EAQ Quiz Pscychosis B
While speaking with a client with schizophrenia, the nurse notes that the client keeps interjecting sentences that have nothing to do with the main thoughts being expressed. The client asks whether the nurse understands. What is the best response by the nurse? 1 "You aren't making any sense; let's talk about something else." 2 "You're so confused; I can't understand what you're saying to me." 3 "Why don't you take a rest? We can talk again later this afternoon." 4 "I'd like to understand what you're saying, but I'm having difficulty following you."
"I'd like to understand what you're saying, but I'm having difficulty following you." The statement "I'd like to understand what you are saying, but I'm having difficulty following you" lets the client know the nurse is trying to understand; it increases the client's self-esteem and points out reality. Clients with schizophrenia have problems with associative links, and these same problems will occur regardless of the topic. The statement "You're so confused; I can't understand what you're saying to me" and telling the client to take a rest and promising to talk about the client's concerns again later in the day cut off communication and tell the client that the nurse will speak only if the client's communication makes sense. STUDY TIP: Answer every question. A question without an answer is the same as a wrong answer. Go ahead and guess. You have studied for the test and you know the material well. You are not making a random guess based on no information. You are guessing based on what you have learned and your best assessment of the question.
A client with schizophrenia who is being admitted to a psychiatric hospital for evaluation refuses to remove dirty clothing. What should the nurse do to best meet the client's needs? 1 Allow the client to undress when ready to help maintain identity. 2 Provide two outfits and help the client decide which one to wear. 3 Explain that clean clothes will look more attractive and increase self-esteem. 4 Get assistance and remove the clothing to meet the client's basic hygiene needs.
Allow the client to undress when ready to help maintain identity. Any approach other than allowing the client to undress when ready will probably be seen as threatening, increase anxiety, and result in a physical confrontation. Providing two outfits and helping the client make a simple decision will increase anxiety, not foster decision-making. Explaining that clean clothes will look more attractive and increase self-esteem will increase anxiety, not increase self-esteem. Getting assistance and removing the clothing to meet the client's basic hygiene needs will increase the client's anxiety and will probably result in a physical confrontation.
A client with the diagnosis of schizophrenia who has been hospitalized on a mental health unit for 2 weeks is to be discharged home. The client is vacillating between being happy and sad about going home. What term best describes these conflicting emotions? 1 Double bind 2 Ambivalence 3 Loose association 4 Inappropriate affect
Ambivalence The simultaneous existence of two conflicting emotions, impulses, or desires is known as ambivalence. A single communication containing two conflicting messages is known as a double-bind message. A lack of connections between thoughts is known as loose associations. Inappropriate affect is not two conflicting emotions but instead the inappropriate expression of emotions.
A nurse is preparing a teaching plan to educate a relative of a client with schizophrenia about the early signs of relapse. What signs should the nurse plan to include? Select all that apply. 1 Appearing disheveled 2 Socializing with peers 3 Staying alone in the house 4 Joining a local church singing group 5 Exhibiting indifference to family activities
Appearing disheveled, Staying alone in the house, Exhibiting indifference to family activities Appearing disheveled, a negative sign, may indicate schizophrenic relapse, because the individual does not have the interest or energy to complete the activities of daily living. Staying at home alone can be a sign of mental illness relapse, because the individual is becoming isolated and not socializing. Indifference to family activities may indicate mental illness relapse, because it may reflect feelings of apathy or a lack of emotional energy to become involved with others. Socializing with peers is a sign of mental health, because the individual is interacting with others; humans are highly social beings. Joining a church singing group indicates mental health, because the individual is interacting with others and is interested in an activity.
Which food should be avoided by a client who is prescribed monoamine oxidase inhibitors (MAOIs)? 1 Bologna 2 Potatoes 3 Citrus fruit 4 Grapefruit juice
Bologna Bologna has a high tyramine content; tyramine should not be consumed by clients taking monoamine oxidase inhibitors (MAOIs) because the drug interaction may cause severe hypertension. Potatoes and citrus fruits do not contain tyramine. Grapefruit juice may cause a negative drug interaction in clients taking buspirone.
During a one-on-one interaction with a client with paranoid-type schizophrenia, the client says to the nurse, "I've figured out how foreign agents have infiltrated the news media. They want to shut me up before I spill the beans." How should the nurse describe this statement when documenting this client's response? 1 Nihilistic delusion 2 Delusions of persecution 3 Delusions of control 4 Delusions of grandeur
Delusions of persecution Thoughts of being pursued by powerful agents because of one's special attributes or powers are fixed false beliefs and are referred to as delusions of persecution. There is no evidence to indicate that there are nihilistic delusions of total or partial nonexistence. There is also no evidence to support that external forces are controlling the client (delusions of control) or that the client has false beliefs of being a famous figure (delusions of grandeur).
Which second-generation antidepressant can worsen uncontrolled angle closure glaucoma? 1 Trazodone 2 Bupropion 3 Duloxetine 4 Mirtazapine
Duloxetine Duloxetine can worsen uncontrolled angle-closure glaucoma. Trazodone is contraindicated in clients with a known drug allergy. Bupropion is contraindicated for clients with seizures. Mirtazapine is contraindicated in cases of known drug allergy and concurrent use of monoamine oxidase inhibitors.
What characteristics are commonly associated with adolescent depression? Select all that apply. 1 Exercising daily 2 Having suicidal ideation 3 Exhibiting tearfulness 4 Having poor muscle tone 5 Avoiding previously enjoyed activities and relationships
Having suicidal ideation Exhibiting tearfulness Avoiding previously enjoyed activities and relationships Having suicidal ideation, exhibiting tearfulness, and avoiding previously enjoyed activities and relationships are characteristic features of depression. Having poor muscle tone and performing physical exercise routine are uncommon in depressed adolescents.
When a newly admitted client with paranoid ideation tells the nurse about people coming through the doors to commit murder, what should the nurse do? 1 Ignore the client's stories. 2 Listen to what the client is saying. 3 Explain that no one can get through the door. 4 Ask for an explanation of where the information was obtained.
Listen to what the client is saying. Listening to what the client is saying demonstrates that the nurse believes that what the client has to say is important; it also encourages verbalization of feelings. Ignoring the client's stories may increase the client's feelings of worthlessness and persecution. Explaining that no one can get through the door will accomplish little; a paranoid individual cannot be talked out of his or her feelings. These are feelings, not information, and they cannot always be explained; asking where the information came from forces the client to further develop the delusional system.
A client who has been admitted with a diagnosis of schizophrenia says to the nurse, "Yes, it's March. March is Little Women. That's literal, you know." What do these statements illustrate? 1 Echolalia 2 Neologisms 3 Flight of ideas 4 Loosening of associations
Loosening of associations Loose associations are thoughts that are presented without the logical connections that are usually necessary for the listener to interpret the message. Echolalia is the purposeless repetition of words spoken by others or repetition of overheard sounds. Neologisms are new meaningless words coined by the client or new, unique meanings given to old words. Flight of ideas is the rapid skipping from one thought to another; these thoughts usually have only superficial or chance relationships.
Which antipsychotic drugs have the higher risk of causing tardive dyskinesia? Select all that apply. 1 Loxapine 2 Quetiapine 3 Haloperidol 4 Ziprasidone 5 Olanzapine
Loxapine,Haloperidol First-generation antipsychotic drugs such as loxapine and haloperidol may cause tardive dyskinesia, an extrapyramidal reaction. Second-generation antipsychotic drugs such as quetiapine, ziprasidone, and olanzapine have a lower risk of causing extrapyramidal reactions.
After assessing a client, the nurse suspects that the client has shift-work sleep disorder (SWSD). Which medication would be prescribed to the client? 1 Caffeine 2 Modafinil 3 Atomoxetine 4 Methylphenidate
Modafinil Modafinil is a unique nonamphetamine stimulant used to treat shift-work sleep disorder (SWSD). This drug promotes wakefulness in clients suffering from excessive sleepiness associated with SWSD. Caffeine is a central nervous stimulant used to promote wakefulness, but this drug is not as effective in the treatment of SWSD. Atomoxetine is a nonstimulant used to treat attention deficit hyperactivity disorder (ADHD). Methylphenidate is considered the first choice drug for the treatment of attention deficit hyperactivity disorder (ADHD).
Which atypical antipsychotics are approved for long-term use to prevent the recurrence of mood episodes in clients with bipolar disease? Select all that apply.
Olanzapine, ziprasidone, and aripiprazole are atypical antipsychotics approved for long-term use to prevent recurrence of mood episodes. Quetiapine and risperidone are atypical antipsychotics approved for use in bipolar disease but are not approved for long-term use to prevent the recurrence of mood episodes.
A nurse is caring for a client with the diagnosis of schizophrenia. What should the nurse plan to do to increase the self-esteem of this client? 1 Reward healthy behaviors. 2 Explain the treatment plan. 3 Identify various means of coping. 4 Encourage participation in community meetings.
Reward healthy behaviors. By realistically rewarding the healthy behaviors, the nurse provides secondary gains and encourages the continued use of healthy behaviors. Explaining the treatment plan, identifying various means of coping, and encouraging participation in community meetings are important but will do little to increase the client's self-esteem.
In addition to hallucinating, a client yells and curses throughout the day. What should the nurse do? 1 Ignore the client's behavior. 2 Isolate the client until the behavior stops. 3 Explain the meaning of the behavior to the client. 4 Seek to understand what the behavior means to the client.
Seek to understand what the behavior means to the client. All behavior has meaning; before planning intervention, the nurse must try to understand what the behavior means to the client. Ignoring behavior does little to alter it and may even cause further acting out. Isolation may increase anxiety and precipitate more acting-out behavior. The nurse cannot explain the meaning of the client's behavior; only the client can.
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? 1 Controlling anxiety 2 Terminating the session on time 3 Accepting the psychiatric diagnosis 4 Setting mutual goals for the relationship
Setting mutual goals for the relationship 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.
On the afternoon of admission to a psychiatric unit, an adolescent boy with the diagnosis of schizophrenia exposes his genitals to a female nurse. What should the nurse's immediate therapeutic response be? 1 Ignoring the client at this time 2 Stating that this behavior is unacceptable 3 Moving him to his room for a short time-out 4 Telling the client to come to the office later to discuss the behavior
Stating that this behavior is unacceptable When clients enter a new milieu, limits should be set on unacceptable behavior and acceptable behavior should be reinforced. Neither clients nor unacceptable behavior should ever be ignored. Moving the client to his room for a short time-out is punishment. Unacceptable attention-getting behavior must be addressed immediately; also, the focus should be on appropriate behavior. Test-Taking Tip: If the question asks for an immediate action or response, all of the answers may be correct, so base your selection on identified priorities for action.
A client with schizophrenia is given an antipsychotic drug. The nurse recalls all the extrapyramidal effects associated with this type of medication and anticipates that the drug will be discontinued if which occurs? 1 Akathisia 2 Tardive dyskinesia 3 Parkinsonian syndrome 4 Acute dystonic reaction
Tardive dyskinesia Tardive dyskinesia is characterized by protrusion and vermicular movements of the tongue, chewing and puckering movements of the mouth, and a puffing of the cheeks. These adverse effects may or may not be reversible when the antipsychotic medication is withdrawn. Motor restlessness (akathisia), parkinsonian symptoms, or an acute dystonic reaction can be treated with an antiparkinsonian or anticholinergic drug while the antipsychotic medication is continued.
Which drugs are considered typical antipsychotics? Select all that apply. 1 Asenapine 2 Lurasidone 3 Aripiprazole 4 Thioridazine 5 Chlorpromazine
Thioridazine, Chlorpromazine First-generation antipsychotic drugs are also known as typical/conventional antipsychotics. Thioridazine and chlorpromazine are typical antipsychotics. Asenapine, lurasidone, and aripiprazole are atypical antipsychotics, also known as second-generation antipsychotics.
While watching television in the dayroom, a client who has demonstrated withdrawn, regressed behavior suddenly screams, bursts into tears, and runs from the room to the far end of the hallway. What is the most therapeutic intervention by the nurse? 1 Walking to the end of the hallway where the client is standing 2 Accepting the action as the impulsive behavior of a sick person 3 Asking another client in the dayroom why the client acted in this way 4 Documenting the incident in the client's record while the memory is fresh
Walking to the end of the hallway where the client is standing Walking to the end of the hallway where the client is standing lets the client know that the nurse is available. It also demonstrates an acceptance of the client. Accepting the action as the impulsive behavior of a sick person is an avoidance technique; it shows a lack of acceptance of the client as a person. Another client's perception of the incident may or may not be valid. Although it is important to document the incident in the client's record, this does not take precedence over letting the client know the nurse is available if needed.
