Mental Health Practice Questions

A delirious client sees a design on the wallpaper and perceives it as an animal. How should a nurse communicate in the change-of-shift report what the client perceived? -A delusion -An illusion -A hallucination -An idea of reference

-an illusion Rationale An illusion is a misperception or misinterpretation of an actual external stimulus. A delusion is a false belief that cannot be changed even by evidence; it is associated with psychosis. A hallucination results from an imaginary, not real, stimulus. An idea of reference is a belief that others are talking about the person.

Which drugs can be used as preanesthetic agents? Select all that apply. -Barbiturates -Benzodiazepines -Antiepileptic agents -Atypical antipsychotics -Mood stabilizing agents

-barbiturates -benzodiazepines Rationale Barbiturates and benzodiazepines are sedative-hypnotics that may also be used to decrease effects of anxiety in presurgical clients. Antiepileptic agents are used to treat seizure activity and manage bipolar disorder. Atypical antipsychotics are mainly used to treat bipolar disorder and psychosis. Mood stabilizing agents are used to treat bipolar disorder.

The primary healthcare provider prescribes valproate and olanzapine to a client. Which clinical finding would support this intervention? -Euphoric mania -Dysphoric mania -Rapid cycling mania -Mania with psychosis

-mania with psychosis Rationale Valproate is a mood stabilizer drug, and olanzapine is an antipsychotic. Clients experiencing mania with psychosis are generally prescribed with mood stabilizers and antipsychotics. Euphoric mania is treated with a mood stabilizer alone, preferably lithium. Dysphoric and rapid cycling mania is treated with a mood stabilizer alone, preferably valproate.

The nurse is caring for a client with newly diagnosed schizophrenia. What factor in the client's history indicates a greater potential for recovery? -Vague prepsychotic symptoms -Brain abnormalities on PET scan -Insidious onset of the client's illness -A relative who also has schizophrenia

-vague prepsychotic symptoms Rationale The presence of vague prepsychotic symptoms is associated with decreased morbidity related to schizophrenia. Brain abnormalities on PET scan, insidious onset of the client's illness, and a relative who also has schizophrenia tend to contribute to a poor prognosis.

The nurse is caring for a 60-year-old client who is diagnosed with dementia. Which antipsychotic drugs would be contraindicated for the client? Select all that apply. -Quetiapine -Haloperidol -Aripiprazole -Risperidone -Chlorpromazine

-Haloperidol -Chlorpromazine Rationale First-generation antipsychotic drugs such as haloperidol and chlorpromazine are contraindicated because they may increase the risk of mortality when used to treat dementia-related psychosis in elderly clients. Quetiapine, aripiprazole, and risperidone are second-generation antipsychotic drugs that are not contraindicated in elderly adults suffering from dementia-related psychosis.

The nurse is developing a care plan for a client with postpartum psychosis. Which priority intervention should the nurse implement? -Teaching the client about normal newborn care -Ensuring adequate bonding time with the infant -Giving the client time and space to express her feelings -Referring the client to a psychiatric healthcare provider as prescribed

-Referring the client to a psychiatric healthcare provider as prescribed Rationale Assessment and management of postpartum psychosis are beyond the scope of a maternity nurse. A mother who experiences this condition must be referred to a specialist for comprehensive therapy. Women with signs of postpartum psychosis need immediate medical attention to prevent suicide or infanticide. In light of this psychiatric emergency condition it would not be appropriate to plan bonding time for the client and infant, teach her about normal newborn care, or allow expression of her feelings.

Schizophrenia is associated with both positive and negative symptoms. While assessing a client with schizophrenia, the nurse notes that the client is experiencing positive symptoms; what does the nurse observe that leads to this conclusion? Select all that apply. -Poverty of speech -Agitated behavior -Lack of motivation -Delusions of grandeur -Auditory hallucinations

-agitated behavior -delusions of grandeur -auditory hallucinations Rationale Agitated and restless behaviors are positive symptoms of schizophrenia. A delusion is a fixed false belief that is resistant to reasoning; when a person believes that he or she is a famous, historical or fictional omnipotent character this is called a delusion of grandeur; a delusion is a positive symptom associated with schizophrenia. An auditory hallucination is a sensory perception involving the sense of hearing that occurs in the absence of an external stimulus and is a positive symptom associated with schizophrenia. Decreased verbalization, including a sudden stoppage in the flow of speech (blocking) and lack of inflection, is a negative symptom associated with schizophrenia. Lack of motivation (avolition) and apathy are negative symptoms associated with schizophrenia.

A nurse is assessing a client with chronic schizophrenia. Which effects will the client most likely exhibit? Select all that apply. -Apathy -Hostility -Flatness -Sadness -Happiness -Depression

-apathy -flatness Rationale Apathy (indifference) is common among people with chronic schizophrenia because negative symptoms are more apparent. Flatness, with few extremes of emotion, is common among people with chronic schizophrenia because negative symptoms are more apparent. Extremes in emotions are not associated with chronic schizophrenia. Sadness is related more to mood disorders, such as a depressive episode of bipolar disorder or major depression. Hostility may be seen in some forms of schizophrenia, such as paranoid schizophrenia, but it is rarely seen in the chronic stages. Happiness and elation are associated with manic episodes of bipolar disorder, not chronic schizophrenia. Depression is related to mood disorders, such as a depressive episode of bipolar disorder or major depression.

A client is admitted to the hospital with the diagnosis of schizophrenia, undifferentiated type. The client sits rocking in a corner for long periods and responds to voices with words that the staff cannot understand. What should the nurse include when developing the plan of care for this client? -Including the client in a discussion group on the unit -Encouraging the client to talk to other clients during the day -Allowing the client to be alone while observing from a distance -Arranging the client's day to allow for short periods to be spent with the nurse

-arranging the clients day to allow for short periods to be spent with the nurse Rationale Clients with undifferentiated schizophrenia manifest psychotic signs and symptoms that preclude interaction with others for more than just short periods. Clients with undifferentiated schizophrenia cannot function in a discussion group. Psychotic manifestations such as fragmented delusions, vague hallucinations, disorientation, and incoherence prevent these clients from interacting with others. Clients with undifferentiated schizophrenia have problems with interpersonal relations because their behavior is often bizarre and disorganized. Allowing the client to be alone will not relieve anxiety; instead, it will foster further withdrawal.

An 18-year-old woman is brought to the emergency department by her two roommates after being found unconscious in the bathroom. Laboratory tests are ordered. The nurse reviewing the findings notes that the urinalysis is positive for flunitrazepam. The nurse knows that flunitrazepam is often used for what? -As a date rape drug -To control symptoms of psychosis -To control symptoms of bipolar mania -To treat hangover symptoms after excessive alcohol consumption

-as a date rape drug Rationale Flunitrazepam, illegal in the United States, has been used in date rapes; the victim is attacked after consuming a drink spiked with the drug. Flunitrazepam is not used to treat psychosis, mania, or hangover symptoms.

A client is admitted to a psychiatric hospital after a month of unusual behavior that has included eating and sleeping very little, talking and singing constantly, and going on frequent shopping sprees. In the hospital, the client is demanding, bossy, and sarcastic. Which disorder does the nurse associate with these behaviors? -Bipolar disorder, manic phase -Antisocial personality disorder -Obsessive-compulsive disorder -Chronic undifferentiated schizophrenia

-bipolar disorder, manic phase Rationale This kind of hyperactive behavior is typical of the manic flight into reality associated with mood disorders. The behaviors are more indicative of a mood disorder than a personality disorder. Ritualistic, not manic, behavior is indicative of obsessive-compulsive disorder. A flat affect and apathy are more indicative of a schizophrenic disorder.

A client is admitted to a psychiatric unit with the diagnosis of schizophrenia, undifferentiated type. When assessing the client, the nurse identifies the presence of several characteristics related to this disorder. What may this include? Select all that apply. -Bizarre behavior -Extreme negativism -Disorganized speech -Persecutory delusions -Auditory hallucinations

-bizarre behavior -disorganized speech -auditory hallucinations Rationale Bizarre behavior, disorganized speech, and auditory hallucinations are associated with undifferentiated schizophrenia. Extreme negativism is associated with catatonic schizophrenia. Persecutory delusions are associated with paranoid schizophrenia.

Electroconvulsive therapy (ECT) is a mode of treatment that is used primarily to treat what? -Clinical depression -Substance abuse disorders -Antisocial personality disorder -Psychosis occurring in schizophrenia

-clinical depression Rationale ECT is used to treat clinical depression in clients who do not respond well to a trial of psychotropic medications or are so severely depressed that immediate intervention is needed. ECT is not used as a primary treatment for clients with substance abuse disorders, antisocial personality disorder, or schizophrenic psychosis.

Electroconvulsive therapy (ECT) is a mode of treatment that is used primarily to treat which mental disorder? -Clinical depression -Substance abuse disorders -Antisocial personality disorder -Psychosis occurring in schizophrenia

-clinical depression Rationale ECT is used to treat clinical depression in clients who do not respond well to a trial of psychotropic medications or who are so severely depressed that immediate intervention is needed. ECT is not used as a primary treatment for clients with substance abuse disorders, antisocial personality disorder, or schizophrenic psychosis.

A client has a diagnosis of schizoid personality disorder. During the assessment what should the nurse expect of the client's behavior? -Rigid and controlling -Dependent and submissive -Detached and socially distant -Superstitious and socially anxious

-detached and socially distant Rationale Clients with the diagnosis of schizoid personality disorder neither desire nor enjoy close relationships; prefer solitary activities; and demonstrate emotional coldness, detachment, and a flattened affect. Rigid and controlling behavior is typical of clients with the diagnosis of obsessive-compulsive personality disorder. Dependent and submissive behavior is typical of clients with the diagnosis of dependent personality disorder. Superstitious and socially anxious behavior is typical of clients with the diagnosis of schizotypal personality disorder.

A nurse is caring for a client with the diagnosis of schizophrenia. During assessment the nurse identifies both positive (type I) and negative (type II) signs and symptoms. Which clinical findings should the nurse document as positive? Select all that apply. -Anergy -Flat affect -Social withdrawal -Disorganized thoughts -Auditory hallucinations

-disorganized thoughts -auditory hallucinations Rationale Disorganized thoughts (e.g., derailment, tangentiality, illogicality, incoherence, and circumstantiality) are a positive sign of schizophrenia. Positive signs and symptoms, referred to as "florid psychotic symptoms," are related to alterations in thinking, speech, perception, and behavior. They usually respond to antipsychotic medications. Positive symptoms reflect an excess or distortion of function and include delusions, hallucinations, increased speech production with associations, and bizarre behavior. A lack of energy (anergy) is a negative symptom associated with schizophrenia. Negative symptoms reflect a lessening or loss of normal function. A lack of emotional expression (flat affect) is a negative sign associated with schizophrenia. Inadequate social skills leading to withdrawal and isolation are negative symptoms associated with schizophrenia.

A nurse in an outpatient mental health setting has been assigned to care for a new client who has been found to have an antisocial personality disorder. What does the nurse expect to observe in the client during the assessment? -Pays great attention to detail and demonstrates a high level of anxiety -Has scars from self-mutilation and a history of many negative relationships -Displays charm, has an above-average intelligence, and tends to manipulate others -Demonstrates suspiciousness, avoids eye contact, and engages in limited conversation

-displays charm, has an above-average intelligence, and tends to manipulate others Rationale A client with an antisocial personality disorder is charming on first contact, but this charm is a manipulative ploy. These clients usually are bright and use their intelligence for self-gain. Paying great attention to detail and demonstrating a high level of anxiety are traits of an individual with an obsessive-compulsive personality disorder. The client with a borderline personality disorder self-mutilates when under stress; there is a fear of abandonment so that any relationship is better than no relationship. Demonstrating suspiciousness, avoiding eye contact, and engaging in limited conversation resembles the behavior of an individual with a paranoid personality, which includes suspiciousness and lack of trust.

The nurse is working with a client who has a diagnosis of borderline personality disorder. What personality traits should the nurse expect the client to exhibit? Select all that apply. -Engaging -Indecisive -Withdrawn -Manipulative -Perfectionistic

-engaging -manipulative Rationale Clients with borderline personality disorders initially tend to be engaging and to establish intense relationships. They may be manipulative because they are opinionated and want people to conform to their agendas. These clients are often decisive and opinionated, have a pronounced intolerance for being alone, and are usually quite social. These clients are not perfectionists.

A client is found to have a borderline personality disorder. What is a realistic initial intervention for this client? -Establishing clear boundaries -Exploring job possibilities with the nurse -Initiating a discussion of feelings of being victimized -Spending 1 hour twice a day discussing problems with the nurse

-establish clear boundaries Rationale Individuals with borderline personality disorder are impulsive and have difficulty identifying and respecting boundaries in relation to others. Exploration of this topic in a meaningful manner can be done only after an ongoing relationship has been established. Feeling victimized is a frequent theme among clients with this disorder; however, they rarely have the insight to initiate discussion of these feelings and usually show resistance when the topic is broached. An individual with a borderline personality disorder may not be able to spend this length of time having a meaningful discussion with the nurse; usually they are too impulsive to engage in consistent work until a therapeutic relationship has been established.

A client with a diagnosis of schizophrenia, undifferentiated type, is being admitted to the psychiatric unit. What clinical manifestations does the nurse expect when assessing this client? Select all that apply. -Excited behaviors -Loose associations -Inappropriate affect -Feelings of depression -Hypervigilant behavior

-excited behaviors -loose associations -inappropriate affect Rationale Excited behaviors, such as aggressive hitting or biting, often are associated with an acute onset of undifferentiated schizophrenia. Loose association is a characteristic related to thought disorders such as schizophrenia, undifferentiated type. The affect usually is inappropriate, rather than flat, in undifferentiated schizophrenia. Depression is not characteristic of undifferentiated schizophrenia. Hypervigilant behaviors generally are associated with paranoid schizophrenia, not undifferentiated schizophrenia.

The nursing staff is discussing the best way to develop a relationship with a new client who has antisocial personality disorder. What characteristic of clients with antisocial personality should the nurses consider when planning care? -Engages in many rituals -Independence of others -Exhibits lack of empathy for others -Possesses limited communication skills

-exhibits lack of empathy for others Rationale Self-motivation and self-satisfaction are of paramount concern to people with antisocial personality disorder, and they have little or no concern for others. Clients with obsessive-compulsive disorder, not antisocial personality disorder, engage in rituals. Individuals with antisocial personality disorder are extremely dependent on others; they count on others to extricate them from their problems. They are usually charming on the surface and can easily con people into doing what they want.

A client has the diagnosis of histrionic personality disorder. Which behavior should the nurse expect when assessing this client? -Boastful and egotistical -Rigid and perfectionistic -Extroverted and dramatic -Aggressive and manipulative

-extroverted and dramatic Rationale Clients with histrionic personality disorder draw attention to themselves, are vain, and demonstrate emotionality and attention-seeking behavior. Boastful and egotistical behaviors are typical of clients with the diagnosis of narcissistic personality disorder. Rigid and perfectionistic behaviors are typical of clients with the diagnosis of obsessive-compulsive personality disorder. Aggressive and manipulative behaviors are typical of clients with the diagnosis of antisocial personality disorder.

A client with a diagnosis of schizophrenia is discharged from the hospital. At home the client forgets to take the medication, is unable to function, and must be rehospitalized. What medication may be prescribed that can be administered on an outpatient basis every 2 to 3 weeks? -Lithium -Diazepam -Fluvoxamine -Fluphenazine

-fluphenazine Rationale Fluphenazine can be given intramuscularly every 2 to 3 weeks to clients who are unreliable about taking oral medications; it allows them to live in the community while keeping the disorder under control. Lithium is a mood-stabilizing medication that is given to clients with bipolar disorder. This drug is not given for schizophrenia. Diazepam is an antianxiety/anticonvulsant/skeletal muscle relaxant that is not given for schizophrenia. Fluvoxamine is a selective serotonin reuptake inhibitor; it is administered for depression, not schizophrenia.

Which drug is a high-potency medication used to treat schizophrenia? -Loxapine -Thioridazine -Fluphenazine -Perphenazine

-fluphenazine Rationale Fluphenazine is a high-potency medication used for schizophrenia. Loxapine and perphenazine are medium-potency medications used to treat schizophrenia. Thioridazine is a low-potency medication used to treat schizophrenia.

When a nurse is admitting an older client to the mental health unit, it is important to identify any signs of dementia. What signs and symptoms denote the presence of dementia of the Alzheimer type? Select all that apply. -Ambivalence -Forgetfulness -Flight of ideas -Loose associations -Expressive aphasia

-forgetfulness -expressive aphasia Rationale Older clients who have dementia[1][2] often have short-term memory loss. Clients in whom dementia is developing often have difficulty expressing themselves (expressive aphasia) or understanding the spoken word (receptive aphasia). Clients with the diagnosis of schizophrenia or depression are often indecisive and ambivalent. A client who is experiencing a manic episode of bipolar disorder experiences flight of ideas. Loose associations between thoughts are related to schizophrenia, not dementia.

A client with schizophrenia is admitted to an acute care psychiatric unit. Which clinical findings indicate positive signs and symptoms of schizophrenia? -Withdrawal, poverty of speech, inattentiveness -Flat affect, decreased spontaneity, asocial behavior -Hypomania, labile mood swings, episodes of euphoria -Hyperactivity, auditory hallucinations, loose associations

-hyperactivity, auditory hallucinations, loose associations Rationale Hyperactivity, auditory hallucinations, and loose associations are positive symptoms of schizophrenia; positive symptoms reflect a distortion or excess of normal function. Hypomania, labile mood swings, and episodes of euphoria are associated with bipolar disorder, manic episode. Withdrawal, poverty of speech, inattentiveness, flat affect, decreased spontaneity, and asocial behavior are all negative symptoms associated with schizophrenia; negative symptoms reflect a diminution or absence of normal function.

A client is found to have a borderline personality disorder. What behavior does the nurse consider is most typical of these clients? -Inept -Eccentric -Impulsive -Dependent

-impulsive Rationale Impulsive, potentially self-damaging behaviors are typical of clients with this personality disorder. Inept behavior, by itself, is not typical of clients with any specific personality disorder. Eccentric behavior is more typical of the client with a schizotypal personality disorder. Dependent behavior is more typical of the client with a dependent personality disorder.

A college student is brought to the mental health clinic by parents with a diagnosis of borderline personality disorder. Which factors in the client's history support this diagnosis? Select all that apply. -Impulsiveness -Lability of mood -Ritualistic behavior -Psychomotor retardation -Self-destructive behavior

-impulsiveness -lability of mood -self-destructive behavior Rationale Clients with borderline personality disorder often lead complex, chaotic lives because of their inability to control or limit impulses. Extremes of emotions, ranging from apathy and boredom to anger, may be displayed within short periods. Impulsive self-destructive acts such as reckless driving, spending money, and engaging in unsafe sex often result in negative consequences. Ritualistic behavior is associated with obsessive-compulsive disorders. Psychomotor retardation is associated with mood disorders such as depression.

A client who has a history of psychiatric problems, including an antisocial personality disorder, is admitted to the hospital. What typical behavior does the nurse anticipate? -Sexual acting out -Interpersonal difficulties -Diminished contact with reality -Compulsive behaviors associated with following rules.

-interpersonal difficulties Rationale These clients usually have a history of interpersonal difficulties. They are unable to engage in the give-and-take a relationship requires because of their consistent disregard for and exploitation of others. There is no direct relationship between antisocial personality disorders and sexual acting out. These clients are in contact with reality. Compulsive behaviors are typical of clients with obsessive-compulsive disorder, not antisocial personality disorder. These clients typically do not conform to societal rules.

An adult is found to have schizotypal personality disorder. How should a nurse describe the client's behavior? -Rigid and controlling -Submissive and immature -Arrogant and attention-seeking -Introverted and emotionally withdrawn

-introverted and emotionally withdrawn Rationale These clients usually display social inadequacy and lack of emotional contact with others. Rigid and controlling behaviors reflect an obsessive-compulsive personality disorder. Submissive and immature behaviors reflect a dependent personality disorder. Arrogant and attention-seeking behaviors probably reflect a narcissistic personality disorder.

Which clinical indicators can the nurse expect when assessing a client with Cushing syndrome? Select all that apply. -Lability of mood -Slow wound healing -A decrease in the growth of hair -Ectomorphism with a moon face -An increased resistance to bruising

-lability of mood -slow wound healing Rationale Excess adrenocorticoids cause emotional lability, euphoria, and psychosis. Hypercortisolism impairs the inflammatory response, slowing wound healing. Increased secretion of androgens results in hirsutism. Although a moon face is associated with corticosteroid therapy, ectomorphism is a term for a tall, thin, genetically determined body type and is unrelated to Cushing syndrome. There is increased bruising because capillary fragility results in multiple ecchymotic areas.

The nurse is caring for a client diagnosed with Cushing syndrome. Which symptoms does the nurse expect the client to exhibit? -Lability of mood -Postural hypotension -Increased skin thickness -Ectomorphism with a moon face

-lability of mood Rationale Excess adrenocorticoids can cause emotional lability, euphoria, and psychosis. Increased secretion of androgens results in hirsutism, hypertension, and hyperglycemia. Capillary fragility results in multiple ecchymotic areas, not skin thickness. Although a moon face is associated with corticosteroid therapy, ectomorphism is a term for a tall, thin, genetically-determined body type and is not related to adaptations to Cushing syndrome.

Schizophrenia is associated with negative symptoms. In the assessment of a client with schizophrenia, which symptoms are classified as negative symptoms? Select all that apply. -Lack of energy -Poor grooming -Illogical speech -Ideas of reference -Agitated behavior

-lack of energy -poor grooming Rationale A lack of energy (anergy) is a negative symptom associated with schizophrenia. Inadequate grooming results from apathy and lack of energy and is a negative symptom associated with schizophrenia. Illogical speech that reflects disorganized thinking is a positive symptom of schizophrenia type 1. Ideas of reference, a thought process in which a person believes he or she is the object of environmental attention, is a positive symptom of schizophrenia. Agitated, hostile, angry, and violent behaviors are positive symptoms of schizophrenia.

Which drug does the nurse recognize as an effective mood-stabilizing drug used in clients with bipolar disorder and in the acute treatment of mania and prevention of recurrent mania and depressive episodes? -Doxepin -Clozapine -Amitriptyline -Lithium carbonate

-lithium carbonate Rationale Lithium carbonate is often the first choice of treatment, once primary acute mania has been diagnosed, to calm acute manic symptoms and relieve recurrent mania. Doxepin and amitriptyline are antidepressants used to treat depression but not mania. Clozapine is an antipsychotic medication used to control hallucinations and delusions in clients with psychosis but is not a first-line drug because of its side effects, which include seizures and significant weight gain.

A nurse is assessing an adolescent client with the diagnosis of schizophrenia, undifferentiated type. Which signs and symptoms should the nurse expect the client to experience? -Paranoid delusions and hypervigilance -Depression and psychomotor retardation -Loosened associations and hallucinations -Ritualistic behavior and obsessive thinking

-loosened associations and hallucinations Rationale Loosened associations and hallucinations are the primary behaviors associated with a thought disorder such as schizophrenia. Paranoid delusions and hypervigilance are more common in paranoid-type schizophrenia than in the undifferentiated type. Depression and psychomotor retardation are not characteristic of schizophrenia. Ritualistic behavior and obsessive thinking are generally associated with obsessive-compulsive disorders, not schizophrenia.

During an interview a 32-year-old man describes symptoms of decreased appetite, insomnia, anhedonia, and feelings of worthlessness that have been present for the past few weeks. He reports having had a few episodes of feeling depressed in the past but says that the feelings subsided. Recently he has felt worse, and he is now concerned that his symptoms are negatively affecting his job performance and fears he may lose his job "if someone doesn't help me soon." The nurse suspects these symptoms are related to which disorder? -Schizophrenia -Bipolar disorder -Dysthymic disorder -Major depressive disorder

-major depressive disorder Rationale The client is describing symptoms of major depressive disorder. Symptoms include depression that has lasted at least 2 weeks, that has resulted in a change in previous function, and that can impair important areas of function such as work performance. The client does not describe feeling depressed for most of his life. There are no symptoms of paranoia or psychosis that would be present in schizophrenia. For bipolar disorder to be considered, symptoms of mania would need to be included in the findings. With dysthymic disorder, depressive symptoms are chronic and present for 2 years or longer. Because of its chronic nature, dysthymia is difficult to distinguish from the person's usual pattern of function.

The nurse is assessing a new mother at a healthcare facility. Which symptom does the nurse identify as a risk factor for postpartum blues? -Frantic energy -Mild irritability -Hallucinations -Unwillingness to sleep

-mild irritability Rationale Postpartum blues are transient symptoms that a client may experience after childbirth. About 85% of women experience postpartum blues with symptoms of mild irritability, tearfulness, rapid mood fluctuations, and anxiety. About 0.1% to 0.2% of postpartum women experience postpartum psychosis. Frantic energy, hallucinations, and unwillingness to sleep are clinical manifestations of postpartum psychosis.

Personality disorders are identified in the DSM-V in clusters. How should the nurse describe the behaviors of an individual with a cluster A personality disorder? -Odd and eccentric -Anxious and fearful -Dramatic and erratic -Hostile and impulsive

-odd and eccentric Rationale Cluster A includes paranoid, schizoid, and schizotypal personality disorders. These clients are odd and eccentric and use strange speech, are angry, and have impaired relationships. Cluster C includes avoidant, dependent, and obsessive-compulsive personality disorders. These clients are anxious, fearful, tense, and rigid. Cluster B includes antisocial, borderline, histrionic, and narcissistic personality disorders. These clients are dramatic, erratic, labile, impulsive, hostile, and manipulative.

A female graduate student who has become increasingly withdrawn and neglectful of her studies and personal hygiene is brought to the psychiatric hospital by her roommate. After a detailed assessment, a diagnosis of schizophrenia is made. Which characteristic is unlikely to be demonstrated by this client? -Neologisms -Low self-esteem -Concrete thinking -Organized speech and thoughts

-organized speech and thoughts Rationale A person with this disorder will not always have organized speech or thought process. Neologisms, words that have meaning only to the client, are associated with schizophrenia. Low self-esteem is associated with schizophrenia because these people often experience internal stimulation, such as auditory hallucinations, that can be demeaning, as well as distortions of reality. Concrete thinking is symptomatic of schizophrenia.

A nurse is caring for a male client who was admitted to the mental health unit with the diagnosis of schizophrenia. The client is hostile and experiencing auditory hallucinations and states that the voices are saying that they are going to poison him because he is bad. What type of schizophrenic behavior does the nurse identify? -Residual -Paranoid -Catatonic -Disorganized

-paranoid Rationale Clients with paranoid schizophrenia tend to experience persecutory or grandiose delusions and auditory hallucinations and exhibit behavioral changes such as anger, hostility, or violence. Residual schizophrenia is characterized by the negative symptoms of schizophrenia, but the client does not experience delusions, hallucinations, disorganized speech, or disorganized or catatonic behavior. Catatonia is a state in which the client displays extreme psychomotor retardation to the point of not talking or moving. There may be brief intermittent hyperactive episodes with catatonia. Disorganized schizophrenia is characterized by a disintegration of the personality and withdrawn behavior.

Which drug would be used to treat a client with severe motor tics, barking cries, and outbursts of obscene language? -Loxapine -Pimozide -Thiothixene -Thioridazine

-pimozide Rationale Severe motor tics, barking cries, and outbursts of obscene language are signs of Tourette syndrome. Pimozide is a high-potency drug used to treat this syndrome. Loxapine is a medium-potency agent indicated only for schizophrenia. Thiothixene is a high-potency agent indicated for schizophrenia. Thioridazine is a low-potency first-generation antipsychotic indicated for schizophrenia.

The nurse manager of a psychiatric unit informs the primary nurse that a client will be admitted to the unit within an hour. The client's admission diagnosis is paranoid schizophrenia. What classic clinical findings should the nurse anticipate? Select all that apply. -Mutism -Posturing -Flat affect -Extreme negativism -Prominent delusions -Auditory hallucinations

-prominent delusions -auditory hallucinations Rationale Prominent delusions are the essential feature of paranoid schizophrenia; delusions are typically persecutory, grandiose, or both, but delusions with other themes, such as jealousy, religiosity, or somatization, also may occur. Auditory hallucinations are a characteristic associated with paranoid schizophrenia; usually they are related to the delusional theme. Mutism is associated more commonly with the subtype of catatonic schizophrenia. Psychomotor retardation and posturing are associated with catatonic schizophrenia. A flat affect is associated more commonly with the subtype of disorganized schizophrenia. Extreme negativism is associated more commonly with the subtype of catatonic schizophrenia.

Which nursing intervention is most important for a client who has the diagnosis of antisocial personality disorder? -Teaching and modeling assertiveness -Using a gentle and reassuring approach -Providing clear boundaries and consequences -Presenting an empathetic and democratic approach

-providing clear boundaries and consequences Rationale Clients with antisocial personality disorder interact with others through manipulation, aggressiveness, and exploitation; therefore clear limits, with consistently enforced consequences for crossing set boundaries, must be set. These clients can be too assertive; teaching and modeling assertiveness is appropriate for a client with the diagnosis of dependent personality disorder. These clients need a firm, consistent approach with clear and realistic limits on inappropriate behavior; a gentle and reassuring approach should be used with clients who have the diagnosis of avoidant personality disorder. The nurse should provide a neutral, nonemotional approach with clear, realistic boundaries and consequences.

A nurse is assessing a client with the diagnosis of schizophrenia, undifferentiated type. What defense mechanisms should the nurse anticipate that this client might use? -Projection -Repression -Regression -Conversion

-regression Rationale Regression is an unconscious defense mechanism that reduces anxiety by returning to behavior that was successful in earlier years. Regression commonly is used by clients with undifferentiated schizophrenia to reduce anxiety. Projection is the attributing of unacceptable feelings or thoughts to others. It is an organized defense used by clients with paranoid, not undifferentiated, schizophrenia. Clients with undifferentiated schizophrenia have psychotic manifestations that are extreme and do not have thought processes effective enough to use projection. Repression is unintentionally putting disturbing thoughts, feelings, or desires out of the conscious mind. Clients with schizophrenia are not able to do this and therefore have a need to escape from reality. Conversion is an unconscious defense mechanism in which a person develops physical symptoms that have no organic cause. Conversion serves the purpose of reducing anxiety. Conversion is not used by clients with undifferentiated schizophrenia.

What defense mechanism should the nurse anticipate that a client with the diagnosis of schizophrenia, undifferentiated type, will most often exhibit? -Projection -Regression -Repression -Rationalization

-regression Rationale Regression is the defense mechanism that is commonly used by clients with schizophrenia, undifferentiated type, to reduce anxiety by returning to earlier behavior. Projection is an organized defense used by clients with schizophrenia, paranoid type, in which the delusional system is well systematized. Repression, or unconscious forgetting, is not a major defense used by clients with schizophrenia; if it were, they would not need to break with reality. Rationalization, in which the individual blames others for problems and attempts to justify actions, is seldom used by clients with schizophrenia.

A nurse begins a therapeutic relationship with a client with the diagnosis of schizotypal personality disorder. What is the best initial nursing action? -Setting limits on manipulative behavior -Encouraging participation in group therapy -Respecting the client's need for social isolation -Recognizing that seductive behavior is expected

-respecting the client's need for social isolation Rationale These clients are withdrawn, aloof, and socially distant; allowing distance and providing support may foster the eventual development of a therapeutic alliance. Manipulative behavior is typical of clients with the diagnosis of antisocial personality disorder or borderline personality disorder. Group therapy will increase this client's anxiety; cognitive or behavioral therapy is more appropriate. Seductive behavior is associated with clients with the diagnosis of histrionic personality disorder.

A newly admitted client is apathetic and exhibits an inappropriate affect. A diagnosis of schizophrenia is made. In light of the diagnosis, what is one symptom the nurse expects to identify in the client's communication or behavior? -Logical deductions -Suicidal preoccupation -Absence of self-criticism -Response to internal stimulation

-responds to internal stimulation Rationale These clients have increased levels of dopamine, which produces hallucinations. The most common are auditory hallucinations, causing the client to respond to internal stimulation. The loosening of associative links that occurs in schizophrenia makes logical deductions impossible. Clients with severe depression, not schizophrenia, may be preoccupied with suicidal thoughts. Clients with schizophrenia have low self-esteem and usually have feelings of guilt and self-blame and self-criticism.

A nurse is working in the orientation phase of a therapeutic relationship with a client who has borderline personality disorder. What will be most difficult for the client at this stage of the relationship? -Controlling anxiety -Terminating the session on time -Accepting the psychiatric diagnosis -Setting mutual goals for the relationship

-setting mutual goals for the relationship Rationale Clients with borderline personality disorder frequently demonstrate a pattern of unstable interpersonal relationships, impulsiveness, affective instability, and frantic efforts to avoid abandonment; these behaviors usually create great difficulty in establishing mutual goals. Although the client with a borderline personality disorder may have difficulty in the areas of controlling anxiety, ending sessions on time, and accepting the diagnosis, none is the most significant issue.

A client with schizophrenia is actively psychotic, and a new medication regimen is prescribed. A student nurse asks the primary nurse, "Which of the medications will be the most helpful against the psychotic signs and symptoms?" What response will the nurse give? -Citalopram -Ziprasidone -Benztropine -Acetaminophen with hydrocodone

-ziprasidone Rationale Ziprasidone is a neuroleptic, which will reduce psychosis by affecting the action of both dopamine and serotonin. Citalopram is a selective serotonin reuptake inhibitor antidepressant. Benztropine is an anticholinergic. Acetaminophen with hydrocodone is an analgesic/opioid.

As a nurse enters a room and approaches a client who has schizophrenia, the client shouts, "Get out of here before I hit you! Go away!" What does the nurse conclude provoked the client's aggressive behavior? -Voices are directing his behavior. -He felt confined when the nurse walked into the room. -He was afraid of doing harm to the nurse if the nurse came closer. -He thought that the nurse was similar to someone who had frightened him in the past.

-He felt confined when the nurse walked into the room Rationale Clients acutely ill with schizophrenia frequently do not trust others; feeling trapped may be frightening, causing them to lash out. There is no indication that voices are speaking to the client in this instance. Clients acutely ill with schizophrenia usually are more concerned with what is happening to them and are not able to be concerned about others. Although the nurse may have reminded the client of a threatening person from his past, it is not the primary motivation for this behavior.