The client yells, "My family is trying to make it look like I'm insane! They just want to take all my money." This behavior is an example of: a. A delusion of grandeur b. A delusion of persecution c. A delusion of reference d. A delusion of control or influence

b. A delusion of persecution

A client admitted to the inpatient psychiatric unit with bipolar disorder tells the nurse, "I need to sit in on change-of-shift report because I have been appointed director of this unit." Which action by the nurse demonstrates the best clinical judgment at this point? a. Invite the client to sit in on the change-of-shift report, but do not share any confidential client information. b. Instruct the client that this is not permitted and redirect the client to other unit activities that are available. c. Tell the client that she is delusional but that these symptoms will go away with medication. d. Place the client in seclusion for protection of self and others.

b. Instruct the client that this is not permitted and redirect the client to other unit activities that are available.

A client is brought to the emergency department by a family member who reports that the client stopped taking mood stabilizer medication a few months ago and is now agitated, pacing, demanding, and speaking very loudly. Her family member reports that she eats very little, is losing weight, and almost never sleeps. What is the priority nursing diagnosis? a. Imbalanced nutrition: Less than body requirements related to not eating b. Risk for injury related to hyperactivity c. Disturbed sleep pattern related to agitation d. Ineffective coping related to denial of depression

b. Risk for injury related to hyperactivity

A nurse is educating a patient about his lithium therapy and explaining the signs and symptoms of lithium toxicity. Which of the following would she instruct the patient to be on the alert for? a. Fever, sore throat, malaise b. Tinnitus, severe diarrhea, ataxia c. Occipital headache, palpitations, chest pain d. Skin rash, marked rise in blood pressure, bradycardia

b. Tinnitus, severe diarrhea, ataxia

One way to promote adequate nutritional intake for a client in an acute manic episode who is not eating is to: a. Sit with the client during meals to reinforce the importance of eating everything on the tray. b. Have family members bring food from home so the client will have only favorite foods. c. Provide high-calorie, nutritious finger foods and snacks that can be eaten "on the run." d. Restrict the client to their room until they begin to gain weight.

c. Provide high-calorie, nutritious finger foods and snacks that can be eaten "on the run."

A client experiencing a manic episode enters the milieu area dressed in a provocative and physically revealing outfit. Which of the following is the most appropriate intervention by the nurse? a. Tell the client she cannot wear this outfit while she is in the hospital. b. Do nothing, and allow her to learn from the responses of her peers. c. Quietly walk with her back to her room and help her change into something more appropriate. d. Explain to her that if she wears this outfit, she must remain in her room.

c. Quietly walk with her back to her room and help her change into something more appropriate.

What is the most common comorbid condition in children with bipolar disorder? a. Schizophrenia b. Substance disorders c. Oppositional defiant disorder d. Attention deficit-hyperactivity disorder

d. Attention deficit-hyperactivity disorder

When asking Sarah about her current medications, she states that she recently started on a new antidepressant along with her current ADHD medication. The nurse knows that these medications can precipitate a manic episode. Which of the following substances or medications would the nurse want to assess for as well to determine if the manic episode was substance induced? Select all that apply. A. Opioids B. Cocaine C. Steroids D. Antihistamines E. Antihypertensives

A. Opioids B. Cocaine C. Steroids E. Antihypertensives

Which outcome of neurodegeneration occurs in the nigrostriatal pathway? A. Parkinson disease B. Endocrine abnormalities C. Neuroleptic malignant syndrome D. Positive symptoms of schizophrenia

A. Parkinson disease

The healthcare provider is teaching a group of students about the biological basis of schizophrenia. Which of the following will be included in the teaching? Select all that apply. A. Prenatal exposure to influenza B. GABAergic interneuron dysregulation C. Increased dopamine levels D. Decreased norepinephrine levels E. Family history of schizophrenia F. Stimulation of the amygdala

A. Prenatal exposure to influenza B. GABAergic interneuron dysregulation C. Increased dopamine levels D. Decreased norepinephrine levels E. Family history of schizophrenia

A client diagnosed with bipolar disorder: depressive episode intentionally overdoses on sertraline (Zoloft). Family reports that the client has experienced anorexia, insomnia, and recent job loss. What should be the priority nursing diagnosis for this client? A. Risk for suicide R/T hopelessness B. Imbalanced nutrition: less than body requirements R/T refusal to eat C. Anxiety: severe R/T hyperactivity D. Dysfunctional grieving R/T loss of employment

A. Risk for suicide R/T hopelessness

A nurse is caring for a client who has schizoaffective disorder. Which of the following statements indicates the client is experiencing depersonalization? A. "I am a superhero and am immortal." B. "I am no one, and everyone is me." C. "I feel monsters pinching me all over." D. "I know that you are stealing my thoughts."

B. "I am no one, and everyone is me."

A patient diagnosed with paranoid schizophrenia states, "My roommate is plotting to have others kill me." Which is the appropriate nursing response? A. "I can see why you feel that way." B. "I find that hard to believe." C. "Why made you think such a thing?" D. "I know your roommate. He would do no such thing."

B. "I find that hard to believe."

A woman reports to the prescriber that she has developed a fever, sore throat, and malaise after starting clozapine therapy. Which of the following interventions is most important? A. Treat the patient with a broad-spectrum antibiotic. B. Discontinue the clozapine and obtain a complete blood count with differential. C. Inform the patient that this is normal when taking clozapine. D. Assess the patient for diminished mental alertness.

B. Discontinue the clozapine and obtain a complete blood count with differential.

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. How to make eye contact when communicating. C. Deep breathing techniques to decrease stress. D. How to be a leader.

B. How to make eye contact when communicating.

A nurse is caring for a client on an acute mental health unit. The client reports hearing voices that are stating, "kill your doctor." Which of the following actions should the nurse take first? A. Encourage the client to participate in group therapy on the unit. B. Initiate one‐to‐one observation of the client. C. Focus the client on reality. D. Notify the provider of the client's statement.

B. Initiate one‐to‐one observation of the client.

In monitoring the status of a patient on a course of a phenothiazine antipsychotic, the nurse needs to be most aware that an adverse effect of phenothiazine antipsychotics is the development of which of the following? A. glaucoma B. akathisia C. hypertension D. diabetes

B. akathisia

A patient is taking thiothixene. Which of the following outcomes is desirable with this medication? A. decreased heart rate and diminished agitation B. blood pressure within normal limits and diminished psychosis C. heart rate of 60 beats/min with increased pulse pressure D. a widened QT complex and normal ST segment

B. blood pressure within normal limits and diminished psychosis

A man is diagnosed with schizophrenia. He exhibits anhedonia, which is defined as which of the following? A. seizure activity B. inability to experience pleasure C. wormlike movements D. depression

B. inability to experience pleasure

A nurse is providing discharge teaching for a client who has schizophrenia and a new prescription for iloperidone. Which of the following client statements indicates understanding of the teaching? A. "I will be able to stop taking this medication as soon as I feel better." B. "If I feel drowsy during the day, I will stop taking this medication and call my provider." C. "I will be careful not to gain too much weight while taking this medication." D. "This medication is highly addictive and must be withdrawn slowly."

C. "I will be careful not to gain too much weight while taking this medication."

Which statement made by a man indicates that he requires further patient teaching regarding adherence to his medication regimen? A. "If I experience muscle spasms in my neck, I must report that to the health care provider." B. "If I experience sudden fever and difficulty breathing, I must report that to the health care provider." C. "If I experience sedation, I must cut down on my medication." D. "If I experience dizziness, I must report that to the health care provider."

C. "If I experience sedation, I must cut down on my medication."

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 verbalizing a word salad." C. "The client is expressing a neologism." D. "The client is experiencing a paranoia."

C. "The client is expressing a neologism."

An elderly woman with dementia is receiving haloperidol. What adverse effect is this woman at increased risk for developing? A. anorexia B. increased temperature C. infection D. tardive dyskinesia

D. tardive dyskinesia

Ronn, who has been diagnosed with schizophrenia, was newly admitted to an inpatient unit. He becomes agitated and starts shouting to himself, "Stop talking to me! I don't want to die!" What positive symptom of schizophrenia is the patient experiencing? hallucinations delusions of persecution delusions of reference somatic delusions loose associations neologisms clang associations word salad circumstantiality tangentiality perseveration grandiose delusions echolalia echopraxia waxy flexibility

hallucinations

The nurse, while assessing a newly admitted client, asks, "What brought you in today, Gloria?" She responds with, "The police." What negative symptom of schizophrenia is the patient experiencing? apathy avolition anosognosia anergia anhedonia lack of abstract thinking

lack of abstract thinking Abstract thinking becomes impaired in some individuals with schizophrenia and is part of the negative symptomology. Concrete thinking is defined as a literal interpretation of the environment and represents regression to earlier level of cognitive development. For example, the client with schizophrenia would have great difficulty describing the abstract meaning of sayings such as "I'm climbing the walls" or "It's raining cats and dogs." They will give very literal answers to questions that are seeking complex responses.

Terry has been on the unit for 3 days. He comes to the nurses' station and looks scared. He tells the nurse, "There's a fleedledee in my room!!" What positive symptom of schizophrenia is the patient experiencing? hallucinations delusions of persecution delusions of reference somatic delusions loose associations neologisms clang associations word salad circumstantiality tangentiality perseveration grandiose delusions echolalia echopraxia waxy flexibility

neologisms Neologisms are newly invented words that have no meaning to others but only have meaning to the person using them.

A nurse is caring for a client who takes ziprasidone. The client reports difficulty swallowing the oral medication and becomes extremely agitated with injectable administration. The nurse should contact the provider to discuss a change to which of the following medications? (Select all that apply.) A. Olanzapine B. Quetiapine C. Aripiprazole D. Clozapine E. Asenapine

A. Olanzapine C. Aripiprazole D. Clozapine E. Asenapine

A nurse is completing an admission assessment for a client who has schizophrenia. Which of the following findings should the nurse document as positive symptoms? (Select all that apply.) A. Auditory hallucination B. Lack of motivation C. Use of clang associations D. Delusion of persecution E. Constantly waving arms F. Flat affect

A. Auditory hallucination C. Use of clang associations D. Delusion of persecution E. Constantly waving arms

The nurse is assessing a patient to determine which manic stage the patient is experiencing. Which of the following is true regarding the stages of mania? Select all that apply. A. Stage I: Irritable with rapid flow of ideas B. Stage I: Outgoing, but easily distracted C. Stage II: Euphoric and irritable D. Stage II: Poor impulse control with decreased need for sleep E. Stage III: Agitation with anxiety

A. Stage I: Irritable with rapid flow of ideas B. Stage I: Outgoing, but easily distracted C. Stage II: Euphoric and irritable D. Stage II: Poor impulse control with decreased need for sleep E. Stage III: Agitation with anxiety

The nurse finds that a client is imitating all the hand movements of a family member while communicating. Which does the nurse infer from this behavior? A. The client is exhibiting echolalia. B. The client is exhibiting anhedonia. C. The client is exhibiting echopraxia. D. The client is exhibiting neologisms.

C. The client is exhibiting echopraxia.

Which finding in the client in the psychiatric ward enables the nurse to reach the conclusion that the client is in the premorbid phase of schizophrenia? A. The client is anxious and irritable. B. The client has disorganized speech. C. The client is very shy and withdrawn. D. The client has diminished emotional expression.

C. The client is very shy and withdrawn.

Which of the following statement(s) is best representative of delusions of reference? Select all that apply. A. "Worms are burrowing under my skin and eating my organs." B. "The cell company is monitoring my calls on behalf of the government." C. "The news reporter sends me special messages during the nightly newscast." D. "Demons are making me think bad thoughts." E. "These internet videos have a code that I need to figure out."

C. "The news reporter sends me special messages during the nightly newscast." E. "These internet videos have a code that I need to figure out."

A client tells the nurse, "The person singing on the radio right now is in love with me and often sends me flowers." Which type of delusion does the nurse document for the client based on this statement? A. Jealous B. Grandiose C. Erotomanic D. Persecutory

C. Erotomanic

A patient approaches a nurse with a look of distress and anguish on his face and shares, "Can't you hear him? It's the devil. He's telling me I'm going to hell." What symptom of schizophrenia is this patient experiencing? A. Delusions of reference B. Circumstantiality C. Hallucinations D. Grandiose delusions

C. Hallucinations

An adult client diagnosed with bipolar I disorder is prescribed lamotrigine (Lamictal), 400 mg three times a day, for mood stabilization. Which is a true statement about this medication order? A. This dosage is four times higher than the recommended dosage range. B. This dosage is lower than the recommended dosage range. C. This dosage is more than twice the recommended dosage range. D. This dosage is within the recommended dosage range.

C. This dosage is more than twice the recommended dosage range.

A patient is receiving haloperidol decanoate 100 mg intramuscularly. What assessment should the nurse make before and after the administration of the medication? A. pulse rate B. respiratory rate C. blood pressure D. mental status

C. blood pressure

A nurse is providing teaching to a client who has a new prescription for clozapine. EVALUATION OF MEDICATION EFFECTIVENESS: Identify at least two outcomes.

EVALUATION OF MEDICATION EFFECTIVENESS - Improvement of positive and negative symptoms - Improvement in ability to perform ADLs - Improvement in ability to interact socially with peers - Improvement in sleeping and eating habits

A nurse is caring for a client who has schizophrenia and is reviewing discharge instructions which include a new prescription for risperidone. What are the therapeutic uses of risperidone?

Risperidone is a second‐generation/ atypical antipsychotic medication used to treat positive and negative symptoms of schizophrenia.

A nurse is providing teaching to a client who has a new prescription for clozapine. THERAPEUTIC USES: Identify two.

THERAPEUTIC USES: - Treatment of negative and positive symptoms of schizophrenia spectrum disorders - psychosis induced by levodopa therapy - Relief of psychotic manifestations in nonpsychotic disorders, such as bipolar disorder

A client on the psychiatric unit tells the nurse that the CIA is looking for him and will kill him if they find him. The client's false belief is an example of a: a. Delusion of persecution. b. Delusion of reference. c. Delusion of control or influence. d. Delusion of grandeur.

a. Delusion of persecution.

A client with schizophrenia has physician's orders for haloperidol (Haldol) 5 mg IM STAT and then 3 mg PO tid; 2 mg benztropine PO bid prn. Why is benztropine ordered? a. To treat extrapyramidal symptoms b. To prevent neuroleptic malignant syndrome c. To decrease psychotic symptoms d. To induce sleep

a. To treat extrapyramidal symptoms

Jen was just admitted to the inpatient psychiatric unit. She has a long history of schizophrenia and has case management services through a local community organization. Jen has been acting paranoid and doesn't want to speak to anyone. When the nurse goes to assess her, Jen yells at the nurse, "I don't belong here. There is nothing wrong with me. You guys are the ones who are crazy and you are going to get in trouble for locking me in here against my will!" What negative symptom of schizophrenia is the patient experiencing? apathy avolition anosognosia anergia anhedonia lack of abstract thinking

anosognosia Anosognosia is defined as a person's lack awareness of having an illness or disorder even when symptoms are obvious to others. This symptom has been identified as a predictor of nonadherence to treatment with a high rate of involuntary treatments.

A client has been diagnosed with schizophrenia. He has been socially isolated and is hearing voices telling him to kill his parents. He has been admitted to the psychiatric unit from the emergency department. The initial nursing intervention for Josh is to: a. Give him an injection of haloperidol. b. Assess his safety toward himself and others. c. Place him in restraints. d. Order him a nutritious diet.

b. Assess his safety toward himself and others.

A client on the psychiatric unit has been diagnosed with schizophrenia. He tells the nurse that the CIA is looking for him and will kill him if they find him. The most appropriate response by the nurse is: a. "That's ridiculous. No one is going to hurt you." b. "The CIA isn't interested in people like you." c. "Why do you think the CIA wants to kill you?" d. "I know you believe that, but it's really hard for me to believe."

d. "I know you believe that, but it's really hard for me to believe."

Which of the following assessments by the nurse would convey a need for prn benztropine? a. Increased level of agitation b. Complaints of a sore throat c. A yellowish cast to the skin d. Muscle spasms

d. Muscle spasms

Benjamin has been following the nurse around on the unit all morning and mimicking his movements. What positive symptom of schizophrenia is the patient experiencing? hallucinations delusions of persecution delusions of reference somatic delusions loose associations neologisms clang associations word salad circumstantiality tangentiality perseveration grandiose delusions echolalia echopraxia waxy flexibility

echopraxia Patients exhibiting echopraxia imitate movements made by others. Researchers are not sure why this happens, but current evidence suggests that it may involve a disturbance in mirror neuron activity in the presence of social cognition impairments and self-monitoring deficits, resulting in imitative psychomotor behavior.

A newly admitted patient, Larry, tells the nurse that he needs to be discharged because he is in the run for state senator and needs to campaign. Larry then starts handing out his "Vote for Larry 2022" card to everyone on the unit. What positive symptom of schizophrenia is the patient experiencing? hallucinations delusions of persecution delusions of reference somatic delusions loose associations neologisms clang associations word salad circumstantiality tangentiality perseveration grandiose delusions echolalia echopraxia waxy flexibility

grandiose delusions

A client recently admitted to the hospital reports to the nurse, "I don't understand why I was brought here. I was simply hanging out in my apartment and the police said I had to come with them." This is an example of what symptom of schizophrenia? a. Delusions of reference b. Loose association c. Anosognosia d. Auditory hallucinations

c. Anosognosia

The nurse is interviewing a client on the psychiatric unit. The client tilts his head to the side, stops talking in midsentence, and listens intently. Which of the following is the most appropriate follow-up assessment based on this information? a. Ask the patient if he is experiencing loose associations. b. Ask the patient if he needs more medication. c. Ask the patient if he is hearing something or someone other than the nurse's voice. d. Ask the patient if his neck is stiff.

c. Ask the patient if he is hearing something or someone other than the nurse's voice.

A client reports to the nurse that his foot is on fire and he thinks the demons are trying to burn off his flesh. The priority nursing intervention for this symptom is to: a. Administer prn haloperidol as ordered. b. Evaluate the client's foot to rule out physical causes for his complaint. c. Administer prn benztropine as ordered. d. Ask the client if he would like to speak with a chaplain.

b. Evaluate the client's foot to rule out physical causes for his complaint.

The primary focus of family therapy for clients with schizophrenia and their families is: a. To discuss problem-solving and adaptive behaviors for coping with stress. b. To introduce the family to others with the same problem. c. To keep the client and family in touch with the health-care system. d. To promote family interaction and increase understanding of the illness.

d. To promote family interaction and increase understanding of the illness.

Which nursing diagnosis would the nurse assign to a client who lives in an unclean, unsafe, and disorderly environment? A. Impaired home maintenance B. Ineffective health maintenance C. Self-care deficit D. Disabled family coping

A. Impaired home maintenance

The nurse should administer chlorpromazine in which of the following ways? A. intramuscularly into the deltoid muscle B. subcutaneously into the abdomen C. intramuscularly in the ventrogluteal muscle D. subcutaneously in the small of the back

C. intramuscularly in the ventrogluteal muscle