Question 1

A most useful strategy for helping a patient with schizophrenia prevent a potential relapse is to:

Accepted Answer

When the patient or family members are aware of the symptoms of an impending relapse,they can use symptom management strategies to prevent the relapse.While medication is a critical part of this condition's management,relapse can occur even when the client is medication-compliant.

Question 2

Which data gathered from the assessment of a family with a member diagnosed with schizophrenia would be of greatest importance in discharge planning for the patient?

Accepted Answer

The patient and family should be made aware of symptom triggers to which the patient is particularly reactive.Triggers may precipitate relapse.Teaching the family to modify this behavior is ideal,but if it is impossible,the patient can be taught to contact a mental health provider.

Question 3

An appropriate short-term goal for a withdrawn,isolated patient diagnosed with schizophrenia is,"The patient will:

Accepted Answer

Interacting with at least one person is desirable to reduce complete withdrawal and isolation.Such interaction provides the basis for formation of trust and the development of a nurse-patient relationship.

Question 4

A patient displays positive symptoms of schizophrenia as evidenced by psychotic disorders of thinking.The nurse can expect the patient to evidence:

Accepted Answer

Positive symptoms of schizophrenia represent an excess or distortion of normal function.Delusions and hallucinations are considered psychotic disorders of thinking.The other symptoms listed are noted in schizophrenia,but they are not considered thought disorders.

Question 5

A nurse observes a patient who is sitting alone in a room muttering,"You don't know what you're talking about! Leave me alone." The nurse attempts to validate whether the patient is:

Accepted Answer

Impulsive activity,talking to people who are not present,and covering the ears are behaviors that may indicate the patient is responding to auditory hallucinations.

Question 6

A patient diagnosed with schizophrenia has difficulty completing tasks and seems forgetful and disinterested in activities.A nurse can best select successful strategies by understanding that these behaviors are due to:

Accepted Answer

The information processing of individuals with schizophrenia may be altered by brain deficits affecting memory and attention that then affect retention,ability to focus,and ability to make decisions.

Question 7

What part of the brain is dysfunctional in persons with schizophrenia? Research has implicated the:

Accepted Answer

The two most consistent neurobiological research findings in schizophrenia are imaging studies that show reduced brain volume and abnormal function,and neurochemical studies that show alterations of neurotransmitter systems affecting the prefrontal cortex and the limbic system.

Question 8

Which neurological deficits would the nurse be most likely to encounter when assessing a patient diagnosed with schizophrenia?

Accepted Answer

Patients with schizophrenia are considered to have neurobiological problems."Soft signs" are neurological deficits consistent with brain dysfunction of the frontal or parietal lobes.Soft signs include astereognosis,agraphesthesia,dysdiadochokinesia,impaired fine motor skills,increased eye blinking,abnormal smooth pursuit eye movements,and muscle twitches.By contrast,hard signs include loss of function,weakness,diminished reflexes,and paralysis.

Question 9

A novice nurse asks the assigned mentor,"Why should I avoid telling the patient that his ideas are bizarre and simply not logical?" The mentor responds,"If you do that:

Accepted Answer

Developing trust is fundamental to working with a delusional patient.Much assessment data must be gathered before questioning the facts and their meaning and discussing the consequences of the delusion.

Question 10

A severely withdrawn patient diagnosed with schizophrenia will spend time in the dayroom but will not speak to staff or other patients.The most therapeutic nursing intervention in response to this behavior would be to:

Accepted Answer

Developing trust is fundamental to developing a nurse-patient relationship.The nurse must demonstrate consistent and genuine caring.Initially schedule brief (5- to 10-minute),frequent contacts.Increase time gradually based on patient agreement.

Question 11

A patient who has been hospitalized for 2 days remains anxious and continues to be preoccupied with paranoid delusions.What intervention will best help the patient focus less on the delusions?

Accepted Answer

Engaging the patient in physical activity will help distract the patient and keep the patient from focusing solely on the delusions.The patient would still be able to focus on the delusions while appearing to be reading or listening to music.The latter two activities are better addressed later in the course of treatment.

Question 12

A patient diagnosed with schizophrenia is standing naked after showering and appears dazed and indecisive.The nursing intervention that will be most helpful to promote dressing would be:

Accepted Answer

When cognitive functioning is disrupted,a self-care deficit may be severe.The nurse may need to dress the patient.Each step of the process of dressing should be undertaken singly,and a simple explanation as to what is expected should be given.

Question 13

A patient reports,"My brain is controlled by government agents who can trace my whereabouts and listen to my thoughts." An appropriate nursing response to this information would be:

Accepted Answer

It is appropriate for the nurse to help the patient place the delusion in a time frame and to identify triggers that may be related to stress or anxiety.

Question 14

A patient diagnosed with schizophrenia reveals to the nurse that voices have warned of danger and adds,"They're so loud they frighten me.Do you hear them?" The nurse's best initial response would be:

Accepted Answer

When asked,the nurse should point out that he or she is not experiencing the same stimuli but should accept the reality of the hallucinations for the patient.Being able to communicate with the nurse at the time the hallucinations are occurring is helpful to the patient.Interactive discussion of hallucinations is a vital element in the development of reality-testing skills.

Question 15

A patient with schizophrenia repeatedly asks for directions and the time of day.The nurse should:

Accepted Answer

The person with schizophrenia has brain malfunction resulting in poor memory and attention.The information should be repeated as often as necessary in a kind,matter-of-fact manner.

Question 16

A patient reports,"The government has implanted a device in my head." What outcome would the nurse identify as being appropriate for the patient to achieve within 1 week of admission?

Accepted Answer

An appropriate outcome for a delusional patient is that the patient will interpret reality correctly.

Question 17

Which teaching point will have the most positive effect on patients diagnosed with schizophrenia and their families concerning the risk of relapses?

Accepted Answer

Caffeine intake greater than 250 mg daily or smoking 10 to 20 cigarettes daily dramatically reduces the effectiveness of antipsychotic and antianxiety drugs and lithium.The need to limit the use of these substances is an important teaching point.

Question 18

The nursing diagnosis most likely to be applicable for a person who has schizophrenia,paranoid type,is:

Accepted Answer

Individuals with paranoid schizophrenia are usually distrustful of others and socially withdrawn.They often have delusions of persecution and auditory hallucinations that further serve to isolate them from others.

Question 19

During occupational therapy a patient diagnosed with schizophrenia sits staring at a piece of paper.Which response is most therapeutic at this time?

Accepted Answer

Patients with disrupted cognitive functioning have difficulty focusing on an activity in a sustained,concentrated fashion.They may need direction.Because multistage commands are often not understood,simple directions should be given one step at a time.

Question 20

The medical record of a patient diagnosed with schizophrenia states that the patient has cognitive dysfunction.From this statement,the nurse can expect to see evidence of:

Accepted Answer

Problems in cognitive functioning include impaired short-term and long-term memory,distractibility and poor concentration,loose associations,tangentiality,incoherence,illogical speech,concrete thinking,indecisiveness,impaired judgment,and delusions.

Quiz 20: Neurobiological Responses and Schizophrenia and Psychotic Disorders