Psychotic Disorders
The nurse recognizes the client in the emergency department from a picture in the local paper. The client has recently received a major scholarship for high academic achievement. The client tells the nurse that he hears voices that tell him he is worthless. He has tried to kill himself. What statement is the most appropriate for the nurse to use first when attempting to establish a therapeutic relationship? a) "Would you like me to call your parents?" b) "I am sorry this is happening to you." c) "You have a lot to live for." d) "The voices are not real."
"I am sorry this is happening to you."
A client with a diagnosis of schizophrenia is admitted to the inpatient unit of the mental health center. He's shouting that the government of France is trying to assassinate him. Which response is most appropriate? a) "I don't see evidence that a foreign government or anyone else is trying to hurt you. You must feel frightened by this." b) "I think you're wrong. France is a friendly country. The French government wouldn't try to kill you." c) "You're wrong. Nobody is trying to kill you." d) "A foreign government is trying to kill you? Please tell me more about it."
"I don't see evidence that a foreign government or anyone else is trying to hurt you. You must feel frightened by this."
The nurse should judge client education regarding valproic acid as effective if the client states which statement? a) "I might need to take the valproic acid for a long time." b) "I can stop the valproic acid because the serum level is normal." c) "I can take the valproic acid when I feel I need it." d) "Valproic acid is safe to use when I get pregnant."
"I might need to take the valproic acid for a long time."
A client comes to the mental health clinic 2 days after being discharged from the hospital. The client was given a 1-week supply of clozapine. Which client statement indicates an accurate understanding of the nurse's teaching about this medication? a) "I need to keep my appointment here at the clinic this week for a blood test." b) "I need to call my health care provider in 2 weeks for a checkup." c) "I can take over-the-counter sleeping medication if I have trouble sleeping." d) "I can drink alcohol with this medication."
"I need to keep my appointment here at the clinic this week for a blood test."
client is being successfully treated with clozapine. Which statement by the client reflects a need for further teaching about managing the drug's adverse effects? a) "If I eat too many fruits, I will get constipated." b) "Sometimes I have to push myself because I am sleepy." c) "I need to take the medicine with food to avoid nausea." d) "I have to get up slowly so I do not get dizzy."
"If I eat too many fruits, I will get constipated."
A client with bipolar disorder, manic phase, begins to swear at the nurse when reminded to limit telephone calls to 10 minutes. The nurse should respond by saying: a) "Others can hear you." b) "You know better than to use that language." c) "You need to act like an adult." d) "Stop! Swearing is not appropriate behavior."
"Stop! Swearing is not appropriate behavior."
The parents of a 20-year-old female client diagnosed with paranoid schizophrenia admitted 4 days ago are attending a family psychoeducation group in the hospital. Which statement by the mother indicates that she understands her daughter's illness and management? a) "Tasks as simple as getting out of bed and showering in the morning may be difficult for her." b) "She will not experience a relapse as long as she takes her prescribed medication." c) "I know that I will have to do everything for my daughter when she comes home." d) "I know that visits from her friends at home should be discouraged for a while."
"Tasks as simple as getting out of bed and showering in the morning may be difficult for her."
A client with schizophrenia and delusions tells a nurse, "There is a man wearing a red coat who's out to get me." The client exhibits increasing anxiety when focusing on the delusion. Which response by the nurse is appropriate? a) "There is no need to be concerned about a man who isn't even real." b) "This subject seems to be troubling you. Let's walk to the activity room." c) "There is no reason to be afraid of that man. This hospital is very secure." d) "Describe the man who's out to get you. What does he look like?"
"This subject seems to be troubling you. Let's walk to the activity room."
A young client diagnosed with schizophrenia is talking with the nurse and says, "You know, when I thought everyone was out to get me, I was staying in my apartment all the time. Now, I would like to get out and do things again." What is the best initial response by the nurse? a) "What kind of transportation do you use?" b) "How much money can you spend?" c) "With whom do you want to do things?" d) "What activities did you enjoy in the past?"
"What activities did you enjoy in the past?"
A client admitted in an acute psychotic state hears terrible voices in the head and thinks a neighbor is upset with the client. What is the nurse's best response? a) "What has your neighbor been doing that bothers you?" b) "How long have you been hearing these terrible voices?" c) "We will not let your neighbor visit, so you will be safe." d) "What exactly are these terrible voices saying to you?"
"What exactly are these terrible voices saying to you?"
A client with schizophrenia repeatedly uses profanity during an activity therapy session. Which response by the nurse is appropriate? a) "I'm disappointed in you. You can't control yourself for even a few minutes." b) "You're just doing this to get back at me for making you come to therapy." c) "Your behavior won't be tolerated. Go to your room immediately." d) "Your cursing is interrupting the activity. Take time out in your room for 10 minutes."
"Your cursing is interrupting the activity. Take time out in your room for 10 minutes."
A client is about to be discharged with a prescription for the antipsychotic agent haloperidol, 10 mg by mouth twice per day. During a discharge teaching session, a nurse should provide which instruction to the client? a) Decrease the dosage if signs of illness decrease. b) Take the medication 1 hour before a meal. c) Apply a sunscreen before exposure to the sun. d) Increase the dosage up to 50 mg twice per day if signs of illness don't decrease.
Apply a sunscreen before exposure to the sun.
A client is unable to get out of bed and get dressed unless a nurse prompts every step. This is an example of which behavior? a) Tangential b) Word salad c) Avolition d) Perseveration
Avolition
The wife of a client admitted for treatment of newly diagnosed paranoid schizophrenia visits 2 days after her husband's admission and states to the nurse, "Why is he not eating? He is still talking about his food being poisoned." Which appraisal by the nurse is most accurate? a) Her expectations of her husband are realistic. b) The wife's inquiry is reasonable. c) Education about her husband's medications is needed. d) An increase in the client's medication is indicated.
Education about her husband's medications is needed.
A client is hearing voices that are telling her to kill herself. She is demanding a knife to use on her wrists. Which is most appropriate intervention at this time? a) Ask the client to talk about her anger and what is causing it. b) Put the client in restraints after giving an IM dose of PRN medication. c) Search the client's room for potential weapons after locking the unit kitchen. d) Give oral PRN doses of haloperidol and lorazepam as prescribed.
Give oral PRN doses of haloperidol and lorazepam as prescribed.
A client begins clozapine therapy after several other antipsychotic agents fail to relieve her psychotic symptoms. The nurse instructs her to return for weekly white blood cell (WBC) counts to assess for which adverse reaction? a) Granulocytopenia b) Infection c) Systemic dermatitis d) Hepatitis
Granulocytopenia
The nurse is working in a community mental health clinic. A client who is diagnosed with schizophrenia is taking clozapine and reports of a sore throat. What is the most appropriate action for the nurse to take? a) Encourage the use of saline mouth rinses until the sore throat is gone. b) Have the client decrease the daily amount of clozapine by half. c) Suggest that the client drink warm beverages and rest. d) Obtain an order for the client to have a white blood cell count drawn.
Obtain an order for the client to have a white blood cell count drawn.
A man with a 5-year history of multiple psychiatric admissions is brought to the emergency department by the police. This client was found wandering the streets disheveled, shoeless, and confused. Based on his previous medical records and current behavior, he is diagnosed with schizophrenia. The nurse should assign highest priority to which nursing diagnosis? a) Disturbed thought processes b) Dressing or grooming self-care deficit c) Impaired verbal communication d) Risk for injury
Risk for injury
A man with a 5-year history of multiple psychiatric admissions is brought to the emergency department by the police. This client was found wandering the streets disheveled, shoeless, and confused. Based on his previous medical records and current behavior, he is diagnosed with schizophrenia. The nurse should assign highest priority to which nursing diagnosis? a) Impaired verbal communication b) Risk for injury c) Disturbed thought processes d) Dressing or grooming self-care deficit
Risk for injury
A client has a history of schizophrenia. Because he has a history of noncompliance with antipsychotic therapy, he will receive fluphenazine decanoate injections every 4 weeks. Before discharge, what should the nurse include in her teaching plan? a) Expecting transient symptoms of tardive dyskinesia to occur b) Sitting up for a few minutes before standing to minimize orthostatic hypotension c) Asking the physician for droperidol to control any extrapyramidal symptoms that occur d) Notifying the physician if the client's thoughts do not normalize within 1 week
Sitting up for a few minutes before standing to minimize orthostatic hypotension
A client has a history of schizophrenia. Because he has a history of noncompliance with antipsychotic therapy, he will receive fluphenazine decanoate injections every 4 weeks. Before discharge, what should the nurse include in her teaching plan? a) Notifying the physician if the client's thoughts do not normalize within 1 week b) Asking the physician for droperidol to control any extrapyramidal symptoms that occur c) Sitting up for a few minutes before standing to minimize orthostatic hypotension d) Expecting transient symptoms of tardive dyskinesia to occur
Sitting up for a few minutes before standing to minimize orthostatic hypotension
When assessing a hospitalized client diagnosed with Major Depression and Borderline Personality Disorder, the nurse should ask the client about which of the following first? a) Suicidal thoughts. b) Suicidal plans. c) Seriousness of the client's intent to die. d) Access to pills and weapons.
Suicidal thoughts.
A nurse is teaching a psychiatric client about his ordered drugs, chlorpromazine and benztropine. What evaluation would indicate a therapeutic response to these drugs? a) The client expresses a decrease in anxiety. b) The client does not report nausea and vomiting. c) The client is experiencing less psychosis and a decrease in extrapyramidal symptoms. d) The client displays akathisia while sitting
The client is experiencing less psychosis and a decrease in extrapyramidal symptoms.
A client has been receiving chlorpromazine, an antipsychotic, to treat his psychosis. Which findings should alert the nurse that the client is experiencing pseudoparkinsonism? a) Extremity and neck spasms, facial grimacing, and jerky movements b) Tremors, shuffling gait, and masklike face c) Restlessness, difficulty sitting still, and pacing d) Involuntary rolling of the eyes
Tremors, shuffling gait, and masklike face
The mother of a client with schizophrenia calls the visiting nurse in the outpatient clinic to report that her daughter has not answered the phone in 10 days. "She was doing so well for months. I do not know what is wrong. I am worried." Which response by the nurse is most appropriate? a) "She may have stopped taking her medications. I will check on her." b) "Maybe she is just mad at you. Did you have an argument?" c) "Do not worry about this. It happens sometimes." d) "Go over to her apartment and see what is going on."
a) "She may have stopped taking her medications. I will check on her."
What is the most appropriate long-term goal for an outpatient client with schizophrenia who has been withdrawn from friends and family for 3 weeks? a) calling the client's mother once a day b) allowing two friends to visit every day c) attending day therapy three times a week d) remaining out of bed for 10 hours a day
attending day therapy three times a week
A nurse must administer a medication to reverse or prevent Parkinson-type symptoms in a client receiving an antipsychotic. The medication the client will likely receive is: a) propranolol. b) haloperidol. c) benztropine. d) diphenhydramine.
benztropine
During a home visit for a client diagnosed with paranoid schizophrenia discharged 1 week ago, the client's mother tearfully states, "I can hardly sleep because I am so worried about my daughter. I am afraid to leave her alone in the house. What if something should happen while I am gone?" Which caregiver problem would be the most inclusive one for the nurse to incorporate into the client's plan of care? a) caregiver role strain b) disturbed sleep pattern c) fear d) anxiety
caregiver role strain
The nurse is facilitating a group of clients with schizophrenia when one client says, "I like to drive my car, bar, tar, far." This client is exhibiting: a) clang association. b) neologisms c) echolalia. d) echopraxia.
clang association.
The nurse is facilitating a group of clients with schizophrenia when one client says, "I like to drive my car, bar, tar, far." This client is exhibiting: a) echolalia. b) neologisms c) echopraxia. d) clang association.
clang association.
The client thinks he is being followed by foreign agents who are after secret papers in his briefcase. What thought process does this indicate? a) idea of reference b) delusion of persecution c) delusion of grandeur d) idea of influence
delusion of persecution
A client whose symptoms of schizophrenia are under control with olanzapine, and who is functioning at home and in her part-time employment, states that she is very concerned about her 20-lb (9.1-kg) weight gain since she started taking the medication 6 months ago. The nurse should: a) suggest that the client talk with her healthcare provider about changing to another antipsychotic. b) advise the client to decrease her dosage by one-half. c) discuss nutrition, daily diet, and exercise with the client. d) tell the client not to worry because she should stop gaining weight.
discuss nutrition, daily diet, and exercise with the client.
One of the causes of schizophrenia involves an overstimulation of: a) dopamine. b) norepinephrine. c) epinephrine. d) serotonin.
dopamine
When caring for a client receiving haloperidol, the nurse should assess for which problem? a) extrapyramidal symptoms b) hypersalivation c) oversedation d) orthostasis
extrapyramidal symptoms
When caring for a client receiving haloperidol, the nurse should assess for which problem? a) extrapyramidal symptoms b) oversedation c) orthostasis d) hypersalivation
extrapyramidal symptoms
A psychotic client tells the evening nurse that the day nurse put something suspicious in his water with his medication. The nurse replies, "You're worried about your medication?" The nurse's communication is: a) an example of presenting reality. b) a technique called mind reading. c) focusing on emotional content. d) reinforcing the client's delusions.
focusing on emotional content.
A nurse knows that a physician has ordered the liquid form of the drug chlorpromazine rather than the tablet form because the liquid: a) has a longer duration of action. b) produces fewer anticholinergic effects. c) produces fewer drug interactions. d) has a more predictable onset of action.
has a more predictable onset of action.
A client with schizophrenia reports to the nurse that he does very little all day except sleep and eat. The nurse should: a) have three meals per day brought in to increase the amount of time the client spends out of bed. b) ask a relative to call the client at least 10 times a day to decrease the sleeping. c) arrange for the client to move to a group home with structured activities. d) help the client set up a daily activity schedule to include setting a wake-up alarm.
help the client set up a daily activity schedule to include setting a wake-up alarm.
During a home visit, the nurse discovers that the client is less verbal, less active, less responsive to directions, severely anxious, and more stuporous. The nurse interprets these findings to indicate that the client needs which intervention? a) an increase in medication b) immediate medical evaluation c) a clinic appointment d) a sleep aid
immediate medical evaluation
A client with schizophrenia tells a nurse he hears the voices of his dead parents. To help the client ignore the voices, the nurse should recommend that he: a) engage in strenuous exercise. b) listen to a personal stereo through headphones and sing along with the music. c) call a friend and discuss the voices and his feelings about them. d) sit in a quiet, dark room and concentrate on the voices.
listen to a personal stereo through headphones and sing along with the music.
A client diagnosed with paranoid personality disorder is hospitalized for physically threatening his wife because he suspects her of having an affair with a coworker. What approach should the nurse employ with this client? a) matter-of-fact b) controlling c) authoritarian d) parental
matter-of-fact
A nurse is planning care for a regressed, chronically ill client diagnosed with schizophrenia. What is the most appropriate milieu? a) confrontation and peer pressure to break down the client's denial b) reminder that all clients must participate fully in unit self-governance c) required attendance at group activities with equal participation from all clients d) nurturance and supportive interaction focusing on individual needs
nurturance and supportive interaction focusing on individual needs
A client with a chronic mental illness has worked as a hotel maid for the past 3 years. She tells the nurse she is thinking of quitting her job because "voices on television are talking about me." The nurse should first: a) check with the client's employer about her work performance. b) arrange for the client to be admitted to a psychiatric hospital for a short stay. c) obtain information about the client's medication compliance. d) remind the client that hearing voices is a symptom of her illness with which she can cope.
obtain information about the client's medication compliance.
A client with a chronic mental illness has worked as a hotel maid for the past 3 years. She tells the nurse she is thinking of quitting her job because "voices on television are talking about me." The nurse should first: a) check with the client's employer about her work performance. b) remind the client that hearing voices is a symptom of her illness with which she can cope. c) obtain information about the client's medication compliance. d) arrange for the client to be admitted to a psychiatric hospital for a short stay.
obtain information about the client's medication compliance.
A 20-year-old client diagnosed with schizophrenia is recovering from his first psychotic break. Before discharge from the hospital, the client becomes depressed and states, "I do not want this illness. I am about to begin my junior year in college." Which issue would be most important for the nurses to address at this time? a) potential for medication noncompliance b) communication problems c) disturbed sensory perceptions d) disturbed thought process
potential for medication noncompliance
A man is brought to the hospital by his wife, who states that he has refused all meals for the past week and accused her of trying to poison him. During the initial interview, the client's speech, only partly comprehensible, reveals that his thoughts are controlled by delusions that he is possessed by the devil. A physician diagnoses paranoid schizophrenia. Schizophrenia is best described as a disorder characterized by: a) preoccupation with persecutory delusions, anxiety, anger, and potential for violence. b) auditory and tactile hallucinations. c) severe mood swings and periods of low to high activity. d) multiple personalities, one of which is more destructive than the others.
preoccupation with persecutory delusions, anxiety, anger, and potential for violence.
When developing the plan of care for a client diagnosed with a personality disorder, the nurse plans to assist the client primarily with what factor? a) specific dysfunctional behaviors b) manipulation of the environment c) psychopharmacologic compliance d) examination of developmental conflicts
specific dysfunctional behaviors
After working multiple shifts in the psychiatric intensive care unit, a nurse recognizes that she's becoming more distant and, at times, even irritable. The best action for the nurse to take would be to: a) request vacation time in order to achieve emotional restoration. b) talk with the charge nurse and seek support from her peers on the unit. c) continue to work and recognize that her feelings are normal. d) ask the charge nurse if another, less-demanding assignment is available.
talk with the charge nurse and seek support from her peers on the unit.
Propranolol is used in the mental health setting to: a) treat antipsychotic-induced akathisia and anxiety. b) reduce ritualistic behavior in clients with obsessive-compulsive disorder (OCD). c) alleveiate delusions for clients suffering from schizophrenia. d) stabilize mood in the manic phase of bipolar illness.
treat antipsychotic-induced akathisia and anxiety.
