Test 3 review:Schizophrenia Q (NK) test
A client with paranoid schizophrenia tells the nurse "I have to get away. The volmers are coming to execute me." The term volmers can be assessed as: A neologism Clang association Blocking Delusion
A neologism
A client with paranoid schizophrenia refuses food. The client states the voices are telling the client the food is contaminated and will change the individual's sexual orientation. A therapeutic response for the nurse to give would be: A." I understand that the voices are very real to you. I do not hear them." B. "The voices are wrong about the hospital food. It is not contaminated." C. " You are safe here in the hospital, nothing bad will happen to you." D. "Other people are eating the food and nothing is happening to them."
A." I understand that the voices are very real to you. I do not hear them."
A salesman has had difficulty holding a job because he accuses co-workers of conspiring to take his sales. Today, he argued with several office mates and threatened to kill one of them. The police were called, and he was brought to the mental health center for evaluation. He has had previous admissions to the unit for stabilization of paranoid schizophrenia. When the nurse meets him, he points at staff in the nursing station and states loudly, "They're all plotting to destroy me. Isn't that true?" Which would be the most appropriate response? A. "No, that is not true. People here are trying to help you if you will let them." B. "Let's think about it; what reason would people have to want to destroy you?" C. "Thinking that people want to destroy you must be very frightening." D. "That doesn't make sense; staff are health care workers, not murders."
C. resist focusing on content; instead focus on the feelings the client is expressing. It avoids aruguing about the reality of delusional beliefs. such arguments can increase anxity to the patient. Other optiins focus on content and opens a window for argument.
The purpose for the nurse periodically performing the Abnormal Involuntary Movement Scale (AIMS) assessment on a persistently mentally ill client who has schizophrenia is early detection of: Acute psychoses Cholestatic jaundice Tardive dyskinesia Metabolic syndrome
TD
A patient with catatonic schizophrenia exhibits little spontaneous movement and demonstrates waxy flexibility. Which nursing intervention should receive the highest priority? A. conducting passive range of motion exercises B. Exposing the patient to auditory and visual stimuli C. Interacting with the as if he is responding D. Including the patient in a wide variety of milieu activities.
a
A patient was admitted to the mental health unit after arguing with co-workers and threatening to kill them. He is diagnosed with paranoid schizophrenia. On the unit he is aloof and suspicious. He mentioned that two physicians he saw talking were plotting to kill him. On the basis of data gathered at this point, which two primary nursing diagnoses should the nurse consider? A. Disturbed personal identity and risk for other directed violence B. Spiritual distress and Social Isolation C. Risk for loneliness and Knowledge deficit D. Disturbed personal identity and Nonadherence
a delusions of persecutions and ideas of reference
Family members of a patient newly diagnosed with paranoid schizophrenia state that they do not understand what caused the patient's illness. The nurse's response should be predicated on the: A. Neurobiological-genetic model B. stress model C. family theory model D. Developmental model
a. compelling evidence exists that schizophrenia is a neurological disorder probably r/t neurotransmitter abnormalities, neuroanatomical disruption of brain function, and genetic vulnerability.
Which of the following would be assessed as a negative symptom of schizophrenia? a. anhedonia b. hostility c. agitation d. hallucinations
a. anhedonia (loss of feeling of joy)
A newly admitted patient diagnosed with paranoid schizophrenia is hypervigilant and constantly scans the environment. He states that he saw two doctors talking in the hall and knows they were plotting to kill him. When charting, how should the nurse identify this behavior? A. Idea of reference B. Delusion of infidelity C. Auditory hallucination D. Echolalia
a. idea of reference ideas of reference are misinterpretation of the verbalizations or actions of others that give special personal message/meanings to these behaviors.
A patient is noted to be bending over backward in the group room. A peer asks what he is doing, and he replies, "People say they are bending over backwards to help me, so I am bending over backwards to help myself." This is an example of: A. abstract thinking B. concrete thinking C. impaired reality testing D. boundary impairment
b
A patient with schizophrenia has received typical (first-generation) antipsychotics for a year. His hallucinations are less intrusive, but he remains apathetic, has poverty of thought, cannot work, and is socially isolated. To address these symptoms, the nurse might consult the prescribing health care provider to suggest a change to: A. haloperidol (Haldol) B. olanzapine (Zyprexa) C. diphenhydramine (Benadryl) D. chlorpromazine (Thorazine)
b
The nursing intervention to help the client manage relapse is to: a Schedule the client to attend group therapy b Teach the client and family about behaviors that signal or trigger relapse c Remind the client of the need for periodic blood work d Help the client and family adapt to the stigma of mental illness
b Teach the client and family about behaviors that signal or trigger relapse
When a patient diagnosed with paranoid schizophrenia was discharged from the unit 6 months ago, the plan was for him to take chlorpromazine (Thorazine), a conventional (first generation) antipsychotic medication, 300 mg po daily. He tells the nurse he stopped taking his pills after a few months because they made him feel like a "zombie." What other common side effects should the nurse determine if the patient experienced? A. Sweating, nausea, and weight gain B. Sedation, tremor, and muscle stiffness C. Headache, watery eyes and runny nose D. Mild fever, sore throat, and skin rash
b sedation,
a descriptor for a subtype of schizophernia is a. delusional b. catatonic d. dissociated d. developmental
b. catatonic
A newly admitted patient with schizophrenia approaches the unit nurse and says, "The voices are bothering me. They are yelling and telling me stuff. They are really bad." Which response by the nurse would be most appropriate? A. "Do you hear these voices very often?" B. "Do you have a plan for getting away from the voices?" C. "I'll stay with you. Tell me what you are hearing." D. "Try to ignore them and play cards with the others."
c
A patient on antipsychotic medications is observed to be moving from chair to chair in the day room and pacing in the hallway repeatedly, rapidly, and for extended periods. The patient is likely demonstrating _________ , and the nurse should __________. A. a dystonic reaction...administer prn IM benztropine (Cogentin). B. anxiety....teach and guide the patient to use relaxation exercises C. akathisia....administer prn diphenhydramine (Benadryl) po D. tardive dyskinesia...recommend a change in medication
c
A client with schizophrenia with executive functioning issues would have the greatest difficulty with the nurse : a Interacting with a neutral attitude b Using concrete language c Giving multistep directions d Providing nutritional supplements
c Giving multistep directions
The type of altered perceptions most commonly experienced by clients with schizophrenia is: a. delusions b. illusions c auditory hallucinations d. tactile hallucinations
c auditory hallucinations
The nursing student would need further instruction in the positive symptoms of schizophrenia if the student stated positive symptoms are: a. "delusions of persecution b. "auditory hallucinations c. "flat affect" d. "ideas of reference"
c. flat affect
The current most understood etiology of schizophrenia is that schizophrenia: a. Is stress related b. Is a result of excessive amounts of the neurotransmitter dopamine c. Is a combination of inherited and non-genetic factors d. Is a result of excessive amounts of the neurotransmitter serotonin
c. is a combination of inherited and non genetic factros
A patient with schizophrenia refuses to take his medication because he believes he is not ill. What phenomenon most likely underlies this presentation? A. The patient is unable to face having an illness and is in denial. B. Stigma causes the patient to refuse to admit his mental illness C. The illness itself is preventing the patient from realizing he is ill. D. Command hallucinations are instructing him to deny the illness.
c. the illness itself is preventing the patient from realizing he is ill ANOSOGNOSIA lack of insight
A highly suspicious patient who has delusions of persecution about being poisoned has refused all hospital meals for 3 days. Which of the following interventions would be most appropriate under these circumstances? A. Feed the patient via tube, involuntarily via court order if needed. B. Offer to taste each food item on the tray yourself while he watches. C. Allow the patient to contact a local restaurant to deliver his meals. D. Allow him supervised access to use food vending machines in the hospital lobby.
d
A patient's nursing care plan includes assessment for auditory hallucinations. Indicators that suggest the patient may be hallucinating include: A. aloofness, increased distractibility, and suspicion. B. elevated mood, hypertalkativeness, and distractibility C. performing rituals and avoiding open places D. darting eyes, distracted and mumbling to self.
d
The physician and advanced practice nurse are considering which antipsychotic medication to prescribe for a patient with schizophrenia who demonstrates auditory hallucinations, apathy, anhedonia, and poor social functioning. The patient is overweight and has hypertension. Bearing these facts in mind, the drug the nurse should advocate would be: A. clozapine (Clozaril) B. haloperidol (Haldol) C. olanzapine (Zyprexa) D. aripiprazole (Abilify)
d
When a patient with paranoid schizophrenia has a recurrence of positive symptoms after stopping his antipsychotic medication because of its postural hypotension (orthostasis) side effect, he is readmitted to the mental health unit. What measure should the nurse suggest to help the patient address this side effect? A. Ask the doctor to prescribe an anticholinergic drug like trihexyphenidyl (Artane). B. Chew sugarless gum or use sugarless hard candy to moisten your mouth. C. Increase the amount of sleep you get ,and try to take frequent rest breaks. D. Wear elastic support hose, drink adequate fluids and change positions slowly.
d
Schizophrenia is best characterized as: a. split personality b. multiple personality c. ambivalent p d. deteriorating p
d. deteriorating personality
Which side effect of antipsychotic medication has no known treatment? Anticholinergic Pseudoparkinsonism Dystonic reaction Tardive dyskinesia
tardive dyskinesia
