Varcarolis: Chapter 12 - Schizophrenia and Schizophrenia Spectrum Disorders

1. A person has had difficulty keeping a job because of arguing with co-workers and accusing them of conspiracy. Today the person shouts, "They're all plotting to destroy me. Isn't that true?" Select the nurse's most therapeutic response.

a. "Everyone here is trying to help you. No one wants to harm you."

b. "Feeling that people want to destroy you must be very frightening."

c. "That is not true. People here are trying to help you if you will let them."

d. "Staff members are health care professionals who are qualified to help you."

b. "Feeling that people want to destroy you must be very frightening."

A newly admitted patient diagnosed with schizophrenia is hypervigilant and constantly scans the environment. The patient states, "I saw two doctors talking in the hall. They were plotting to kill me." The nurse may correctly assess this behavior as:

a. echolalia.

b. an idea of reference.

c. a delusion of infidelity.

d. an auditory hallucination.

b. an idea of reference.

3. A patient diagnosed with schizophrenia says, "My co-workers are out to get me. I also saw two doctors plotting to kill me." How does this patient perceive the environment?

a. Disorganized

b. Dangerous

c. Supportive

d. Bizarre

b. Dangerous

4. When a patient diagnosed with schizophrenia was discharged 6 months ago, haloperidol (Haldol) was prescribed. The patient now says, "I stopped taking those pills. They made me feel like a robot." What are common side effects the nurse should validate with the patient?

a. Sedation and muscle stiffness

b. Sweating, nausea, and diarrhea

c. Mild fever, sore throat, and skin rash

d. Headache, watery eyes, and runny nose

a. Sedation and muscle stiffness

5. Which hallucination necessitates the nurse to implement safety measures? The patient says,

a. "I hear angels playing harps."

b. "The voices say everyone is trying to kill me."

c. "My dead father tells me I am a good person."

d."The voices talk only at night when I'm trying to sleep."

b. "The voices say everyone is trying to kill me."

6. A patient's care plan includes monitoring for auditory hallucinations. Which assessment findings suggest the patient may be hallucinating?

a. Detachment and overconfidence

b. Darting eyes, tilted head, mumbling to self

c. Euphoric mood, hyperactivity, distractibility

d. Foot tapping and repeatedly writing the same phrase

b. Darting eyes, tilted head, mumbling to self

7. A health care provider considers which antipsychotic medication to prescribe for a patient diagnosed with schizophrenia who has auditory hallucinations and poor social function. The patient is also overweight and hypertensive. Which drug should the nurse advocate?

a. Clozapine (Clozaril)

b. Ziprasidone (Geodon)

c. Olanzapine (Zyprexa)

d. Aripiprazole (Abilify)

d. Aripiprazole (Abilify)

8. A patient diagnosed with schizophrenia tells the nurse, "I eat skiller. Tend to end. Easter. It blows away. Get it?" Select the nurse's best response.

a. "Nothing you are saying is clear."

b. "Your thoughts are very disconnected."

c. "Try to organize your thoughts and then tell me again."

d. "I am having difficulty understanding what you are saying."

d. "I am having difficulty understanding what you are saying."

9. A patient diagnosed with schizophrenia exhibits little spontaneous movement and demonstrates waxy flexibility. Which patient needs are of priority importance?

a. Self-esteem

b. Psychosocial

c. Physiological

d. Self-actualization

c. Physiological

10. A patient diagnosed with schizophrenia demonstrates little spontaneous movement and has waxy flexibility. The patient's activities of daily living are severely compromised. An appropriate outcome would be that the patient will:

a. demonstrate increased interest in the environment by the end of week 1.

b. perform self-care activities with coaching by the end of day 3.

c. gradually take the initiative for self-care by the end of week 2.

d. accept tube feeding without objection by day 2.

b. perform self-care activities with coaching by the end of day 3.

11. A nurse observes a catatonic patient standing immobile, facing the wall with one arm extended in a salute. The patient remains immobile in this position for 15 minutes, moving only when the nurse gently lowers the arm. What is the name of this phenomenon?

a. Echolalia

b. Waxy flexibility

c. Depersonalization

d. Thought withdrawal

b. Waxy flexibility

12. A patient is experiencing delusions of persecution about being poisoned. The patient has refused all hospital meals for 3 days. Which intervention is most likely to be acceptable to the patient?

a. Allowing the patient supervised access to food vending machines

b. Allowing the patient to phone a local restaurant to deliver meals

c. Offering to taste each portion on the tray for the patient

d. Providing tube feedings or total parenteral nutrition

a. Allowing the patient supervised access to food vending machines

13. A community mental health nurse wants to establish a relationship with a very withdrawn patient diagnosed with schizophrenia. The patient lives at home with a supportive family. Select the nurse's best plan.

a. Visit daily for 4 days, then every other day for 1 week; stay with patient for 20 minutes, accept silence; state when the nurse will return.

b. Arrange to spend 1 hour each day with the patient; focus on asking questions about what the patient is thinking or experiencing; avoid silences.

c. Visit twice daily; sit beside the patient with a hand on the patient's arm; leave if the patient does not respond within 10 minutes.

d. Visit every other day; remind the patient of the nurse's identity; encourage the patient to talk while the nurse works on reports.

a. Visit daily for 4 days, then every other day for 1 week; stay with patient for 20 minutes, accept silence; state when the nurse will return.

14. Withdrawn patients diagnosed with schizophrenia:

a. are usually violent toward caregivers.

b. universally fear sexual involvement with therapists.

c. exhibit a high degree of hostility as evidenced by rejecting behavior.

d. avoid relationships because they become anxious with emotional closeness.

d. avoid relationships because they become anxious with emotional closeness.

15. A newly admitted patient diagnosed with schizophrenia says, "The voices are bothering me. They yell and tell me I am bad. I have got to get away from them." Select the nurse's most helpful reply.

a. "Do you hear the voices often?"

b. "Do you have a plan for getting away from the voices?"

c. "I'll stay with you. Focus on what we are talking about, not the voices. "

d. "Forget the voices and ask some other patients to play cards with you."

c. "I'll stay with you. Focus on what we are talking about, not the voices. "

16. A patient diagnosed with schizophrenia has taken fluphenazine (Prolixin) 5 mg po bid for 3 weeks. The nurse now observes a shuffling propulsive gait, a mask-like face, and drooling. Which term applies to these symptoms?

a. Neuroleptic malignant syndrome

c. Pseudoparkinsonism

b. Hepatocellular effects

d. Akathisia

c. Pseudoparkinsonism

17. A patient diagnosed with schizophrenia is very disturbed and violent. After several doses of haloperidol (Haldol), the patient is calm. Two hours later the nurse sees the patient's head rotated to one side in a stiff position, the lower jaw thrust forward, and drooling. Which problem is most likely?

a. An acute dystonic reaction

b. Tardive dyskinesia

c. Waxy flexibility

d. Akathisia

a. An acute dystonic reaction

18. An acutely violent patient diagnosed with schizophrenia receives several doses of haloperidol (Haldol). Two hours later the nurse notices the patient's head rotated to one side in a stiffly fixed position, the lower jaw thrust forward, and drooling. Which intervention by the nurse is indicated?

a. Administer diphenhydramine (Benadryl) 50 mg IM from the PRN medication administration record.

b. Reassure the patient that the symptoms will subside. Practice relaxation exercises with the patient.

c. Give trihexyphenidyl (Artane) 5 mg orally at the next regularly scheduled medication administration time.

d. Administer atropine sulfate 2 mg subcut from the PRN medication administration record.

a. Administer diphenhydramine (Benadryl) 50 mg IM from the PRN medication administration record.

19. A patient took trifluoperazine 30 mg po daily for 3 years. The clinic nurse notes that the patient grimaces and constantly smacks both lips. The patient's neck and shoulders twist in a slow, snakelike motion. Which problem would the nurse suspect?

a. Agranulocytosis

b. Tardive dyskinesia

c. Tourette's syndrome

d. Anticholinergic effects

b. Tardive dyskinesia

20. A nurse sits with a patient diagnosed with schizophrenia. The patient starts to laugh uncontrollably, although the nurse has not said anything funny. Select the nurse's best response.

a. "Why are you laughing?"

b. "Please share the joke with me."

c. "I don't think I said anything funny."

d. "You're laughing. Tell me what's happening."

d. "You're laughing. Tell me what's happening."

21. The nurse assesses a patient diagnosed with schizophrenia. Which assessment finding would the nurse regard as a negative symptom of schizophrenia?

a. Auditory hallucinations

b. Delusions of grandeur

c. Poor personal hygiene

d. Psychomotor agitation

c. Poor personal hygiene

22. What assessment findings mark the prodromal stage of schizophrenia?

a. Withdrawal, misinterpreting, poor concentration, and preoccupation with religion

b. Auditory hallucinations, ideas of reference, thought insertion, and broadcasting

c. Stereotyped behavior, echopraxia, echolalia, and waxy flexibility

d. Loose associations, concrete thinking, and echolalia neologisms

a. Withdrawal, misinterpreting, poor concentration, and preoccupation with religion

23. A patient diagnosed with schizophrenia says, "Contagious bacteria are everywhere. When they get in your body, you will be locked up with other infected people." Which problem is evident?

a. Poverty of content

b. Concrete thinking

c. Neologisms

d. Paranoia

d. Paranoia

24. A patient diagnosed with schizophrenia begins a new prescription for lurasidone HCL (Latuda). The patient is 5'6" and currently weighs 204 lbs. Which topic is most important for the nurse to include in the teaching plan related to this medication?

a. How to recognize tardive dyskinesia

b. Weight management strategies

c. Ways to manage constipation

d. Sleep hygiene measures

b. Weight management strategies

25. A patient diagnosed with schizophrenia says, "It's beat. Time to eat. No room for the cat." What type of verbalization is evident?

a. Neologism

b. Idea of reference

c. Thought broadcasting

d. Associative looseness

d. Associative looseness

26. A patient diagnosed with schizophrenia has taken a conventional antipsychotic medication for a year. Hallucinations are less intrusive, but the patient continues to have apathy, poverty of thought, and social isolation. The nurse would expect a change to which medication?

a. Haloperidol (Haldol)

b. Olanzapine (Zyprexa)

c. Chlorpromazine (Thorazine)

d. Diphenhydramine (Benadryl)

b. Olanzapine (Zyprexa)

27. The family of a patient diagnosed with schizophrenia is unfamiliar with the illness and family's role in recovery. Which type of therapy should the nurse recommend?

a. Psychoeducational

b. Psychoanalytic

c. Transactional

d. Family

a. Psychoeducational

28. A patient diagnosed with schizophrenia has been stable for a year; however, the family now reports the patient is tense, sleeps 3 to 4 hours per night, and has difficulty concentrating. The patient says, "My computer is sending out infected radiation beams." The nurse can correctly assess this information as an indication of:

a. the need for psychoeducation.

b. medication noncompliance.

c. chronic deterioration.

d. relapse.

d. relapse.

29. A patient diagnosed with schizophrenia begins to talks about "macnabs" hiding in the warehouse at work. The term "macnabs" should be documented as:

a. a neologism.

b. concrete thinking.

c. thought insertion.

d. an idea of reference.

a. a neologism.

30. A patient diagnosed with schizophrenia anxiously says, "I can see the left side of my body merging with the wall, then my face appears and disappears in the mirror." While listening, the nurse should:

a. sit close to the patient.

b. place an arm protectively around the patient's shoulders.

c. place a hand on the patient's arm and exert light pressure.

d. maintain a normal social interaction distance from the patient.

d. maintain a normal social interaction distance from the patient.

31. A patient diagnosed with schizophrenia and auditory hallucinations anxiously tells the nurse, "The voice is telling me to do things." Select the nurse's priority assessment question.

a. "How long has the voice been directing your behavior?"

b. "Does what the voice tell you to do frighten you?"

c. "Do you recognize the voice speaking to you?'

d. "What is the voice telling you to do?"

d. "What is the voice telling you to do?"

32. A patient receiving risperidone (Risperdal) reports severe muscle stiffness at 1030. By 1200, the patient has difficulty swallowing and is drooling. By 1600, vital signs are 102.8° F; pulse 110; respirations 26; 150/90. The patient is diaphoretic. Select the nurse's best analysis and action.

a. Agranulocytosis; institute reverse isolation.

b. Tardive dyskinesia; withhold the next dose of medication.

c. Cholestatic jaundice; begin a high-protein, high-cholesterol diet.

d. Neuroleptic malignant syndrome; notify health care provider stat.

d. Neuroleptic malignant syndrome; notify health care provider stat.

33. A nurse asks a patient diagnosed with schizophrenia, "What is meant by the old saying 'You can't judge a book by looking at the cover.'?" Which response by the patient indicates concrete thinking?

a. "The table of contents tells what a book is about."

b. "You can't judge a book by looking at the cover."

c. "Things are not always as they first appear."

d. "Why are you asking me about books?"

a. "The table of contents tells what a book is about."

34. The nurse is developing a plan for psychoeducational sessions for several adults diagnosed with schizophrenia. Which goal is best for this group? Members will:

a. gain insight into unconscious factors that contribute to their illness.

b. explore situations that trigger hostility and anger.

c. learn to manage delusional thinking.

d. demonstrate improved social skills.

d. demonstrate improved social skills.

35. A client says, "Facebook has a new tracking capacity. If I use the Internet, Homeland Security will detain me as a terrorist." Select the nurse's best initial action.

a. Tell the client, "Facebook is a safe website. You don't need to worry about Homeland Security."

b. Tell the client, "You are in a safe place where you will be helped."

c. Administer a prn dose of an antipsychotic medication.

d. Tell the client, "You don't need to worry about that."

a. Tell the client, "Facebook is a safe website. You don't need to worry about Homeland Security."

36. Which finding constitutes a negative symptom associated with schizophrenia?

a. Hostility

b. Bizarre behavior

c. Poverty of thought

d. Auditory hallucinations

c. Poverty of thought

37. A patient insistently states, "I can decipher codes of DNA just by looking at someone." Which problem is evident?

a. Visual hallucinations

b. Magical thinking

c. Idea of reference

d. Thought insertion

b. Magical thinking

38. A newly hospitalized patient experiencing psychosis says, "Red chair out town board." Which term should the nurse use to document this finding?

a. Word salad

b. Neologism

c. Anhedonia

d. Echolalia

a. Word salad

1. A nurse at the mental health clinic plans a series of psychoeducational groups for persons newly diagnosed with schizophrenia. Which two topics take priority?

a. "The importance of taking your medication correctly"

b. "How to complete an application for employment"

c. "How to dress when attending community events"

d. "How to give and receive compliments"

e. "Ways to quit smoking"

ANS: A, E

Stabilization is maximized by adherence to the antipsychotic medication regimen. Because so many persons with schizophrenia smoke cigarettes, this topic relates directly to the patients' physiological well-being. The other topics are also important but are not priority topics.

a. "The importance of taking your medication correctly"

e. "Ways to quit smoking"

2. A patient diagnosed with schizophrenia was hospitalized after arguing with co-workers and threatening to harm them. The patient is aloof, suspicious, and says, "Two staff members I saw talking were plotting to kill me." Based on data gathered at this point, which nursing diagnoses relate?

Select all that apply.

a. Risk for other-directed violence

b. Disturbed thought processes

c. Risk for loneliness

d. Spiritual distress

e. Social isolation

ANS: A, B

a. Risk for other-directed violence

b. Disturbed thought processes

Delusions of persecution and ideas of reference support the nursing diagnosis of disturbed thought processes. Risk for other-directed violence is substantiated by the patient's feeling endangered by persecutors. Fearful individuals may strike out at perceived persecutors or attempt self-harm to get away from persecutors. Data are not present to support the other diagnoses.

1. Which characteristic in an adolescent female is sometimes associated with the prodromal phase of schizophrenia?

a. Always afraid another student will steal her belongings.

b. An unusual interest in numbers and specific topics.

c. Demonstrates no interest in athletics or organized sports.

d. Appears more comfortable among males.

a. Always afraid another student will steal her belongings.

2. Which nursing intervention is particularly well chosen for addressing a population at high risk for developing schizophrenia?

a. Screening a group of males between the ages of 15 and 25 for early symptoms.

b. Forming a support group for females aged 25 to 35 who are diagnosed with substance use issues.

c. Providing a group for patients between the ages of 45 and 55 with information on coping skills that have proven to be effective.

d. Educating the parents of a group of developmentally delayed 5- to 6-year-olds on the importance of early intervention.

a. Screening a group of males between the ages of 15 and 25 for early symptoms.

3. To provide effective care for the patient diagnosed with schizophrenia, the nurse should frequently assess for which associated condition?

Select all that apply.

a. Alcohol use disorder

b. Major depressive disorder

c. Stomach cancer

d. Polydipsia

e. Metabolic syndrome

a. Alcohol use disorder

b. Major depressive disorder

d. Polydipsia

e. Metabolic syndrome

4. A female patient diagnosed with schizophrenia has been prescribed a first-generation antipsychotic medication. What information should the nurse provide to the patient regarding her signs and symptoms?

a. Her memory problems will likely decrease.

b. Depressive episodes should be less severe.

c. She will probably enjoy social interactions more.

d. She should experience a reduction in hallucinations.

d. She should experience a reduction in hallucinations.

5. Which characteristic presents the greatest risk for injury to others by the patient diagnosed with schizophrenia?

a. Depersonalization

b. Pressured speech

c. Negative symptoms

d. Paranoia

d. Paranoia

6. Gilbert, age 19, is described by his parents as a "moody child" with an onset of odd behavior about at age 14, which caused Gilbert to suffer academically and socially. Gilbert has lost the ability to complete household chores, is reluctant to leave the house, and is obsessed with the locks on the windows and doors. Due to Gilbert's early and slow onset of what is now recognized as schizophrenia, his prognosis is considered:

a. Favorable with medication

b. In the relapse stage

c. Improvable with psychosocial interventions

d. To have a less positive outcome

d. To have a less positive outcome

7. Which therapeutic communication statement might a psychiatric-mental health registered nurse use when a patient's nursing diagnosis is altered thought processes?

a. "I know you say you hear voices, but I cannot hear them."

b. "Stop listening to the voices, they are NOT real."

c. "You say you hear voices, what are they telling you?"

d. "Please tell the voices to leave you alone for now."

c. "You say you hear voices, what are they telling you?"

8. When patients diagnosed with schizophrenia suffer from anosognosia, they often refuse medication, believing that:

a. Medications provided are ineffective.

b. Nurses are trying to control their minds.

c. The medications will make them sick.

d. They are not actually ill.

d. They are not actually ill.

9. Kyle, a patient with schizophrenia, began to take the first-generation antipsychotic haloperidol (Haldol) last week. One day you find him sitting very stiffly and not moving. He is diaphoretic, and when you ask if he is okay he seems unable to respond verbally. His vital signs are: BP 170/100, P 110, T 104.2°F. What is the priority nursing intervention? Select all that apply.

a. Hold his medication and contact his prescriber.

b. Wipe him with a washcloth wet with cold water or alcohol.

c. Administer a medication such as benztropine IM to correct this dystonic reaction.

d. Reassure him that although there is no treatment for his tardive dyskinesia, it will pass.

e. Hold his medication for now and consult his prescriber when he comes to the unit later today.

a. Hold his medication and contact his prescriber.

b. Wipe him with a washcloth wet with cold water or alcohol.

10. Tomas is a 21-year-old male with a recent diagnosis of schizophrenia. Tomas's nurse recognizes that self-medicating with excessive alcohol is common in this disease and can co-occur along with:

a. Generally good health despite the mental illness.

b. An aversion to drinking fluids.

c. Anxiety and depression.

d. The ability to express his needs.

c. Anxiety and depression.