Chapter 49: Care of Patients with Thought and Personality Disorders My Nursing Test Banks

Chapter 49: Care of Patients with Thought and Personality Disorders

MULTIPLE CHOICE

1. The nurse is aware that it is estimated that approximately _____% of the United States population is affected with schizophrenia.

a.

1

b.

2

c.

3

d.

4

ANS: A

Schizophrenia is the most common thought disorder. It is estimated that 1.1% of the general population is affected with schizophrenia, and in the United States this represents 2.4 million Americans.

DIF: Cognitive Level: Comprehension REF: 1102 OBJ: 1 (theory)

TOP: Schizophrenia: Incidence KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance

2. The nurse explains that depression is thought to be the result of a deficit of:

a.

norepinephrine.

b.

serotonin.

c.

acetylcholine.

d.

dopamine.

ANS: B

Serotonin is a neurotransmitter of the central nervous system. It is important in sleep, pain perception, and emotional states. Lack of serotonin can lead to depression. Norepinephrine and acetylcholine are neurotransmitters of the autonomic nervous system. Norepinephrine plays an important role in the fight-or-flight reaction (constriction of the blood vessels, dilation of the pupils, increased heart rate, increased awareness and vigilance). Acetylcholine causes decreased heart rate and force of contraction and plays a role in the sleep-wake cycle. Dopamine is located mostly in the brainstem. It is thought to play a role in controlling complex movements, motivation, and cognition.

DIF: Cognitive Level: Comprehension REF: 1103 OBJ: 3 (theory)

TOP: Depression: Etiology KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

3. The nurse documents a schizophrenics delusion of persecution when the patient says:

a.

Did you know that I own this hospital and pay all these people to work for me?

b.

My doctor talked to all the other patients, but not to me. He doesnt want me to get well.

c.

The presidents speech tonight is going to give me a coded message.

d.

I am going to wait in front of the hospital this morning for my limousine to pick me up and take me to my private jet.

ANS: B

Delusions can be either grandiose or persecutory. An individual who believes he owns the hospital or is planning to be picked up by a limousine or has a private jet is having delusions of grandeur. Individuals with delusions of persecution believe that they are being persecuted by agencies, by other people, or by supernatural beings. The patient who believes the presidents speech is coded is having an idea of reference.

DIF: Cognitive Level: Application REF: 1104 OBJ: 3 (theory)

TOP: Delusions: Persecution KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity

4. When the paranoid schizophrenic states that his whole family has conspired to have him put in the hospital and that the medical staff is part of the conspiracy, the nurses most therapeutic response would be:

a.

Im not like that. I want to help you.

b.

You know your family is concerned about you.

c.

Im sorry you feel that way. Ill be around if you want to talk about your feelings.

d.

The doctors are trying to help you feel better. They have your best interest in mind.

ANS: C

Arguing with the paranoid patient, or defending self or others, reinforces the paranoia. Passively offering self to the patient to approach you rather than the other way around is helpful to the nurse-patient relationship.

DIF: Cognitive Level: Application REF: 1109 OBJ: 3 (theory)

TOP: Paranoia: Intervention KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

5. The delusional patient has become agitated and angry. The patient reports that the cook put tacks in his cereal. He is pacing back and forth in the crowded dining room and cursing the cook. The best intervention by the nurse would be:

a.

keeping distance from the patient, say, Can we go to the dayroom and talk about this, Carl?

b.

touching the patients arm, say, Calm down, Carl. Im sure we can straighten this out.

c.

call experienced CNAs to restrain the patient.

d.

standing calmly, say, This behavior is unacceptable. Sit down and eat, Carl.

ANS: A

Allowing the angry patient space is important. Encourage the patient to find a quieter place. Acknowledge the anger and demonstrate willingness to help. The agitated patient should not be touched without permission. Restraints are a last resort and will increase the patients anger and feelings of persecution.

DIF: Cognitive Level: Application REF: 1109 OBJ: 2 (clinical)

TOP: Agitation and Anger: Intervention KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

6. The manipulative patient approaches the nurse and says, I know its too early to give me my pain medication, but you are the only one who seems to care. Could you give me my pain medication now? The best response would be:

a.

The charge nurse is really tough about scheduled medications. She would be very angry with me if I gave you the medication now.

b.

I know how it is when you are in pain. Ill give you your medication early.

c.

Your medication is due in 2 hours. I will be glad to give it to you on schedule.

d.

It makes me feel good to know you are appreciative of our care. Here is your medication.

ANS: C

Setting clear limits is important when managing manipulative patients. Once limits are set it is important to maintain them. Blaming the charge nurse provides incentive for further manipulative behaviors. The nurse telling the patient that they know what it is like when they are in pain is not accurate or therapeutic. Providing the medication early likely does not follow the prescribed plan.

DIF: Cognitive Level: Application REF: 1113 OBJ: 3 (clinical)

TOP: Manipulation: Intervention KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

7. The nurse observes a withdrawn schizophrenic sitting alone and moving her lips as if she is talking, but there is no audible sound. The nurse speaks to the patient by name, but the patient does not seem to hear. What action by the nurse is indicated initially?

a.

Hug the patients shoulders, say, Hey, Mary! Are you praying?

b.

Document patients nonresponsiveness and continued detached behavior.

c.

Sit down in the chair next to the patient and touch her arm, say, I am right here, Mary.

d.

Touch the patients shoulder, then join another group of patients.

ANS: C

Sitting with the patient and touching her presents the reality of the nurses presence. Continued attention will make the patient feel safe. Feelings of safety are needed in the beginning of the nursepatient relationship. Hugging the patient may invade the patients personal space. The nurses assessment will be documented but it is most appropriate to attempt an interaction with the patient.

DIF: Cognitive Level: Application REF: 1109 OBJ: 2 (theory)

TOP: Withdrawal: Intervention KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

8. The CNA reports that a patient has been caught smoking in his room for the third time this week. The behavior has been addressed with a contract indicating that further infractions will result in the patients smoking materials being taken and locked in the nurses station and smoking will only be possible with supervision. The nurse should say:

a.

Why are you smoking in your room when you know it is not allowed?

b.

Larry, the contract was, if you smoke in your room, you must give me your smoking materials. Let me have them, please.

c.

Okay, Larry, give me your cigarettes and lighter now.

d.

I am going to give you one more chance, Larry. Lets see if you can live up to the contract.

ANS: B

Reminding the patient of contract violation and the penalty attached should be done before taking the cigarettes. This approach is fair and puts the blame for the consequence on the offender. Providing the patient with the opportunity to explain the actions does not conform to the agreed-on contract. Providing additional opportunities for compliance does not support the contract and may encourage manipulative behavior.

DIF: Cognitive Level: Application REF: 1113 OBJ: 2 (theory)

TOP: Manipulation: Intervention KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

9. The nurse is receiving beginning-of-shift report. During report, it is communicated that a schizophrenic patient has been admitted to the unit displaying waxy flexibility. Which behavior can the nurse anticipate finding when assessing the patient?

a.

Sitting and staring at the wall without speaking

b.

Arranging self in several seated postures on the couch

c.

Marching stiffly up and down the center of the dayroom

d.

Holding his arm over his head with the fist clenched for 1 hour

ANS: D

The catatonic patient will exhibit a stuporous demeanor. It is associated with rigidity and unusual posturing. Waxy flexibility refers to maintaining a limb in one position for a long time.

DIF: Cognitive Level: Comprehension REF: 1105 OBJ: 2 (theory)

TOP: Catatonia: Waxy Flexibility KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

10. The nurse is caring for a schizophrenic patient who has been prescribed large doses of thioridazine (Mellaril). Which manifestation may signal an overdose of the medication?

a.

The patient walking with a shuffling gait and drooling

b.

Lethargy during the day and taking frequent daytime naps

c.

Disorganized thought processes

d.

Extreme excitability with periods of mania and crying

ANS: A

Extrapyramidal side effects of pseudo-parkinsonism with a shuffling gait, tremors, and excessive salivation are cardinal signs of overdose of neuroleptics.

DIF: Cognitive Level: Application REF: 1105 OBJ: 2 (theory)

TOP: Extrapyramidal Side Effects: Pseudo-Parkinsonism

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

11. The nurse adds an intervention to the nursing care plan for a patient on neuroleptics to:

a.

increase fluid intake to compensate for the side effect of diarrhea.

b.

encourage snacks to prevent weight loss.

c.

monitor vital signs for hypertension.

d.

assess urinary output for evidence of urinary retention.

ANS: D

Neuroleptics cause urinary retention, weight gain, constipation, and hypotension. Diarrhea is not associated with the administration of neuroleptics. Weight gain and not weight loss is associated with this type of medication. Hypertension is not associated with this type of medication.

DIF: Cognitive Level: Analysis REF: 1105 OBJ: 2 (theory)

TOP: Neuroleptic Drugs: Side Effects KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

12. The nurse documents episodes of echolalia when, after the nurse has asked a catatonic patient, Where is your hat? the patient:

a.

excitedly says, Hat, cat, rat, fat, scat, splat!

b.

begins to cry and says, I had a hat when my mother drove her yellow car.

c.

repeatedly says, Your hat, your hat, your hat.

d.

places his hands on his head, saying, Where is your hat?

ANS: D

Echolalia is the repetition of words spoken to the patient by another person.

DIF: Cognitive Level: Comprehension REF: 1105 OBJ: 2 (theory)

TOP: Catatonia: Echolalia KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity

13. A student nurse questions the nurse about the frequency of administration of antipsychotics, such as risperidone (Risperdal). The nurse responds by explaining that risperidone (Risperdal) is a newer medication that is effective and has the advantage that it:

a.

does not cause photosensitivity.

b.

has fewer serious side effects.

c.

is less expensive.

d.

does not cause drowsiness.

ANS: B

Risperidone (Risperdal) is a newer generation of atypical antipsychotic medications that is known for having fewer serious side effects, such as tardive dyskinesia, but they still have significant effects.

DIF: Cognitive Level: Comprehension REF: 1105 OBJ: 2 (theory)

TOP: Atypical Antipsychotics KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

14. The nurse is aware that interventions for the negative symptoms of schizophrenia are based on:

a.

establishment of trust.

b.

getting the patient to accept medication protocols.

c.

supporting patient in interpersonal social activities.

d.

promoting conversation with the patient.

ANS: A

General nursing interventions for the negative symptoms include establishing trust and teaching the patient and family how to manage the signs and symptoms. An attitude of acceptance is necessary to promote trust.

DIF: Cognitive Level: Comprehension REF: 1106 OBJ: 2 (theory)

TOP: Negative Symptoms: Establish Trust

KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity

15. During report, the nurse is told that a patient has Cluster B group type of personality disorder. When assessing the patient, which type of behaviors can be anticipated?

a.

Paranoia

b.

Avoidance

c.

Antisocial

d.

Obsessive-compulsive

ANS: C

The antisocial personality disorder is included in Cluster B: dramatic and erratic.

DIF: Cognitive Level: Comprehension REF: 1113-1114 OBJ: 4 (theory)

TOP: Cluster B: Dramatic and Erratic KEY: Nursing Process Step: Planning

MSC: NCLEX: Psychosocial Integrity

16. The nurse is aware the patient with borderline personality disorder did not have a family visit this week. The nurse adds an intervention to address the patients probable perception of abandonment. Which intervention would be most appropriate?

a.

Schedule patient for pet therapy visit.

b.

Arrange for remote activity during next visiting time.

c.

Assess daily for evidence of self-mutilation.

d.

Assign a young CNA to his care.

ANS: C

Patients with borderline personality disorder have a deep fear of abandonment and react with intense, emotionally charge acts, such as suicide attempts or self-mutilation.

DIF: Cognitive Level: Application REF: 1114 OBJ: 4 (theory)

TOP: Borderline Personality Disorder: Self-Mutilation

KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity

17. By using clear, direct communication with people with borderline personality disorder, the nurse can:

a.

avoid having an intense reaction to the patient.

b.

eliminate the possibility of manipulation.

c.

decrease the probability of the patient reacting emotionally.

d.

role model good communication.

ANS: D

Clear communication can role model a communication style that allows a person to verbalize feelings and make thoughts and expectations known.

DIF: Cognitive Level: Comprehension REF: 1114 OBJ: 4 (theory)

TOP: Communication: Setting a Model KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

18. The nurse is changing the dressing on self-inflicted cigarette burns on a patient with borderline personality disorder. When providing the care, which action by the nurse would be most therapeutic?

a.

Perform the actions while being nurturing and caring to keep patient from feeling abandoned.

b.

Approach the interventions with a matter-of-fact demeanor to decrease secondary gains of sympathy.

c.

Present a stern attitude to underscore the seriousness of the act.

d.

Interact in a professional and distant manner to diminish the opportunity for manipulation.

ANS: B

The person with borderline personality disorder will seek additional secondary gains in terms of attention about the manipulative act of self-mutilation. Nurturing will reinforce the effectiveness of the mutilation to gain attention. Stern and distant demeanors may appear confrontational to the patient and reduce the therapeutic aspects of the intervention.

DIF: Cognitive Level: Comprehension REF: 1114 OBJ: 4 (theory)

TOP: Borderline Personality Disorder: Use of Attitude

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

19. The nurse is talking with a patient who voices concerns about the incidence of schizophrenia in her family. The patient states that she is worried the condition will be inherited by her teenage daughter. What response by the nurse is most appropriate?

a.

Unfortunately, schizophrenia does run in families.

b.

There is no exact cause known for schizophrenia but there are some familial factors.

c.

Your daughter would be showing some evidence of the condition by this point in her life so there is no real reason to worry.

d.

As long as your home environment is warm and loving she will be fine.

ANS: B

The exact cause of schizophrenia is unknown; however, current research favors the theory that there is a neurologic basis with a genetic component. As with most chronic conditions, an unfavorable social environment contributes to a poor prognosis. Schizophrenia usually develops in late adolescence or the early twenties.

DIF: Cognitive Level: Application REF: 1103 OBJ: 2 (theory)

TOP: Schizophrenia: Etiology and Pathophysiology

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

20. The family of a patient being treated for a recent diagnosis of schizophrenia voices concerns to the nurse. They report the patient just told them that the pepper flakes on his potatoes were crawling bugs. What response by the nurse is most appropriate?

a.

At this stage it is most important to humor him and agree that you see them as well.

b.

To reduce his stress, just throw out the food.

c.

It is important to tell him that you do not see the bugs.

d.

The best thing to do in this case is to confront him and let him know that he is mistaken.

ANS: C

The patient is experiencing an illusion. It is most important to offer support but to attempt to provide reality orientation. Confronting him may cause anger or increased anxiety and should be avoided.

DIF: Cognitive Level: Comprehension REF: 1109 OBJ: 2 (theory)

TOP: Schizophrenia: Signs and Symptoms

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

21. The wife of a patient being treated for a recent diagnosis of schizophrenia asks how long it will be until her husband is cured. What response by the nurse is most appropriate?

a.

Unfortunately there is no cure but the condition can be managed.

b.

It will take approximately 1 to 2 months of medication therapy to alleviate the symptoms being experienced by your husband.

c.

We cannot consider your husband cured until he has been symptom free for at least 1 year.

d.

There is no way to predict his outcome during his initial episode.

ANS: A

Schizophrenia can be managed with therapy and medications. It cannot be permanently cured. Evidence suggests that early treatment for schizophrenia improves long-term prognosis. Patients who are treated for first episodes generally respond to the therapeutic effects and require lower doses of antipsychotic medications. After starting a medication, the patient should be monitored for 2 to 4 weeks for therapeutic response.

DIF: Cognitive Level: Application REF: 1103 OBJ: 2 (theory)

TOP: Schizophrenia: Treatment KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: Mental Health Concepts

MULTIPLE RESPONSE

22. The nurse is aware that schizophrenia is a thought disorder that is characterized by psychotic features, which include: (Select all that apply.)

a.

hallucinations.

b.

sexual dysfunction.

c.

delusions.

d.

disorganized speech.

e.

disorganized behavior.

ANS: A, C, D, E

Sexual dysfunction is not a characteristic of schizophrenia.

DIF: Cognitive Level: Comprehension REF: 1103 OBJ: 2 (theory)

TOP: Schizophrenia: Characteristics KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance

23. The nurse points out that negative symptoms of schizophrenia are more difficult to modify. Examples of negative symptoms are: (Select all that apply.)

a.

avolition.

b.

hallucination.

c.

psychomotor retardation.

d.

delusions.

e.

anhedonia.

ANS: A, C, E

Negative symptoms are abilities or personal characteristics that are absent or lost to the patient.

DIF: Cognitive Level: Comprehension REF: 1104 OBJ: 2 (theory)

TOP: Schizophrenia: Negative Symptoms

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

24. The nurse explains that neuroleptic drugs such as chlorpromazine (Thorazine) are very effective in treating positive symptoms of schizophrenia by: (Select all that apply.)

a.

stopping hallucinations.

b.

stimulating effective interpersonal relationships.

c.

enabling organized thought.

d.

increasing activity level.

e.

eliminating delusional systems.

ANS: A, C, E

Hallucinations, disorganized thought, and delusional systems are the positive symptoms that respond to neuroleptics. Negative symptoms such as withdrawal and inactivity do not respond well to these drugs.

DIF: Cognitive Level: Comprehension REF: 1105 OBJ: 2 (theory)

TOP: Neuroleptic Drugs: Advantages KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

25. The nurse takes into consideration that the characteristics of personality disorders include: (Select all that apply)

a.

impaired cognition.

b.

maladaptive response to lifes events.

c.

inability to maintain relationships.

d.

poor impulse control.

e.

inappropriate emotional responses.

ANS: B, C, D, E

There is no impaired cognition in the individual with a personality disorder.

DIF: Cognitive Level: Comprehension REF: 1113 OBJ: 4 (theory)

TOP: Personality Disorders: Characteristics

KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity

26. Milieu therapy is a therapeutic application for people with personality disorders in which the therapy is based on: (Select all that apply.)

a.

maintaining a structured environment.

b.

participating as a member of the structured environment.

c.

practicing appropriate social behavior.

d.

actively attempting to modify behavior.

e.

learning to modify feelings and emotional responses.

ANS: A, B, C, D, E

Milieu therapy provides all these options for treating people with personality disorders.

DIF: Cognitive Level: Comprehension REF: 1114 OBJ: 5 (theory)

TOP: Milieu Therapy: Characteristics KEY: Nursing Process Step: NA

MSC: NCLEX: NA

COMPLETION

27. The delusional patient rushes up to the nurse and begins to brush her uniform with his hands, saying, I must get the weegos off of you! The nurse recognizes that the word weegos is a(n) ________.

ANS:

neologism

A neologism is a word that the patient makes up to express his or her disorganized thinking.

DIF: Cognitive Level: Comprehension REF: 1109 OBJ: 2 (theory)

TOP: Schizophrenia: Use of Neologisms KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity

28. The paranoid schizophrenic who is taking a neuroleptic is brought to the emergency department with acute muscle spasm of the face and neck with eyes that are fixed in an upward stare. The nurse recognizes the condition of ________.

ANS:

dystonia

Overdoses of neuroleptics can cause muscle spasms of the face and neck called dystonia.

DIF: Cognitive Level: Application REF: 1105 OBJ: 2 (theory)

TOP: Neuroleptic Drugs: Dystonia KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

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