Chapter 15: Schizophrenia Spectrum and Other Psychotic DisordersSchizophrenia My Nursing Test Banks

Chapter 15: Schizophrenia Spectrum and Other Psychotic DisordersSchizophrenia

Multiple Choice

Identify the choice that best completes the statement or answers the question.

____ 1. Your patient reports a hallucination where he is aware of strange smells that no one else is aware of. What type of hallucination is this?

A.

Olfactory

B.

Tactile

C.

Gustatory

D.

Auditory

____ 2. You are asked to report any extrapyramidal symptoms (EPSs) of your patient. Which of the following are examples of EPS?

A.

Dry mouth, anorexia

B.

Heart palpitations

C.

Muscle rigidity, tremors

D.

Constipation, nausea

____ 3. Which of the following is characteristic of a paranoid delusion?

A.

Suspicion and jealousy

B.

Self-pity and self-depreciation

C.

Making up words and phrases

D.

Exposing beliefs of inflated self-importance

____ 4. Your new patient is admitted with a diagnosis of schizophrenia. Which of the following is he most likely to demonstrate?

A.

Concrete thinking

B.

Effective ego boundaries

C.

Inflated self-image

D.

Fatigue and loss of appetite

____ 5. When is schizophrenia most likely to be diagnosed?

A.

Grade school

B.

College age

C.

After the birth of the first child

D.

After retirement

____ 6. The schizophrenic patient tells you, I know that the man down the hall wants to kill me. How should you respond?

A.

I will protect you from him.

B.

What makes you say that?

C.

Lets walk over here to join in afternoon activities.

D.

You need to go to your room.

____ 7. The statement made by the patient in question 6 is an example of a(n):

A.

Paranoid delusion.

B.

Visual hallucination.

C.

Idea of reference.

D.

Flight of ideas.

____ 8. Your patient with schizophrenia who is English speaking says no acu moona to you. What is this called?

A.

Neologism

B.

Echolalia

C.

Echopraxia

D.

Concretism

____ 9. Which statement is most true about schizophrenia treatment today?

A.

Most require lifelong institutionalization.

B.

Patients can stop taking their antipsychotics once stabilized.

C.

Psycho-education for the family is part of the treatment plan.

D.

Most can function normally in society with little support after treatment for the first episode.

____ 10. A young man with severe schizophrenia is being discharged home. Which of the following medications would he most likely be taking?

A.

Amitriptyline

B.

Fluphenazine decanoate

C.

Lithium

D.

Lorazepam

____ 11. Which of the following is not a positive sign of schizophrenia?

A.

Hallucinations

B.

Avolition

C.

Flat affect

D.

Social withdrawal

____ 12. Which of the following is not an atypical antipsychotic?

A.

Aripiprozole

B.

Clozaril

C.

Olanzapine

D.

Haloperidol

____ 13. Your hospitalized schizophrenic patient has been taking clozapine (Clozaril) for several months. You recognize this medication is effective by which of the following patient reports?

A.

He no longer has a memory of past psychotic behavior.

B.

He is drowsier, so less bothered by the hallucinations.

C.

He no longer hears voices.

D.

He is more uncomfortable around others.

____ 14. Which of the following is most important to monitor for your patient on Clozaril?

A.

White blood cell count

B.

Clozaril blood level

C.

Urine output

D.

Vision

____ 15. Your psychotic patient states my arms and legs are on fire. What would be your best response?

A.

Thats silly. There is nothing wrong with your legs.

B.

Does the fire travel from one side of your body to the other?

C.

That must be distressing. How do you stop it?

D.

I will get you some ice to put out the burning feeling.

____ 16. Your schizophrenic patient is sitting in her room with her hands over her ears and crying. Which is the best way to approach her?

A.

Take her hands away from her ears and hold her hands in a sympathetic manner.

B.

Leave her alone as she most likely wants privacy.

C.

Make eye contact with her and ask her what is going on.

D.

Leave the room and call the charge nurse to determine if she needs an adjustment in her medication.

____ 17. Later in the day you find this patient standing in the lounge in a strange position: on one leg with both arms extended. How should you respond?

A.

Ignore the behavior, as this must be something she needs to do.

B.

Tell the patient sternly that this is not appropriate and to move to her room.

C.

Calmly acknowledge the position and ask the patient to stand on both legs.

D.

Encourage other patients in the lounge to do the same position to make the patient more comfortable.

____ 18. Which of the following medications would this schizophrenic patient be least likely to have prescribed?

A.

Fluphenazine

B.

Carbamazepine

C.

Olanzapine

D.

Quetiapine

____ 19. This schizophrenic patient has been taking Prolixin for 6 months. She now is experiencing extrapyramidal symptoms (EPS). Which medication is most likely to be added?

A.

Acetaminophen (Tylenol)

B.

Alprazolam (Xanax)

C.

Benztropine (Cogentin)

D.

Amitriptyline (Elavil)

____ 20. Which of the following side effects is most common with olanzapine?

A.

Weight gain

B.

Orthostatic hypotension

C.

Dry mouth

D.

Diarrhea

____ 21. Your schizophrenic patient suddenly is observed with her head turned in an awkward position that she is unable to move. What would be your first action?

A.

Obtain a blood specimen per standing order.

B.

Ignore the patient, as this is most likely part of her psychotic behavior.

C.

Call the charge nurse and physician immediately.

D.

Administer an additional dose of prn antipsychotic medication.

____ 22. Your patient reports feeling that bugs are crawling on his skin. Which type of hallucination is this most likely an example of?

A.

Visual

B.

Tactile

C.

Paranoid

D.

Histrionic

____ 23. The ability to think abstractly is often absent in which diagnosis?

A.

Depression

B.

Anorexia nervosa

C.

Schizophrenia

D.

Sociopathic personality

____ 24. Your schizophrenic patient tells you he is suspicious that his doctor is trying to kill him. Which nursing diagnosis would be most appropriate?

A.

Impaired verbal communication

B.

Disturbed thought processes

C.

Risk for violence

D.

Ineffective communication

____ 25. You find your schizophrenic patient sitting in a wet bed and singing nursery rhymes. What should you do?

A.

Scold the patient for wetting the bed.

B.

Help the patient clean up in a calm manner.

C.

Show the patient again where the bathroom is.

D.

Tell the patient his privileges will be withdrawn if this happens again.

____ 26. What is the purpose of detoxification in substance abuse?

A.

Slowly removing the substance from the body under medical supervision.

B.

A quick treatment for addiction.

C.

Replacing one addictive substance with another.

D.

Reducing the length of treatment for the abused substance.

____ 27. Another term for codependency is:

A.

Enabling.

B.

Dual diagnosis.

C.

Rationalization.

D.

Identification with the alcoholic.

____ 28. Which response is most accurate about hallucinations?

A.

Hallucinations are the same thing as hearing voices.

B.

Hallucinations occur without external stimulus.

C.

Hallucinations present only in schizophrenia.

D.

Hallucinations are the same thing as illusions.

____ 29. You notice a patient who seems to be listening to someone, but you do not see anyone else in the room. You interpret this behavior as a(n):

A.

Illusion.

B.

Delusion.

C.

Hallucination.

D.

Confabulation.

____ 30. Which of the following characteristics are most closely associated with schizophrenia?

A.

Flat affect, autism, ambivalence, and loose associations

B.

Bright affect, paranoia, and anhedonia

C.

Autistic behavior, inability to function in school or work, accuracy of perception

D.

Insight, suspiciousness, and flight of ideas

____ 31. A patient who is diagnosed with schizophrenia would display all of the following characteristics except:

A.

Suspiciousness.

B.

Hallucinations.

C.

Intense relationships with friends.

D.

Delusions.

____ 32. A teenage patient is brought to your hospital by her parents. The patient exhibits unusual behaviors, including illogical thought processes and strange combinations of words that you do not understand. She is wearing dirty clothes and has body odor. The patient also appears to carry on a conversation with a person who is not seen by you. Your first priority for this patient is:

A.

Have her shower and change clothes.

B.

Bring her a snack.

C.

Resocialize her.

D.

Ensure her safety.

____ 33. Tim is a new patient to your mental health unit. He gets your attention, and when the two of you are alone he informs you that he has the secret to eternal youth. He offers to tell you, but he is unable to because theyre out there hiding so they can steal it from me. I must be very careful. Your best therapeutic response to Tim is:

A.

Tim, I dont see anyone but you and me. Its time for dinner now. Ill walk with you to the dining room.

B.

Tim, nobody can have eternal youth. Thats not realistic, so dont talk about that anymore.

C.

Id love to hear about it, Tim. Lets go to the other room so no one else can hear.

D.

Ill make sure they are all gone, then you can tell me.

____ 34. Which of the following is the most appropriate nursing intervention for a patient with schizophrenia?

A.

Teach the patient about the illness.

B.

Maintain consistency with the patients plan of care.

C.

Insist that the patient participate in all activities provided on the unit.

D.

Allow the patient time to listen to the radio alone in his or her room.

____ 35. Max says, Nurse, see that man on the television? He is the reason why I am sick. He told them to make me this way. The nurse documents this as an episode of a(n):

A.

Hallucination.

B.

Delusion.

C.

Illusion.

D.

Autistic thought.

____ 36. When providing discharge teaching to a patient who has schizophrenia and is taking clozapine (Clozaril), it is important to teach all of the following except:

A.

Be sure to have you lab work on time and as ordered.

B.

Do not stop this drug abruptly. First call your doctor.

C.

Do not take any over-the-counter medications or alcohol while on this medication without your doctors approval.

D.

You may begin driving immediately while taking this medication.

____ 37. Which of the following drugs is NOT an atypical antipsychotic?

A.

Asenapine

B.

Olanzapine

C.

Haloperidol

D.

Risperidone

____ 38. When discharging a schizophrenic patient who is taking haloperidol (Haldol), it is important for the nurse to advise the patient to:

A.

Keep track of how much salt and water he or she consumes.

B.

Avoid exercise.

C.

Report any symptoms of tremors right away.

D.

Stop taking the medication if dry mouth develops and call the doctor immediately.

____ 39. Sally is experiencing an exacerbation of symptoms of her schizophrenia. She tells you, her nurse, that the voices are getting louder and that they are telling her to walk in front of a big truck. Your first nursing action for Sally would be to:

A.

Divert her into a group activity immediately.

B.

Implement suicide precautions to keep her safe.

C.

Explain that there is nobody telling her to walk in front of a big truck.

D.

Notify her family and ask them if she has said this before.

____ 40. You are one of the nurses monitoring the dining room during dinner. A male patient who has schizophrenia asks a table mate to please pass the pepper. When the table mate does so, the first patient throws the pepper shaker at you. He or she screams, Now look what youve done! There are spiders all over my food! I cant eat this! Get the spiders out of there! Your best response is:

A.

Those arent spiders; that is the pepper you asked for!

B.

I dont see any spiders. Lets go to the game room for a little while before you try eating again.

C.

Where are the spiders? I am also afraid of them!

D.

It is inappropriate for you to throw things; you need to go to the locked unit now.

____ 41. Mrs. Jones has been taking chlorpromazine to combat the effects of her auditory hallucinations. Which response is the best indication that the medication is effective?

A.

There is more than one voice now!

B.

They are whispering instead of talking loudly now!

C.

I dont hear the voices now!

D.

I only hear them sometimes now.

____ 42. You are helping with breakfast service in the dining room. A resident begins screaming and hitting at her food stating, There are bugs on my eggs. Bugs! Get them off. You approach her to see that someone sprinkled pepper on her eggs. An appropriate response is:

A.

No, those arent bugs! That is just pepper.

B.

Dont eat them then if you believe those are bugs. Eat the toast instead. There are no bugs on the toast.

C.

I see no bugs; only pepper. I will get you a new plate of food.

D.

There are no bugs! Nobody else sees bugs!

____ 43. The doctor ordered a lithium level to be drawn on a patient who is suspected to be toxic. The patient, although bipolar, is also experiencing hallucinations. The lab technician enters the patients room to draw the specimen. The patient begins to shout, I am going to be sucked dry. The nurse enters the patients room and states the following:

A.

The technician must draw your blood now.

B.

Dont worry, we will leave enough for you to live.

C.

Ill stay with you awhile and we can go over todays activities.

D.

The technician is here to help you and needs to take your blood in order to assist you.

Completion

Complete each statement.

44. Your patient describes feeling spiders crawling on his skin rather than seeing spiders. This is an example of a ____________________ hallucination.

45. The nurse tells the schizophrenic patient its time to go to bed. The patient responds with its time for bed, its time for bed, its time for bed. The patients response is an example of ____________________.

Multiple Response

Identify one or more choices that best complete the statement or answer the question.

____ 46. Which of the following is (are) true about atypical antipsychotics? (Select all that apply)

A.

Weak dopamine receptor antagonists

B.

Strong dopamine receptor antagonists

C.

Higher risk of extrapyramidal symptoms

D.

Used to treat negative and positive symptoms of schizophrenia

E.

Only available in oral form

____ 47. Which of the following are valid nursing interventions in treating schizophrenic patients? (Select all that apply)

A.

Do not reinforce hallucinations, delusions, or illusions.

B.

Provide a stimulating environment for the patient to provide distraction.

C.

Keep communication simple.

D.

Promote the patients problem-solving skills.

E.

Emphasize behavior that is appropriate to the situation.

F.

Encourage the patient to confront stressful situations.

____ 48. Antipsychotics are used to treat schizophrenia and other acute psychotic behavior. Typical antipsychotic agents treat these symptoms (select all that apply):

A.

The negative symptoms of schizophrenia

B.

Hallucinations

C.

Delusions

D.

Social Withdrawal

E.

Suspiciousness

____ 49. Describe the symptoms that appear in drug-induced Parkinsonism (select all that apply):

A.

Shuffling gait

B.

Drooling

C.

Muscle rigidity

D.

Tremors

E.

Fatigue and masklike facial expression

True/False

Indicate whether the statement is true or false.

____ 50. Schizophrenia is caused by a major trauma in childhood.

Chapter 15: Schizophrenia Spectrum and Other Psychotic DisordersSchizophrenia

Answer Section

MULTIPLE CHOICE

1. ANS: A

Olfactory refers to hallucinations involving the sense of smell.

PTS: 1

REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Table 15-3, Recognizing Hallucinations; page 234

KEY: Integrated Processes: Nursing Process: Assessment | Content Area: Mental Health: Psychotic disorders | Cognitive Level: Knowledge | Client Need: Psychosocial Integrity: Mental health concepts

2. ANS: C

The classic symptoms include muscle rigidity, tremors, shuffling gait, and restlessness.

PTS: 1

REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Box 15-1, Extrapyramidal Symptoms; page 237

KEY: Integrated Processes: Nursing Process: Assessment | Content Area: Mental Health: Pharmacology | Cognitive Level: Knowledge | Client Need: Physiological Integrity: Pharmacological and parenteral therapies: Adverse effects/contraindications/side effects/interactions

3. ANS: A

These are the classic signs of paranoid delusions. Response B is associated with depression, response C with general psychotic process, and response D with manic episode.

PTS: 1

REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Table 15-2, Common Delusions; page 234

KEY: Integrated Processes: Nursing Process: Assessment | Content Area: Mental Health: Psychotic disorders | Cognitive Level: Comprehension | Client Need: Psychosocial Integrity: Mental health concepts

4. ANS: A

Concrete thinking is one of the classic symptoms of schizophrenia.

PTS: 1

REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Symptoms; page 233

KEY: Integrated Processes: Nursing Process: Assessment | Content Area: Mental Health: Psychotic disorders | Cognitive Level: Comprehension | Client Need: Psychosocial Integrity: Mental health concepts

5. ANS: B

Late adolescence/young adulthood is the most common age for this diagnosis to be initially made.

PTS: 1

REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Introduction; page 233

KEY: Integrated Processes: Nursing Process: Assessment | Content Area: Mental Health: Psychotic disorders | Cognitive Level: Knowledge | Client Need: Psychosocial Integrity: Mental health concepts

6. ANS: C

The response does not get involved in the patients delusion and refocuses on here and now. Response A is communicating that the threat is real to you; response B is not helpful, because the patient will not know why he says that; and response D may increase the patients anxiety by promoting isolation.

PTS: 1

REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Nursing Care of the Schizophrenic Patient; page 238

KEY: Integrated Processes: Nursing Process: Implementation | Content Area: Mental Health: Psychotic disorders | Cognitive Level: Application | Client Need: Psychosocial Integrity: Mental health concepts

7. ANS: A

A paranoid delusion is a belief of deliberate harassment and persecution, such as the belief that a stranger wants to kill the patient.

PTS: 1

REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Table 15-2, Common Delusions; page 234

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Psychotic disorder | Cognitive Level: Application | Client Need: Psychosocial Integrity: Mental health concepts

8. ANS: A

Neologisms are invented new words that only have meaning to the individual.

PTS: 1

REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Positive Symptoms of Schizophrenia; page 233

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Psychotic disorder | Cognitive Level: Application | Client Need: Psychosocial Integrity: Mental health concepts

9. ANS: C

Most schizophrenics require lifelong treatment including medication and their families require extensive support and education to help maintain the patient in society. Recurrence rate after the first psychotic episode is high.

PTS: 1

REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Introduction and Psychiatric Treatment of Schizophrenia; pages 231 and 235

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Psychotic disorder | Cognitive Level: Application | Client Need: Psychosocial Integrity: Mental health concepts

10. ANS: B

This long-acting antipsychotic is commonly used for treatment of schizophrenia on an outpatient basis when the patient may be noncompliant with the medication regimen.

PTS: 1

REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Psychiatric Treatment of Schizophrenia; page 235

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Psychotic disorders | Cognitive Level: Comprehension | Client Need: Physiological Integrity: Pharmacological and parenteral therapies: Medication administration as well as expected actions/outcomes

11. ANS: A

Hallucinations are a negative sign of schizophrenia. All of the other responses are positive signs.

PTS: 1

REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Symptoms; page 233

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Psychotic disorders | Cognitive Level: Knowledge | Client Need: Psychosocial Integrity: Mental health concepts

12. ANS: D

Haloperidol is one of the oldest antipsychotics and is classified as typical.

PTS: 1

REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Table 15-4, Comparison of Side Effects Among Typical and Atypical Antipsychotic Agents; page 236

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Psychotic disorder | Cognitive Level: Knowledge | Client Need: Physiological Integrity: Pharmacological and parenteral therapies: Medication administration as well as expected actions/outcomes

13. ANS: C

Reduction in hallucinations is a target symptom that atypical antipsychotics, such as Clozaril, treat. Drowsiness may be a side effect. Responses A and D would not be indicative of effectiveness of the medication.

PTS: 1

REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Psychiatric Treatment of Schizophrenia; page 235

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Pharmacology | Cognitive Level: Application | Client Need: Physiological Integrity: Pharmacological and parenteral therapies: Medication administration as well as expected actions/outcomes

14. ANS: A

Clozaril has been associated with agranulocytosis, a serious blood disorder that is diagnosed by low white blood cell count.

PTS: 1

REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Psychiatric Treatment of Schizophrenia; page 237

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Pharmacology | Cognitive Level: Application | Client Need: Physiological Integrity: Pharmacological and parenteral therapies: Medication administration and Physiological Integrity: Reduction of risk potential: Laboratory values

15. ANS: C

This response acknowledges the distress and supports that the patient has some control over the distress. Responses B and D reinforce the delusion, and response A minimizes her experience.

PTS: 1

REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; General Nursing Interventions; page 238

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Psychotic disorders | Cognitive Level: Application | Client Need: Psychosocial Integrity: Therapeutic communication

16. ANS: C

The patients behavior may be indicative of hearing voices that are creating distress. This response acknowledges the distress. Touching the schizophrenic patient, as in response A, is usually too threatening. Responses B and D both demonstrate inadequate information. Leaving the patient in distress alone will increase anxiety. The patient may need an adjustment in medication but would not be your first action.

PTS: 1

REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Table 15-6, Nursing Care Plan; page 239

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Psychotic disorders | Cognitive Level: Application | Client Need: Psychosocial Integrity: Mental health concepts

17. ANS: C

This response demonstrates acceptance of the patients behavior and also reinforces reality. Response A is not reality based. Responses B and D could be viewed as punitive or embarrassing to the patient.

PTS: 1

REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Table 15-6, Nursing Care Plan of the Schizophrenic Patient; page 239

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Psychotic disorders | Cognitive Level: Application | Client Need: Psychosocial Integrity: Mental health concepts

18. ANS: B

Carbamazepine is a mood stabilizer that is usually used to treat bipolar disorder. This would not be given to a schizophrenic patient unless she had that additional diagnosis. The other three drugs are all antipsychotics.

PTS: 1

REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Table 15-4, Comparison of side effects among typical and atypical antipsychotic agents | Chapter 12: Bipolar Disorders; Pharmacology Corner; page 196

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Psychotic disorders | Cognitive Level: Comprehension | Client Need: Physiological Integrity: Pharmacological and parenteral therapies: Medication administration as well as expected actions/outcomes

19. ANS: C

Cogentin works as an anticholinergic to reduce EPS. The other medications are not used to treat EPS.

PTS: 1

REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Psychiatric Treatment of Schizophrenia; page 237

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Psychotic disorders: Adult health: Pharmacology | Cognitive Level: Comprehension | Client Need: Physiological Integrity: Pharmacological and parenteral therapies: Medication administration as well as expected actions/outcomes

20. ANS: A

Olanzapine is an antipsychotic and weight gain is the most common of these side effects. Orthostatic hypotension and dry mouth occur to a lesser extent and diarrhea is not listed as a side effect.

PTS: 1

REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Table 15-4, Comparison of Side Effects Amongst Typical and Atypical Antipsychotic Agents; page 236

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Psychotic disorders: Adult health: Pharmacology | Cognitive Level: Knowledge | Client Need: Physiological Integrity: Pharmacological and parenteral therapies: Medication administration as well as adverse effects/contraindications/side effects/interactions

21. ANS: C

This patient may be experiencing torticollisa severe EPS (extrapyramidal symptom) reaction to antipsychotic medication that needs treatment. The physician should be notified to determine if an anticholinergic drug should be given.

PTS: 1

REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Box 15-1, Extrapyramidal Symptoms; page 237

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Psychotic disorders: Adult health: Pharmacology | Cognitive Level: Application | Client Need: Physiological Integrity: Pharmacological and parenteral therapies: Medication administration as well as adverse effects/contraindications/side effects/interactions

22. ANS: B

Tactile hallucinations involve bizarre or unusual perceptions of something touching the skin. Responses C and D are not types of hallucinations. Visual hallucinations are false visual perceptions.

PTS: 1

REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Table 15-3, Recognizing Hallucinations; page 234

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Psychotic disorders | Cognitive Level: Application | Client Need: Psychosocial Integrity: Mental health concepts

23. ANS: C

Schizophrenics are often unable to think abstractly and tend to make literal interpretations of their environment. This is not normally a characteristic of the other conditions.

PTS: 1

REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Symptoms; page 233-234

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Psychotic disorders | Cognitive Level: Comprehension | Client Need: Psychosocial Integrity: Mental health concepts

24. ANS: B

Delusions are an example of disturbed thought processes.

PTS: 1

REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Nursing Care of the Schizophrenic Patient; page 238

KEY: Integrated Processes: Nursing Process: Planning | Content Area: Mental Health: Psychotic disorders | Cognitive Level: Application | Client Need: Psychosocial Integrity: Mental health concepts

25. ANS: B

This response offers reassurance and assistance. Responses A, C, and D all imply that the patient had control of his behavior.

PTS: 1

REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Nursing Care of the Schizophrenic Patient; page 238

KEY: Integrated Processes: Nursing Process: Implementation | Content Area: Mental Health: Psychotic disorders | Cognitive Level: Application | Client Need: Psychosocial Integrity: Therapeutic communication

26. ANS: A

Detoxification involves the safe removal of the addictive substance from the body under medical supervision to control withdrawal symptoms. It does not treat the actual addictive behaviors.

PTS: 1

REF: Chapter 15: Substance Use and Addictive Disorders; Pharmacology Corner for Substance Use; page 278

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Substance Abuse | Cognitive Level: Comprehension | Client Need: Psychosocial Integrity: Mental health concepts: Physiological Integrity: Physiological adaptation: Illness management

27. ANS: A

Enabling is another term for codependency. Dual diagnosis is a co-occurring psychiatric disorder. Responses C and D are defense mechanisms.

PTS: 1

REF: Chapter 15: Substance Use and Addictive Disorders; Impact on the family; page 265

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Substance Abuse | Cognitive Level: Knowledge | Client Need: Psychosocial Integrity: Chemical and other dependencies

28. ANS: B

Hallucinations occur in a wide variety of diagnoses and are the result of brain dysfunction. These false sensory perceptions can affect any of the five senses. Illusions are different, as the stimulus is external.

PTS: 1

REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Schizophrenia: Symptoms; Table 15-3, Recognizing Hallucinations; page 234 and Glossary; page 399

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Psychotic disorders | Cognitive Level: Comprehension | Client Need: Psychosocial Integrity: Sensory/perceptual alterations

29. ANS: C

Hallucinations are real to the patient who could be experiencing a sensory perception of someone in the room even though no one is there. Illusions are misinterpretations of a real external stimulus. Delusions are false beliefs. Confabulations are creating imaginary events to fill in memory gaps.

PTS: 1

REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; General Nursing Interventions; page 238 and Glossary; page 399

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Psychotic disorders | Cognitive Level: Application | Client Need: Psychosocial Integrity: Mental health concepts

30. ANS: A

Response A includes the classic schizophrenia symptoms. Bright affect, accuracy of perception, and insight are all characteristics you would not see in the schizophrenic.

PTS: 1

REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Symptoms; page 233

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Psychotic disorders | Cognitive Level: Comprehension | Client Need: Psychosocial Integrity: Mental health concepts

31. ANS: C

Schizophrenics tend to be challenged in social situations and avoid close relationships. Change is often very challenging. The other responses are common characteristics.

PTS: 1

REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Symptoms; page 233

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Psychotic disorders | Cognitive Level: Comprehension | Client Need: Psychosocial Integrity: Mental health concepts

32. ANS: D

While all of these responses may be appropriate, the first priority is safety, as you do not know how the patient will respond in this new situation.

PTS: 1

REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; General Nursing Interventions; page 238

KEY: Integrated Processes: Nursing Process: Implementation | Content Area: Mental Health: Psychotic disorders and therapeutic communication | Cognitive Level: Application | Client Need: Psychosocial Integrity: Therapeutic communication

33. ANS: A

By focusing gently on reality and then encouraging the participation in the here and now, you are helping this patient stay in reality. The other responses give the impression that you are validating his unrealistic claim.

PTS: 1

REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; General Nursing Interventions; page 238

KEY: Integrated Processes: Nursing Process: Implementation | Content Area: Mental Health: Psychotic disorders and therapeutic communication | Cognitive Level: Application | Client Need: Psychosocial Integrity: Therapeutic communication

34. ANS: B

Consistency is a primary intervention. Responses A and C may be too demanding for the patient. Response D may reinforce hallucinations and delusions.

PTS: 1

REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; General Nursing Interventions; page 238

KEY: Integrated Processes: Nursing Process: Implementation | Content Area: Mental Health: Psychotic disorders | Cognitive Level: Application | Client Need: Psychosocial Integrity: Therapeutic communication

35. ANS: B

A delusion is a fixed, false belief. Hallucinations refer to altered sensory perceptions and illusions are misinterpretations of real stimuli. Autistic thoughts would not be as organized as this delusion.

PTS: 1

REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Table 15-2, Common Delusions and Glossary; page 397

KEY: Integrated Processes: Communication and Documentation | Content Area: Mental Health: Psychotic disorders | Cognitive Level: Application | Client Need: Psychosocial Integrity: Mental health concepts

36. ANS: D

Clozaril may contribute to sedation, so more time must pass before approving driving.

PTS: 1

REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Table 15-4, Comparison of Side Effects Amongst Typical and Atypical Antipsychotic Agents; page 236

KEY: Integrated Processes: Teaching/Learning | Content Area: Mental Health: Pharmacology | Cognitive Level: Application | Client Need: Physiological Integrity: Pharmacological and parenteral therapies: Adverse effects/contraindications/side effects/ interactions

37. ANS: C

Haloperidol is one of the older antipsychotics and is categorized as typical.

PTS: 1

REF: Chapter 15: Schizophrenic Spectrum and Other Psychotic Disorders; Table 15-4, Comparison of Side Effects Among Typical and Atypical Antipsychotic Agents; page 236

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Pharmacology | Cognitive Level: Comprehension | Client Need: Physiological Integrity: Pharmacological and parenteral therapies: Medication administration

38. ANS: C

Tremors could be a sign of extrapyramidal symptoms. Medications need to be added to treat this to prevent further complications. Dry mouth is a common side effect and would not be a reason to stop taking this drug. The drug has no restrictions on exercise.

PTS: 1

REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Box 15-1, Extrapyramidal Side Effects; page 237

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Pharmacology | Cognitive Level: Application | Client Need: Physiological Integrity: Pharmacological and parenteral therapies: Medication administration and adverse effects/contraindications/side effects/interactions

39. ANS: B

Auditory hallucinations telling a patient to harm herself require immediate intervention for safety, which would include suicide precautions so she is not left unsupervised. Distraction, determining past behavior, or challenging her thinking are not appropriate in this serious situation.

PTS: 1

REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; General Nursing Interventions; page 238

KEY: Integrated Processes: Nursing Process: Implementation | Content Area: Mental Health: Psychotic disorders | Cognitive Level: Application | Client Need: Psychosocial Integrity: Therapeutic environment

40. ANS: B

This response acknowledges the patients distress, describes reality, and then focuses on other behaviors. Response A is reality based, but it devalues the patients view of reality. Response C is reinforcing the presence of spiders. Response D is punishing the patient for his psychosis.

PTS: 1

REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Table 15-7, Suggested Interventions for Patients with Schizophrenia Who Are Hallucinating; page 240

KEY: Integrated Processes: Nursing Process: Implementation | Content Area: Mental Health: Therapeutic communication and psychotic disorders | Cognitive Level: Application | Client Need: Psychosocial Integrity: Therapeutic communication

41. ANS: C

Chlorpromazine is an effective medication for positive symptoms of schizophrenia such as hallucinations. Elimination of the voices would be a sign of effective action of this drug.

PTS: 1

REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Pharmacology Corner; page 235

KEY: Integrated Processes: Nursing Process: Evaluation | Content Area: Mental Health: Pharmacology | Cognitive Level: Application | Client Need: Physiological Integrity: Pharmacological and parenteral therapies: Medication administration

42. ANS: C

This response is reality based, lets the patient know you heard her, and then directs attention to a new plate of food. There is a difference in meaning between I see no bugs from no, those arent bugs. Response C acknowledges the patient experience rather than denying it.

PTS: 1

REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Table 15-7, Suggested Interventions for Patients with Schizophrenia Who Are Hallucinating; page 240

KEY: Integrated Processes: Nursing Process: Implementation | Content Area: Mental Health: Therapeutic communication | Cognitive Level: Application | Client Need: Psychosocial Integrity: Therapeutic communication

43. ANS: C

Reduce the patients anxiety first. Then proceed with attempting the blood draw.

PTS: 1

REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; General Nursing Interventions; page 238

KEY: Integrated Processes: Caring | Content Area: Mental Health: Therapeutic Communication | Cognitive Level: Application | Client Need: Psychosocial Integrity: Mental Health Concepts

COMPLETION

44. ANS:

tactile

Tactile hallucination involves the sense of touch.

PTS: 1

REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Table 15-3, Recognizing Hallucinations; page 234

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Psychotic disorders | Cognitive Level: Application | Client Need: Psychosocial Integrity: Mental health concepts

45. ANS:

echolalia

This is a symptom seen in schizophrenia where the patient repeats words over and over.

PTS: 1 REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; page 234

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Psychotic disorders | Cognitive Level: Application | Client Need: Psychosocial Integrity: Mental health concepts

MULTIPLE RESPONSE

46. ANS: A, D

Atypicals are newer antipsychotics that are weak dopamine receptor antagonists which lead to a milder side effect profile and less extrapyramidal symptoms. They treat both positive and negative symptoms and some formulations are available in long-acting injectable forms.

PTS: 1

REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Psychiatric Treatment of Schizophrenia; page 235

KEY: Integrated Processes: Nursing Process: Analysis | Content Area: Mental Health: Pharmacology | Cognitive Level: Comprehension | Client Need: Physiological Integrity: Pharmacological and parenteral therapies: Medication administration and adverse effects/contraindications/side effects/interactions

47. ANS: A, C, E

These responses reinforce reality without creating more stress for the patient, which would be the case in promoting more stimulation, problem solving, and confrontation.

PTS: 1

REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; General Nursing Interventions; page 238

KEY: Integrated Processes: Nursing Process: Implementation | Content Area: Mental Health: Therapeutic communication | Cognitive Level: Application | Client Need: Psychosocial Integrity: Therapeutic communication

48. ANS: B, C, E

Typical antipsychotic agents treat the positive symptoms of schizophrenia. Positive symptoms are those that are found among people with schizophrenia but not present among those who do not have the disorder.

PTS: 1

REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Symptoms; page 233

KEY: Integrated Processes: Teaching/Learning | Content Area: Mental Health: Psychotic Disorders | Cognitive Level: Application | Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies; Expected actions/outcomes

49. ANS: A, B, C, D, E

These are major symptoms manifested in Parkinsonism, which can be a side effect of anti psychotic medications.

PTS: 1

REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Box 15-1, Extrapyramidal Side Effects; page 237

KEY: Integrated Processes: Nursing Process: Assessment | Content Area: Mental Health: Pharmacology | Cognitive Level: Knowledge | Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies: Adverse Effects/Contraindications/Side Effects/Interactions

TRUE/FALSE

50. ANS: F

Schizophrenia is now known to be brain disorder and unrelated to the individuals personal experiences.

Integrated Process: Teaching/Learning | Content Area: Mental Health: Psychotic Disorders | Cognitive Level: Knowledge | Client Needs: Psychosocial Integrity: Mental Health Concepts

Ref. Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders: Etiology; page 234

PTS: 1

REF: Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders; Etiology; page 234

KEY: Integrated Processes: Teaching/Learning | Content Area: Mental Health: Psychotic Disorders | Cognitive Level: Knowledge | Client Need: Psychosocial Integrity: Mental Health Concepts

Leave a Reply