Psychotic Disorders NCLEX 3000

"(SELECT ALL THAT APPLY) Which instructions should the nurse include when teaching a client about quetiapine (Seroquel) therapy?

"(2) Avoid becoming overheated or dehydrated during therapy. (3) Change position slowly to prevent orthostatic hypotension. (4) Contact the prescriber before taking over-the-counter preparations.

"(SELECT ALL THAT APPLY) A physician starts a client on the antipsychotic medication haloperidol (Haldol). The nurse is aware that this medication has extrapyramidal adverse effects. Which nursing measures should the nurse take during haloperidol administration?

"(2) Closely monitor vital signs, especially temperature. (3) Provide the client with the opportunity to pace. (5) Provide the client with hard candy.

"Which of the following effects is an advantage of the antipsychotic medication risperidone (Risperdal)?

"A lower incidence of extrapyramidal effects

"Propranolol (Inderal) is used in the mental health setting to manage which condition?

"Antipsychotic-induced akathisia and anxiety

A client with borderline personality disorder becomes angry when he is told that today's psychotherapy session with the nurse will be delayed 30 minutes because of an emergency. When the session finally begins, the client expresses anger. Which response by the nurse would be helpful in dealing with the client's anger?

"Can we talk about how this is making you feel right now?"

"The physician prescribes loxapine (Loxitane), 50 mg by mouth twice per day. The client requires the liquid form of the drug. Which action should the nurse take before administering the drug?

"Dilute the liquid concentrate with orange or grapefruit juice.

"A client with acute schizophrenia is receiving antipsychotic medication. Which nursing diagnosis may be appropriate for this client?

"Ineffective protection related to blood dyscrasias

"A 39-year-old client in the residual phase of paranoid schizophrenia asks to see his medical records. Which action by the nurse is most appropriate?

"Notify the nursing supervisor, sign a records release form, and then give the client a copy of his records.

"The nurse is developing a teaching plan for a client receiving clozapine (Clozaril). The nurse should stress the importance of which aspect of follow-up care?

"Routine complete blood count (CBC) with differential

"A client with persistent, severe schizophrenia has been treated with phenothiazines for the past 17 years. Now the client's speech is garbled as a result of drug-induced rhythmic tongue protrusion. What is another name for this extrapyramidal symptom?

"Tardive dyskinesia

"A client with paranoid schizophrenia has been experiencing auditory hallucinations for many years. One approach that has proven to be effective for a hallucinating client is to:

"practice saying ""Go away"" or ""Stop"" when he hears voices.

A client with a diagnosis of paranoid schizophrenia comments to the nurse, "How do I know what is really in those pills?" Which of the following is the appropriate response?

Allow him to open the individual wrappers of the medication.

"A client is unable to get out of bed and get dressed unless the nurse prompts every step. This is an example of which behavior?

Avolition

Positive symptoms of schizophrenia include:

hallucinations, delusions, and disorganized thinking.

The nurse knows that the physician has ordered the liquid form of the drug chlorpromazine (Thorazine) rather than the tablet form because the liquid:

has a more predictable onset of action.

A client tells the nurse that the television newscaster is sending a secret message to her. The nurse suspects the client is experiencing:

ideas of reference.

An agitated and incoherent client, age 29, comes to the emergency department with complaints of visual and auditory hallucinations. The history reveals that the client was hospitalized for paranoid schizophrenia from ages 20 to 21. The physician prescribes haloperidol (Haldol), 5 mg I.M. The nurse understands that this drug is used in this client to treat:

psychosis.

A 62-year-old male client with paranoid schizophrenia tells a nurse that he wants to die. After further discussion, the nurse discovers that the client doesn't have a suicide plan. Which response by the nurse is appropriate?

"I would like to explore your thoughts further. Can you tell me more?"

"When teaching the family of a client with schizophrenia, the nurse should provide which information?

"Support is available to help family members meet their own needs.

"A client, age 36, with paranoid schizophrenia believes the room is bugged by the Central Intelligence Agency and that his roommate is a foreign spy. The client has never had a romantic relationship, has no contact with family members, and hasn't been employed in the last 14 years. Based on Erikson's theories, the nurse should recognize that this client is in which stage of psychosocial development?

"Trust versus mistrust

"A client with catatonic schizophrenia is mute, can't perform activities of daily living, and stares out the window for hours. What is the nurse's first priority?

"Assist the client with feeding.

"A nurse knows that a physician has ordered the liquid form of the phenothiazine chlorpromazine (Thorazine) rather than the tablet form because the liquid:

"has a more predictable onset of action.

"Important teaching for a client receiving risperidone (Risperdal) would include advising the client to:

"notify the physician if the client notices an increase in bruising.

While pacing in the hall, a client with paranoid schizophrenia runs to the nurse and says, "Why are you poisoning me? I know you work for central thought control! You can keep my thoughts. Give me back my soul!" How should the nurse respond during the early stage of the therapeutic process?

"""I'm a nurse, and you're a client in the hospital. I'm not going to harm you.""

"A client with paranoid schizophrenia repeatedly uses profanity during an activity therapy session. Which response by the nurse would be appropriate?

"""Your cursing is interrupting the activity. Take time out in your room for 10 minutes.""

A delusional client approaches the nurse, stating, "I am the Easter bunny," and insisting that the nurse refer to him as such. The belief appears to be fixed and unchanging. Which nursing interventions should the nurse implement when working with this client?

"(1) Consistently use the client's name in interaction. (6) Provide the client with structured activities.

A client with schizophrenia is taking the atypical antipsychotic medication clozapine (Clozaril). Which of the following signs and symptoms indicate the presence of adverse effects associated with this medication?

"(1) Sore throat (4) Fever"

(SELECT ALL THAT APPLY) The nurse is monitoring a client who appears to be hallucinating. She notes paranoid content in the client's speech and he appears agitated. The client is gesturing at a figure on the television. Which of the following nursing interventions are appropriate?

"(2) Reinforce that the client isn't in any danger. (3) Acknowledge the presence of the hallucinations. (6) Use a calm voice and simple commands.

Since a client's admission 4 days ago, he has refused to take a shower because, he states, "There are poison crystals hidden in the showerhead. They'll kill me if I take a shower." Which nursing action is most appropriate?

"Accepting these fears and allowing the client to take a sponge bath

"The nurse is caring for a client with schizophrenia who experiences auditory hallucinations. The client appears to be listening to someone who isn't visible. He gestures, shouts angrily, and stops shouting in mid-sentence. Which nursing intervention is appropriate ?

"Acknowledge that the client is hearing voices but make it clear that the nurse doesn't hear these voices.

"A 50-year-old male client is hospitalized in a psychiatric unit for treatment of an acute phase of paranoid schizophrenia with delusions of persecution. At the end of her shift, a licensed practical nurse reports the client's status to a registered nurse. Which observation by the licensed practical nurse indicates that the client's condition is improving?

"After shaving and showering, the client reports that the voices have been quiet for several days.

"Which medication can control the extrapyramidal effects associated with antipsychotic agents?

"Amantadine (Symmetrel)

"A man with a 5-year history of multiple psychiatric admissions is brought to the emergency department by the police. He was found wandering the streets disheveled, shoeless, and confused. Based on his previous medical records and current behavior, he is diagnosed with chronic undifferentiated schizophrenia. The nurse should assign highest priority to which nursing diagnosis?

"Anxiety

"A client is about to be discharged with a prescription for the antipsychotic agent haloperidol (Haldol), 10 mg by mouth twice per day. During a discharge teaching session, the nurse should provide which instruction to the client?

"Apply a sunscreen before exposure to the sun.

"Which medication is a nonantipsychotic that may be used to treat a client with schizoaffective disorder?

"Lithium carbonate (Lithane)

"A 36-year-old client with a history of schizophrenia is admitted to the emergency department with a fever of 102° F (38.9° C), severe headache, photophobia, nuchal rigidity, and nausea. A physician believes that a lumbar puncture is necessary to help confirm his suspicions of meningitis. The nurse is asked to witness the informed consent. How can the nurse best assess the client's mental status before witnessing the consent?

"Perform a brief mental status examination to determine whether the client is oriented to person, place, time, and purpose.

"A 32-year-old homeless client is referred to an outpatient treatment program for delusional behavior. A nurse notes during the history-taking process that the client eats only one meal a day, which is high in fat and contains no vegetables. The client also states that she rarely eats fruit. Which approach can the nurse use to help the client eat more nutritious meals?

"Provide the client with a nutritional lunch and arrange for the nutritionist and psychiatrist to see the client after lunch.

"A client has a history of chronic undifferentiated schizophrenia. Because she has a history of noncompliance with antipsychotic therapy, she'll receive fluphenazine decanoate (Prolixin Decanoate) injections every 4 weeks. Before discharge, what should the nurse include in her teaching plan?

"Sitting up for a few minutes before standing to minimize orthostatic hypotension

"Teaching for women in their childbearing years who are receiving antipsychotic medications should include which of the following facts?

"The client should continue using contraception during periods of amenorrhea.

"The nurse is caring for a client with schizophrenia. Which outcome should prompt a revision to the client's plan of care?

"The client spends more time by himself.

"A man is brought to the hospital by his wife, who states that for the past week her husband has refused all meals 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. The physician diagnoses schizophrenia. Schizophrenia is best described as a disorder characterized by:

"disturbed relationships related to an inability to communicate and think clearly.

"A 24-year-old client is experiencing an acute schizophrenic episode. He has vivid hallucinations that are making him agitated. The nurse's best response at this time would be to:

"explore the content of the hallucinations.

A psychotic client reports to 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:

"focusing on emotional content.

During a group therapy session in the psychiatric unit, a client constantly interrupts with impulsive behavior and exaggerated stories that cast her as a hero or princess. She also manipulates the group with attention-seeking behaviors, such as sexual comments and angry outbursts. The nurse realizes that these behaviors are typical of:

"histrionic personality disorder.

Teaching for clients receiving an antipsychotic medication such as haloperidol (Haldol) include which instruction?

Use sunscreen because of photosensitivity.

A client tells the nurse that a voice keeps telling him to crawl on his hands and knees like a dog. Which response by the nurse is most appropriate for this client?

"Even though I don't hear the voices, I understand that you do."

"Yesterday, a client with schizophrenia began treatment with haloperidol (Haldol). Today, the nurse notices that the client is holding his head to one side and complaining of neck and jaw spasms. What should the nurse do?

"Evaluate the client for adverse reactions to haloperidol.

A client who has been hospitalized with disorganized type schizophrenia for 8 years can't complete activities of daily living (ADLs) without staff direction and assistance. The nurse assists with formulating a nursing diagnosis of Dressing or grooming self-care deficit related to inability to function without assistance. What is an appropriate goal for this client?

The client will be able to complete ADLs with assistance in organizing grooming items and clothing within 1 month.

A client who is preparing for discharge to a halfway house must be referred to an outpatient clinic. Which criteria should be considered when choosing an outpatient treatment program for this client?

The clinic is within walking distance, and a staff member will send a caseworker to the halfway house to assess the client and develop a treatment plan.

The nurse is caring for a client who experiences false sensory perceptions with no basis in reality. These perceptions are known as:

hallucinations.

Every day for the past 2 weeks, a client with schizophrenia stands up during group therapy and screams, "Get out of here right now! The elevator bombs are going to explode in 3 minutes!" The next time this happens, how should the nurse respond?

"I know you think there are bombs in the elevator, but there aren't."

"A client with schizophrenia tells the nurse he hears the voices of his dead parents. To help the client ignore the voices, the nurse should recommend that he:

"listen to a personal stereo through headphones and sing along with the music.

A client begins clozapine (Clozaril) 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?

Granulocytopenia

Nursing care for a client with schizophrenia must be based on valid psychiatric and nursing theories. The nurse's interpersonal communication with the client and specific nursing interventions must be:

flexible enough for the nurse to adjust the plan of care as the situation warrants.

A client is admitted to the psychiatric unit with active psychosis. The physician diagnoses schizophrenia after ruling out several other conditions. Schizophrenia is characterized by:

disturbances in affect, perception, and thought content and form.

A client with paranoid schizophrenia is admitted to the psychiatric unit of a hospital. Data collection should include careful observation of the client's:

thinking, perceiving, and decision-making skills.

"A 27-year-old female client is brought to the emergency department by police officers. They report that she has been eating garbage, throwing food, and threatening bystanders on the street. Which health care team member should be consulted immediately to help with this client?

"The emergency department crisis intervention worker

"A client is admitted to the psychiatric unit with a diagnosis of borderline personality disorder. The nurse expects data collection to reveal:

"unpredictable behavior and intense interpersonal relationships.

"A client is admitted to the psychiatric hospital with a diagnosis of catatonic schizophrenia. During the physical examination, the client's arm remains outstretched after the nurse obtains the pulse and blood pressure, and the nurse must reposition the arm. This client is exhibiting:

"waxy flexibility.

"What medication would probably be ordered for the acutely aggressive schizophrenic client?

"Haloperidol (Haldol)

"A client is admitted with a diagnosis of delusions of grandeur. This diagnosis reflects a belief that he is:

"highly important or famous.

"A client is admitted to the inpatient unit of the mental health center with a diagnosis of paranoid schizophrenia. He's shouting that the government of France is trying to assassinate him. Which response is appropriate?

"""I find it hard to believe that a foreign government or anyone else is trying to hurt you. You must feel frightened by this.""

"A 45-year-old client with schizophrenia expresses a fear of sleeping because voices become threatening when she attempts to sleep. To avoid sleeping the client reports drinking 40 cups of coffee a day. Which response by the nurse is appropriate?

"""I know that you're afraid to sleep; let's discuss the effect of caffeine on your voices.""

"A client with disorganized type schizophrenia has been hospitalized for the past 2 years on a unit for chronic mentally ill clients. The client's behavior is labile and fluctuates from childishness and incoherence to loud yelling to slow but appropriate interaction. The client needs assistance with all activities of daily living. Which behavior is characteristic of disorganized type schizophrenia?

"Extreme social impairment

A client with paranoid personality disorder is admitted to a psychiatric facility. Which remark by the nurse would best establish trust and rapport and encourage the client to confide in the nurse?

"I get upset once in a while, too."

"A 54-year-old client who was admitted to the psychiatric unit during an acute phase of paranoid schizophrenia has hardly eaten and hasn't bathed or changed his clothes for 3 weeks. He undergoes 4 weeks of psychotherapy and medication adjustment. Which statement by the client indicates that he's ready for discharge?

"I know a sign of my disease is not bathing and maintaining my personal appearance."

A 45-year-old client with schizophrenia expresses a fear of sleeping because voices become threatening when she attempts to sleep. To avoid sleeping the client reports drinking 40 cups of coffee a day. Which response by the nurse is appropriate?

"I know that you're afraid to sleep; let's discuss the effect of caffeine on your voices."

"Which characteristics would the nurse expect to see in the client with schizophrenia?

"Loose associations, grandiose delusions, and auditory hallucinations

"The nurse is aware that antipsychotic medications may cause which adverse effect?

"Lower seizure threshold

"The nurse is assigned to a client with catatonic schizophrenia. Which intervention should the nurse include in the client's plan of care?

"Meeting all of the client's physical needs

"A client with chronic schizophrenia who takes neuroleptic medication is admitted to the psychiatric unit. Nursing assessment reveals rigidity, fever, hypertension, tachycardia, altered consciousness, and diaphoresis. These findings suggest which life-threatening reaction?

"Neuroleptic malignant syndrome

"A client who's taking antipsychotic medication develops a very high temperature, severe muscle rigidity, tachycardia, and rapid deterioration in mental status. The nurse suspects what severe complication of antipsychotic therapy?

"Neuroleptic malignant syndrome (NMS)

"A client with delusional thinking shows a lack of interest in eating at meal times. She states that she is unworthy of eating and that her children will die if she eats. Which nursing action would be appropriate for this client?

"Restricting the client's access to food except at specified meal and snack times

"How soon after chlorpromazine (Thorazine) administration should the nurse expect to see a client's delusional thoughts and hallucinations eliminated?

"Several weeks

"A client has a history of chronic undifferentiated schizophrenia. Because she has a history of noncompliance with antipsychotic therapy, she'll receive fluphenazine decanoate (Prolixin Decanoate) injections every 4 weeks. Before discharge, what should the nurse include in her teaching plan for this client?

"Sitting up for a few minutes before standing to minimize orthostatic hypotension

A schizophrenic client with delusions tells the nurse, "There is a man wearing a red coat who's out to get me." The client exhibits increasing anxiety when focusing on the delusions. Which of the following would be an appropriate response?

"This subject seems to be troubling you. Let's walk to the activity room."

"The nurse is teaching a psychiatric client about her prescribed drugs, chlorpromazine and benztropine. Why is benztropine administered?

"To reduce extrapyramidal symptoms

"A client has been receiving chlorpromazine (Thorazine), an antipsychotic, to treat his psychosis. Which findings should alert the nurse that the client is experiencing pseudoparkinsonism?

"Tremors, shuffling gait, and masklike face

A client is admitted to the psychiatric unit with a tentative A client is admitted to the psychiatric unit with a tentative diagnosis of psychosis. Her physician prescribes the phenothiazine thioridazine (Mellaril), 50 mg by mouth three times per day. Phenothiazines differ from central nervous system (CNS) depressants in their sedative effects by producing:

"a calming effect from which the client is easily aroused.

"The etiology of schizophrenia is best described by:

"a combination of biological, psychological, and environmental factors.

"A dopamine receptor agonist such as bromocriptine (Parlodel) relieves muscle rigidity caused by antipsychotic medication by:

"activating dopamine receptors in the CNS.

"A client receiving haloperidol (Haldol) complains of a stiff jaw and difficulty swallowing. The nurse's first action is to:

"administer an as-needed dose of benztropine (Cogentin) I.M. as ordered.

A woman is admitted to the psychiatric emergency department. Her significant other reports that she has difficulty sleeping, has poor judgment, and is incoherent at times. The client's speech is rapid and loose. She has a history of depressed mood for which she has been taking an antidepressant. The nurse suspects which diagnosis?

Bipolar illness

"A client with chronic schizophrenia receives 20 mg of fluphenazine decanoate (Prolixin Decanoate) by I.M. injection. Three days later, the client has muscle contractions that contort his neck. This client is exhibiting which extrapyramidal reaction?

Dystonia

A client diagnosed with schizoaffective disorder is suffering from schizophrenia with elements of which of the following disorders?

Mood disorder

A 38-year-old client with paranoid schizophrenia comes to the clinic and reports hearing voices that keep telling him to kill his neighbor. The voices have explained a method, which the client plans to follow through with in the morning. Which action should the nurse take?

Notify the nursing supervisor while the client is in the clinic.

A client is admitted with a diagnosis of schizotypal personality disorder. Which signs would this client exhibit during social situations?

Paranoid thoughts

Which information is important for the nurse to include in a teaching plan for a schizophrenic client taking clozapine (Clozaril)?

Report a sore throat or fever to the physician immediately.

The nurse is planning care for a client admitted to the psychiatric unit with a diagnosis of paranoid schizophrenia. Which nursing diagnosis should receive the highest priority?

Risk for self- or other-directed violence

For several years, a client with chronic schizophrenia has received 10 mg of fluphenazine hydrochloride (Prolixin) by mouth four times per day. Now the client has a temperature of 102° F (38.9° C), a heart rate of 120 beats/minute, a respiratory rate of 20 breaths/minute, and a blood pressure of 210/140 mm Hg. Because the client also is confused and incontinent, the nurse suspects malignant neuroleptic syndrome. What steps should the nurse take?

Withhold the next dose of fluphenazine, call the physician, and monitor vital signs.

A client with schizophrenia hears a voice telling him he is evil and must die. The nurse understands that the client is experiencing:

a hallucination.

""During data collection, a client with schizophrenia leaves his arm in the air after the nurse has taken his blood pressure. His action shows evidence of:

waxy flexibility.

"A 62-year-old male client with paranoid schizophrenia tells a nurse that he sexually molests his cousin. He tells the nurse that he's never told anyone and begs her to keep his secret. Which action should the nurse take?

"Document the details of the conversation and notify the nursing supervisor.

"(SELECT ALL THAT APPLY) A client with schizophrenia is admitted to the facility. When collecting data about the client, the nurse should document which symptoms as negative symptoms of schizophrenia?

"(3) Apathy (4) Blunted affect (5) Lack of motivation

"(SELECT ALL THAT APPLY) A physician prescribes lithium (Eskalith) for a client diagnosed with bipolar disorder. Which topics should the nurse cover in the client education for this drug?

"(2) Signs and symptoms of drug toxicity (5) The need to consistently monitor blood levels (6) Changes in his mood may take 7 to 21 days

"A client is admitted to the psychiatric unit of a local hospital with chronic undifferentiated schizophrenia. During the next several days, the client is seen laughing, yelling, and talking to herself. This behavior is characteristic of:

"hallucination.

A schizophrenic client states, "I hear the voice of King Tut." Which response by the nurse would be therapeutic?

"""I don't hear the voice, but I know you hear what sounds like a voice.""

"Hormonal effects of the antipsychotic medications include:

"retrograde ejaculation and gynecomastia.

A client with schizophrenia tells the nurse, "My intestines are rotted from the worms chewing on them." This statement indicates a:

"somatic delusion.

"A client with paranoid schizophrenia becomes angry and tells the nurse to leave him alone. The nurse should:

"tell him that she'll leave for now but will return soon.

"The nurse is providing care to a client with a catatonic type of schizophrenia who exhibits extreme negativism. To help the client meet his basic needs, the nurse should:

"tell the client specifically and concisely what needs to be done.

"A client is prescribed quetiapine (Seroquel), 400 mg by mouth daily in two divided doses, to treat psychosis. The pharmacy dispenses 200 mg tablets. How many tablets should the nurse administer with each dose?

1

"A client tells the nurse that people from Mars are going to invade the earth. Which response by the nurse would be therapeutic?

"""That must be frightening to you. Can you tell me how you feel about it?""

During the initial interview, a client with schizophrenia suddenly turns to the empty chair beside him and whispers, "Now just leave. I told you to stay home. There isn't enough work here for both of us!" What should be the nurse's initial response?

"""When people are under stress, they may see things or hear things that others don't. Is that what just happened?""

Since admission 4 days ago, a client has refused to take a shower, stating, "There are poison crystals hidden in the showerhead. They'll kill me if I take a shower." Which nursing action is appropriate?

Accepting these fears and allowing the client to take a sponge bath

"A client receiving fluphenazine decanoate (Prolixin Decanoate) therapy develops pseudoparkinsonism. The physician is likely to prescribe which drug to control this extrapyramidal effect?

Amantadine (Symmetrel)

The nurse is caring for a client who has schizophrenia. What is the first-line treatment for this client?

Antipsychotics

While looking out the window, a client with schizophrenia remarks, "That school across the street has creatures in it that are waiting for me." Which term best describes what the creatures represent?

Delusion

A dystonic reaction can be caused by which medication

Haloperidol (Haldol)

A client is prescribed fluphenazine hydrochloride (Prolixin), 10 mg by mouth daily in divided doses. The pharmacy sends liquid concentrate for the client because he has difficulty swallowing tablets. Which precaution should the nurse take when administering this medication?

Wear gloves when preparing the solution and avoid having the drug contact the skin.