Mental Health Nclex style Questions - focus on schizophrenia- EXAM 1

A client experiencing disturbed thought processes believes that his food is being poisoned. Which communication technique should the nurse use to encourage the client to eat?
A. Using open-ended questions and silence
B. Sharing personal preference regarding food choices
C. Documenting reasons why the client does not want to eat
D. Offering opinions about the necessity of adequate nutrition

A client experiencing disturbed thought processes believes that his food is being poisoned. Which communication technique should the nurse use to encourage the client to eat?
A. Using open-ended questions and silence
B. Sharing personal preference regarding food choices
C. Documenting reasons why the client does not want to eat
D. Offering opinions about the necessity of adequate nutrition

A. Using open-ended questions and silence
Rationale:
Open-ended questions and silence are strategies used to encourage clients to discuss their problems. Sharing personal food preferences is not a client-centered intervention. The remaining options are not helpful to the client because they do not encourage the client to express feelings. The nurse should not offer opinions and should encourage the client to identify the reasons for the behavior.

A client admitted to a mental health unit for treatment of psychotic behavior spends hours at the locked exit door shouting, "Let me out. There's nothing wrong with me. I don't belong here." What defense mechanism is the client implementing?

A. Denial
B. Projection
C. Regression
D. Rationalization

A. Denial
Rationale:
Denial is refusal to admit to a painful reality, which is treated as if it does not exist. In projection, a person unconsciously rejects emotionally unacceptable features and attributes them to other persons, objects, or situations. Regression allows the client to return to an earlier, more comforting, although less mature, way of behaving. Rationalization is justifying illogical or unreasonable ideas, actions, or feelings by developing acceptable explanations that satisfy the teller and the listener.

A client says to the nurse, "The federal guards were sent to kill me." What is the best nursing response to the client's concern?

A. "I don't believe this is true."
B. "The guards are not out to kill you."
C. "Do you feel afraid that people are trying to hurt you?"
D. "What makes you think the guards were sent to hurt you?"

C. "Do you feel afraid that people are trying to hurt you?"
Rationale:
It is most therapeutic for the nurse to empathize with the client's experience. The remaining options lack this connection with the client. Disagreeing with delusions may make the client more defensive, and the client may cling to the delusions even more. Encouraging discussion regarding the delusion is inappropriate.

A client is admitted to a medical nursing unit with a diagnosis of acute blindness after being involved in a hit-and-run accident. When diagnostic testing cannot identify any organic reason why this client cannot see, a mental health consult is prescribed. Which condition will be the focus of this consult?

A. Psychosis
B. Repression
C. Conversion disorder
D. Dissociative disorder

C. Conversion disorder
Rationale:
A conversion disorder is the alteration or loss of a physical function that cannot be explained by any known pathophysiological mechanism. A conversion disorder is thought to be an expression of a psychological need or conflict. In this situation, the client witnessed an accident that was so psychologically painful that the client became blind. Psychosis is a state in which a person's mental capacity to recognize reality, communicate, and relate to others is impaired, interfering with the person's ability to deal with life's demands. Repression is a coping mechanism in which unacceptable feelings are kept out of awareness. A dissociative disorder is a disturbance or alteration in the normally integrative functions of identity, memory, or consciousness.

The nurse is preparing a client with 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 understands the instructions?

A. "My medications aren't likely to make me anxious."
B. "I'll go to support group and talk so that I don't hurt anyone."
C. "It's not likely that I'll get anxious or hear things if I get enough sleep and eat well."
D. "When I begin to hallucinate, I'll call my therapist and talk about what I should do."

D. "When I begin to hallucinate, I'll call my therapist and talk about what I should do."
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 should ask the client whether he or she has intentions to hurt him- or herself 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 nurse is caring for a client diagnosed with catatonic stupor who is lying on the bed in a fetal position. What is the most appropriate nursing intervention?

A. Ask direct questions to encourage talking.
B. Leave the client alone so as to minimize external stimuli.
C. Sit beside the client in silence with occasional open-ended questions.
D. Take the client into the dayroom with other clients so that they can help watch him.

C. Sit beside the client in silence with occasional 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 open-ended questions rather than direct questions, and pausing to provide opportunities for the client to respond. While 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 who is experiencing disturbed thought processes as a result of paranoia. In formulating nursing interventions with the members of the health care team, what best instruction should the nurse provide to the staff?

A. Increase socialization of the client with peers.
B. Avoid laughing or whispering in front of the client.
C. Begin to educate the client about social supports in the community.
D. Have the client sign a release of information to appropriate parties for assessment purposes.

B. Avoid laughing or whispering in front of the client.
Rationale:
Disturbed thought process related to paranoia is the client's problem, and the plan of care must address this problem. The client is experiencing paranoia and is distrustful and suspicious of others. The members of the health care team need to establish a rapport and trust with the client. Laughing or whispering in front of the client would be counterproductive. The remaining options ask the client to trust on a multitude of levels. These options are actions that are too intrusive for a client who is paranoid.

The nurse in the mental health unit is performing an assessment in a client who has a history of multiple somatic complaints involving several organ systems. Diagnostic studies revealed no organic pathology. The care plan developed for this client will reflect that the client is experiencing which disorder?

A. Depression
B. Schizophrenia
C. Somatization disorder
D. Obsessive-compulsive disorder

C. Somatization disorder
Rationale:
Somatization disorder is characterized by a long history of multiple physical problems with no satisfactory organic explanation. The clinical findings associated with schizophrenia, depression, and obsessive-compulsive disorder are unrelated to somatic complaints.

During a therapy session with a client with paranoid disorder, the client says to the nurse, "You look so nice today. I love how you do your hair, and I love that perfume you're wearing." Which response by the nurse would be therapeutic?

A. "Your comment is inappropriate."
B. "Thank you for noticing. I just bought this new perfume."
C. "My hair has been a mess. I really needed to have it done."
D. "We are not here to discuss how I look or smell. We are here to talk about you."

D. "We are not here to discuss how I look or smell. We are here to talk about you."
Rationale:
The therapeutic response by the nurse is the one that clarifies the content of the client's statements and directs the client to the purpose of the session. The nurse should confront the client verbally regarding the inappropriate statements and refocus the client back to the issue of the session. Option 1 may be judgmental and may provide an opening for a verbal struggle. Options 2 and 3 are social responses and could be misinterpreted by the client.

The nurse is monitoring a client with a diagnosis of schizophrenia. The nurse notes that the client's emotional responses to situations occurring throughout the day are incongruent with the tone of the situation. The nurse should document the findings using which description of the client's behavioral response?

A. Flat affect
B. Bizarre affect
C. Blunted affect
D. Inappropriate affect

D. Inappropriate affect
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.

A mental health nurse notes that a client with schizophrenia is exhibiting an immobile facial expression and a blank look. Which should the nurse document in the client's record?

A. The client has a flat affect.
B. The client has an inappropriate affect.
C. The client is exhibiting bizarre behavior.
D. The client's emotional responses exhibit a blunted affect.

A. The client has a flat affect.
Rationale:
A flat affect is manifested as an immobile facial expression or blank look. An inappropriate affect refers to an emotional response to a situation that is incongruent with the tone of the situation. 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.

The nurse is developing a plan of care for the client with a diagnosis of paranoia and should include which interventions in the plan of care? Select all that apply.

A. Provide a warm approach to the client.
B. Ask permission before touching the client.
C. Eliminate physical contact with the client.
D. Defuse any anger or verbal attacks with a nondefensive stance.
E. Use simple and clear language when communicating with the client.

B. Ask permission before touching the client.
C. Eliminate physical contact with the client.
D. Defuse any anger or verbal attacks with a nondefensive stance.
E. Use simple and clear language when communicating with the client.
Rationale:
When caring for a client with paranoia, the nurse should ask permission if touch is necessary because touch may be interpreted as a sexual or physical assault. The nurse must eliminate any physical contact and not touch the client. The anger that a paranoid client expresses often is displaced, and when a staff member becomes defensive, both client and staff anger may escalate. Simple and clear language should be used in speaking to the client to prevent misinterpretation and to clarify the nurse's intent and action. The nurse should avoid a warm approach because warmth can be frightening to a person who needs emotional distance.

Schizophrenia is best characterized as
A. split personality.
B. multiple personalities.
C. ambivalent personality.
D. deteriorating personality.

D. deteriorating personality.
The course of the disease is marked by recurrent acute exacerbations. With each relapse of psychosis, an increase in residual dysfunction and deterioration occurs.

A descriptor for a subtype of schizophrenia is
A. delusional.
B. dissociated.
C. disorganized.
D. developmental

C. disorganized.
Disorganized schizophrenia is a subtype of schizophrenia listed in the DSM-IV-TR and refers to the most regressed and socially impaired of all the schizophrenic disorders

Which of the following would be assessed as a negative symptom of schizophrenia?
A. Anhedonia
B. Hostility
C. Agitation
D. Hallucinations

A. Anhedonia
Negative symptoms include the crippling symptoms of affective blunting, anergia, anhedonia avolition, poverty of content of speech, poverty of speech, and thought blocking.

The type of altered perception most commonly experienced by clients with schizophrenia is
A. delusions.
B. illusions.
C. tactile hallucinations.
D. auditory hallucinations.

D. auditory hallucinations.
Hallucinations, especially auditory hallucinations, are the major example of alterations of perception in schizophrenia. They are experienced by as many as 90% of schizophrenic individuals.

What is the most common course of schizophrenia? Initial episode followed by
A. recurrent acute exacerbations and deterioration.
B. recurrent acute exacerbations.
C. continuous deterioration.
D. complete recovery.

A. recurrent acute exacerbations and deterioration.
Schizophrenia is usually a disorder marked by an initial episode followed by recurrent acute exacerbations. With each relapse of psychosis an increase in residual dysfunction and deterioration occurs.

The causation of schizophrenia is currently understood to be
A. a combination of inherited and nongenetic factors.
B. excessive amounts of the neurotransmitter dopamine.
C. excessive amounts of the neurotransmitter serotonin.
D. stress related.

A. a combination of inherited and nongenetic factors.
Causation is a complicated matter. Schizophrenia most likely occurs as a result of a combination of inherited genetic factors and extreme nongenetic factors (such as virus, birth injuries, nutritional factors) that can affect the genes governing the brain or directly injure the brain

Which symptom would not be assessed as a positive symptom of schizophrenia?
A. Delusion of persecution
B. Auditory hallucinations
C. Affective flattening
D. Idea of reference

C. Affective flattening
Positive symptoms are the attention-getting symptoms such as hallucinations, delusions, bizarre behavior, and paranoia. They are referred to as florid symptoms. Affective flattening is one of the negative symptoms that contribute to rendering the person inert and unmotivated.

A withdrawn client is assessed as having distorted thinking that is not reality based. A nursing diagnosis that should be considered for her would be
A. impaired verbal communication.
B. disturbed thought processes.
C. disturbed self-esteem.
D. defensive coping

B. disturbed thought processes.
disturbed thought processes is a nursing diagnosis defined as a state in which an individual experiences a disruption in cognitive operations and activities

When a client with schizophrenia hears hallucinated voices saying he is a vile human being, the nurse can correctly assume that the hallucination
A. is a projection of the client's own feelings.
B. derives from neuronal impulse misfiring.
C. is a retained memory fragment.
D. may signal seizure onset.

A. is a projection of the client's own feelings.
One theory about derogatory hallucinations is that the content is a projection of the individual's feelings about self. The derogatory hallucinations are an extension of the strong feelings of rejection and lack of self-respect experienced by the individual during the prodromal period.

Which side effect of antipsychotic medication has no known treatment?
A. Anticholinergic effects
B. Pseudoparkinsonism
C. Dystonic reaction
D. Tardive dyskinesia

D. Tardive dyskinesia
Tardive dyskinesia is not always reversible with discontinuation of the medication and has no proven cure. Options 1, 2, and 3 often appear early in therapy and can be minimized with treatment.

A client with residual schizophrenia is uninterested in community activities. He lacks initiative, demonstrates both poverty of content of speech and poverty of speech, and seems unable to follow the schedule for taking his antipsychotic medication. The case manager continues to direct his care with the knowledge that his behavior is most likely prompted by

A. chronic uncooperativeness.
B. personality conflict.
C. neural dysfunction.
D. dependency needs

C. neural dysfunction.
Schizophrenia is considered a neurobiological disorder. The course of schizophrenia involves recurrences. With each relapse further deterioration is noted. Residual schizophrenia refers to the disorder when active phase symptoms are no longer present and the individual is left with two or more of the following symptoms: lack of initiative, social withdrawal, impaired role function, marked speech deficits, and odd beliefs.

A client with paranoid schizophrenia refuses food. He states the voices are telling him the food is contaminated and will change him from a male to a female. A therapeutic response for the nurse would be

A. "You are safe here in the hospital, nothing bad will happen to you."
B. "The voices are wrong about the hospital food. It is not contaminated."
C. "I understand that the voices are very real to you, but I do not hear them."
D. "Other people are eating the food and nothing is happening to them."

C. "I understand that the voices are very real to you, but I do not hear them."
This reply acknowledges the client's reality but offers the nurse's perception that he or she is not experiencing the same thing.

A client with disorganized schizophrenia would have greatest difficulty with the nurse

A. interacting with a neutral attitude.
B. using concrete language.
C. giving multistep directions.
D. providing nutritional supplements.

C. giving multistep directions.
The thought processes of the client with disorganized schizophrenia are severely disordered and severe perceptual problems are present, making it extremely difficult for the client to understand what others are saying. All communication should be simple and concrete and may need to be repeated several times.

A nursing intervention designed to help a schizophrenic client manage relapse is to

A. schedule the client to attend group therapy.
B. teach the client and family about behaviors associated with relapse.
C. remind the client of the need to return for periodic blood draws.
D. help the client and family adapt to the stigma of chronic mental illness.

B. teach the client and family about behaviors associated with relapse.
By knowing what behaviors signal impending relapse, interventions can be quickly invoked when the behaviors occur. The earlier the intervention, the greater the likelihood that a recurrence can be averted.

A client with paranoid schizophrenia tells the nurse "I have to get away. The volmers are coming to execute me." The term "volmers" can be assessed as

A. a neologism.
B. clang association.
C. blocking.
D. a delusion.

A. a neologism.
A neologism is a newly coined word that has meaning only for the client.

When a client with paranoid schizophrenia tells the nurse "I have to get away. The volmers are coming to execute me," an appropriate response for the nurse would be

A. "You are safe here. This is a locked unit and no one can get in."
B. "I do not believe I understand the word volmers. Tell me more about them."
C. "Why do you think someone or something is going to harm you?"
D. "It must be frightening to think something is going to harm you."

D. "It must be frightening to think something is going to harm you."
This response focuses on the client's feelings and neither directly supports the delusion nor denies the client's experience. Option 1 gives global reassurance. Option 2 encourages elaboration about the delusion. Option 3 asks for information that the client will likely be unable to answer.

A desired outcome for a client with schizophrenia who has a nursing diagnosis of Disturbed sensory perception: auditory hallucinations related to neurobiological dysfunction would be that the client will

A. ask for validation of reality.
B. describe content of hallucinations.
C. demonstrate a cool, aloof demeanor.
D. identify prodromal symptoms of disorder.

A. ask for validation of reality.
Beginning to question his or her own altered perceptions by seeking input from staff is highly desirable.

A client has reached the stable plateau phase of schizophrenia. An appropriate clinical focus for planning would be

A. safety and crisis intervention.
B. acute symptom stabilization.
C. stress and vulnerability assessment.
D. social, vocational, and self-care skills.

D. social, vocational, and self-care skills.
During the stable plateau phase of schizophrenia, planning is geared toward client and family education and skills training that will help maintain the optimal functioning of schizophrenic individuals in the community.

A client has been receiving antipsychotic medication for 6 weeks. At her clinic appointment she tells the nurse that her hallucinations are nearly gone and that she can concentrate fairly well. She states her only problem is "the flu" that she's had for 2 days. She mentions having a fever and a very sore throat. The nurse should

A. suggest that the client take something for her fever and get extra rest.
B. advise the physician that the client should be admitted to the hospital.
C. arrange for the client to have blood drawn for a white blood cell count.
D. consider recommending a change of antipsychotic medication.

C. arrange for the client to have blood drawn for a white blood cell count.
Antipsychotic medications may cause agranulocytosis, the first manifestation of which may be a sore throat and flulike symptoms.

The purpose for a nurse periodically performing the Abnormal Involuntary Movement Scale (AIMS) assessment on a persistently mentally ill client who has schizophrenia is early detection of

A. acute dystonia.
B. tardive dyskinesia.
C. cholestatic jaundice.
D. pseudoparkinsonism.

B. tardive dyskinesia.
An AIMS assessment should be performed periodically on clients who are being treated with antipsychotic medication known to cause tardive dyskinesia.

The nurse is working with the multidisciplinary healthcare team to optimize the care of a patient with schizophrenia. Which concepts will guide the nursing care of this patient? (Select all that apply.)

A. The second-generation antipsychotics generally are more effective than the first-generation agents.
B. Most antipsychotic agents increase the risk of mortality in elderly patients with dementia.
C. Antipsychotic depot preparations carry a greater risk of neuroleptic malignant syndrome.
D. The lipid levels of patients receiving second-generation antipsychotics should be monitored.
E. Schizophrenia is characterized by disordered thinking and loss of touch with reality.

B, D, E
The first- and second-generation antipsychotics are considered equally effective, even though the second-generation agents are more widely used today. Most antipsychotics should be avoided in elderly patients with dementia because of increased mortality. Antipsychotic depot preparations are effective for the long-term control of schizophrenia and do not have an increased risk of side effects. Second-generation antipsychotics may cause weight gain, diabetes, and dyslipidemia. Schizophrenia is characterized by disordered thinking and loss of touch with reality.

Which statement does the nurse include when teaching a patient about antipsychotic drug therapy? (Select all that apply.)

A. "Restrict the use of antipsychotic drugs to 3 months to prevent the development of addiction."
B. "Dilute oral preparations in fruit juice to improve their palatability."
C. "Store oral preparations in a dark area."
D. "Do not make skin contact with these drugs; flush the affected area with water if a spill occurs."
E. "Take an over-the-counter sleep aid if you have trouble falling asleep at night."

B, C, D
Patients should be informed that antipsychotic drugs do not cause addiction and that they should be taken as prescribed. Patients should be instructed to avoid all drugs with anticholinergic properties, including the antihistamines and certain over-the-counter sleep aids to prevent drug interactions. All other statements are appropriate to include in teaching the patient about the use of antipsychotic medications.