Psychotic Disorders Dynamic Quiz
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A nurse is caring for a client who has schizophrenia and started taking a first-generation antipsychotic medication 3 weeks ago. The client reports a feeling of inner restlessness, rocks back and forth when sitting down, and paces frequently. The nurse should identify that the client is experiencing which of the following adverse effects of antipsychotic medications?
A.
Neuroleptic malignant syndrome
B.
Akathisia
C.
Anticholinergic toxicity
D.
Opisthotonos
B.
Akathisia
Akathisia is an extrapyramidal adverse effect that can occur in a client within the first 2 months of beginning a first-generation antipsychotic medication. The client might be unable to rest due to a feeling of inner restlessness. Rocking back and forth and pacing the floor can also be manifestations of akathisia. The nurse should report this finding to the provider. Several medications, such as propranolol, can be used to treat akathisia.
A. Neuroleptic malignant syndrome is a rare and serious adverse effect of antipsychotic medications. Manifestations of this disorder include a high fever, hypertension, tachycardia, and muscle rigidity.
C. Anticholinergic toxicity can occur when a client takes medications that cause anticholinergic effects, such as antipsychotic medications. Manifestations of anticholinergic toxicity include delirium, unstable vital signs, and decreased bowel sounds.
D. Opisthotonos is a position demonstrated by extreme arching of the head and spine during a severe muscle spasm called acute dystonia, which is an adverse effect of some antipsychotic medications.
A nurse is teaching a client who has schizophrenia about involuntary commitment. Which of the following statements should the nurse identify as an indication that the client understands the teaching?
A.
"My family cannot commit me because I am homeless."
B.
"Even when I'm calm, I'll be forced to take psychotropic medication."
C.
"At least 2 doctors must support the commitment application."
D.
"I am afraid the doctors will make me have surgery."
"At least 2 doctors must support the commitment application."
Involuntary commitment is a court-ordered mandate requiring admission of a client to receive mental health services either at an outpatient or at an inpatient mental health facility. At least 2 doctors or other mental health professionals must agree that the client should be involuntarily committed to ensure due process and avoid accidentally committing the client.
A. The family of a person who is severely disabled or mentally ill and unable to provide for basic needs such as food, shelter, and clothing can petition the court to commit the client to a mental health facility involuntarily if the client is unwilling to commit.
B. Under involuntary commitment, the client has the right to refuse psychotropic medications unless the client is a danger to self or others.
D. Clients who are involuntarily committed have the right to treatment decisions. This includes the right to not be subjected to lobotomies, electroconvulsive therapies, and other treatments without fully informed consent.
A nurse is caring for a client who has schizophrenia. The client tells the nurse that he’s hearing voices in his head telling him to purchase a knife today. He states that he knows purchasing the knife will make him "do something bad." Which of the following responses should the nurse make?
A.
"Why do you think the voices want you to buy a knife?"
B.
"Do you already own any knives?"
C.
"When the voices speak, do you always do what they say?"
D.
"I don't hear any voices, just yours and mine. But, I understand that you are fearful."
"I don't hear any voices, just yours and mine. But, I understand that you are fearful."
With this response, the nurse conveys that there are no voices, that he feels empathy for the client, and that he is not dismissing the client's perceptions.
B. This response demonstrates the nontherapeutic communication technique of probing and, to some extent, changing the subject. Asking about having other knives shift the client’s focus.
A nurse is assessing a client who has schizophrenia. The client states, “I need to get my gummamoshu from by my house.” The nurse recognizes this statement as an example of which of the following?
A.
Flight of ideas
B.
Echolalia
C.
Perseveration
D.
Neologism
D. Neologism
The nurse should recognize the client’s response as a neologism, an invented word which has no meaning to others.
A. Flight of ideas is the nearly continuous flow of accelerated speech with abrupt changes from topic to topic before the original topic is completed. This phenomenon is frequently associated with manic episodes.
B. Echolalia is the repetition or echoing of words or phrases stated by others.
C. Perseveration is the persistent repetition of words or ideas to an excessive point. This phenomenon is commonly associated with organic mental disorders or schizophrenia.
A nurse is working with a client who exhibits extreme superstition, elaborate speech patterns, and eccentric behavior. The nurse should identify these features as which of the following personality disorders?
A.
Paranoid
B.
Histrionic
C.
Antisocial
D.
Schizotypal
D. Schizotypal
Findings of schizotypal personality disorder include a pattern of social impairments and cognitive alterations, including superstitious actions that are not congruent with the client's cultural norms and speech changes (e.g. an increase in the use of metaphors and other elaborate speech patterns).
A. The nurse should identify extreme suspicion of others, difficulty trusting, and a persistent unwillingness to forgive as findings of paranoid personality disorder.
B. The nurse should identify excessive attention-seeking behaviors and rapidly shifting emotions as findings of histrionic personality disorder. The client might dress in a manner that attracts attention and show dramatic behavior.
C. The nurse should identify behaviors that exhibit disregard for the rights and feelings of others as indications of antisocial personality disorder. The client might exhibit deceitfulness, aggressiveness towards others, and a reckless lack of concern for the safety of self or others.
A nurse is caring for a client who has schizophrenia. Which of the following client statements should the nurse identify as a persecutory delusion?
A.
"A tornado is going to wipe us out in 9 days."
B.
"My brain is dead, and my body is slowly rotting away."
C.
"The government is after me because I know top-secret information."
D.
"The TV is purposely playing commercials for products I don't like."
"The government is after me because I know top-secret information."
The nurse should identify this statement as an indication of a persecutory delusion.
Incorrect Answers:
A. The nurse should identify this statement as an indication of a nihilistic delusion.
B. The nurse should identify this statement as an indication of a somatic delusion.
D. The nurse should identify this statement as an indication of a referential delusion.
A nurse is admitting a client who has schizophrenia. During the initial interview, which of the following behaviors should the nurse identify as a positive manifestation of schizophrenia?
A.
Anhedonia
B.
Avolition
C.
Flat affect
D.
Hallucinations
D.
Hallucinations
Positive manifestations of schizophrenia are behaviors or thought patterns that are not usually present. Positive manifestations include hallucinations, religiosity, delusions, paranoia, and disorganized speech.
A. Negative manifestations of schizophrenia are behaviors or thought patterns that reflect an absence of something that should be present. Anhedonia (an inability to feel pleasure) is a negative manifestation of schizophrenia.
B. Avolition (a lack of motivation) is a negative manifestation of schizophrenia.
C. A flat affect (a reduction in emotional expressiveness) is a negative manifestation of schizophrenia.
A nurse is caring for a client who has schizophrenia and a prescription for chlorpromazine. For which of the following adverse effects should the nurse monitor?
A.
Orthostatic hypotension
B.
Diarrhea
C.
Urinary frequency
D.
Bradycardia
A. Orthostatic hypotension
Orthostatic hypotension is an adverse effect of chlorpromazine. Other adverse effects include palpitations, tachycardia, constipation, sedation, and photosensitivit
A nurse is caring for a client who has schizophrenia and is admitted to the mental health unit. The client has a history of aggression and is observed continually pacing the hallway in an agitated manner over the past hour. Which of the following responses should the nurse make?
A.
"It's a beautiful day outside. Let's take a walk together."
B.
"Sit down and we'll try out a relaxation exercise."
C.
"Would you like your anti-anxiety medication now?"
D.
"You are pacing back and forth. Can you tell me what you are feeling?"
"You are pacing back and forth. Can you tell me what you are feeling?"
Using the nursing process, the nurse should first collect data from the client. By asking the client to identify feelings of anxiety, the nurse promotes trust and can assist the client with decreasing anxiety before an episode of aggression occurs.
A. The nurse should offer a distraction to help calm the client and provide a positive outlet for energy; however, there is another statement the nurse should make first.
B. The nurse should assist the client to learn positive coping skills and relaxation techniques to decrease anxiety; however, there is another statement the nurse should make first.
C. The nurse should offer a PRN anti-anxiety medication if other less restrictive interventions fail; however, there is another statement the nurse should make first
A nurse is providing teaching to a client who has a new prescription for chlorpromazine. Which of the following statements should the nurse make?
A.
"This medication is a tricyclic antidepressant and will improve your mood."
B.
"This medication is an opioid antagonist that blocks the pleasurable effects of alcohol."
C.
"This medication is an antipsychotic that controls manifestations of schizophrenia."
D.
"This medication is a cholinesterase inhibitor that slows the progression of dementia."
"This medication is an antipsychotic that controls manifestations of schizophrenia."
Antipsychotic medications like chlorpromazine are thought to act directly on dopamine receptors in the brain to prevent the reuptake of dopamine, thereby controlling psychotic manifestations.
A. Tricyclic antidepressants include amitriptyline and clomipramine. Chlorpromazine is sometimes indicated to control mania in bipolar disorder but is not an antidepressant.
B. Naltrexone is an opioid antagonist used to block the pleasurable effects of alcohol. Chlorpromazine is not used to treat alcohol addiction.
D. Cholinesterase inhibitors that slow the progression of dementia include tacrine and donepezil. Chlorpromazine is not a cholinesterase inhibitor and does not affect dementia manifestations.
A nurse is performing an admission assessment for a client who has schizophrenia. The nurse notices that the client’s appearance is unkempt, and he appears to be actively hallucinating. Which of the following should be the nurse's priority assessment?
A.
Perception of reality
B.
Ability to follow directions
C.
Physical needs
D.
Mental status
C. Physical needs
The nurse should consider Maslow’s Hierarchy of Needs, which includes 5 levels of priority. These levels are as follows: physiological needs, safety and security needs, love and belonging needs, personal achievement and self-esteem needs, and achieving full potential while problem-solving and coping with life situations. When applying Maslow’s Hierarchy of Needs as a priority-setting framework, the nurse should review physiological needs first and then address the client’s needs by following the remaining 4 hierarchal levels. It is important, however, for the nurse to consider all contributing client factors, as higher levels of the pyramid can compete with lower levels, depending on the specific client situation.
A nurse is caring for a client with schizophrenia who is having command hallucinations. Which of the following actions is the priority for the nurse to take?
A.
Identify triggers that initiate the client's hallucinations
B.
Administer an antipsychotic medication
C.
Focus on reality-based orientation
D.
Determine what the voices are saying
D. Determine what the voices are saying
When using the greatest risk priority framework, the nurse should identify that the greatest risk is a command hallucination that instructs the client to harm self or others. Therefore, the priority action the nurse should take is to determine the content of the command hallucinations and assess the client's reactions to them.
A nurse is creating a plan of care for a client who has borderline personality disorder and exhibits manipulative behaviors. Which of the following interventions should the nurse include to address limit-setting?
A.
Teach the client to use reaction formation for behavior control.
B.
Recommend the client attend assertiveness training.
C.
Establish and explain consequences for the client's behavior.
D.
Encourage the client to increase socialization.
C. Establish and explain consequences for the client's behavior.
The nurse should communicate desired behavior and expectations to the client, as well as the detailed consequences of not meeting them. When addressing limit-setting with the client, these expectations and consequences should be included in the plan of care.
A nurse is assessing a client who has schizophrenia. The client suddenly states, "I'm blue, so are you, and I'm leaving on a choo, choo, choo!" The nurse should identify the client's statement as which of the following speech patterns?
A.
Clang association
B.
Word salad
C.
Neologism
D.
Echolalia
A. Clang association
The nurse should identify this statement as a clang association, a pattern of speech often used by clients who have schizophrenia. These statements often rhyme or contain a string of words that have the same beginning sound.
Incorrect Answers:
B. In word salad, words are completely meaningless and disorganized. This client's speech pattern is not word salad.
C. Neologism consists of words that are made up by the client. This client's speech pattern does not contain neologisms.
D. In echolalia, the client repeats the words of another person. This client's speech pattern is not echolalia.
A nurse in an acute mental health facility is caring for a client who has schizophrenia. The client asks the nurse, "Can I vote in the upcoming presidential election?" Which of the following responses should the nurse offer?
A.
"Why do you want to vote while you are in the hospital?"
B.
"I wouldn’t worry about voting right now."
C.
"We can work together to find out how you can get a mail-in ballot."
D.
"You’ll have a lot more opportunities to vote after you get better."
C. "We can work together to find out how you can get a mail-in ballot."
This therapeutic response suggests collaborating and formulating a plan of action that will result in obtaining information and addressing the client's need.
A nurse is caring for a client who has schizophrenia. Which of the following client statements indicates clang associations?
A.
"I am the king, and everyone should bow to me."
B.
"I'm feeling schmoolizious today."
C.
"Option, contrary, moose, allergic."
D.
"Basketball in the hall very tall."
D. "Basketball in the hall very tall."
A client who speaks using clang associations is choosing words based on their sound rather than meaning. The words often rhyme.
Incorrect Answers:
A. A client who believes he has a superior position or ability than he does in reality is suffering from grandiose delusions.
B. A client who speaks using a word that is made up and meaningless to others is using neologisms.
C. A client who speaks a string of words that are meaningless is using a word salad.
A nurse is caring for a client who has borderline personality disorder. Which of the following manifestations should the nurse expect?
A.
Self-mutilation
B.
Submission
C.
Exploitation of others
D.
Reclusive behavior
A. Self-mutilation
The nurse should expect clients who have borderline personality disorder to exhibit impulsive behaviors, such as suicide and self-mutilation. Other impulsive behaviors include separation anxiety and splitting behaviors.
Incorrect Answers:
B. The nurse should expect clients who have dependent personality disorder to exhibit submissive behaviors, excessive clinging, self-sacrificing, and neediness.
C. The nurse should expect clients who have narcissistic personality disorder to exhibit rage, an inability to show empathy, exploitation of others, and grandiose behaviors.
D. The nurse should expect clients who have schizoid behaviors to exhibit reclusive, avoidant, and uncooperative behaviors.
A nurse is creating a plan of care for a group of clients. Which of the following interventions is the priority for the nurse to include?
A.
Offering high-calorie beverages to a client who is in the manic phase of bipolar disorder
B.
Practicing relaxation techniques with a client who has an anxiety disorder
C.
Assisting a client who has a depressive disorder with decision-making regarding group activities
D.
Providing teaching to a client who has schizophrenia about a new prescription for clozapine
A.Offering high-calorie beverages to a client who is in the manic phase of bipolar disorder
When using Maslow's hierarchy of needs, the priority intervention the nurse should address is the client's physiological need for food and water. Offering a client high-calorie beverages will help the client meet daily caloric requirements and prevent dehydration.
A nurse is caring for a client who has schizophrenia. The client spends a great deal of time repeating rhyming syllables such as, "Me, see, bee, tree." The nurse recognizes that the client is demonstrating which of the following positive manifestations of schizophrenia?
A.
Clang association
B.
Echolalia
C.
Magical thinking
D.
Word salad
A. Clang association
Stringing and repeating words together because of their rhyming sounds is called clang association. Clang association is a positive manifestation of schizophrenia.
Incorrect Answers:
B. Echolalia is the pathological consistent repeating of another’s words by imitation. Echolalia is frequently seen in clients who have autism or Tourette’s syndrome.
C. Magical thinking is the belief that thoughts or behaviors have control over specific people and situations. Magical thinking is a positive manifestation of schizophrenia.
D. Word salad is a mixture of phrases and words strung together without meaning or relation. Word salad is frequently seen in clients who have bipolar disorder or schizophrenia.
A nurse is caring for a client who has schizophrenia and is being discharged from an acute mental health setting. Which of the following should be included in the discharge plan?
A.
Refer the client to respite care services
B.
Provide a list of primary preventive mental health groups
C.
Enroll the client in a 12-step program
D.
Contact an intensive outpatient program
D. Contact an intensive outpatient program
A client who has received in-patient treatment for schizophrenia can benefit from an intensive outpatient program. These programs allow clients to receive step-down care similar to what was provided in the inpatient setting to stabilize their condition further.
A. Respite care is designed to serve people who are caregivers in the home for those who are ill or disabled (e.g. clients who have Alzheimer's disease). During respite care, the client is cared for while the caregiver is given time to leave the home.
B. Primary preventive services are designed to help clients prior to the manifestations of illness. Treatment with primary prevention services can delay or prevent disorders from occurring.
C. Twelve-step programs are support groups that help clients overcome addiction from substance abuse disorders. These programs are not designed to support clients who have schizophrenia.
A nurse is reviewing the laboratory data for a client who is receiving clozapine for schizophrenia. The nurse should identify which of the following findings as a potential adverse effect of the medication?
A.
Fasting blood glucose 95 mg/dL
B.
Triglycerides 135 mg/dL
C.
Total cholesterol 175 mg/dL
D.
Absolute neutrophil count 1,200 mm^3
D. Absolute neutrophil count 1,200 mm^3
The nurse should identify that an absolute neutrophil count of 1,200/mm^3 is less than the expected reference range of 2,500 to 8,000/mm^3. An adverse effect of clozapine can include agranulocytosis, which is a life-threatening conditioning in which WBCs (including neutrophils) are severely decreased.
Incorrect Answers:
A. The nurse should identify that a fasting blood glucose of 95 mg/dL is within the expected reference range of 74 to 106 mg/dL. An adverse effect of clozapine can be hyperglycemia.
B. The nurse should identify that a triglyceride level of 135 mg/dL is within the expected reference range of 35 to 160 mg/dL. An adverse effect of clozapine is dyslipidemia, including an elevated triglyceride level.
C. The nurse should identify that a total cholesterol level of 175 mg/dL is within the expected reference range of less than 200 mg/dL. Dyslipidemia can be an adverse effect of clozapine.
A nurse is performing an admission assessment for a client who has schizophrenia. The client suddenly stops talking and begins staring intently at a chair in the corner of the room. Which of the following responses should the nurse make?
A.
"Please try to focus on our conversation."
B.
"There is nothing over there except a chair."
C.
"Tell me what you are seeing by that chair."
D.
"Whatever you are seeing by that chair is not real."
C. "Tell me what you are seeing by that chair."
The nurse should recognize that the client might be experiencing a hallucination and should assess the client and situation further. This response directly asks the client about the hallucination and promotes further communication about the possible perceptual alteration.
A nurse is caring for a client who has schizophrenia. The nurse notices that the client is pacing up and down the hall rapidly and muttering in an angry manner. Which of the following actions should the nurse perform first?
A.
Apply mechanical restraints to the client
B.
Administer PRN haloperidol IM to the client
C.
Approach the client in a non-threatening manner
D.
Place the client in seclusion
C. Approach the client in a non-threatening manner
The nurse should first approach the client calmly to create a non-threatening environment. The nurse should apply the least restrictive priority-setting framework when caring for this client, which assigns priority to nursing interventions that are the least restrictive to the client, as long as these interventions do not jeopardize client safety. Less restrictive interventions promote client safety without using restraints. The nurse should only use physical or chemical restraints when the safety of the client, staff members, or others is at risk.
A nurse in an outpatient mental health clinic is interviewing a client who has schizophrenia and appears to be experiencing auditory hallucinations. Which of the following actions should the nurse take first?
A.
Teach the client strategies to decrease the hallucinations.
B.
Identify whether the client is on antipsychotic medications.
C.
Distract the client from the hallucination.
D.
Explore what the voices are saying to the client.
D. Explore what the voices are saying to the client.
The nurse should apply the safety and risk-reduction priority-setting framework when caring for this client. This framework assigns priority to the factor or situation posing the greatest safety risk to the client. When there are several risks to client safety, the one posing the greatest threat is the highest priority.
The nurse should use Maslow’s Hierarchy of Needs, the ABC priority-setting framework, and/or nursing knowledge to identify which risk poses the greatest threat to the client. The nurse must assess what the voices are saying to the client to identify suicidal or homicidal ideation, which poses the greatest risk to the client and to others.
A nurse is providing teaching to a client who has schizophrenia and is taking quetiapine fumarate. Which of the following blood tests should be performed periodically?
A.
Potassium
B.
Uric acid
C.
Glucose
D.
Calcium
C. Glucose
Clients taking quetiapine are at risk of abnormal glucose metabolism, which can result in diabetes mellitus. Therefore, the client should have glucose testing periodically.
A nurse is assessing a client who has a new prescription for chlorpromazine to treat schizophrenia. The client has a mask-like facial expression and is experiencing involuntary movements and tremors. Which of the following medications should the nurse anticipate administering?
A.
Amantadine
B.
Bupropion
C.
Phenelzine
D.
Hydroxyzine
A. Amantadine
This client is experiencing Parkinsonism, which is an adverse effect of the antipsychotic medication chlorpromazine. Amantadine is an antiparkinsonian medication used to treat the extrapyramidal manifestations that can occur with chlorpromazine therapy.
Incorrect Answers:
B. Bupropion is an atypical antidepressant. It is not used to treat Parkinsonism adverse effects caused by chlorpromazine.
C. Phenelzine is an MAOI antidepressant. It is not used to treat Parkinsonism adverse effects caused by chlorpromazine.
D. Hydroxyzine is an antihistamine used to treat mild to moderate anxiety. It is not used to treat Parkinsonism adverse effects caused by chlorpromazine.
A nurse is assessing a newly admitted client who has schizophrenia. The client suddenly looks at an empty chair and appears to be listening to something. Which of the following responses should the nurse make?
A.
"I thought I heard something too."
B.
"Is someone telling you something?"
C.
"What are you hearing?"
D.
"There is nobody in that chair for you to listen to."
C.
"What are you hearing?"
Nurses' Notes
7 days ago, 0700:
A client was brought into the mental health facility by law enforcement. Law enforcement was called to the local beach by concerned citizens. The client was yelling that they could control the water during a mandatory evacuation order due to a hurricane. The client was wearing a mermaid costume and holding a sword. Client is accompanied by their partner. The partner states that the client has had erratic behavior for a week and has not been eating or sleeping.
History and Physical
Diagnosed with major depressive disorder 2 months ago. Provider prescribed escitalopram 20 mg daily.
Blood pressure 118/72
Heart rate 85/min
Respiratory rate 18/min
Temperature 37° C (98.6° F)
BMI 19
Urine toxicology screen: Negative
When recognizing cues, the nurse should recognize that erratic behavior, such as believing they can control the water during a hurricane, wearing a mermaid costume, and holding a sword, requires follow-up. In addition, not eating or sleeping for a week requires follow-up. The nurse should recognize that a diagnosis of major depressive disorder and initiation of antidepressant therapy can precede a manic episode.
Bipolar Disorder vs Schizophrenia
Speech patterns like pressured speech, flight of ideas, and clang associations
Delusional thought processes and hallucinations
Manifestations present for less than 6 months
Speech patterns like pressured speech, flight of ideas, and clang associations
Delusional thought processes and hallucinations
Manifestations present for 6 months or more
3 days ago, 1000:
Client is attending their first group therapy session with other clients to discuss coping strategies. The client is speaking loudly and interrupting other clients to discuss the weather and how studying weather patterns is the best way to cope.
The nurse is responding to the client's actions during the group therapy session. The nurse should Target 1and Target 2.
Options
have the client reduce the number of topics discussed
place the client in a seclusion room
ask the client why they are interrupting so much
inform the client they agree with their coping strategy
allow group members to offer feedback to the client
When taking action to stop a monopolizing group member, the nurse should have the client reduce the number of topics discussed and allow group members to offer feedback to the client.
It is important to redirect the client’s behavior and set boundaries for the client, such as having the client reduce their contributions to a specific number of times. Allowing other members of the group to give feedback is empowering to the group and allows the client to self-reflect on their behavior.
7 days ago, 0900:
Lithium 300 mg PO twice daily
Haloperidol 2 mg IM every 6 hr PRN agitation
Select the 4 statements that indicate an understanding of the teaching.
"A hand tremor is a sign that my medication level is too high."
"I should increase the amount of sodium in my diet."
"I should let my provider know if I have diarrhea."
"I should take my medication with meals."
"I will need to monitor my medication blood levels often."
"I can stop taking this medication once I feel back to myself."
"I should reduce my daily fluid intake."
1) "I should let my provider know if I have diarrhea."
2) "I will need to monitor my blood levels often."
3) "A hand tremor is a sign that my medication level is too high."
4) "I should take my medication with meals."
Diarrhea could be a sign of lithium toxicity, or it could cause the client to become dehydrated, causing elevated lithium levels. The client should check their blood levels frequently to ensure a therapeutic level is reached and maintained. A hand tremor is a sign of lithium toxicity.
A nurse is teaching a group of newly licensed nurses about violations of client rights. Which of the following examples of a violation of client rights should the nurse include in the teaching?
A.
A client who is confused and recovering from abdominal trauma has mitten restraints placed to prevent disruption of an abdominal wound.
B.
A client who has schizophrenia is placed in the seclusion room of the psychiatric unit for making frequent outbursts of obscenities directed at nurses of the opposite sex.
C.
A health care proxy releases the medical records of a client to a long-term care facility for a placement evaluation.
D.
The parents of a 16-year-old who has gunshot wounds decide to limit their child’s visitors to family members only.
B. A client who has schizophrenia is placed in the seclusion room of the psychiatric unit for making frequent outbursts of obscenities directed at nurses of the opposite sex.
Seclusion is a restraint that should be used when a client is demonstrating violent or self-destructive behavior that jeopardizes the safety of self or others. This client does not meet the criteria for seclusion.
A nurse is caring for a client who has schizophrenia. The client states, "My internal organs have turned to stone." The nurse should document this finding as which of the following types of delusions?
A.
Somatic
B.
Reference
C.
Persecutory
D.
Grandiose
A. Somatic
The nurse should identify that the client is experiencing a somatic delusion. Clients experiencing a somatic delusion believe that a body part is no longer functioning in a realistic or expected manner.
Incorrect Answers:
B. A client who has a delusion of reference believes that occurrences in the environment are about or because of personal actions.
C. A client who has a persecutory delusion believes that someone or something wants to intentionally cause harm.
D. A client who has a grandiose delusion believes in personal superiority compared to others.
A nurse is caring for a client who has schizophrenia. The client states, "Aliens came into my room last night and took a sample of my blood." Which of the following responses should the nurse make?
A.
"Aliens do not exist."
B.
"Has your daughter had her baby?"
C.
"Do you mean to say a laboratory technician drew your blood last night?"
D.
"That does not sound real."
D. "That does not sound real."
The nurse is voicing doubt with this response, which expresses uncertainty regarding the reality of the client's conclusion of the hallucination. This is a therapeutic response because the statement allows the client to expand upon the earlier statement, which allows exploration of the client's thought processes.
Incorrect Answers:
A. This response is disagreeing, which can make the client defensive and feel a sense of rejection. It is a form of nontherapeutic communication that implies the client's statement is inaccurate. The client is likely to discontinue further interaction with the nurse, preventing the development of a therapeutic nurse-client relationship.
B. This response is changing the subject, which can invalidate the client's feelings and needs. With this response, the nurse is taking over the conversation, which can result in the client discontinuing further interaction with the nurse.
C. This response is interpreting the client's meaning into something that seems more plausible to the nurse. This invalidates the client's thoughts and statements, which is nontherapeutic.
A nurse in an acute mental health facility is reviewing the medication records of a group of clients. The nurse should expect a prescription for memantine for a client who has which of the following diagnoses?
A.
Postpartum depression
B.
Schizophrenia
C.
Obesity
D.
Severe Alzheimer’s disease
D. Severe Alzheimer’s disease
The nurse should expect a prescription for memantine for a client who has moderate to severe Alzheimer’s disease. Memantine, an NMDA receptor agonist, slows the progression of manifestations and improves cognitive function.
Incorrect Answers:
A. Memantine is not indicated for the treatment of depression.
B. Memantine is not indicated for the treatment of schizophrenia.
C. Memantine is not indicated for the treatment of obesity.
A nurse is assessing a client who has schizophrenia and takes haloperidol 3 times daily. The client has developed involuntary writhing movements of the tongue and constant lip smacking. The nurse should identify that these manifestations indicate which of the following adverse effects of haloperidol?
A.
Akathisia
B.
Acute dystonia
C.
Tardive dyskinesia
D.
Pseudoparkinsonism
C. Tardive dyskinesia
Tardive dyskinesia can be manifested by involuntary movement of many body parts. Early findings include writhing movements of the tongue and smacking of the lips. The nurse should report these manifestations to the provider immediately because the findings might not be reversible and can progress to affect all extremities.
Incorrect Answers:
A. Akathisia is psychomotor restlessness that is usually manifested by fidgeting or pacing, not writhing movements.
B. Acute dystonia is manifested by severe muscle spasms that often occur in the head and neck, not writhing movements.
D. Pseudoparkinsonism is manifested by tremors of the extremities, loss of balance, and difficulties with gait, not writhing movements.
A nurse is assessing a client who was diagnosed with schizophrenia. Which of the following client findings is considered a positive symptom of schizophrenia?
A.
Hallucinations
B.
Social withdrawal
C.
Anergia
D.
Flat affect
Correct Answer: A.
Hallucinations
Positive symptoms are grouped into the following categories: content of thought, form of thought, perception, and sense of self. The nurse should identify that hallucinations fall under the category of perception and cause the client to experience sensory perceptions that are not associated with reality. Other positive symptoms include delusions, depersonalization, and concrete thinking.
A nurse is discussing exercise activities with an acute care client who has schizophrenia and is overweight due to psychotropic medications. The client refuses to participate in an aerobic exercise class and instead requests to walk in the facility's gym. Which of the following responses should the nurse make?
A.
"Can you tell me why you do not want to participate in the planned group activity?"
B.
"Do you understand that psychotropic medications cause weight gain?"
C.
"The aerobics class will be more effective at burning calories than walking."
D.
"It sounds like you have come up with an alternative exercise that works for you."
D. "It sounds like you have come up with an alternative exercise that works for you."
The nurse is using therapeutic techniques of acceptance, giving recognition, and encouragement by supporting the client's idea of a way to exercise.
A nurse is observing a client with schizophrenia in the dayroom. Another client asks him if several items of clothing match. He replies, "A match. I like matches. They are the givers of light, the light of the world. Let your light shine on." The nurse should identify these statements as which of the following speech alterations?
A.
Clang association
B.
Echolalia
C.
Word salad
D.
Associative looseness
D. Associative looseness
This client is demonstrating associative looseness, a pattern of disordered speech that reflects haphazard and illogical thoughts.
Incorrect Answers:
A. With clang association, the sound rather than the meaning of words drives the client’s speech pattern (e.g. rhyming).
B. With echolalia, the client continues to repeat the word or statements of another individual.
C. With word salad, the client uses individual words to construct incoherent sentences without meaning.
A nurse working in a mental health facility is preparing to discharge a client who has schizophrenia and requires assistance with housing. Which of the following referrals should the nurse recommend to the provider?
A.
Occupational therapist
B.
Social worker
C.
Physical therapist
D.
Spiritual support
B. Social worker
A nurse is caring for a client who is receiving chlorpromazine to treat schizophrenia. Which of the following statements by the client should prompt the nurse to notify the provider immediately?
A.
"My last bowel movement was 2 days ago."
B.
"My tongue keeps moving like a worm."
C.
"I feel dizzy when I stand up too quickly."
D.
"I can't stop blinking when I'm in the sun."
B. "My tongue keeps moving like a worm."
Involuntary tongue movement indicates that this client is at greatest risk for tardive dyskinesia, which is a rare neurological syndrome that has no cure. Therefore, this is the priority statement.
Incorrect Answers:
A. A lack of bowel movements for 2 days indicates that the client is at risk for experiencing the adverse effect of constipation; however, another statement is the priority.
C. Feeling dizzy upon standing can indicate that the client is at risk for the adverse effect of orthostatic hypotension; however, another statement is the priority.
D. Blinking when in the sun indicates that the client is at risk for the adverse effect of photophobia; however, another statement is the priority.
A nurse is collecting data from a client with schizophrenia who was recently admitted to acute care. Which of the following findings should the nurse expect?
A.
Seductive behaviors
B.
Obsession with rituals
C.
Uncontrolled appetite
D.
Associative looseness
D. Associative looseness
The nurse should recognize associative looseness (speech that reveals thought patterns that shift rapidly from one topic to another) as a common finding for a client who has schizophrenia. Other findings include the presence of delusions, hallucinations, and altered speech patterns, such as echolalia.
Incorrect Answers:
A. Seductive behaviors are an expected finding for a client who has bipolar disorder and is experiencing mania. A client who has schizophrenia might exhibit religiosity or magical thinking.
B. An obsession with rituals is a finding of obsessive-compulsive disorder. A client who has schizophrenia might exhibit repetitive psychomotor behaviors, such as pacing and rocking.
C. Uncontrolled appetite is a manifestation reported by clients who have bulimia. A client who has schizophrenia often has difficulty eating properly and might have issues with grooming and hygiene.
A nurse is planning recreational activities for a young adult client who has an acute exacerbation of schizophrenia. Which of the following activities should the nurse plan for this client?
A.
Walking with a staff member
B.
Playing ping-pong in the dayroom with another client
C.
Playing basketball with other clients in the gym
D.
Riding a stationary bike alone in the fitness room
A. Walking with a staff member
The nurse should plan to encourage the client to participate in non-threatening, non-competitive physical activities. Walking with the staff also provides an opportunity for verbal interaction.
Incorrect Answers:
B. The nurse should discourage the stimulation of competitive activities, which can increase the client's level of anxiety and suspiciousness.
C. The nurse should discourage the stimulation of competitive activities and contact sports, which can increase the client’s level of anxiety and suspiciousness.
D. The nurse should not leave the client alone around dangerous objects due to the risk of harm to self and to others.
A nurse is caring for a client who has schizophrenia and is hearing voices. Which of the following actions is the nurse's priority?
A.
Ask the client what the voices are saying
B.
Focus the client's attention on reality-based activities
C.
Make eye contact when speaking with the client
D.
Encourage the client to listen to music through headphones
A. Ask the client what the voices are saying
The greatest risk for this client is an injury to self or others due to command hallucinations. Command hallucinations can be a psychiatric emergency. Therefore, the nurse's priority is to ask the client what the voices are saying.
Findings
Borderline personality disorder
Schizophrenia
Hallucinations
Speech
Paranoia
Delusions
Schizophrenia
Hallucinations
Speech (clang association, etc)
Delusions
Paranoia
Borderline personality disorder
Paranoia (w/ anxiety, anger, and depression)
Acute schizophrenic episode with voices telling them to hurt others:
Encourage the client to listen to music.
Obtain a prescription for clozapine.
Obtain an order to place the client in seclusion.
Decrease environmental stimuli.
Ask the client what the voices are saying.
Use reality-based interventions.
Debate the content of the delusional thought.
Indicated
Encourage the client to listen to music.
Obtain a prescription for clozapine.
Decrease environmental stimuli.
Ask the client what the voices are saying.
Use reality-based interventions.
Contraindicated
Obtain an order to place the client in seclusion.
Debate the content of the delusional thought.
A nurse is assessing a client who is receiving clozapine to treat schizophrenia. The nurse should identify an increase in which of the following parameters as an early indication of an adverse effect of this medication?
A.
Urine specific gravity
B.
Urine output
C.
Blood pressure
D.
Temperature
D. Temperature
Antipsychotic medications such as clozapine can cause agranulocytosis, which is the depletion of WBCs. This increases the client’s risk of infection. A fever is an early indication to check the client’s WBC count to detect agranulocytosis.
Incorrect Answers:
A. Antipsychotic medications do not typically affect fluid balance, although they can cause urinary retention.
B. Clozapine causes urinary retention, not polyuria.
C. Clozapine is unlikely to cause hypertension; however, it can cause orthostatic hypotension.
A nurse is caring for a client with schizophrenia who has been taking chlorpromazine for the past 2 months. Which of the following findings demonstrates that the chlorpromazine has been effective?
A.
The client reports that hallucinations occur less frequently.
B.
The client sleeps uninterrupted for 6 hr each night.
C.
The client reports that she is the "most important person on the unit."
D.
The client demonstrates stereotyped behaviors.
A. The client reports that hallucinations occur less frequently.
The nurse should identify that chlorpromazine, when used to treat schizophrenia, reduces hallucinations. Chlorpromazine is a first-generation conventional antipsychotic medication and is effective in decreasing delusions, hallucinations, and agitation. It can also treat manic behavior in clients who have bipolar disorder.
Incorrect Answers:
B. Sedation is an adverse effect of chlorpromazine. Sleeping uninterrupted for 6 hours each night is not an expected therapeutic effect of antipsychotic medications for a client who has schizophrenia.
C. Thoughts of grandeur, in which a client demonstrates feelings of elevated power, are manifestations of schizophrenia. These thoughts do not demonstrate that chlorpromazine is effective for this client.
D. Stereotypical behaviors like repetitive movements are manifestations of schizophrenia, which are undesirable and do not demonstrate the effectiveness of chlorpromazine.
A nurse is providing teaching to the family of a client who has schizophrenia. Which of the following statements by a family member indicates an understanding of the teaching?
A.
"We will not set time limits for discussing her delusions."
B.
"We will avoid reacting to her command hallucinations."
C.
"She might lose weight due to her medications."
D.
"She might be having a relapse if she stops attending social events."
D. "She might be having a relapse if she stops attending social events."
The family of a client who has schizophrenia should be taught the signs of relapse, including avoiding other people, sleep disturbances, difficulty concentrating, and being unable to tell reality from nonreality.
Incorrect Answers:
A. The family of a client who has schizophrenia should be taught not to allow the client to dwell excessively on her delusions. Time limits should be set, and the focus of the conversation should be reality-based.
B. The family of a client who has schizophrenia should be taught that it is important to find out what the client hears the voices say. The client might hear the voices directing her to hurt herself or someone else.
C. The family of a client who has schizophrenia should be taught that an adverse effect of antipsychotic medications is weight gain. The family should encourage the client to exercise and follow a low-calorie diet.
A nurse is assessing a client with psychotic disorder who has a new prescription for haloperidol. The client is pacing in the hallway and states, "I can’t seem to sit still." Which of the following extrapyramidal side effects is this client likely experiencing?
A.
Dystonia
B.
Parkinsonism
C.
Tardive dyskinesia
D.
Akathisia
D. Akathisia
Akathisia is an extrapyramidal adverse effect characterized by a sense of inner restlessness and observable behaviors such as pacing, rocking forward and backward in a chair, and constant foot tapping.
Incorrect Answers:
A. Dystonia is an extrapyramidal adverse effect characterized by muscle spasms, not motor restlessness.
B. Parkinsonism is an extrapyramidal adverse effect characterized by manifestations that resemble those seen in Parkinson’s disease such as shuffling gait, drooling, and stooped posture.
C. Tardive dyskinesia is an irreversible finding characterized by involuntary movements of the extremities.
A nurse is assessing a client who has brief psychotic disorder. Which of the following manifestations should the nurse expect?
A.
Evidence of self-mutilation
B.
Suicidal threats
C.
Disorganized speech
D.
Report of chronic depression
C. Disorganized speech
Clients who have brief psychotic disorder manifest confusion, disorganized speech, delusions, and hallucinations. The behavior can be brought on by a psychosocial stressor.
Incorrect Answers:
A. A client who has borderline personality disorder can manifest self-mutilation behaviors.
B. A client who has borderline personality disorder can manifest recurrent suicidal behaviors, gestures, or threats.
D. Brief psychotic disorder lasts from 1 day to less than 1 month and results in a sudden onset of psychotic behaviors. It is not the result of a chronic condition.
A nurse is providing teaching to a client who has a new prescription for chlorpromazine. Which of the following statements should the nurse make?
A.
"This medication is a tricyclic antidepressant and will improve your mood."
B.
"This medication is an opioid antagonist that blocks the pleasurable effects of alcohol."
C.
"This medication is an antipsychotic that controls manifestations of schizophrenia."
D.
"This medication is a cholinesterase inhibitor that slows the progression of dementia."
C. "This medication is an antipsychotic that controls manifestations of schizophrenia."
Antipsychotic medications like chlorpromazine are thought to act directly on dopamine receptors in the brain to prevent the reuptake of dopamine, thereby controlling psychotic manifestations.
Incorrect Answers:
A. Tricyclic antidepressants include amitriptyline and clomipramine. Chlorpromazine is sometimes indicated to control mania in bipolar disorder but is not an antidepressant.
B. Naltrexone is an opioid antagonist used to block the pleasurable effects of alcohol. Chlorpromazine is not used to treat alcohol addiction.
D. Cholinesterase inhibitors that slow the progression of dementia include tacrine and donepezil. Chlorpromazine is not a cholinesterase inhibitor and does not affect dementia manifestations.