Schizophrenia Practice Questions (Test #2, Fall 2020)

The nurse is teaching a client diagnosed with schizophreniform disorder about what may affect a good prognosis. Which of the following features should the nurse include? Select all that apply. 1. Confusion and perplexity at the height of the psychotic episode. 2. Good premorbid social and occupational functioning. 3. Absence of blunted or flat affect. 4. Predominance of negative symptoms. 5. Onset of prominent psychotic symptoms within 4 weeks of first noticeable change in usual behavior or functioning.

1,2,3,5 1. Confusion and perplexity at the height of the psychotic episode is a feature of schizophreniform disorder that is thought to lead to a good prognosis. When the client is exhibiting perplexity, there is an element of insight that is absent in the more severe cases of cognitive impairment. This insight may lead to a future positive prognosis. 2. Good premorbid social and occupational functioning is a feature of schizophreniform disorder that is thought to lead to a good prognosis. 3. Absence of blunted or flat affect is a feature of schizophreniform disorder that is thought to lead to a good prognosis. 4. If negative symptoms are experienced, a good prognosis for schizophreniform disorder is unlikely. 5. When the onset of prominent psychotic symptoms is within 4 weeks of the first noticeable change in usual behavior or functioning, a good prognosis is likely. TEST-TAKING HINT: Because "3" and "4" are opposites, the test taker can eliminate one of these answer choices. Because clients who experience negative symptoms of schizophrenia generally have a poor prognosis, "4" is a good choice to eliminate

On an in-patient unit, the nurse is caring for a client who is assuming bizarre positions for long periods of time. To which diagnostic category of schizophrenia would this client most likely be assigned? 1. Disorganized schizophrenia. 2. Catatonic schizophrenia. 3. Paranoid schizophrenia. 4. Undifferentiated schizophrenia

1. A client diagnosed with disorganized schizophrenia exhibits markedly regressive and primitive behaviors. Contact with reality is extremely poor. Affect is flat or grossly inappropriate. Personal appearance is neglected, and social impairment is extreme. The client in the question is not exhibiting the signs and symptoms of disorganized schizophrenia. 2. A client diagnosed with catatonic schizophrenia exhibits marked abnormalities in motor behavior manifested in extreme psychomotor retardation with pronounced decreases in spontaneous movements and activity. Waxy flexibility is exhibited. Waxy flexibility is a type of posturing or voluntary assumption of bizarre positions in which the individual may remain for long periods. Efforts to move the individual may be met with rigid bodily resistance. The client described in the question is exhibiting signs and symptoms of catatonic schizophrenia. 3. A client diagnosed with paranoid schizophrenia exhibits delusions of persecution or grandeur. Auditory hallucinations related to a persecutory theme are present. The client is tense, suspicious, and guarded, and may be argumentative, hostile, and aggressive. The client in the question is not exhibiting the signs and symptoms of paranoid schizophrenia. 4. Clients diagnosed with undifferentiated schizophrenia do not meet the criteria for any of the subtypes or for more than one subtype. They are clearly psychotic, but their symptoms cannot be easily classified. The client in the question is exhibiting clear signs and symptoms of catatonic, not undifferentiated, schizophrenia. TEST-TAKING HINT: The test taker must recognize the description of the client's behaviors as waxy flexibility to determine in which diagnostic category these behaviors occur.

A nurse is admitting a client to the in-patient unit who is exhibiting bizarre delusions, auditory hallucinations, and incoherent speech. The client is experiencing suicidal ideations and rates mood at 2/10. Based on this clinical picture, the client is manifesting symptoms in what diagnostic category? 1. Paranoid schizophrenia. 2. Brief psychotic disorder. 3. Schizoaffective disorder. 4. Schizophreniform disorder.

1. A client diagnosed with paranoid schizophrenia exhibits delusions of persecution or grandeur. Auditory hallucinations related to a persecutory theme are present. The client is tense, suspicious, and guarded, and may be argumentative, hostile, and aggressive. These symptoms are not described in the question. The auditory hallucinations experienced by this client are not described as persecutory in nature 2. The essential feature of brief psychotic disorder is the sudden onset of psychotic symptoms that may or may not be preceded by a severe psychosocial stressor. These symptoms last at least 1 day, but less than 1 month, and there is eventual full return to the premorbid level of functioning. There is no mood component to the symptoms experienced during a brief psychotic disorder. 3. Schizoaffective disorder is manifested by schizophrenic behaviors with a strong element of symptoms associated with the mood disorders (mania or depression). The client may appear depressed with suicidal ideations. When the mood disorder has been assessed, the decisive factor in the diagnosis is the presence of characteristic schizophrenia symptoms, such as bizarre delusions, prominent hallucinations, or incoherent speech. 4. The essential features of schizophreniform disorder are identical to schizophrenia, with the exception that the duration is at least 1 month, but less than 6 months. There is no mood component to the symptoms experienced in schizophreniform disorder. TEST-TAKING HINT: The clinical picture of schizoaffective disorder must include psychotic and mood symptoms. All other answer choices do not include the mood symptom component and can be eliminated

Clients diagnosed with schizophrenia may have difficulty knowing where their ego boundaries end and others' begin. Which client behavior reflects this deficit? 1. The client eats only prepackaged food. 2. The client believes that family members are adding poison to food. 3. The client looks for actual animals when others state, "It's raining cats and dogs." 4. The client imitates other people's physical movements.

1. A client's eating only prepackaged foods is a behavior that reflects paranoid thinking. Individuals experiencing paranoia have extreme suspiciousness of others and of their actions or intentions. Paranoid thinking is not indicative of problems with ego boundaries. 2. Clients believing that their family members are adding poison to food, is an example of delusions of persecution. Experiencing delusions of persecution does not reflect that the client has difficulty knowing where his or her ego boundaries end and others' begin. 3. When clients look for actual animals when others state, "It's raining cats and dogs," they are experiencing concrete thinking. Concreteness, or literal interpretations of the environment, represents a regression to an earlier level of cognitive development. Concrete thinking does not indicate that the client has difficulty knowing where his or her ego boundaries end and others' begin. 4. When clients imitate other people's physical movements, they are experiencing echopraxia. The behavior of echopraxia is an indication of alterations in the client's sense of self. These clients have difficulty knowing where their ego boundaries end and others' begin. Weak ego boundaries cause these clients to lack feelings of uniqueness. Echopraxia is an attempt to identify with others. TEST-TAKING HINT: It is important to recognize the various defenses used by clients diagnosed with schizophrenia to deal with the symptoms of their disease. Alterations in thought such as paranoia and delusions of persecution thinking also can be experienced. The correct answer choice in this question is the symptom that reflects the client's difficulty knowing where his or her ego boundaries end and others' begin

The nurse is interviewing a client who states, "The dentist put a filling in my tooth; I now receive transmissions that control what I think and do." The nurse accurately documents this symptom with which charting entry? 1. "Client is experiencing a delusion of persecution." 2. "Client is experiencing a delusion of grandeur." 3. "Client is experiencing a somatic delusion." 4. "Client is experiencing a delusion of influence."

1. A delusion of persecution occurs when a client feels threatened and believes that others intend harm or persecution. The statement of the client is not reflective of a delusion of persecution. 2. A delusion of grandeur occurs when a client has an exaggerated feeling of importance, power, knowledge, or identity. The statement of the client is not reflective of a delusion of grandeur. 3. A somatic delusion occurs when a client has a false idea about the functioning of his or her body. The statement of the client is not reflective of a somatic delusion. 4. A delusion of influence or control occurs when a client believes certain objects or persons have control over his or her behavior. The statement of the client is reflective of a delusion of influence. TEST-TAKING HINT: To answer this question correctly, the test taker must understand the definition of the various types of delusions and be able to recognize these delusions in the statements and behaviors of clients.

A client is brought to the emergency department after being found wandering the streets and talking to unseen others. Which situation is further evidence of a diagnosis of schizophrenia for this client? 1. If the client exhibits a developmental disorder, such as autism. 2. If the client has a medical condition that could contribute to the symptoms. 3. If the client experiences manic or depressive signs and symptoms. 4. If the client's signs and symptoms last for 6 months.

1. A history of a developmental disorder would not be further evidence for a diagnosis of schizophrenia. If there is a history of an autistic disorder or another pervasive developmental disorder, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations also are present for at least 1 month. This determination must be made before diagnosing the client with schizophrenia. 2. The presence of a medical condition that contributes to the client's signs and symptoms of schizophrenia is not further evidence of this diagnosis. To meet the criteria for a diagnosis of schizophrenia, the client's symptoms must not be due to the direct physiological effects of a general medical condition. 3. Experiencing manic or depressive signs and symptoms is not further evidence for the diagnosis of schizophrenia. Schizoaffective disorders and mood disorders must be excluded for the client to meet the criteria for this diagnosis. 4. The client's signs and symptoms lasting for 6 months is further evidence for the diagnosis of schizophrenia. Two or more characteristic symptoms must be present for a significant amount of time during a 1-month period and must last for 6 months to meet the criteria for the diagnosis of schizophrenia. TEST-TAKING HINT: To answer this question correctly, the test taker must be familiar with the DSM-IV-TR criteria for the diagnosis of schizophrenia. This question asks what would contribute to the diagnosis of schizophrenia; the test taker should look for correct and appropriate criteria.

The nurse documents that a client diagnosed with a thought disorder is experiencing anticholinergic side effects from long-term use of thioridazine (Mellaril). Which symptoms has the nurse noted? 1. Akinesia, dystonia, and pseudoparkinsonism. 2. Muscle rigidity, hyperpyrexia, and tachycardia. 3. Hyperglycemia and diabetes. 4. Dry mouth, constipation, and urinary retention

1. Akinesia, dystonia, and pseudoparkinsonism are extrapyramidal, not anticholinergic, side effects caused by the use of antipsychotic drugs such as thioridazine (Mellaril). 2. Muscle rigidity, hyperpyrexia, and tachycardia are symptoms that indicate the client is experiencing neuroleptic malignant syndrome, not anticholinergic side effects of thioridazine (Mellaril). Neuroleptic malignant syndrome is a rare but potentially fatal complication of treatment with neuroleptic drugs. 3. Research has shown that clients receiving atypical antipsychotic medications are at increased risk for developing hyperglycemia and diabetes. Thioridazine (Mellaril) is classified as a typical antipsychotic 4. Dry mouth, constipation, and urinary retention are anticholinergic side effects of antipsychotic medications such as thioridazine (Mellaril). Anticholinergic side effects are caused by agents that block parasympathetic nerve impulses. Thioridazine (Mellaril) has a high incidence of anticholinergic side effects. TEST-TAKING HINT: The test taker must distinguish the various categories of side effects and the symptoms that may occur with antipsychotic therapy to answer this question correctly.

A client on an in-patient psychiatric unit refuses to take medications because, "The pill has a special code written on it that will make it poisonous." What kind of delusion is this client experiencing? 1. An erotomanic delusion. 2. A grandiose delusion. 3. A persecutory delusion. 4. A somatic delusion.

1. An erotomanic delusion is a type of delusion in which the individual believes that someone, usually of higher status, is in love with him or her. The situation described in the question does not reflect this type of delusion. 2. A grandiose delusion is a type of delusion in which the individual has an irrational idea regarding self-worth, talent, knowledge, or power. The situation described in the question does not reflect this type of delusion. 3. A persecutory delusion is a type of delusion in which the individual believes he or she is being malevolently treated in some way. Frequent themes include being conspired against, cheated, spied on, followed, poisoned or drugged, maliciously maligned, harassed, or obstructed in the pursuit of long-term goals. The situation described in the question reflects this type of delusion. 4. A somatic delusion is a type of delusion in which individuals believe they have some sort of physical defect, disorder, or disease. The situation described in the question does not reflect this type of delusion. TEST-TAKING HINT: The root word of "persecutory" is "persecute," which means to afflict or harass constantly so as to injure or distress. Knowing the definition of persecute should assist the test taker to choose the correct answer.

The nurse is discussing the side effects experienced by a female client taking antipsychotic medications. The client states, "I haven't had a period in 4 months." Which client teaching should the nurse include in the plan of care? 1. Antipsychotic medications can cause a decreased libido. 2. Antipsychotic medications can interfere with the effectiveness of birth control. 3. Antipsychotic medications can cause amenorrhea, but ovulation still occurs. 4. Antipsychotic medications can decrease red blood cells, leading to amenorrhea.

1. Antipsychotic medications can cause a decreased libido, but the client's symptom does not warrant this teaching. 2. There is no evidence that antipsychotic medications can interfere with the effectiveness of birth control. 3. Antipsychotic medications can cause amenorrhea, but ovulation still occurs. If this client does not understand this, there is a potential for pregnancy. This is vital client teaching information that must be included in the plan of care. 4. There is no evidence that antipsychotic medications can decrease red blood cells, which would lead to amenorrhea. TEST-TAKING HINT: The test taker must recognize the side effects of antipsychotic medications to answer this question correctly. The test taker also must understand terminology such as "amenorrhea" to determine what is being asked in the question.

The nurse is assessing a client diagnosed with schizophrenia. The client states, "We wanted to take the bus, but the airport took all the traffic." Which charting entry accurately documents this symptom? 1. "The client is experiencing associative looseness." 2. "The client is attempting to communicate by the use of word salad." 3. "The client is experiencing delusional thinking." 4. "The client is experiencing an illusion involving planes."

1. Associative looseness is thinking characterized by speech in which ideas shift from one unrelated subject to another. The client is unaware that the topics are unconnected. The client statement is an example of associative looseness. 2. Word salad is a group of words that are strung together in a random fashion without any logical connection. The client statement presented is not an example of word salad. 3. Delusions are false personal beliefs that are inconsistent with the client's cultural background. The client statement presented is not an example of a delusion. 4. Illusions are misperceptions or misinterpretations of real external stimuli. The client statement presented is not an example of an illusion. TEST-TAKING HINT: Loose associations and word salad can be confused because there is disconnection of meaning in both. The test taker needs to understand that when looseness of association is present, phrases may be understood, but their meaning is not linked. In word salad, words are isolated, and no meaning is communicated.

The male client diagnosed with schizophrenia is prescribed ziprasidone. Which statement to the nurse indicates the client understands the medication teaching? 1. "I need to keep taking this medication even if I become impotent." 2. "I should not go out in the sun without wearing protective clothing." 3. "This medication may cause my breast size to increase." 4. "I may have trouble sleeping when I take this medication."

1. Atypical antipsychotic medications have a lower risk of sexual dysfunction than conventional antipsychotic medications; therefore, if the client experiences impotency, he should call his HCP. This statement does not indicate he understands the medication teaching. 2. Atypical antipsychotic medications do not cause photosensitivity (unlike conventional antipsychotic drugs). This statement does not indicate he understands the medication teaching. 3. Atypical antipsychotic medications do not cause gynecomastia (unlike conventional antipsychotic drugs). This statement indicates that the client does not understand the medication teaching. 4. Ziprasidone (Geodon), an atypical antipsychotic, is well tolerated, but the most common side effect is difficulty in sleeping, perhaps because of the histamine antagonist blockade effect of the drug. This comment indicates the client understands the teaching

The client admitted to the psychiatric unit experiencing hallucinations and delusions is prescribed risperidone. Which intervention should the nurse implement? 1. Provide the client with a low tyramine diet. 2. Assess the client's respiration for 1 full minute. 3. Instruct the client to change positions slowly. 4. Monitor the client's intake and output

1. Atypical antipsychotics do not have any food interactions. A low-tyramine diet is prescribed for clients taking an MAOI, an antidepressant. 2. Respirations are not assessed to determine the effectiveness of the medication, nor are they used to determine when to question the medication; therefore, this is not an appropriate intervention for risperidone (Risperdal), an atypical antipsychotic. 3. A side effect of all types of antipsychotics is orthostatic hypotension (light-headedness, dizziness), which can be minimized by moving slowly when assuming an erect posture. 4. The client's renal system is not affected by risperidone (Risperdal), an atypical antipsychotic; therefore, it does not need to be monitored while taking this medication.

A homeless client being seen in the mental health clinic complains of an infestation of insects on the skin. Which intervention would the nurse implement first? 1. Check the client for body lice. 2. Present reality regarding somatic delusions. 3. Explain the origin of persecutory delusions. 4. Refer for in-patient hospitalization because of substance-induced psychosis

1. Before assuming that the client is experiencing a somatic delusion, the nurse first must rule out a physical cause for the client's symptoms, such as body lice. A somatic delusion occurs when an individual has an unsubstantiated belief that he or she is experiencing a physical defect, disorder, or disease. 2. After ruling out a physical cause for symptoms, the nurse then would present reality. 3. If this client is experiencing a delusion, it would be somatic, not persecutory. Also, using logic to counteract a delusion is not effective. 4. Substance-induced psychosis is the presence of prominent hallucinations and delusions that are judged to be directly attributable to the physiological effect of a substance. No information is presented in the question that would indicate this client is experiencing substance-induced psychosis. TEST-TAKING HINT: When asked to choose the first nursing intervention to be implemented, the test taker must look for an intervention that rules out physical causes before determining that symptoms are psychological in nature

Which information should the nurse discuss with the client diagnosed with schizophrenia who is prescribed an atypical antipsychotic medication? Select all that apply. 1. Drink decaffeinated coffee and tea. 2. Decrease the dietary intake of salt. 3. Eat six small, high-protein meals a day. 4. Report muscle spasms and rigidity. 5. Monitor glucose levels and lipid levels.

1. Caffeine-containing substances will negate the effects of antipsychotic medication; therefore, the client should drink caffeine-free beverages such as decaffeinated coffee and tea and caffeine-free colas. 2. Salt intake does not affect antipsychotic medication, nor does it affect schizophrenia; therefore, the dietary intake of salt does not need to be decreased. 3. Small meals and protein do not affect antipsychotic medications, nor will they affect schizophrenia; therefore, the client does not have to eat high-protein meals. 4. Long-term use of typical antipsychotic medications may lead to a condition called tardive dyskinesia (TD), exhibited by muscle spasms and rigidity. 5. Atypical antipsychotics may increase the client's risk of developing diabetes and high cholesterol; therefore, the client's weight, glucose levels, and lipid levels should be monitored regularly

A client states to the nurse, "I see headless people walking down the hall at night." Which nursing response is appropriate? 1. "What makes you think there are headless people here?" 2. "Now let's think about this. A headless person would not be able to walk down the hall." 3. "It must be frightening. I realize this is real to you, but there are no headless people here." 4. "I don't see those people you are talking about."

1. Challenging an altered sensory perception does not assist the client with reality orientation and can generate hostile, defensive behaviors. 2. Presenting logical reasons and challenging altered sensory perceptions serves no useful purpose. Hallucinations are not eliminated and may be aggravated by this approach. 3. Empathizing with the client about the altered perception encourages trust and promotes further client communication about hallucinations. The nurse must follow this by presenting the reality of the situation. Clients must be assisted to accept that the perception is unreal to maintain reality orientation. 4. By using terms such as "those people," the nurse has unwittingly implied validation of the altered perception. Hallucinations should not be reinforced. TEST-TAKING HINT: The test taker first must recognize the client problem as an alteration in sensory perception (hallucination). When a client is out of touch with reality, the nurse first must communicate empathy and understanding followed by the presentation of reality. The test taker should eliminate answers that belittle the client or logically argue against the hallucination.

Although symptoms of schizophrenia occur at various times in the life span, what client would be at highest risk for the diagnosis? 1. A 10-year-old girl. 2. A 20-year-old man. 3. A 50-year-old woman. 4. A 65-year-old man.

1. Children are not typically diagnosed with thought disorders such as schizophrenia. Thought processes must be fully developed before alterations in thought can be diagnosed. 2. Symptoms of schizophrenia generally appear in late adolescence or early adulthood. Some studies have indicated that symptoms occur earlier in men than in women. 3. Although symptoms of schizophrenia can occur during middle or late adulthood, this is not typical. 4. Although symptoms of schizophrenia can occur during middle or late adulthood, this is not typical. TEST-TAKING HINT: Thought processes such as magical and concrete thinking, which occur normally in childhood thought development, are not symptoms of schizophrenia. This knowledge assists the test taker to eliminate "1" as a possible answer choice.

A nurse is working with a client diagnosed with schizoid/premorbid personality disorder. What symptom of this diagnosis should the nurse expect to assess, and at what risk is this client for acquiring schizophrenia? 1. Delusions and hallucinations—high risk. 2. Limited range of emotional experience and expression—high risk. 3. Indifferent to social relationships—low risk. 4. Loner who appears cold and aloof—low risk.

1. Clients diagnosed with schizoid personality disorder do not typically experience delusions and hallucinations. Not all individuals who demonstrate the characteristics of schizoid personality disorder progress to schizophrenia, but most individuals diagnosed with schizophrenia show evidence of the characteristics of schizoid personality disorder premorbidly. 2. Individuals diagnosed with schizoid personality disorder are indifferent to social relationships and have a very limited range of emotional experience and expression. They do not enjoy close relationships and prefer to be loners. They appear cold and aloof. Not all individuals who demonstrate the characteristics of schizoid personality disorder progress to schizophrenia, but most individuals diagnosed with schizophrenia show evidence of the characteristics of schizoid personality disorder premorbidly, putting them at high risk for schizophrenia. 3. Individuals diagnosed with schizoid personality disorder are typically indifferent to social relationships, but this diagnosis puts them at high, not low, risk for a later diagnosis of schizophrenia. 4. Individuals diagnosed with schizoid personality disorder are typically loners who appear cold and aloof, but this diagnosis puts them at high, not low, risk for a later diagnosis of schizophrenia. TEST-TAKING HINT: To answer this question correctly, the test taker must realize that if one part of an answer is incorrect, the entire answer is incorrect. In "1," the first part of the answer is incorrect, eliminating this as a correct choice. In "3" and "4," the second part of the answer is incorrect, eliminating these choices.

The client diagnosed with paranoid schizophrenia is prescribed aripiprazole. Which statement best describes the scientific rationale for administering this medication? 1. It decreases the anxiety associated with hallucinations and delusions. 2. It increases the dopamine secretion in the brain tissue to improve speech. 3. It reduces positive symptoms of schizophrenia and improves negative symptoms. 4. It blocks the cholinergic receptor sites in the diseased brain tissue.

1. Clients diagnosed with schizophrenia do not have an anxiety disorder and this medication does not help decrease anxiety. 2. Aripiprazole (Abilify), a dopamine system stabilizer (DDS), affects the receptor sites for dopamine and does not increase the secretion of dopamine. 3. Like other antipsychotics, aripiprazole (Abilify), a DDS, treats the positive and negative symptoms of schizophrenia, but it does so with fewer side effects than other antipsychotics. This medication does not cause significant weight gain, hypotension, or prolactin release, and it poses no risk of anticholinergic effects or dysrhythmias 4. This medication does not block cholinergic receptors.

The nurse is performing an admission assessment on a client diagnosed with paranoid schizophrenia. To receive the most accurate assessment information, which should the nurse consider? 1. This client will be able to make a significant contribution to history data collection. 2. Much data will need to be gained by reviewing old records and talking with family members and significant others. 3. Assessment of this client will be simple because of the commonly occurring nature of the disease process of schizophrenia. 4. The nurse will refer to the client's global assessment of functioning score to determine client problems and nursing interventions.

1. Clients experiencing active symptoms of paranoid schizophrenia are seldom able to make a significant contribution to their history because of thought disorder and communication problems. 2. Background assessment information must be gathered from numerous sources, including family members and old records. A client in an acute episode would be unable to provide accurate and insightful assessment information because of deficits in communication and thought. 3. Assessment of a client diagnosed with schizophrenia is a complex, not simple, process. The nurse must gather as much information as possible to gain a total symptomatic clinical picture of the client. This is difficult because of the client's thought and communication deficits. 4. The global assessment of functioning is one area of assessment that the nurse must explore. It is related to the client's ability to function. This assessment score does not solely determine client problems and nursing interventions. TEST-TAKING HINT: The test taker must understand client limitations when active signs and symptoms of schizophrenia are present. This knowledge helps the test taker to recognize the need to use other sources to obtain assessment information

The client diagnosed with schizophrenia is prescribed clozapine. Which information should the nurse discuss with the client concerning this medication? Select all that apply. 1. Discuss the need for regular exercise. 2. Instruct the client to monitor for weight gain. 3. Tell the client to take the medication with food. 4. Explain to the client the need to stop taking aspirin. 5. Encourage the client to quit smoking cigarettes.

1. Clozapine (Clozaril), an atypical antipsychotic, can promote signifi - cant weight gain; therefore, the client should exercise regularly, monitor weight, and reduce caloric intake. 2. Clozaril promotes weight gain. 3. Clozaril does not cause gastrointestinal distress and can be taken with food or on an empty stomach. 4. Aspirins do not affect taking this medication. 5. Cigarette smoking may decrease the effectiveness of clozapine (Clozaril), an atypical antipsychotic.

The children's saying, "Step on a crack and you break your mother's back," is an example of which type of thinking? 1. Concrete thinking. 2. Thinking using neologisms. 3. Magical thinking. 4. Thinking using clang associations.

1. Concrete thinking is a literal interpretation of the environment. It is normal during the cognitive development of childhood. When experienced by clients diagnosed with schizophrenia, it is a regression to an earlier level of cognitive development. The statement presented is not reflective of concrete thinking. 2. A neologism is the invention of new words that are meaningless to others, but have symbolic meaning to the individual experiencing psychosis. The statement presented is not reflective of a neologism. 3. Magical thinking occurs when the individual believes that his or her thoughts or behaviors have control over specific situations or people. It is commonly seen during cognitive development in childhood. The statement presented is an example of magical thinking. 4. A clang association is the choice of words that is governed by sounds. Clang associations often take the form of rhyming. An example of a clang association is "Bang, rang, sang. My cat has a fang." The statement presented is not reflective of a clang association. TEST-TAKING HINT: There are many terms related to the symptoms experienced by clients diagnosed with schizophrenia. To answer this type of question, the test taker must understand the meaning of these terms and recognize examples of these symptoms.

A client diagnosed with schizophrenia is experiencing anhedonia. Which nursing diagnosis addresses concerns regarding this client's problem? 1. Disturbed thought processes. 2. Disturbed sensory perception. 3. Risk for suicide. 4. Impaired verbal communication.

1. Disturbed thought processes is defined as the disruption in cognitive operations and activities. An example of a disturbed thought process is a delusion. The nursing diagnosis of disturbed thought processes does not address the symptom of anhedonia. 2. Disturbed sensory perception is defined as a change in the amount or patterning of incoming stimuli (either internally or externally initiated), accompanied by a diminished, exaggerated, distorted, or impaired response to such stimuli. An example of a disturbed sensory perception is a hallucination. The nursing diagnosis of disturbed sensory perception does not address the symptom of anhedonia. 3. Risk for suicide is defined as a risk for self-inflicted, life-threatening injury. The negative symptom of anhedonia is defined as the inability to experience pleasure. This is a particularly distressing symptom that generates hopelessness and compels some clients to attempt suicide. 4. Impaired verbal communication is defined as the decreased, delayed, or absent ability to receive, process, transmit, and use a system of symbols. The nursing diagnosis of impaired verbal communication does not address the symptom of anhedonia. TEST-TAKING HINT: To answer this question correctly, the test taker first must understand the definition of "anhedonia." When this symptom of schizophrenia is understood, the test taker can discern the client problem that this distressful symptom may generate.

Which interaction is most reflective of an appropriate psychotherapeutic approach when interacting with a client diagnosed with schizophrenia? 1. The nurse should exhibit exaggerated warmth to counteract client loneliness. 2. The nurse should profess friendship to decrease social isolation. 3. The nurse should attempt closeness with the client to decrease suspiciousness. 4. The nurse should be honest and respect the client's privacy to begin the establishment of a relationship.

1. Exaggerated warmth and professions of friendship are likely to be met with confusion and suspicion when dealing with clients diagnosed with schizophrenia. 2. The client diagnosed with schizophrenia is desperately lonely, yet defends against kindness, compassion, and trust. The nurse needs to maintain a professional relationship, and professing friendship is inappropriate. 3. The client diagnosed with schizophrenia is likely to respond to attempts at closeness with suspiciousness, anxiety, aggression, or regression. It is important for the nurse to maintain professional boundaries. 4. Successful intervention may best be achieved with honesty, simple directness, and a manner that respects the client's privacy and human dignity. TEST-TAKING HINT: To answer this question correctly, the test taker must understand that establishing a relationship with a client diagnosed with schizophrenia is often particularly difficult and should not be forced.

A client taking olanzapine (Zyprexa) has a nursing diagnosis of altered sensory perception R/T command hallucinations. Which outcome would be appropriate for this client's problem? 1. The client will verbalize feelings related to depression and suicidal ideations. 2. The client will limit caloric intake because of the side effect of weight gain. 3. The client will notify staff members of bothersome hallucinations. 4. The client will tell staff members if experiencing thoughts of self-harm.

1. Expecting the client to verbalize feelings related to depression and any suicidal ideations is appropriate for a nursing diagnosis of risk for suicide, not altered sensory perception R/T command hallucinations. 2. Weight gain is a side effect of many antipsychotic drugs, including olanzapine (Zyprexa). The outcome of limiting caloric intake because of the side effect of weight gain does not relate to the nursing diagnosis of altered sensory perception R/T command hallucinations. 3. When the client has the insight to recognize hallucinations and report them to staff members, the client is in better touch with reality and moving toward remission. This is an outcome that relates to the client's problem of altered sensory perception. Reporting to staff members also can assist in preventing the client from following through with the commands given by auditory hallucinations. 4. Expecting the client to tell staff members if the client is experiencing thoughts of selfharm is an outcome that is appropriate for a nursing diagnosis of risk for violence: selfdirected, not altered sensory perception. TEST-TAKING HINT: To answer this question correctly, the test taker needs to determine the problem being addressed in the question. The answers may address side effects of olanzapine (Zyprexa), but the question asks for the client problem outcome based on the nursing diagnosis of altered sensory perception R/T command hallucinations

A client admitted to an in-patient setting has not been compliant with antipsychotic medications prescribed for schizophrenia. Which outcome related to this client's problem should the nurse expect the client to achieve? 1. The client will maintain anxiety at a reasonable level by day 2. 2. The client will take antipsychotic medications by discharge. 3. The client will communicate to staff any paranoid thoughts by day 3. 4. The client will take responsibility for self-care by day 4.

1. General anxiety is not addressed in this question as this client's problem. If the client is noncompliant with antipsychotic medications because of paranoid thinking, anxiety may be present. An outcome of decreased anxiety is not directly related to the client's described noncompliant behaviors. Also, a "reasonable" level of anxiety is not specific or measurable. 2. Taking antipsychotic medications by discharge is an appropriate outcome for this client's problem of noncompliance. The outcome is realistic, client-centered, and measurable. 3. Communicating to staff any paranoid thoughts by day 3 is not an outcome that is directly related to the client's noncompliance issue. No information is presented to indicate that the reason for the client's noncompliance is paranoid thinking. If paranoid thinking is the cause of the noncompliance, this outcome may be appropriate. 4. Taking responsibility for self-care by day 4 is an inappropriate outcome for the client problem of noncompliance with antipsychotic medications. This outcome would be appropriate for a self-care deficit problem. TEST-TAKING HINT: To answer this question correctly, the test taker must choose the outcome that is directly related to the client's medication noncompliance. It is important not to read anything into the question. Overthinking questions usually results in incorrect answers.

Which client is most likely to benefit from group therapy? 1. A client diagnosed with schizophrenia being followed up in an out-patient clinic. 2. A client diagnosed with schizophrenia newly admitted to an in-patient unit for stabilization. 3. A client experiencing an exacerbation of the signs and symptoms of schizophrenia. 4. A client diagnosed with schizophrenia who is not compliant with antipsychotic medications.

1. Group therapy for clients diagnosed with thought disorders has been shown to be effective, particularly in an out-patient setting and when combined with medication management. 2. In-patient treatment usually occurs when symptoms and social disorganization are at their most intense. Because these clients experience lower functioning levels, they are not appropriate candidates for group therapy. 3. A less stimulating environment is most beneficial for clients experiencing an exacerbation of the signs and symptoms of schizophrenia. Because group therapy can be an intensive and highly stimulating environment, it may be counterproductive early in treatment. 4. Group therapy for clients diagnosed with thought disorders has been shown to be effective when combined with medication management. Because the psychotic manifestations of the illness subside with use of antipsychotic drugs, clients are generally more cooperative with psychosocial therapies such as group therapy. Without the effects of psychotropic drugs, group therapy may not be as beneficial. TEST-TAKING HINT: To answer this question correctly, the test taker must understand the common signs and symptoms of schizophrenia that may hinder clients from benefiting from group therapy. It also is important to realize the effect antipsychotic medications have on the ability of these clients to participate in therapeutic groups.

A client's family is having a difficult time accepting the client's diagnosis of schizophrenia, and this has led to family conflict. Which nursing diagnosis reflects this problem? 1. Impaired home maintenance. 2. Interrupted family processes. 3. Social isolation. 4. Disturbed thought processes

1. Impaired home maintenance can be related to regression, withdrawal, lack of knowledge or resources, or impaired physical or cognitivefunctioning in clients experiencing thought disorders. This is evidenced by an unsafe, unclean, disorderly home environment. There is no information in the question that indicates impaired home maintenance is the problem. 2. The nursing diagnosis of interrupted family processes is defined as a change in family relationships or functioning or both. This nursing diagnosis is reflected in the family's conflict related to an inability to accept the family member's diagnosis of schizophrenia. 3. Social isolation is defined as aloneness experienced by the individual and perceived as imposed by others and as a negative or threatened state. No evidence is presented in the question that would indicate social isolation is the problem. 4. The nursing diagnosis of disturbed thought processes is defined as the disruption in cognitive operations and activities. An example of a disturbed thought process is a delusion. No evidence is presented in the question that would indicate disturbed thought processes are present. TEST-TAKING HINT: The only nursing diagnosis that relates to a problem with family dynamics is interrupted family processes. All of the other nursing diagnoses relate to individual client problems and can be eliminated.

A client diagnosed with a thought disorder is experiencing clang associations. Which nursing diagnosis reflects this client's problem? 1. Impaired verbal communication. 2. Risk for violence. 3. Ineffective health maintenance. 4. Disturbed sensory perception.

1. Impaired verbal communication is defined as the decreased, delayed, or absent ability to receive, process, transmit, and use a system of symbols. Clang associations are choices of words that are governed by sound. Words often take the form of rhyming. An example of a clang association is "It is cold. I am bold. The gold has been sold." This type of language is an impairment to verbal communication. 2. Risk for violence is defined as a risk for behaviors in which an individual demonstrates that he or she can be physically, emotionally, or sexually harmful either to self or to others. The symptom described in the question does not reflect the nursing diagnosis of risk for violence. 3. Ineffective health maintenance is defined as the inability to identify, manage, or seek out help to maintain health. Noncompliance with antipsychotic medications is one form of ineffective health maintenance that is common in clients diagnosed with thought disorders, but there is no indication that the client described in the question has this problem. 4. Disturbed sensory perception is defined as a change in the amount or patterning of incoming stimuli (either internally or externally initiated), accompanied by a diminished, exaggerated, distorted, or impaired response to such stimuli. An example of a disturbed sensory perception is a visual hallucination. The symptom presented in the question does not reflect the nursing diagnosis of disturbed sensory perception. TEST-TAKING HINT: To answer this question correctly, the test taker must first understand the definition of "clang associations." When this symptom of schizophrenia is understood, the test taker can discern the client problem that this symptom may generate

In the United States, which diagnosis has the lowest percentage of occurrence? 1. Major depressive disorder. 2. Generalized anxiety disorder. 3. Obsessive-compulsive disorder. 4. Schizophrenia.

1. In the United States, the prevalence of major depressive disorder is 17%. 2. In the United States, the prevalence of generalized anxiety disorder is 5%. 3. In the United States, the prevalence of obsessive-compulsive disorder is 3%. 4. In the United States, the prevalence of schizophrenia is 1%. Approximately 1.7 million American adults are diagnosed with the brain disorder of schizophrenia. TEST-TAKING HINT: The test taker must differentiate between the prevalence rates of schizophrenia and other mental health disorders to answer this question correctly.

A nurse is assessing a client in the mental health clinic. The client has a long history of being a loner and has few social relationships. This client's father has been diagnosed with schizophrenia. The nurse would suspect that this client is in what phase in the development of schizophrenia? 1. Phase I—schizoid/Premorbid personality. 2. Phase II—prodromal phase. 3. Phase III—schizophrenia. 4. Phase IV—residual phase.

1. Individuals diagnosed with schizoid personality disorder are typically loners who appear cold and aloof and are indifferent to social relationships. Not all individuals who demonstrate the characteristics of schizoid personality disorder progress to schizophrenia, but because of a family history of schizophrenia, this client's risk for acquiring the disease increases from 1% in the general population to 10%. 2. Characteristics of the prodromal phase include social withdrawal; impairment in role functioning; eccentric behaviors; neglect of personal hygiene and grooming; blunted or inappropriate affect; disturbances in communication; bizarre ideas; unusual perceptual experiences; and lack of initiative, interests, or energy. The length of this phase varies; it may last for many years before progressing to schizophrenia. The symptoms presented in the question are not reflective of the prodromal phase of the development of schizophrenia. 3. In the active phase of schizophrenia, psychotic symptoms are prominent. Two or more of the following symptoms must be present for a significant portion of time during a 1-month period: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms (affective flattening, alogia, or avolition). The client in the question does not present with these symptoms. 4. Schizophrenia is characterized by periods of remission and exacerbation. A residual phase usually follows an active phase of the illness. Symptoms during the residual phase are similar to those of the prodromal phase, with flat affect and impairment in role function being prominent. There is no indication in the question that the client has recently experienced an active phase of schizophrenia. TEST-TAKING HINT: Understanding the relationship of inherited risk for the development of schizophrenia and the phases of its development will assist the test taker in choosing the correct answer to this question.

A nurse is assessing a client in the mental health clinic 6 months after the client's discharge from in-patient psychiatric treatment for schizophrenia. The client has no active symptoms, but has a flat affect and has recently been placed on disability. What should the nurse document? 1. "The client is experiencing symptoms of the schizoid personality phase of the development of schizophrenia." 2. "The client is experiencing symptoms of the prodromal phase of the development of schizophrenia." 3. "The client is experiencing symptoms of schizophrenia." 4. "The client is experiencing symptoms of the residual phase of the development of schizophrenia."

1. Individuals diagnosed with schizoid personality disorder are typically loners who appear cold and aloof and are indifferent to social relationships. The symptoms described in the question do not reflect symptoms of schizoid personality. 2. Characteristics of the prodromal phase include social withdrawal, impairment in role functioning, eccentric behaviors, neglect of personal hygiene and grooming, blunted or inappropriate affect, disturbances in communication, bizarre ideas, unusual perceptual experiences, and lack of initiative, interests, or energy. The length of this phase varies; it may last for many years before progressing to schizophrenia. The symptoms described in the question are not reflective of the prodromal phase of the development of schizophrenia. 3. In the active phase of schizophrenia, psychotic symptoms are prominent. Two or more of the following symptoms must be present for a significant portion of time during a 1-month period: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms (affective flattening, alogia, or avolition). The client in the question does not currently present with these symptoms. 4. Symptoms during the residual phase are similar to those of the prodromal phase, with flat affect and impairment in role function being prominent. This client has recently experienced an active phase of schizophrenia and has been placed on disability, indicating problems with role functioning. The nurse would recognize the symptoms presented as an indication that the client is in the residual phase of schizophrenia. TEST-TAKING HINT: The test taker needs to note the client symptoms described in the question and the client's history of recently experiencing the active phase of schizophrenia. This information leads the test taker to choose the residual phase of schizophrenia as the correct answer

A client is in the active phase of paranoid schizophrenia. Which nursing intervention would aid in facilitating other interventions? 1. Assign consistent staff members. 2. Convey acceptance of the delusional belief. 3. Help the client understand the connection between anxiety and hallucinations. 4. Encourage participation in group activities.

1. Individuals with paranoia have extreme suspiciousness of others and their actions. It is difficult to establish trust with clients experiencing paranoia. All interventions would be suspect. Only by assigning consistent staff members would there be hope to establish a trusting nurse-client relationship and increase the effectiveness of further nursing interventions. 2. The nurse should convey acceptance of the client and the client's need for the false belief, not the client's false belief itself. The nurse should present, focus on, and reinforce reality. 3. This client is diagnosed with paranoid schizophrenia. Paranoid delusions are a common symptom of this diagnosis and are likely to be the client's main problem. These clients also may experience hallucinations, but this symptom has not been described in the question. 4. Individuals experiencing paranoia have extreme suspiciousness of others and their actions. When the client is in the active phase of this disease, group activities can be misinterpreted. This would not be an appropriate nursing intervention at this time. TEST-TAKING HINT: To answer this question correctly, the test taker must understand the need first to establish trust with a client experiencing paranoia. Assigning consistent staff members is one way to foster trust. Other interventions would be move effective after trust is established.

A client diagnosed with schizophrenia is brought to the emergency department by a family member. The client is experiencing social withdrawal, flat affect, and impairment in role functioning. To distinguish whether this client is in the prodromal or residual phase of schizophrenia, what question would the nurse ask? 1. "Has this client recently experienced an exacerbation of the signs and symptoms of schizophrenia?" 2. "How long have these symptoms been occurring?" 3. "Has the client had a change in mood?" 4. "Has the client been diagnosed with any developmental disorders?"

1. It is important for the nurse to know if this client has recently experienced an active phase of schizophrenia to distinguish the symptoms presented as indications of the prodromal or residual phase of schizophrenia. Schizophrenia is characterized by periods of remission and exacerbation. A residual phase usually follows an active phase of the illness. Symptoms during the residual phase are similar to those of the prodromal phase, with flat affect and impairment in role function being prominent. 2. Duration of symptoms is a criterion for the diagnosis of schizophrenia, but this knowledge does not help the nurse distinguish whether this client is in the prodromal or residual phase of schizophrenia. 3. It is important to rule out schizoaffective and mood disorders when determining the diagnosis of schizophrenia, but this knowledge does not help the nurse distinguish whether this client is in the prodromal or residual phase of schizophrenia. 4. If there is a history of an autistic disorder or another pervasive developmental disorder, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations also are present for at least 1 month. This determination must be made before diagnosing the client with schizophrenia, but this knowledge does not help the nurse distinguish whether this client is in the prodromal or residual phase of schizophrenia. TEST-TAKING HINT: This question is asking for the test taker to determine whether the client is in the prodromal or residual phase. Only "1" deals with this distinction. All other answers are important information related to the client's meeting the criteria for a diagnosis of schizophrenia, but these answers do not deal with phase distinction

A client with a nursing diagnosis of disturbed thought processes has an expected outcome of recognizing delusional thinking. Which intervention would the nurse first implement to address this problem? 1. Reinforce and focus on reality. 2. Convey understanding that the client is experiencing delusional thinking. 3. Indicate that the nurse does not share the belief. 4. Present logical information to refute the delusional thinking.

1. It is important to reinforce and focus on reality when a client is experiencing disturbed thought processes; however, this is not the first intervention that the nurse should implement. 2. When the nurse conveys understanding that the client is experiencing delusional thinking, the nurse is showing empathy for the client's situation and building trust. This should be the first step to address the problem of disturbed thought processes. All further interventions would be based on the relationship's being established by generating trust. 3. It important to indicate that the nurse does not share the client's delusional thought; however, this is not the initial intervention that the nurse should implement. 4. Presenting logical information to refute delusional thinking serves no useful purpose because fixed delusional ideas are not eliminated by this approach. This also may impede the establishment of a trusting relationship. TEST-TAKING HINT: The keyword in this question is "first." Other answer choices may be appropriate, but the correct choice is the intervention that should be implemented first. All interventions would be better accepted if they are implemented in a trusting environment.

The nurse is reviewing lab results for a client diagnosed with a thought disorder who is taking clozapine (Clozaril) 25 mg QD. The following values are documented: RBC 4.7 million/mcL, WBC 2000/mcL, and TSH 1.3 mc-IU. Which would the nurse expect the physician to order based on these values? 1. "Levothyroxine sodium (Synthroid) 150 mcg QD." 2. "Ferrous sulfate (Feosol) 100 mg tid." 3. "Discontinue clozapine (Clozaril)." 4. "Discontinue clozapine (Clozaril) and start levothyroxine sodium (Synthroid) 150 mcg QD."

1. Levothyroxine sodium (Synthroid) is used as replacement or substitution therapy in diminished or absent thyroid function. TSH is thyroid-stimulating hormone. An increased TSH indicates low thyroid functioning. The normal range of TSH is 0.35 to 5.5 mc-IU. This client's TSH level is within normal range, so this medication should not be indicated 2. This client's red blood cell (RBC) count is 4.7 million/mcL, which is within the normal range for male (4.6 to 6) and female (4 to 5) values. Because these values do not indicate anemia, the nurse would not expect replacement iron (ferrous sulfate [Feosol]) to be ordered. 3. A normal adult value of white blood cell (WBC) count is 4500 to 10,000/mcL. This client's WBC count is 2000/mcL, indicating agranulocytosis, which is a potentially fatal blood disorder. There is a significant risk for agranulocytosis with clozapine (Clozaril) therapy. The nurse would expect the physician to discontinue clozapine (Clozaril). 4. The first part of this choice is correct, but the second part is incorrect. This client's TSH level is normal, so levothyroxine sodium (Synthroid) would not be indicated. TEST-TAKING HINT: The test taker first must recognize the WBC count as critically low and the TSH value normal. Recognizing a low WBC as agranulocytosis would lead the test taker to expect the physician to discontinue clozapine (Clozaril). The test taker also must remember that all parts of the answer must be correct, or the entire answer is considered incorrect. This would eliminate "4" because levothyroxine sodium (Synthroid) would not be indicated.

The 43-year-old female client diagnosed with schizophrenia has been taking chlorpromazine for 20 years. Which assessment data warrants discontinuing the medication? 1. The client has had menstrual irregularities for the past year. 2. The client has to get up very slowly from a sitting position. 3. The client reports having a dry mouth and blurred vision. 4. The client has fine, worm-like movements of the tongue.

1. Menstrual irregularity is a common side effect of conventional antipsychotic medications like chlorpromazine (Thorazine) and would not warrant discontinuing the medication. 2. Orthostatic hypotension is a common side effect of conventional antipsychotic medications and would not warrant discontinuing the medication. 3. Anticholinergic effects are common side effects of conventional antipsychotic medications and would not warrant discontinuing the medication. 4. Exhibiting fine, worm-like movements of the tongue is a symptom of tardive dyskinesia, which is an adverse effect that may develop after months or years of continuous therapy with a conventional antipsychotic medication. The conventional antipsychotic medication chlorpromazine (Thorazine) should be discontinued and a benzodiazepine should be administered.

Which intervention used for clients diagnosed with thought disorders is a behavioral therapy approach? 1. Offer opportunities for learning about psycotropic medications. 2. Attach consequences to adaptive and maladaptive behaviors. 3. Establish trust within a relationship. 4. Encourage discussions of feelings related to delusions

1. Offering opportunities to learn about psychotropic medications is a cognitive, not behavioral, therapy approach. 2. When the nurse attaches consequences to adaptive or maladaptive behaviors, the nurse is using a behavioral therapy approach. Behavior therapy can be a powerful treatment tool for helping clients change undesirable behaviors. 3. When the nurse establishes trust within a relationship, the nurse is using an interpersonal, not behavioral therapy approach. 4. When the nurse encourages discussions of feelings related to delusions, the nurse is using an intrapersonal, not behavioral, therapy approach. TEST-TAKING HINT: The test taker must distinguish between the various treatment modalities for clients diagnosed with thought disorders. The use of consequences for behaviors is the hallmark of behavioral therapy and should be recognized as such.

The nurse is educating the family members of a client diagnosed with schizophrenia about the effects of psychotherapy. Which statement should be included in the teaching plan? 1. "Psychotherapy is a short-term intervention that is usually successful." 2. "Much patience is required during psychotherapy because clients often relapse." 3. "Major changes in client symptoms can be attributed to immediate psychotherapy." 4. "Independent functioning can be gained by immediate psychotherapy."

1. Psychotherapy for clients diagnosed with schizophrenia is a long-term, not short-term, endeavor. The therapist must accept the fact that a great deal of client behavioral change may not occur. 2. The psychotherapist requires much patience when treating clients diagnosed with schizophrenia. Depending on the severity of the illness, psychotherapeutic treatment may continue for many years before clients regain some extent of independent functioning. 3. Psychotherapeutic treatment may continue for many years before clients regain some extent of independent functioning. Even with immediate psychotherapy, behavioral changes may not occur. 4. There is no guarantee that clients diagnosed with schizophrenia who receive immediate psychotherapy will gain independent functioning. TEST-TAKING HINT: The test taker must understand that psychotherapy may have limited effects because of the chronic nature of schizophrenia. Noting the word "immediate" in answers "3" and "4" will assist the test taker to eliminate these answer choices

Which outcome should the nurse expect from a client with a nursing diagnosis of social isolation? 1. The client will recognize distortions of reality by day 4. 2. The client will use appropriate verbal communication when interacting with others by day 3. 3. The client will actively participate in unit activities by discharge. 4. The client will rate anxiety as 5/10 by discharge.

1. Recognizing distortions of reality by day 4 is an outcome for the nursing diagnosis of disturbed thought processes, not social isolation. 2. Using appropriate verbal communication when interacting with others by day 3 is an outcome for the nursing diagnosis of impaired verbal communication, not social isolation. Impaired communication can lead to social isolation, but it is not directly related. 3. Actively participating in unit activities by discharge is an outcome for the nursing diagnosis of social isolation. Participation in unit activities indicates interaction with others on the unit, which leads to decreased social isolation. 4. Rating anxiety as 5/10 by discharge is an outcome for the nursing diagnosis of anxiety, not social isolation. If anxiety is decreased, the client is more apt to interact with others, but the stated outcome is not directly related to social isolation. TEST-TAKING HINT: The test taker needs to look for a direct connection between the nursing diagnosis presented and the outcome choices.

From a sociocultural perspective, which accurately describes the etiology of schizophrenia? 1. Relatives of individuals diagnosed with schizophrenia have a much higher probability of developing the disease. 2. Structural brain abnormalities, such as enlarged ventricles, cause schizophrenia. 3. Disordering of pyramidal cells in the hippocampus contributes to the cause of schizophrenia. 4. Greater numbers of individuals from lower socioeconomic backgrounds are diagnosed with schizophrenia

1. Relatives of individuals diagnosed with schizophrenia having a much higher probability of developing the disease is evidence from a genetic, not sociocultural, perspective for the etiology of schizophrenia. 2. Structural brain abnormalities, such as enlarged ventricles, causing schizophrenia is evidence from a physiological, not sociocultural, perspective for the etiology of schizophrenia. Other researchers think these enlarged ventricles may be the result, rather than the cause, of the disease. 3. Disordering of pyramidal cells in the hippocampus is evidence from a physiological, not sociocultural, perspective for the etiology of schizophrenia. 4. Statistically, there are greater numbers of individuals from lower socioeconomic backgrounds diagnosed with schizophrenia. This is evidence from a sociocultural perspective for the etiology of schizophrenia. It is unclear whether this increased diagnosis may occur because of a lower socioeconomic situation or because the disease itself can contribute to a lower socioeconomic status. TEST-TAKING HINT: The test taker must note the keyword "sociocultural." There are numerous theories of etiology for schizophrenia, but the question is asking for a sociocultural perspective

From a biochemical influence perspective, which accurately describes the etiology of schizophrenia? 1. Children born of nonschizophrenic parents and raised by parents diagnosed with schizophrenia have a higher incidence of diagnosis. 2. An excess of dopamine-dependent neuronal activity in the brain. 3. A higher incidence of schizophrenia occurs after prenatal exposure to influenza. 4. Poor parent-child interaction and dysfunctional family systems.

1. Research indicates that children born of nonschizophrenic parents and raised by parents diagnosed with schizophrenia do not seem to suffer more often from schizophrenia than the general population. 2. The dopamine hypothesis suggests that schizophrenia may be caused by an excess of dopamine-dependent neuronal activity in the brain. This excess activity may be related to increased production, or release, of the substance at nerve terminals; increased receptor sensitivity; too many dopamine receptors; or a combination of these mechanisms. This etiological theory is from a biochemical influence perspective. 3. Research has shown a higher incidence of schizophrenia after prenatal exposure to influenza. This theory of the etiology of schizophrenia is from a physiological, not biochemical influence, perspective. 4. Poor parent-child interaction and dysfunctional family systems do not cause schizophrenia. Stress in a family system may precipitate symptoms in an individual who possesses a genetic vulnerability to schizophrenia. TEST-TAKING HINT: The test taker must note the keyword "biochemical." There are numerous etiological theories for schizophrenia, but the question is asking for a biochemical perspective. A neurochemical perspective would relate to a neurochemical imbalance, such as an increased level of dopamine. A physiological perspective would include functional and structural abnormalities.

The client diagnosed with paranoid schizophrenia has been taking haloperidol for several years. Which statement indicates the client needs additional teaching concerning this medication? 1. "I know that if I have any rigidity or tremors I must call my HCP." 2. "I eat high-fiber foods and drink extra water during the day." 3. "I am more susceptible to colds and the flu when taking this medication." 4. "This medication will make my hallucinations and delusions go away."

1. Rigidity and tremors are signs of extrapyramidal side effects and should be reported to the HCP. The client does not need additional teaching. 2. Haloperidol (Haldol), a conventional antipsychotic, has anticholinergic effects, including constipation. Increasing fiber and fluid intake will help prevent constipation. This statement does not indicate that the client needs additional teaching. 3. Haloperidol (Haldol), a conventional antipsychotic, causes agranulocytosis, which diminishes the client's ability to fight infection, but the medication (if the client does not develop the adverse effect of agranulocytosis) does not cause the client to have increased susceptibility to colds and the flu. If the client has a fever or sore throat, the HCP should be notified, and if the WBC count is elevated, the medication will be discontinued. 4. This statement indicates the client understands why the haloperidol (Haldol), a conventional antipsychotic, is being taken. This indicates the medication teaching is effective. MEDICATION MEMORY JOGGER: Usually, if a client is prescribed a new medication and has fl u-like symptoms within 24 hours of taking the first dose, the client should contact the HCP. These are signs of agranulocytosis, which indicates the medication has caused a sudden drop in the WBC count, leaving the body defenseless against bacterial invasion.

A client states, "I can't go into my bathroom because there is a demon in the tub." Which nursing diagnosis reflects this client's problem? 1. Self-care deficit. 2. Ineffective health maintenance. 3. Disturbed sensory perception. 4. Disturbed thought processes

1. Self-care deficit is defined as the impaired ability to perform or complete activities of daily living. The hallucination that the client is experiencing may affect the client's selfcare, but the presenting symptom, a visual hallucination, is not directly related to a selfcare deficit problem. 2. Ineffective health maintenance is defined as the inability to identify, manage, or seek out help to maintain health. Noncompliance with antipsychotic medications is one form of ineffective health maintenance that is common in clients diagnosed with thought disorders, but there is no indication that the client described in the question has this problem. 3. Disturbed sensory perception is defined as a change in the amount or patterning of incoming stimuli (either internally or externally initiated), accompanied by a diminished, exaggerated, distorted, or impaired response to such stimuli. The client's statement in the question indicates that the client is experiencing a visual hallucination, which is an example of a disturbed sensory perception. 4. Disturbed thought processes is defined as the disruption in cognitive operations and activities. An example of a disturbed thought process is a delusion. The client's statement in the question is an example of a visual hallucination, a disturbed sensory perception, not a disturbed thought process. TEST-TAKING HINT: The test taker must differentiate disturbed thought processes from disturbed sensory perceptions to answer this question correctly. Disturbed sensory perceptions predominantly refer to hallucinations, which are false sensory perceptions not associated with real external stimuli. Disturbed thought processes refer predominantly to delusions, which are false beliefs.

A client diagnosed with a thought disorder has body odor and halitosis and is disheveled. Which nursing diagnosis reflects this client's problem? 1. Social isolation. 2. Impaired home maintenance. 3. Interrupted family processes. 4. Self-care deficit.

1. Social isolation is defined as aloneness experienced by the individual and perceived as imposed by others and as a negative or threatened state. Even though poor hygiene may cause others to avoid this client, the statement in the question does not indicate that social isolation is a current client problem. 2. Impaired home maintenance can be related to regression, withdrawal, lack of knowledge or resources, or impaired physical or cognitive functioning in clients experiencing thought disorders. This is evidenced by an unsafe, unclean, disorderly home environment. No information is presented in the question that indicates impaired home maintenance is a client problem. 3. The nursing diagnosis of interrupted family processes is defined as a change in family relationships or functioning or both. The situation described does not reflect this nursing diagnosis. 4. Self-care deficit is defined as the impaired ability to perform or complete activities of daily living. The client's symptoms of body odor, halitosis, and a disheveled appearance are directly related to a selfcare deficit problem. TEST-TAKING HINT: The test taker must determine the nursing diagnosis that relates directly to the client's described symptoms. In this question, although others may avoid the client because of poor personal hygiene, there is no evidence of current social isolation in the question.

Which of the following clients has the best chance of a positive prognosis after being diagnosed with schizophrenia? Select all that apply. 1. A client diagnosed at age 35. 2. A male client experiencing a gradual onset of signs and symptoms. 3. A female client whose signs and symptoms began after a rape. 4. A client who has a family history of schizophrenia. 5. A client who has a family history of a mood disorder diagnosis.

1. Symptoms of schizophrenia generally appear in late adolescence or early adulthood. Onset at a later age is associated with a more positive prognosis. 2. Gradual, insidious onset of symptoms is associated with a poorer prognosis than abrupt onset of symptoms precipitated by a stressful event. Being male also is associated with a poor prognosis. 3. Abrupt onset of symptoms precipitated by a stressful event, such as rape, is associated with a more positive prognosis. Being female also is associated with a more positive prognosis. 4. A family history of schizophrenia is associated with a poor prognosis. 5. A family history of mood disorder is associated with a more positive prognosis. TEST-TAKING HINT: To answer this question correctly, the test taker must be able to differentiate the factors associated with a good prognosis and a poor prognosis for the diagnosis of schizophrenia.

A client newly admitted to an in-patient psychiatric unit is scanning the environment continuously. Which nursing intervention is most appropriate to address this client's behavior? 1. Offer self to build a therapeutic relationship with the client. 2. Assist the client to formulate a plan of action for discharge. 3. Involve the family in discussions about dealing with the client's behaviors. 4. Reinforce the need for medication compliance on discharge.

1. The client described in the question is exhibiting signs of paranoia. Clients with this symptom have trouble trusting others. The nurse should use the therapeutic technique of offering self to assist in building a trusting therapeutic relationship with this client. 2. Because this client is newly admitted and requires stabilization, the client is not ready to formulate a plan of action for discharge. Also, because of paranoia, the client would not be able to trust the nurse to formulate the discharge plan. 3. The nurse needs to work with the client first to build a trusting relationship. The nurse then needs to assess the client's acceptance of family involvement before including family members in discussions about dealing with the client's behaviors. 4. The nurse should reinforce the need for medication compliance; however, a therapeutic relationship should be established before client education for the client to trust the nurse and value the information presented. TEST-TAKING HINT: When reading a question, the test taker must note the client's admission status (newly admitted or ready for discharge). Is the client in an in-patient or out-patient setting? This information would affect the answer choice. It is important always to think about time-wise interventions. If this client were stabilized and ready for discharge, the other three answers could be considered

A 21-year-old client, being treated for asthma with steroid medication, has been experiencing delusions of persecution and disorganized thinking for the past 6 months. Which factor may rule out a diagnosis of schizophrenia? 1. The client has experienced signs and symptoms for only 6 months. 2. The client must hear voices to be diagnosed with schizophrenia. 3. The client's age is not typical for this diagnosis. 4. The client is receiving medication that could lead to thought disturbances

1. The client in the question has experienced two symptoms for a 6-month period, and so the diagnosis of schizophrenia cannot be ruled out. The DSM-IV-TR criteria for the diagnosis of schizophrenia state that two or more symptoms of the disease must be present for a significant amount of time during a 1-month period and last for 6 months. 2. This client is not experiencing auditory hallucinations, but this in itself does not rule out the diagnosis of schizophrenia. Although auditory hallucinations are classic symptoms of schizophrenia, other symptoms also may lead to the diagnosis. Delusions, disorganized speech, grossly disorganized or catatonic behavior, affective flattening, alogia, and avolition are other symptoms that can occur. 3. Symptoms of schizophrenia generally appear in late adolescence or early adulthood. The client described falls within this age range, and schizophrenia cannot not be ruled out. 4. Steroid medications could precipitate the thought disorders experienced by the client and potentially rule out the diagnosis of schizophrenia. According to the DSM-IVTR criteria for this diagnosis, the thought disturbance cannot be due to the direct physiological effects of a substance. TEST-TAKING HINT: To answer this question correctly, the test taker must be familiar with the DSM-IV-TR criteria for the diagnosis of schizophrenia. This question asks what would potentially eliminate the diagnosis of schizophrenia; the test taker should look for incorrect or inappropriate criteria.

The nurse is discussing the prescribed antipsychotic medication with a family member of a client diagnosed with schizophrenia. Which information should the nurse discuss with the family member? 1. Explain the need for the family member to give the client the medication. 2. Encourage the family member to learn cardiopulmonary resuscitation (CPR). 3. Discuss the need for the client to participate in a community support group. 4. Teach the family member what to do in case the client has a seizure.

1. The client should be responsible for taking his or her own medication and not rely on the family member to administer it. The nurse should encourage the family member not to make the client dependent on anyone. 2. There is no reason for the family member to learn CPR because antipsychotic medications do not cause death. 3. The nurse should encourage the family member to attend a support group for families of people diagnosed with schizophrenia. If there are any groups available for people diagnosed with schizophrenia, then the client should attend one. The nurse should encourage the family member to let the client take care of his or her own mental illness. 4. Antipsychotic medications lower the seizure threshold, even if the client does not have a seizure disorder; therefore, the nurse should discuss what to do if the client has a seizure.

Which client has the best chance of a positive prognosis? 1. A client diagnosed with schizophrenia taking antipsychotic medications consistently. 2. A client diagnosed with schizophrenia participating in psychosocial therapies. 3. A client diagnosed with schizophrenia complying with antipsychotic medications and participating in psychosocial therapies. 4. A client whose family provides psychosocial support

1. The efficacy of antipsychotic medications is enhanced by adjunct psychosocial therapy. A better prognosis can be attained by combined therapies. 2. Because the psychotic manifestations of the illness subside with the use of antipsychotic drugs, clients are generally more cooperative with psychosocial therapies. Psychosocial therapy alone without the effects of antipsychotic drugs would be less effective. 3. Research shows that antipsychotic medications are more effective at all levels when combined with psychosocial therapies. Psychosocial therapies are more beneficial to the client when symptoms are controlled by antipsychotic medications. A combination of these therapies gives these clients the best chance for a positive prognosis. 4. A client's family providing psychosocial support is critical to a client's prognosis, but if the client is noncompliant with antipsychotic medications and psychosocial therapies, there is a limited chance for a positive prognosis. TEST-TAKING HINT: The test taker should look for a combination of therapies to achieve a more positive prognosis for clients diagnosed with schizophrenia.

A client diagnosed with paranoid schizophrenia tells the nurse about three previous suicide attempts. Which nursing diagnosis would take priority and reflect this client's problem? 1. Disturbed thought processes. 2. Risk for suicide. 3. Violence: directed toward others. 4. Risk for altered sensory perception

1. The nursing diagnosis of disturbed thought processes is defined as the disruption in cognitive operations and activities. An example of a disturbed thought process is a delusion. Thinking about suicide is not a disturbed thought process. The content of thought that the client is experiencing reflects the client's risk for suicide. No evidence is presented in the question that would indicate disturbed thought processes are present. 2. Risk for suicide is defined as the risk for self-inflicted, life-threatening injury. A past history of suicide attempts greatly increases the risk for suicide and makes this an appropriate diagnosis for this client. Because client safety is always the main consideration, this diagnosis should be prioritized. 3. Violence: directed toward others is defined as being at risk for behaviors in which an individual demonstrates that he or she can be physically, emotionally, or sexually harmful to others. Although clients diagnosed with paranoid schizophrenia can lash out defensively when a threat is perceived, there is no evidence in the question that would indicate that this is a problem. 4. Risk for disturbed sensory perception is defined as being at risk for a change in the amount or patterning of incoming stimuli (either internally or externally initiated), accompanied by a diminished, exaggerated, distorted, or impaired response to such stimuli. An example is an auditory hallucination. Although clients with a diagnosis of paranoid schizophrenia are at risk for disturbed sensory perception because of the nature of their disease, there is no evidence in the question that would indicate the client is at risk for this problem. TEST-TAKING HINT: It is important for the test taker to choose a nursing diagnosis that reflects the client symptom or situation described in the question. The diagnosis of paranoid schizophrenia puts a client at risk for various problems, including violence toward others and disturbed sensory perception. This client's history of suicide attempts determines the appropriate choice and prioritization of the nursing diagnosis risk for suicide.

The nurse reports that a client diagnosed with a thought disorder is experiencing religiosity. Which client statement would confirm this finding? 1. "I see Jesus in my bathroom." 2. "I read the Bible every hour so that I will know what to do next." 3. "I have no heart. I'm dead and in heaven today." 4. "I can't read my Bible because the CIA has poisoned the pages."

1. The statement, "I see Jesus in my bathroom," is an example of a visual hallucination. A visual hallucination is a false visual perception not associated with real external stimuli. This is not an example of religiosity. 2. The statement, "I read the Bible every hour so that I will know what to do next," is evidence of the symptom of religiosity. Religiosity is an excessive demonstration of or obsession with religious ideas and behavior. The client may use religious ideas in an attempt to provide rational meaning and structure to behavior. 3. The statement, "I have no heart. I'm dead and in heaven today," is evidence of a nihilistic delusion. A nihilistic delusion is a false idea that the self, a part of the self, others, or the world is nonexistent. 4. The statement, "I can't read my Bible because the CIA has poisoned the pages," is evidence of paranoid thinking. Individuals experiencing paranoia have extreme suspiciousness of others, of their actions, or of their perceived intentions. TEST-TAKING HINT: The test taker should not confuse the theme of a visual hallucination, which is a false perception, with the delusion or false belief of religiosity. Even though the client in the question sees a religious figure, the client is experiencing a visual hallucination, not religiosity

The client admitted to the psychiatric unit diagnosed with schizophrenia is prescribed clozapine. Which laboratory data should the nurse evaluate? 1. The client's clozapine therapeutic level. 2. The client's white blood cell (WBC) count. 3. The client's red blood cell (RBC) count. 4. The client's arterial blood gases (ABGs).

1. There is no such test as a therapeutic serum level for clozapine. 2. Weekly WBCs are taken because the client is at risk for fatal agranulocytosis. Initially, the clozapine (Clozaril), an atypical antipsychotic medication, will not be administered if the WBC count is not available. 3. The client's RBC count is not affected by clozapine. 4. The respiratory system is not affected by clozapine (Clozaril), an atypical antipsychotic; therefore, ABGs do not have to be evaluated when taking this medication. MEDICATION MEMORY JOGGER: Usually if a client is prescribed a new medication and has flu-like symptoms within 24 hours of taking the first dose, the client should contact the HCP. These are signs of agranulocytosis, which indicates the medication has caused a sudden drop in the WBC count, leaving the body defenseless against bacterial invasion.

What is required for effective treatment of schizophrenia? 1. Concentration on pharmacotherapy alone to alter imbalances in neurotransmitters. 2. Multidisciplinary, comprehensive efforts, which include pharmacotherapy and psychosocial care. 3. Emphasis on social and living skills training to help the client fit into society. 4. Group and family therapy to increase socialization skills.

1. There is not now, and probably never will be, a single treatment that cures schizophrenia. Antipsychotic drugs, also called neuroleptics, are effective in the treatment of acute and chronic manifestations of schizophrenia and in maintenance therapy to prevent exacerbation of symptoms. The efficacy of antipsychotic drugs is enhanced by adjunct psychosocial therapy. 2. Effective treatment of schizophrenia requires a comprehensive, multidisciplinary effort, including pharmacotherapy and various forms of psychosocial care. Psychosocial care includes social and living skills training, rehabilitation, and family therapy. 3. Social and living skills training is only one aspect of the treatment for schizophrenia. Psychotic manifestations of the illness subside with the use of antipsychotic drugs. Clients are then generally more cooperative with the psychosocial therapies that help the client fit into society. 4. Group and family therapy is only one aspect of the treatment for schizophrenia. Psychotic manifestations of the illness subside with the use of antipsychotic drugs. Clients are then generally more cooperative with the psychosocial therapies that increase socialization skills. TEST-TAKING HINT: All answers presented are possible interventions that support various theories of causation of schizophrenia. To choose the correct answer, the test taker must understand that no one intervention has been accepted as a definitive treatment for the disease of schizophrenia. Pharmacotherapy coupled with psychosocial therapies has been recognized as the most effective approach to controlling the symptoms of schizophrenia.

A client who is hearing and seeing things others do not is brought to the emergency department. Lab values indicate a sodium level of 160 mEq/L. Which nursing diagnosis would take priority? 1. Altered thought processes R/T low blood sodium levels. 2. Altered communication processes R/T altered thought processes. 3. Risk for impaired tissue integrity R/T dry oral mucous membranes. 4. Imbalanced fluid volume R/T increased serum sodium levels.

1. This client is experiencing altered thought processes as a result of hypernatremia, not hyponatremia. The appropriate physical condition must be corrected for the psychotic symptoms to improve. 2. As a result of experiencing psychotic symptoms secondary to electrolyte imbalance, this client has impaired communication. Altered thought processes lead to an inability to communicate effectively. Correcting the physical problem, which is the priority, would improve the client's ability to communicate. 3. Because the client is experiencing hypernatremia, the client is at risk for impaired tissue integrity related to dry oral mucous membranes. Correcting the physical problem, which is the priority, would reduce the client's risk for impaired tissue integrity. 4. All physiological problems must be corrected before evaluating thought disorders. In this situation, the psychotic symptoms may be related to the critically high sodium level. If the cause is physiological in nature, the nurse's priority is to assist in correcting the physiological problem. If the client's fluid volume imbalance is corrected, the psychotic symptoms, which are due to the medical condition of hypernatremia, would be eliminated,resulting in an improvement in thought process symptoms. This would improve the client's ability to communicate effectively and decrease the risk of dry mucous membranes. TEST-TAKING HINT: To answer this question correctly, the test taker first must recognize a critically high sodium level and note the word "priority." When choosing a priority nursing diagnosis, the test taker always must focus on the NANDA stem, which is the statement of the client problem, and choose the diagnosis that, if resolved, also would solve other client problems

A client diagnosed with schizoid personality disorder asks the nurse in the mental health clinic, "Does this mean I will get schizophrenia?" What nursing response would be most appropriate? 1. "Does that possibility upset you?" 2. "Not all clients diagnosed with schizoid personality disorders progress to schizophrenia." 3. "Few clients with a diagnosis of schizophrenia show evidence of early personality changes." 4. "What do you know about schizophrenia?"

1. This response from the nurse does not address the client's concern and does not offer the information that the client has requested. 2. Not all individuals who demonstrate the characteristics of schizoid personality disorder progress to schizophrenia. However, most individuals diagnosed with schizophrenia show evidence of having schizoid personality characteristics in the premorbid condition. 3. Most, not few, clients diagnosed with schizophrenia show evidence of having schizoid personality characteristics in the premorbid condition. 4. Although it is important to assess a client's previous knowledge before beginning any teaching, this response from the nurse does not address the client's concern and does not offer the information that the client has requested. TEST-TAKING HINT: When asked to choose the correct response of the nurse, the test taker must make sure that the response addresses the client question or concern. Only "2" addresses this client's concern

Which assessment data indicates quetiapine is effective for the client diagnosed with paranoid schizophrenia? 1. The client does not exhibit any tremors or rigidity. 2. The client reports a 2 on an anxiety scale of 1-10. 3. The family reports the client is sleeping all night. 4. The client denies having auditory hallucinations.

1. Tremors or rigidity indicate the client is having extrapyramidal side effects of antipsychotic medications. Such activity does not indicate the medication is effective. 2. Antipsychotic medications are not prescribed for anxiety; therefore, anxiety cannot be evaluated to determine if the medication is effective. 3. Sleeping all night is a good sign for the client, but it does not determine if the medication is effective. 4. Antipsychotic medications are prescribed to decrease the signs or symptoms of schizophrenia. If the client denies auditory hallucinations, then the atypical antipsychotic quetiapine (Seroquel) medication is effective. MEDICATION MEMORY JOGGER: The nurse determines the effectiveness of a medication by assessing for the symptoms, or lack thereof, for which the medication was prescribed.

The nurse is assessing a client diagnosed with disorganized schizophrenia. Which symptoms should the nurse expect the client to exhibit? 1. Markedly regressive, primitive behavior, and extremely poor contact with reality. Affect is flat or grossly inappropriate. Personal appearance is neglected, and social impairment is extreme. 2. Marked abnormalities in motor behavior manifested in extreme psychomotor retardation with pronounced decreases in spontaneous movements and activity. Waxy flexibility is exhibited. 3. The client is exhibiting delusions of persecution or grandeur. Auditory hallucinations related to a persecutory theme are present. The client is tense, suspicious, and guarded, and may be argumentative, hostile, and aggressive. 4. The client has a history of active psychotic symptoms, but prominent psychotic symptoms are currently not exhibited.

1. When a client exhibits markedly regressive and primitive behavior, and the client's contact with reality is extremely poor, he or she is most likely to be diagnosed with disorganized schizophrenia. In this subcategory, a client's affect is flat or grossly inappropriate. Personal appearance is neglected, and social impairment is extreme. 2. When a client is diagnosed with catatonic, not disorganized, schizophrenia, he or she is likely to exhibit marked abnormalities in motor behavior manifested in extreme psychomotor retardation with pronounced decreases in spontaneous movements and activity. Waxy flexibility also is exhibited. 3. When a client is exhibiting delusions of persecution or grandeur and auditory hallucinations related to a persecutory theme, he or she is likely to be diagnosed with paranoid, not disorganized, schizophrenia. The client is likely to be tense, suspicious, and guarded, and may be argumentative, hostile, and aggressive. 4. When a client has a history of active psychotic symptoms, but is currently not exhibiting prominent psychotic symptoms, he or she is likely to be diagnosed with residual, not disorganized, schizophrenia. TEST-TAKING HINT: All answers describe symptoms exhibited in various subtypes of schizophrenia. The keywords in the question are "disorganized schizophrenia." The test taker must look for symptoms that occur in only this category

A client has the nursing diagnosis of impaired home maintenance R/T regression. Which behavior confirms this diagnosis? 1. The client fails to take antipsychotic medications. 2. The client states, "I haven't bathed in a week." 3. The client lives in an unsafe and unclean environment. 4. The client states, "You can't draw my blood without crayons."

1. When a client fails to take antipsychotic medications, the client is experiencing the problem of ineffective health maintenance R/T noncompliance, not impaired home maintenance. 2. When the client states, "I haven't bathed in a week," the client is presenting evidence of self-care deficit, not impaired home maintenance. 3. Impaired home maintenance can be related to regression, withdrawal, lack of knowledge or resources, or impaired physical or cognitive functioning in clients experiencing thought disorders. This is evidenced by an unsafe, unclean, disorderly home environment. 4. When the client states, "You can't draw my blood without crayons," the client is experiencing concrete thinking, or a literal interpretation of the environment. It represents a regression to an earlier level of cognitive development; however, this is a thought disorder and not a symptom of the nursing diagnosis of impaired home maintenance. TEST-TAKING HINT: To answer this question correctly, the test taker should note that answers "3" and "4" are symptoms of regressive behaviors, but only "3" is related to a home maintenance problem.

Which outcome should the nurse expect from a client diagnosed with schizophrenia who is hearing and seeing things others do not hear and see? 1. The client will recognize distortions of reality by discharge. 2. The client will demonstrate the ability to trust by day 2. 3. The client will recognize delusional thinking by day 3 4. The client will experience no auditory hallucinations by discharge.

1. When a client is hearing and seeing things others do not, the client is experiencing a hallucination, which is an altered sensory perception. A hallucination is defined as a false sensory perception not associated with real external stimuli. Hallucinations may involve any of the five senses. Because schizophrenia is a chronic disease, some individuals, even when compliant with antipsychotic medications, continue to experience hallucinations. Recognizing distortions of reality by discharge is an appropriate outcome for the nursing diagnosis of altered sensory perception. 2. Demonstrating the ability to trust by day 2 is not an outcome directly related to the client problem of hearing and seeing things others do not. Also, trust takes time to develop, and expecting trust by day 2 is unrealistic. 3. Recognizing delusional thinking by day 3 is an inappropriate outcome for the client who is hearing and seeing things others do not. This client is experiencing hallucinations, not delusions. A delusion is a false personal belief not consistent with a person's intelligence or cultural background. The individual continues to have the belief despite obvious proof that it is false or irrational. 4. Experiencing no auditory hallucinations by discharge is an inappropriate outcome for the client problem of hearing and seeing things others do not. Schizophrenia is a chronic disease. Medication and therapy can decrease the signs and symptoms of the disease, but to expect the signs and symptoms to disappear completely is unrealistic. TEST-TAKING HINT: To answer this question correctly, the test taker must recognize schizophrenia as a chronic and incurable disease. Expecting distortions of reality to disappear by discharge is unrealistic, whereas simply being aware of the distortions of reality is a realistic outcome.

The nurse documents that a client diagnosed with schizophrenia is expressing a flat affect. What is an example of this symptom? 1. The client laughs when told of the death of the client's mother. 2. The client sits alone and does not interact with others. 3. The client exhibits no emotional expression. 4. The client experiences no emotional feelings.

1. When a client laughs when told of the death of the client's mother, the client is experiencing inappropriate affect. The client's emotional tone is incongruent with the circumstances. This behavior is not reflective of flat affect. 2. When clients exhibit an indifference to, or disinterest in, the environment, they are experiencing apathy. This behavior is not reflective of flat affect. 3. Flat affect is described as affect devoid of emotional tone. Having no emotional expression is an indication of flat affect. 4. Even with a flat affect, the client continues to experience feelings; however, these emotions are not presented in facial expressions. TEST-TAKING HINT: The test taker must distinguish a flat affect from the inability to feel emotions to answer this question correctly

The nurse states, "It's time for lunch." A client diagnosed with schizophrenia responds, "It's time for lunch, lunch, lunch." Which type of communication process is the client using, and what is the underlying reason for its use? 1. Echopraxia, which is an attempt to identify with the person speaking. 2. Echolalia, which is an attempt to acquire a sense of self and identity. 3. Unconscious identification to reinforce weak ego boundaries. 4. Depersonalization to stabilize self-identity.

1. When clients purposely imitate movements made by others, they are exhibiting echopraxia. The behaviors presented in the question are not reflective of echopraxia. 2. When clients diagnosed with schizophrenia repeat words that they hear, they are exhibiting echolalia. This is an indication of alterations in the client's sense of self. Weak ego boundaries cause these clients to lack feelings of uniqueness. Echolalia is an attempt to identify with the person speaking. 3. Unconscious identification is an ego defense mechanism used by clients diagnosed with schizophrenia in an attempt strengthen ego boundaries. The need to imitate the actions or physical characteristics of others is a result of their confusion with self-identity. The behaviors presented in the question are not reflective of unconscious identification. When a psychiatrist grows a beard and smokes a cigar as an attempt to emulate Sigmund Freud, the psychiatrist is exhibiting unconscious identification. 4. When clients diagnosed with schizophrenia experience feelings of unreality, they are exhibiting depersonalization. The client may have a sense of observing himself or herself from a distance or that parts of his or her body may have changed in size. The behaviors presented in the question are not reflective of depersonalization. TEST-TAKING HINT: The test taker needs to understand that all parts of an answer must be correct. In this question, all answer choices include correct reasons for the use of various defenses. Only "2," however, correctly identifies the echolalia presented in the question.

Which intervention used for clients diagnosed with thought disorders is a milieu therapy approach? 1. Assist family members to deal with major upheavals in their lives caused by interactions with the client. 2. One-on-one interactions to discuss feelings. 3. Role-play to enhance motor and interpersonal skills. 4. Emphasize the rules and expectations of social interactions mediated by peer pressure

1. When the nurse assists the family to deal with major upheavals in their lives caused by interactions with the client, the nurse is using a family therapy, not milieu therapy, approach. Even when families seem to cope well, there is a notable impact on the mental health status of relatives when a family member is diagnosed with a thought disorder. 2. When the nurse offers one-on-one interactions to discuss feelings, the nurse is using an interpersonal, not milieu therapy approach. 3. When the nurse uses role-play to enhance motor and interpersonal skills, the nurse is using a social skills training, not milieu therapy approach. The educational procedure in social skills training focuses on role-play. Social skills training is a type of behavioral therapy where the nurse can serve as a role model for acceptable behaviors. 4. When the nurse emphasizes the rules and expectations of social interactions mediated by peer pressure, the nurse is using a milieu therapy approach. Milieu therapy emphasizes group and social interaction. Rules and expectations are mediated by peer pressure for normalization of adaptation. TEST-TAKING HINT: The test taker must distinguish between the various treatment modalities for clients diagnosed with thought disorders. Rules and realistic client expectations are the hallmarks of milieu therapy and should be recognized as such.

The nurse is educating the family of a client diagnosed with schizophrenia about the importance of medication compliance. Which statement indicates that learning has occurred? 1. "After stabilization, the relapse rate is high, even if antipsychotic medications are taken regularly." 2. "My brother will have only about a 30% chance of relapse if he takes his medications consistently." 3. "Because the disease is multifaceted, taking antipsychotic medications has little effect on relapse rates." 4. "Because schizophrenia is a chronic disease, taking antipsychotic medications has have little effect on relapse rates."

1. Without drug treatment, the relapse rate of a client diagnosed with schizophrenia can be 70% to 80%. With continuous antipsychotic drug treatment, this rate can be reduced to 30%. 2. Research shows that with continuous antipsychotic drug treatment, the relapse rate of clients diagnosed with schizophrenia can be reduced to about 30%. 3. Schizophrenia is a multifaceted disease; however, antipsychotic medications are very effective in treating the symptoms of schizophrenia and can reduce the relapse rate if taken consistently 4. Schizophrenia is a chronic disease; however, research has shown that if antipsychotic medications are taken consistently, relapse rates decrease. TEST- TAKING HINT: Even if the test taker does not know the percentage of relapse rates, the correct answer can be chosen if it is known that antipsychotic medications are effective in reducing the symptoms of schizophrenia

The nurse is interacting with a client diagnosed with schizophrenia. Number the nurse's interventions in the correct sequence. 1. Present and refocus on reality. 2. Educate the client about the disease process. 3. Establish a trusting nurse-client relationship. 4. Empathize with the client about feelings generated by disease symptoms. 5. Encourage compliance with antipsychotic medications.

3,4,1,5,2 3. The establishment of a trusting nurse-client relationship should be the first nursing intervention because all further interventions will be affected by the trust the client has for the nurse. 4.Empathizing with the client helps the nurse to connect with the client and enhances trust further. 1. Presenting reality in a matter-of-fact way helps the client to distinguish what is real from what is not. 5. Encouraging compliance with antipsychotic medications helps to decrease symptoms of the disorder and increases the client's cooperation with psychosocial therapies. 2. Educating the client about the disease process comes later in the therapeutic plan of care. A trusting nurseclient relationship has to be established and the client needs to be stabilized before initiating any effective teaching. TEST-TAKING HINT: To answer this question correctly, the test taker must understand that the establishment of trust is the basis for any other effective nursing intervention. Educating the client would be later in the therapeutic process because trust must be established and the client's symptoms must be stabilized for learning to occur.

The client has a long history of schizophrenia, which has been controlled by haloperidol (Haldol). During an admission assessment resulting from an exacerbation of the disease, the nurse notes continuous restlessness and fidgeting. Which medication would the nurse expect the physician to prescribe for this client? 1. Haloperidol (Haldol). 2. Fluphenazine decanoate (Prolixin Decanoate). 3. Clozapine (Clozaril). 4. Benztropine (Cogentin).

Akathisia, which is uncontrollable restlessness, is an extrapyramidal side effect of antipsychotic medications. 1. Continuous restlessness and fidgeting (akathisia) is the extrapyramidal side effect caused by the use of antipsychotic drugs such as haloperidol (Haldol). If an increased dose of haloperidol (Haldol) is prescribed, the symptom of akathisia would increase, not decrease. 2. Continuous restlessness and fidgeting (akathisia) is the extrapyramidal side effect caused by the use of antipsychotic drugs such as fluphenazine decanoate (Prolixin Decanoate). If fluphenazine decanoate (Prolixin Decanoate) is prescribed, the symptom of akathisia would increase, not decrease. 3. Continuous restlessness and fidgeting (akathisia) is the extrapyramidal side effect caused by the use of antipsychotic drugs such as clozapine (Clozaril). If clozapine (Clozaril) is prescribed, the symptom of akathisia would increase, not decrease. 4. Benztropine (Cogentin) is an anticholinergic medication used for the treatment of extrapyramidal symptoms such as akathisia. The nurse would expect the physician to prescribe this drug for the client's symptoms of restlessness and fidgeting. TEST-TAKING HINT: To answer this question correctly, the test taker must recognize the symptom presented in the question as an extrapyramidal side effect of haloperidol (Haldol), and then be able to distinguish between an antipsychotic and an anticholinergic medication.

A new graduate nurse is assessing a 20-year-old client in the emergency department. The client is seeing and hearing things that others do not see or hear. The nurse tells the supervisor, "I believe the client has schizophrenia." Which of the following supervisor responses is the most appropriate? Select all that apply. 1. "How long has the client experienced these symptoms?" 2. "Has the client taken any drug or medication that could cause these symptoms?" 3. "It is not within your scope of practice to assess for a medical diagnosis." 4. "Does this client have any mood problems?" 5. "What kind of relationships has this client established?"

The DSM-IV-TR lists the diagnostic criteria for the diagnosis of schizophrenia. 1. The duration of symptoms is an important finding to assess to determine the diagnosis of schizophrenia. One of the DSM-IVTR criteria is that symptoms need to be present for a significant amount of time during a 1-month period and last for 6 months. 2. A substance or general medical condition exclusion is an important finding to assess to determine the diagnosis of schizophrenia. One of the DSM-IV-TR criteria is that the presenting symptoms are not due to the direct physiological effects of the use or abuse of a substance or medication. 3. Even though nurses do not diagnose medical conditions such as schizophrenia, nurses must assess the signs and symptoms that meet the criteria for this diagnosis. This assists the nurse in the implementation of appropriate nursing interventions based on client problems. 4. The presence of mood disorders is an important finding to assess to determine the diagnosis of schizophrenia. Schizoaffective disorder and mood disorder with psychotic features must be ruled out for the client to meet the criteria for this diagnosis. No major depressive, manic, or mixed episodes should have occurred concurrently with the active-phase symptoms. If mood episodes have occurred during the active-phase symptoms, their total duration should have been brief, relative to the duration of the active and residual periods. 5. The ability to form relationships is an important finding to assess to determine the diagnosis of schizophrenia. One of the DSM-IV-TR criteria for this diagnosis is a disturbance in one or more major areas of functioning, such as work, interpersonal relationships, or self-care. When the onset is in adolescence, there should be a failure to achieve expected levels of interpersonal or academic functioning. TEST-TAKING HINT: To answer this question correctly, the test taker must be familiar with the DSM-IV TR criteria for the diagnosis of schizophrenia.

A nursing instructor is teaching about the etiology of schizophrenia. What statement by the nursing student indicates an understanding of the content presented? 1. "Schizophrenia is a disorder of the brain that can be cured with the correct treatment." 2. "A person inherits schizophrenia from a parent." 3. "Problems in the structure of the brain cause schizophrenia." 4. "There are lots of potential causes for this disease, and this is continues to be a controversial topic."

The definitive cause of schizophrenia is still uncertain. Most likely, no single factor can be implicated in the etiology; rather, the disease probably results from a combination of influences, including biological, psychological, and environmental factors. 1. Schizophrenia is a disorder of the brain for which many physical factors of possible etiological significance have been identified. At this time there is no cure for schizophrenia. 2. Offspring of a parent diagnosed with schizophrenia have a 5% to 10% or higher risk of acquiring the disease. How schizophrenia is inherited in uncertain. No reliable biological marker has been found yet. 3. With the use of neuroimaging technologies, structural brain abnormalities have been observed in individuals diagnosed with schizophrenia. Ventricular enlargement is the most consistent finding; however, sulci enlargement and cerebellar atrophy also are reported. The definitive cause of schizophrenia, however, is still uncertain. 4. The etiology of schizophrenia remains unclear. No single theory or hypothesis has been postulated that substantiates a clear-cut explanation for this disease. The more research that is conducted, the more evidence is compiled to support the concept of multiple causes in the development of schizophrenia. The most current theory seems to be that schizophrenia is a biologically based disease with a genetic component. The onset of the disease also is influenced by factors in the internal and external environment. TEST-TAKING HINT: All answers presented are possible theories for the cause of schizophrenia. To choose the correct answer, the test taker must understand that no one theory has been accepted as a definitive cause of the disease of schizophrenia.

When one identical twin has been diagnosed with schizophrenia, the other twin has approximately a _____ % chance of developing the disease

. When one identical (monozygotic) twin has been diagnosed with schizophrenia, the other twin has approximately a 50% chance of developing the disease. TEST-TAKING HINT: To answer this question correctly, the test taker must review the statistics of twin studies related to the development of schizophrenia. The keyword "identical" determines the correct percentage.

Which symptom experienced by a client diagnosed with schizophrenia would predict a less positive prognosis? 1. Hearing hostile voices. 2. Thinking the TV is controlling his or her behavior. 3. Continuously repeating what has been said. 4. Having little or no interest in work or social activities

Positive symptoms of schizophrenia tend to reflect an excess or distortion of normal function, whereas negative symptoms reflect a diminution or loss of normal function. Individuals who exhibit mostly negative symptoms often show structural brain abnormalities on CT scan and respond poorly to treatment, leading to a poor prognosis. Clients exhibiting a predominance of positive symptoms have a better prognosis. Individuals who exhibit mostly positive symptoms show normal brain structure on CT scan and relatively good responses to treatment. 1. Hearing hostile voices, or auditory hallucinations, is a positive symptom of schizophrenia. Because this client is exhibiting a positive symptom, the client has the potential for a better prognosis. 2. When the client thinks the TV is controlling his or her behavior, the client is experiencing the positive symptom of a delusion of control or influence. Because this client is exhibiting a positive symptom, the client has the potential for a better prognosis. 3. When a client continuously repeats what has been said, the client is exhibiting the positive symptom of echolalia. Because this client is exhibiting a positive symptom, the client has the potential for a better prognosis. 4. When a client has little or no interest in work or social activities, the client is exhibiting the negative symptom of apathy. Apathy is indifference to, or disinterest in, the environment. Flat affect is a manifestation of emotional apathy. Because this client is exhibiting a negative symptom, the client has the potential for a poorer prognosis TEST-TAKING HINT: To answer this question correctly, the test taker must distinguish positive and negative symptoms and understand that experiencing negative symptoms adversely affects the prognosis of schizophrenia.

When one fraternal twin has been diagnosed with schizophrenia, the other twin has approximately a _____ % chance of developing the disease.

When one fraternal (dizygotic) twin has been diagnosed with schizophrenia, the other twin has approximately a 15% chance of developing the disease. TEST-TAKING HINT: To answer this question correctly, the test taker must review the statistics of twin studies related to the development of schizophrenia. The keyword "fraternal" determines the correct percentage.