Deck 13: Schizophrenia and Other Psychotic Disorders

Question 1

Which response demonstrates both empathy and understanding of the relationship genetics has to the development of schizophrenia in twins?

A) "In fraternal twins, the chance of the other twin developing the disorder is quite small."
B) "Studies show that 50% of twins develop schizophrenia when it is present in the other twin."
C) "No one can say what will happen, so we will hope for the best for you and both of your sons."
D) "You poor woman! I wish I could tell you that your other son he will be free of the disorder."

Answer 1

"In fraternal twins, the chance of the other twin developing the disorder is quite small."

Question 2

A patient has been admitted with disorganized type schizophrenia.The nurse observes blunted affect and social isolation.He occasionally curses or calls another patient a "jerk" without provocation.The nurse asks the patient how he is feeling,and he responds,"Everybody picks on me.They frobitz me." The patient's communication exhibits:

A) A neologism
B) Loose associations
C) Delusional thinking
D) Circumstantial speech

Answer 2

A neologism

Question 3

Which response by the nurse would best assist a patient in de-escalating aggressive behavior?

A) "Tell me what's going on."
B) "Why are you getting so upset?"
C) "If you throw something, you will be restrained."
D) "It's time for group therapy. You can talk there."

Answer 3

"Tell me what's going on."

Question 4

Which response is appropriate when a patient's mother expresses guilt over "causing my child to be schizophrenic"?

A) "I can see how you would be upset over this turn of events."
B) "New findings suggest this disorder is biological in nature."
C) "Don't be so hard on yourself; your daughter needs you to be strong."
D) "It's difficult to see what produces stress for the child at the time it's occurring."

Question 5

Which of the following interventions should the nurse plan to use to reduce patient focus on delusional thinking?

A) Confronting the delusion
B) Refuting the delusion with logic
C) Exploring reasons the patient has the delusion
D) Focusing on feelings suggested by the delusion

Question 6

An appropriate intervention for a patient with an identified nursing diagnosis of situational low self-esteem would be:

A) Providing large muscle activities to relieve stress
B) Attempting to determine triggers to hallucinations
C) Engaging patient in activities designed to permit success
D) Encouraging verbalization of feelings in a safe environment

Question 7

What would be an appropriate short-term outcome for a patient diagnosed with residual schizophrenia who exhibits ambivalence?

A) Decide their own daily schedule.
B) Decide which unit groups they will attend.
C) Choose which clinic staff member to work with.
D) Choose between two outfits to wear each morning.

Question 8

A 34-year-old male admitted with catatonic schizophrenia has been mute and motionless for several days while at home prior to admission.He still appears stuporous in the hospital.Which nursing intervention would be an initial priority?

A) Orienting the patient to the unit
B) Reinforcing reality with the patient
C) Establishing a nonthreatening relationship
D) Assessing the patient for physical problems

Question 9

A newly admitted patient has the diagnosis of catatonic schizophrenia.Which behavior observed in the patient supports that diagnosis?

A) Uses a rhyming form of speech
B) Refuses to eat any unwrapped foods
C) Laughs when watching a sad movie
D) Maintains an immobilized state for hours

Question 10

A 19-year-old patient is admitted for the second time in 9 months and is acutely psychotic with a diagnosis of undifferentiated schizophrenia.The patient sits alone rubbing her arms and smiling.She tells the nurse her thoughts cause earthquakes and that the world is burning.The nurse assesses the primary deficit associated with the patient's condition as:

A) Social isolation
B) Disturbed thinking
C) Altered mood states
D) Poor impulse control

Question 11

The wife of a patient diagnosed with paranoid schizophrenia asks,"I've been told that my husband's illness is probably related to imbalanced brain chemicals.Can you be more specific?" The response based on the dopamine hypothesis is:

A) "Breakdown of dopamine produces LSD, which in large amounts produces psychosis."
B) "An increase in the brain chemical dopamine explains the presence of delusions and hallucinations."
C) "Decreased amounts of the brain chemical dopamine explain the presence of delusions and hallucinations."
D) "An increase in the brain chemical dopamine explains the presence of lack of motivation and disordered affect."

Question 12

What is the basis for the reduction in disturbed thought processes when a patient is administered haloperidol (Haldol)?

A) Reduction in the number of brain cells that crave dopamine
B) Dopamine receptors are blocked, making dopamine less available
C) Dopamine receptors are enhanced, making more dopamine available
D) Medication causes an increased cellular production of dopamine

Question 13

What is the priority nursing diagnosis for a catatonic patient?

A) Ineffective coping
B) Impaired physical mobility
C) Impaired social interaction
D) Risk for deficient fluid volume

Question 14

Which initial short-term outcome would be appropriate for a patient who was admitted expressing delusional thoughts?

A) Accept that delusion is illogical.
B) Distinguish external boundaries.
C) Explain the basis for the delusions.
D) Engage in reality-oriented conversation.

Question 15

Which patient behavior would support the diagnosis of residual schizophrenia with negative symptoms?

A) Communicating using only rhyming phases
B) Claims that "worms are crawling in my brain"
C) Maintaining both arms suspended awkwardly overhead
D) Shows no emotion when telling the story of a sister's recent death

Question 16

Which assessment observation supports a patient's diagnosis of disorganized schizophrenia?

A) Reports suicidal ideations
B) Last relapse was 6 years ago
C) Consistent inappropriate laughing
D) Believes that "the government is out to get me"

Question 17

A patient has been admitted with disorganized type schizophrenia.The nurse asks the patient how he is feeling,and he responds,"Everybody picks on me.They frobitz me." The best response for the nurse to make would be:

A) "That's really too bad that you are being treated that way."
B) "Who do you mean when you say 'everybody'?"
C) "What difference does frobitzing make?"
D) "Why do they frobitz?"

Question 18

By discharge,which outcome is appropriate for a patient who hears voices telling him he is evil?

A) Respond verbally to the voices.
B) Verbalize the reason the voices say he is evil.
C) Identify events that increase anxiety and promote hallucinations.
D) Integrate the voices into his personality structure in a positive manner.

Question 19

Which nursing diagnosis is appropriate for a patient who insists being called "Your Highness" and demonstrates loosely associated thoughts?

A) Risk for violence
B) Defensive coping
C) Impaired memory
D) Disturbed thought processes

Question 20

A patient tried to gouge out his eye in response to auditory hallucinations commanding,"If thine eye offends thee,pluck it out." The nurse would analyze this behavior as indicating:

A) Derealization
B) Inappropriate affect
C) Impaired impulse control
D) Inability to manage anger

Question 21

A patient with schizophrenia tells the nurse as they sit in the day room,"I hear voices telling me bad things." The most therapeutic response the nurse can make is:

A) "Tell me what the voices are saying."
B) "I believe you hear voices, but I don't hear them myself."
C) "The voices are not real. They're a product of your imagination."
D) "Do you think the voices would go away if we went into your room to talk?"

Question 22

Which interventions will the nurse implement to preserve milieu safety when a patient becomes agitated? Select all that apply.

A) Project confidence and control.
B) Provide a show of force when appropriate.
C) Ask the agitated patient why they are feeling so aggressive.
D) Move to within 5 feet of the patient to help contain their movement.
E) Provide the patient with several options as means of de-escalating the crisis.

Question 23

A patient admitted with the diagnosis of schizophreniform disorder R/O organic pathology.Based on this information,the nurse can expect that the patient will:

A) Be scheduled for a magnetic resonance imaging (MRI) test
B) See a mental health specialist for extensive psychological testing
C) Have an immunologic assay performed within 2 days of the admission
D) Participate in a dexamethasone suppression test (DST) administered by the staff

Question 24

During a treatment team meeting,the point is made that a patient with schizophrenia has recovered from the acute psychosis but continues to demonstrate apathy,avolition,and blunted affect.The nurse who relates these symptoms to serotonin (5HT?)excess will suggest that the patient receive:

A) Haloperidol (Haldol)
B) Chlorpromazine (Thorazine)
C) Olanzapine (Zyprexa)
D) Phenelzine (Nardil)

Question 25

What response would be anticipated when a patient who received chlorpromazine (Thorazine)for 15 years to treat schizophrenia is switched to Seroquel (quetiapine)?

A) Development of pseudoparkinsonism
B) Development of dystonic reactions
C) Improvement in tardive dyskinesia
D) Worsening of anticholinergic symptoms

Question 26

A patient tells the nurse,When I'm in the day room,I hear people whispering about me,and that makes me want to punch them." What direction will the nurse provide the staff regarding interacting with this patient?

A) "To minimize the need to whisper, utilize nonverbal techniques when possible."
B) "Stay physically close to this patient and use touch as a tool to interact with him."
C) "Treat this patient matter-of-factly. Be direct; don't talk about him or others in his presence."
D) "Interact with this patient only when necessary. The fewer interactions, the fewer misinterpretations there will be."

Question 27

A patient experiences intrusive,insulting auditory hallucinations.Which independent behavioral technique can the nurse teach the patient to employ when the voices are troublesome?

A) Introduce a distraction like reading.
B) Use positive talk to offset the insults.
C) Sing or whistle to compete with the voices.
D) Increase the daily dose of an antipsychotic medication.

Question 28

A patient is exhibiting auditory hallucinations in addition to being forgetful and easily confused.Which diagnosis does the nurse base this patient's interventions on?

A) Social isolation
B) Deficient knowledge
C) Situational low self-esteem
D) Impaired cognitive functioning

Question 29

Prior to discharge,the nurse plans to teach the patient and family about relapse.Which items will the nurse include in the teaching?

A) Recognizing warning signs of relapse
B) Using street drugs judiciously and only in small amounts
C) Lowering medication dosage to manage emerging side effects
D) Notifying the nurse of warning signs present for more than one month

Question 30

Which interventions will the nurse implement to assure effective staff crises management skills? Select all that apply.

A) Schedule regular staff crises simulations.
B) Encourage the staff to discuss the details of unit crises.
C) Attempt to identify staff who are ineffective during crises.
D) Review documentation that describe the details of unit crises.
E) Review unit crises management policies for needed updates.

Question 31

The wife of a patient newly diagnosed with paranoid schizophrenia is concerned that her husband "will be this sick for the rest of his life." What information can the nurse provide to the wife?

A) "This disorder generally responds well with treatment and follow-up."
B) "All types of schizophrenia by their nature are chronic relapsing disorders."
C) "Outcomes are related to the patient's pre-hospital symptoms of disorganization."
D) "The typical outcome for this diagnosis is that total remission is not achievable."

Question 32

A patient with catatonic schizophrenia has been standing with his left arm upraised and his right foot off the floor for the majority of the last 20 hours,eating only when allowed to eat standing up.Which nursing intervention has priority for this patient?

A) Providing high-calorie drinks hourly
B) Assessing for lower extremity edema bid
C) Taking the patient to activities therapy once daily
D) Encouraging the patient to sit or lie down for 30 minutes hourly

Question 33

Which nursing action best addresses the needs of a paranoid patient who believes the food is poisoned?

A) Explaining that others eat the food and are not harmed
B) Allowing the patient to select food from vending machines
C) Encouraging the patient to discuss why someone would poison the food
D) Taking steps to prevent the patient from verbalizing the delusional thoughts

Question 34

A patient with schizophrenia is medication compliant and has well-controlled symptoms.He has,however,never been successful in holding a job because of poor social skills and lack of understanding of basic job skills.The nurse case manager should consider referring the patient:

A) For cognitive therapy
B) To assertiveness training
C) To a day hospital program
D) For psychosocial rehabilitation

Question 35

A patient prescribed an antipsychotic medication develops a high fever,unstable blood pressure,and muscle rigidity.Her next dose of medication is due.The nurse should:

A) Administer the medication and monitor the vital signs every 4 hours.
B) Give a lower dose of the medication for 24 hours and monitor the blood pressure.
C) Prepare to administer a prn dose of the anticholinergic drug benztropine (Cogentin).
D) Hold the medication and immediately describe the patient's symptoms to the doctor.

Question 36

In planning aftercare for a patient with schizophrenia and whose insurance benefits have been exhausted,the nurse who is concerned about overcoming negative symptoms will make provisions for the patient to have stimulation,structure,socialization,and support.Which option would best incorporate these factors?

A) Day hospitalization
B) Attending a psychosocial club
C) Living with his elderly mother
D) Spending free time in the mall

Question 37

Because of the cognitive disturbances associated with schizophrenia,which technique will be useful as the nurse teaches a patient about self-management?

A) Use only verbal instruction.
B) Teach material in small segments.
C) Offer opportunities for making numerous choices.
D) Plan the teaching for a time when the patient has been recently medicated.