Saunders - Schizophrenia Practice Questions
Which situation will present the most prominent problem when attempting to manage the outpatient care of a client diagnosed with schizophrenia? 1.The client's noncompliance with medication therapy 2.The community's opposition to outpatient mental health clinics 3.The associated increased risk that the client may become homeless 4.The family's negative reaction to transferring the client to community-based care
1.The client's noncompliance with medication therapy Rationale:Clients often forget to take their medications as scheduled, and this is the most prominent problem since medication therapy is vital to the function of clients with such a diagnosis. While the situations described in the remaining options may occur, these problems are not as impacting on the client's prognosis and can be addressed and often controlled.
The nurse is preparing a client with schizophrenia a history of command hallucinations for discharge by providing instructions on interventions for managing hallucinations and anxiety. Which statement in response to these instructions suggests to the nurse that the client has a need for additional information? 1."My medications will help my anxious feelings." 2."I'll go to support group and talk about what I am feeling." 3."When I have command hallucinations, I'll call a friend for help." 4."I need to get enough sleep and eat well to help prevent feeling anxious."
3."When I have command hallucinations, I'll call a friend for help." Rationale:The risk for impulsive and aggressive behavior may increase if a client is receiving command hallucinations to harm self or others. If the client is experiencing a hallucination, the nurse or health care counselor, not a friend, should be contacted to discuss whether the client has intentions to hurt herself or himself or others. Talking about auditory hallucinations can interfere with subvocal muscular activity associated with a hallucination. The client statements in the remaining options will aid in wellness but are not specific interventions for hallucinations, if they occur.
The history assessment of a client diagnosed with schizophrenia confirms a routine that includes smoking 2 packs of cigarettes and drinking 10 cups of coffee daily. Considering the assessment data, the nurse recognizes which as placing the client at most risk for injury? 1.Developing lung cancer and/or other respiratory disorders 2.Withdrawal symptoms triggering a stress-induced relapse 3.Diminishing the effectiveness of psychotropic medication 4.Developing gastrointestinal disorders, including bleeding ulcers
3.Diminishing the effectiveness of psychotropic medication Rationale:Both caffeine and nicotine can inhibit the action of psychotropic medications, which are commonly prescribed for schizophrenia. Although each of the remaining options presents a risk for injury, ineffective medication therapy presents the greatest risk for injury that currently affects this client.
Which client behavior is indicative of negative symptoms associated with schizophrenia? Select all that apply. 1.Verbal communication is almost nonexistent. 2.Gross motor skills are impacted by involuntary body movements. 3.The client needs frequent redirection because of short attention span. 4.Interpersonal relationships are negatively impacted because of delusional thoughts. 5.Conversations are difficult to follow because of demonstration of loose associations of thought.
1, 3 Rationale:Negative symptoms refer to a diminishment or absence of characteristics of normal function. They may appear with or without positive symptoms. Restricted speech and attention deficits are examples of negative symptoms that generally respond to atypical antipsychotic medications. Positive symptoms reflect an excess or distortion of normal functions. Delusional thoughts (delusions), loose associations of thought, and bizarre behaviors such as inappropriate body movements are positive symptoms of schizophrenia.
During the admission assessment process, the nurse observes that a client diagnosed with paranoid schizophrenia has multiple dental caries and mouth ulcers. The client denies oral pain or difficulty eating and does not present any concern over the nurse's finding. The nurse recognizes the client's response as most likely the result of which client factor? 1.Apathy 2.Impaired pain perception 3.Distrust of authority figures 4.Poor verbal communication skills
2.Impaired pain perception Rationale:Commonly, schizophrenia's effect on the pain center in the brain results in poor pain recognition. The client is likely not experiencing oral pain to the degree that may be felt by the individual who does not have schizophrenia. Although the remaining options may be general factors affecting this client's perceptions and personal interactions, they are not related to the pain perception threshold.
The nurse caring for a client diagnosed with schizophrenia should include which interventions in the plan of care to assist in managing the client's concrete thinking? 1.Provide the client with written instructions regarding the routine of the unit. 2.Present verbal instructions regarding expectations in single, simple commands. 3.Assess the client's understanding of instructions by requiring restatement of expectations. 4.Incorporate family members in determining the emotional and physical needs of the client.
2.Present verbal instructions regarding expectations in single, simple commands. Rationale:A client with concrete thinking often has difficulty with multiple-step tasks and commands. The information should be provided in clear, concise, and single-focused commands to minimize client confusion and maximize understanding. The client may be incapable of processing information in written form and is not likely able to restate directions because of thought process dysfunction. These methods do not address the limitations of concrete thinking. Using family to help determine the client's needs may be an appropriate intervention, but this is not directed at minimizing the effect of the client's altered thought processes.
The nurse is monitoring a client diagnosed with schizophrenia who demonstrates a dysfunctional affect. Which situation is congruent with inappropriate affect? 1.When told that a beloved pet has died, the client responds, "OK." 2.The client giggled while describing being physically abused as a child. 3.The client's facial expressions are unchanged during the entire admission process. 4.When staff members attempt to engage the client in conversation, the client only mumbles.
2.The client giggled while describing being physically abused as a child. Rationale:An inappropriate affect refers to an emotional response to a situation that is incongruent with the tone of the situation. A flat affect is manifested as an immobile facial expression or blank look. A bizarre affect such as grimacing, laughing, and self-directed mumbling is marked when the client is unable to relate logically to the environment. A blunted affect is a minimal emotional response or outward affect that typically does not coincide with the client's inner emotions.
Which behavior in a client with schizophrenia demonstrates the client's cognitive inability to appropriately process data from external stimuli? 1.The client remains in the same physical position for hours. 2.The client is convinced that the curtains are actually ghosts. 3.The client looks for a cat when someone says, "It's raining cats and dogs." 4.The client repeatedly asks, "Can you see my dead sister over by the door?"
2.The client is convinced that the curtains are actually ghosts. Rationale:A delusion is a personal belief that is the product of dysfunctional processing of information derived from external reality. This cognitive processing dysfunction is the basis of schizophrenia. Catatonia is a stuporous state that renders the client incapable of physical movement. Magical thinking is a result of concrete thinking that causes the client to interpret a statement literally. Hallucinations are the result of distortions in perceptions of the senses, but they are not reliant on internal or external stimuli.
A client diagnosed with schizophrenia says to the nurse, "Will you protect me from the Grand Duchess?" and points to an older client who is sitting reading a book. Which statement is the therapeutic response by the nurse? 1."Where is she? I'll talk to her." 2."I can see no Grand Duchess. You will need to trust me on that." 3."You will be safe here. Your thinking will be clearer after your medication starts to work." 4."The Grand Duchess, huh? Well, I'm the Queen, and I will order her to stay away from you."
3."You will be safe here. Your thinking will be clearer after your medication starts to work." Rationale:The schizophrenic client is making a paranoid statement. It is important that the nurse provide the client with a supportive and protective intervention. The correct option is the only one that reflects a therapeutic technique, presents reality, and addresses safety. To ask, "Where is she? I'll talk to her" is not therapeutic because the nurse feeds into the client's psychosis by asking where the fantasy client is. To state that the nurse does not see the Grand Duchess and that the client needs to trust the nurse begins by presenting reality, but it does not demonstrate any real support for the client's concern with safety. To say that the nurse is the Queen and will order the Grand Duchess to stay away is sarcastic and belittling to the client.
The nurse is caring for a client just admitted to the mental health unit and diagnosed with catatonic stupor. The client is lying on the bed in a fetal position. Which is the most appropriate nursing intervention? 1.Ask direct questions to encourage talking. 2.Leave the client alone so as to minimize external stimuli. 3.Sit beside the client in silence with simple open-ended questions. 4.Take the client into the dayroom with other clients to provide stimulation.
3.Sit beside the client in silence with simple open-ended questions. Rationale:Clients who are withdrawn may be immobile and mute and may require consistent, repeated approaches. Communication with withdrawn clients requires much patience from the nurse. Interventions include the establishment of interpersonal contact. The nurse facilitates communication with the client by sitting in silence, asking simple open-ended questions rather than direct questions, and pausing to provide opportunities for the client to respond. Although overstimulation is not appropriate, there is no therapeutic value in ignoring the client. The client's safety is not the responsibility of other clients.
The nurse is caring for a client diagnosed with schizophrenia who states, "I decided not to take my medication because I realize that it really can't help me. Only I can help me." Which question asked by the nurse has the best therapeutic value? 1."Why do you think this is a wise decision?" 2."I don't understand. Only you can help you?" 3."You've decided not to take your medication. Is that right?" 4."Do you recall what it was like before you started your medication?"
4."Do you recall what it was like before you started your medication?" Rationale:Noncompliance with antipsychotic medication is 1 of the chief reasons that clients with schizophrenia have relapses. The most therapeutic response is to initiate a conversation with the client directed toward discussing the disadvantages of being noncompliant. While it is therapeutic to use communication techniques like restating and clarification, it is not useful to this client since the intent of the behavior is already understood. Asking a "why" question is usually viewed as argumentative by the client and so is not therapeutic.
The mental health nurse notes that a client diagnosed with schizophrenia is exhibiting flat affect. Which situation supports this documentation? 1.During the entire family visit, the client presented with an expressionless, blank look. 2.The client demonstrated minimal response to the news that his discharge had been postponed. 3.The client grimaced during the entire therapy session that focused on finding one's personal joy. 4.During grief therapy, the client was observed laughing while another client described the death of a parent.
1.During the entire family visit, the client presented with an expressionless, blank look. Rationale:A flat affect is manifested as an immobile facial expression or blank look. A blunted affect is a minimal emotional response or outward affect that typically does not coincide with the client's inner emotions. A bizarre affect such as grimacing, laughing, and self-directed mumbling is marked when the client is unable to relate logically to the environment. An inappropriate affect refers to an emotional response to a situation that is incongruent with the tone of the situation.
The nurse is planning relapse prevention information for a client diagnosed with schizophrenia. The nurse understands that it is important to ensure which primary intervention? 1.Including the client's support system in the teaching 2.Facilitating weekly maintenance therapy for the client 3.Having the client restate discharge goals and strategies 4.Stressing the importance of client compliance with the medication plan
1.Including the client's support system in the teaching Rationale:Of the options provided, including the client's support system in the teaching has the greatest effect on relapse prevention management because it will provide the client with valuable support. Although the remaining options are helpful, they all focus on the client's having the resources and abilities to be self-managing and self-reflective.
The nurse is administering risperidone to a client with schizophrenia who is scheduled to be discharged. Before discharge, which instruction should the nurse provide to the client? 1.Get adequate sunlight. 2.Continue driving as usual. 3.Avoid foods rich in potassium. 4.Get up slowly when changing positions.
4.Get up slowly when changing positions. Rationale: Risperidone can cause orthostatic hypotension. Sunlight should be avoided by the client taking this medication. With any psychotropic medication, caution needs to be taken (such as with driving or other activities requiring alertness) until the individual can determine whether her or his level of alertness is affected. Food interaction is not a concern.
A client with schizophrenia has been started on medication therapy with clozapine. The nurse should assess the results of which laboratory study to monitor for adverse effects from this medication? 1.Platelet count 2.Blood glucose level 3.Liver function studies 4.White blood cell count
4.White blood cell count Rationale:A client taking clozapine may experience agranulocytosis, which is monitored by reviewing the results of the white blood cell count. Treatment is interrupted if the white blood cell count decreases to less than 3000 mm3 (3 × 109/L). Agranulocytosis could be fatal if undetected and untreated. The other laboratory studies are not related specifically to the use of this medication.
