Deck 15: Schizophrenia

Question 1

A patient with schizophrenia refuses to take his medication because he believes he is not ill.What phenomenon most likely underlies this presentation?

A) The patient is unable to face having an illness and is in denial.
B) Stigma causes the patient to refuse to admit his mental illness.
C) The illness itself is preventing the patient from realizing he is ill.
D) Command hallucinations are instructing him to deny the illness.

Answer 1

The illness itself is preventing the patient from realizing he is ill.

Question 2

A highly suspicious patient who has delusions of persecution about being poisoned has refused all hospital meals for 3 days.Which of the following interventions would be most appropriate under these circumstances?

A) Feed the patient via tube,involuntarily via court order if needed.
B) Offer to taste each food item on the tray yourself while he watches.
C) Allow the patient to contact a local restaurant to deliver his meals.
D) Allow him supervised access to use food vending machines in the hospital lobby.

Answer 2

Allow him supervised access to use food vending machines in the hospital lobby.

Question 3

Police bring a 63-year-old woman to the emergency room,reporting that her behavior is disorganized and disruptive,that her speech makes little sense,and that she does not seem able to take care of herself.The woman has had elective surgeries at the hospital previously and was seen in the ER last week after a fall;records show no history of similar symptoms or mental illness.The ER physician speaks with the patient but does not examine her medically,diagnoses her with schizophrenia,and orders admission to the inpatient psychiatric unit.Which response by the nurse would be most appropriate?

A) Ask another physician with more of an interest in psychiatry to also take a look at this patient,explaining that you just want to be as thorough as possible.
B) Suggest that a psychiatric consult be requested before admitting the patient to a psychiatric unit,to validate the diagnosis and speed the initiation of medication.
C) Remind the physician that schizophrenia usually develops earlier in life,that such presentations may be caused by medical problems,and suggest a medical work-up.
D) Note that the patient's blood pressure and respirations were elevated when she arrived,and suggest that they be evaluated before admitting the patient to the psychiatric unit.

Answer 3

Remind the physician that schizophrenia usually develops earlier in life,that such presentations may be caused by medical problems,and suggest a medical work-up.

Question 4

A patient moving from chair to chair in the day room and pacing in the hallway repeatedly,rapidly,and for extended periods is likely demonstrating _________ ,and the nurse should __________.

A) a dystonic reaction…administer PRN IM benztropine (Cogentin)
B) anxiety… teach and guide the patient to use relaxation exercises
C) akathisia…administer PRN diphenhydramine (Benadryl)PO
D) tardive dyskinesia…recommend a change in medication

Question 5

A newly admitted patient diagnosed with paranoid schizophrenia is hypervigilant and constantly scans the environment.He states that he saw two doctors talking in the hall and knows they were plotting to kill him.When charting,how should the nurse identify this behavior?

A) Idea of reference
B) Delusion of infidelity
C) Auditory hallucination
D) Echolalia

Question 6

When a patient diagnosed with paranoid schizophrenia was discharged from the unit 6 months ago,the plan was for him to take chlorpromazine (Thorazine),a conventional (first generation)antipsychotic medication,300 mg po daily.He tells the nurse he stopped taking his pills after a few months because they made him feel like a "zombie." What other common side effects should the nurse determine if the patient experienced?

A) Sweating,nausea,and weight gain
B) Sedation,tremor,and muscle stiffness
C) Headache,watery eyes,and runny nose
D) Mild fever,sore throat,and skin rash

Question 7

A patient with catatonic schizophrenia exhibits little spontaneous movement and demonstrates waxy flexibility.Which nursing intervention should receive the highest priority?

A) Conducting passive range-of-motion exercises
B) Exposing the patient to auditory and visual stimuli
C) Interacting with the patient as if he is responding
D) Including the patient in a variety of milieu activities

Question 8

The wife of a patient with schizophrenia is worried about her 17-year-old daughter and asks the nurse what symptoms mark the prodromal stage of schizophrenia.The nurse should respond by listing behaviors such as:

A) withdrawal,poor concentration,phobic or obsessive behavior,oddities of speech.
B) auditory hallucinations,ideas of reference,thought insertion,and broadcasting.
C) stereotyped behavior,echopraxia,echolalia,waxy flexibility,thought-blocking.
D) looseness of associations,concrete thinking,echolalia,paranoid delusions.

Question 9

A patient has not come out of her room for breakfast.The nurse finds the patient moving restlessly about her room in a disorganized manner.The patient is talking to herself,and her verbal responses to the nurse are nonsensical and suggest disorientation.The nurse notices that the patient's skin is hot and dry,and her pupils are somewhat dilated.All these symptoms are significant departures from the patient's recent presentation.The patient is likely experiencing ________ ,and the nurse should ___________.

A) anticholinergic toxicity…check vital signs and prepare to use a cooling blanket stat
B) relapse of her psychosis…administer PRN antipsychotic drugs and notify her physician
C) neuroleptic malignant syndrome…contact her physician for a transfer to intensive care
D) agranulocytosis…hold her antipsychotic and draw blood for a complete blood count

Question 10

A patient was admitted to the mental health unit after arguing with co-workers and threatening to kill them.He is diagnosed with paranoid schizophrenia.On the unit he is aloof and suspicious.He mentioned that two physicians he saw talking were plotting to kill him.On the basis of data gathered at this point,which two primary nursing diagnoses should the nurse consider?

A) Disturbed thought processes and Risk for other-directed violence
B) Spiritual distress and Social isolation
C) Risk for loneliness and Knowledge deficit
D) Disturbed personal identity and Nonadherence

Question 11

A newly admitted patient with schizophrenia approaches the unit nurse and says,"The voices are bothering me.They are yelling and telling me stuff.They are really bad." Which response by the nurse would be most appropriate?

A) "Do you hear these voices very often?"
B) "Do you have a plan for getting away from the voices?"
C) "I'll stay with you.Tell me what you are hearing."
D) "Try to ignore them and play cards with the others."

Question 12

A salesman has had difficulty holding a job because he accuses co-workers of conspiring to take his sales.Today,he argued with several office mates and threatened to kill one of them.The police were called,and he was brought to the mental health center for evaluation.He has had previous admissions to the unit for stabilization of paranoid schizophrenia.When the nurse meets him,he points at staff in the nursing station and states loudly,"They're all plotting to destroy me.Isn't that true?" Which would be the most appropriate response?

A) "No,that is not true.People here are trying to help you if you will let them."
B) "Let's think about it: what reason would people have to want to destroy you?"
C) "Thinking that people want to destroy you must be very frightening."
D) "That doesn't make sense;staff are health care workers,not murderers."

Question 13

A patient's nursing care plan includes assessment for auditory hallucinations.Indicators that suggest the patient may be hallucinating include:

A) aloofness,increased distractibility,and suspicion.
B) elevated mood,hypertalkativeness,and distractibility.
C) performing rituals and avoiding open places.
D) darting eyes,distracted,and mumbling to self.

Question 14

The nurse is sitting with a patient diagnosed as having schizophrenia,disorganized type,who starts to laugh uncontrollably,although nothing funny has occurred.The nurse should say:

A) "Please share the joke with me."
B) "Why are you laughing?"
C) "I don't think I said anything funny."
D) "You're laughing.Tell me what's happening."

Question 15

A patient with schizophrenia is admitted to the psychiatric unit in an acutely disturbed,violent state.He is given several doses of haloperidol (Haldol)and becomes calm and approachable.During rounds the nurse notices the patient has his head rotated to one side in a stiffly fixed position.His lower jaw is thrust forward and he appears severely anxious.The patient has _________ ,and the nurse should _________.

A) a dystonic reaction…administer PRN IM benztropine (Cogentin)
B) tardive dyskinesia…seek a change in the drug or its dosage
C) waxy flexibility…continue treatment with antipsychotic drugs
D) akathisia…administer PRN diphenhydramine (Benadryl)PO

Question 16

Family members of a patient newly diagnosed with paranoid schizophrenia state that they do not understand what caused the patient's illness.The nurse's response should be predicated on the:

A) neurobiological-genetic model.
B) stress model.
C) family theory model.
D) developmental model.

Question 17

When a patient with paranoid schizophrenia has a recurrence of positive symptoms after stopping his antipsychotic medication because of its postural hypotension (orthostasis)side effect,he is readmitted to the mental health unit.What measure should the nurse suggest to help the patient address this side effect?

A) Ask the doctor to prescribe an anticholinergic drug like trihexyphenidyl (Artane).
B) Chew sugarless gum or use sugarless hard candy to moisten your mouth.
C) Increase the amount of sleep you get,and try to take frequent rest breaks.
D) Wear elastic support hose,drink adequate fluids,and change position slowly.

Question 18

A catatonic patient admitted in a stuporous condition begins to demonstrate increased motor activity.During his assessment,the psychiatrist raises the patient's arm above his head and releases it.The patient maintains the position his arm was placed in,immobile in that position for 15 minutes,moving only when the nurse gently lowers his arm.What symptom is demonstrated by this assessment technique?

A) Echopraxia
B) Waxy flexibility
C) Depersonalization
D) Thought withdrawal

Question 19

A patient received maintenance doses of fluphenazine decanoate (Prolixin Decanoate)25 mg IM every 2 weeks for 2 years.The clinic nurse notes the patient is grimacing and seems to be constantly smacking her lips.On the next clinic visit,the patient's neck and shoulders twist in a slow,snakelike motion.The nurse should suspect the presence of ________ and should __________.

A) agranulocytosis…check the patient's complete blood count for changes
B) tardive dyskinesia…administer the Abnormal Involuntary Movement Scale
C) Tourette's syndrome…consult the patient's physician about a neuro evaluation
D) anticholinergic effects…consult the physician about possible medication changes

Question 20

The nurse is told that a patient with disorganized schizophrenia is being admitted to the unit.The nurse should expect the patient to demonstrate:

A) highly suspicious,delusional behavior.
B) extremes of motor activity and excitement to stupor.
C) social withdrawal and ineffective communication.
D) severe anxiety and ritualistic behavior.

Question 21

A male patient diagnosed with paranoid schizophrenia typically relates effectively with female staff but angrily tells the male nurse,"You act like a homosexual.None of the men trust you or want to be around you." The nurse,who is heterosexual,is perplexed by the patient's statements and discusses the event with his mentor.Which explanation most likely underlies the patient's behavior?

A) The patient was unleashing unconscious,hostile feelings toward the nurse.
B) The patient feared the nurse would reject him,so he coped by rejecting the nurse first.
C) It was the patient's way of distancing himself from potential emotional intimacy.
D) The patient was coping with homosexual urges by projecting them onto the nurse.

Question 22

A patient is noted to be bending over backward in the group room.A peer asks what he is doing,and he replies,"People say they are bending over backwards to help me,so I am bending over backwards to help myself." This is an example of:

A) abstract thinking.
B) concrete thinking.
C) impaired reality testing.
D) boundary impairment.

Question 23

At 11:00 AM,a patient with schizophrenia who exhibits concrete thinking asks the nurse for PRN acetaminophen (Tylenol).However,he last had it at 8:00 AM,and it is ordered only every 4 hours.Which nursing response would be most therapeutic?

A) "I'm sorry,it's not quite time yet;please come back again in 1 hour."
B) "I'm sorry,it's not quite time yet;please come back again at 12 noon."
C) "It's not time yet;please come back when both hands of the clock point straight up."
D) "It's not time yet;I will let you know when it is time.Perhaps a nap would help?"

Question 24

The physician and advanced practice nurse are considering which antipsychotic medication to prescribe for a patient with schizophrenia who demonstrates auditory hallucinations,apathy,anhedonia,and poor social functioning.The patient is overweight and has hypertension.Bearing these facts in mind,the drug the nurse should advocate would be:

A) clozapine (Clozaril).
B) haloperidol (Haldol).
C) olanzapine (Zyprexa).
D) aripiprazole (Abilify).

Question 25

The family of a patient with schizophrenia who has been stable for a year reports to the community mental health nurse that the patient reports feeling tense and having difficulty concentrating.He sleeps only 3 to 4 hours nightly and has begun to talk about creatures called "volmers" hiding in the warehouse where he works and undoing his work each night.This information most likely suggests:

A) medication nonadherence.
B) a need for psychoeducation.
C) the chronic nature of his illness.
D) relapse of his schizophrenia.

Question 26

The physician prescribes haloperidol (Haldol),a first-generation antipsychotic drug,for a patient with schizophrenia who displays delusions,hallucinations,apathy,and social isolation.Which symptoms should most be monitored to evaluate the expected improvement from this medication?

A) Talking to himself,belief that others will harm him
B) Flat affect,avoidance of social activities,poor hygiene
C) Loss of interest in recreational activities,alogia
D) Impaired eye contact,needs help to complete tasks

Question 27

A patient with many positive symptoms of schizophrenia,whose behavior is disorganized and who is highly anxious,tells the nurse in the psychiatric emergency department,"You have got to help me.I do not know what is going on.I think someone is trying to wipe me out.I have to get a gun." The patient,a college student,lives alone and has no family or support system in the immediate area.He has not left his room in 2 weeks,has not eaten in several days,and is unkempt.Of the available treatment settings,the nurse should recommend:

A) admission to an unlocked residential crisis unit.
B) inpatient hospitalization on a locked unit.
C) attending a day treatment program for 4 weeks.
D) admission to a partial hospital program.

Question 28

A patient has schizophrenia and is troubled by negative symptoms,muscle stiffness,and motor restlessness.His Advanced Practice Nurse (APN)is considering changing the patient's antipsychotic medication,haloperidol (Haldol,a typical or first generation antipsychotic drug).For planning purposes,which medication can the nurse assume that the APN will probably choose?

A) Chlorpromazine (Thorazine)
B) Clozapine (Clozaril)
C) Olanzapine (Zyprexa)
D) Fluoxetine (Prozac)

Question 29

A patient with the diagnosis of schizophrenia,disorganized type,approaches the nurse and says,"It's beat,it's eat.No room for doom." The nurse can correctly assess this verbalization as:

A) neologisms.
B) clanging.
C) ideas of reference.
D) associative looseness.

Question 30

A patient with schizophrenia has received typical (first-generation)antipsychotics for a year.His hallucinations are less intrusive,but he remains apathetic,has poverty of thought,cannot work,and is socially isolated.To address these symptoms,the nurse might consult the prescribing health care provider to suggest a change to:

A) haloperidol (Haldol).
B) olanzapine (Zyprexa).
C) diphenhydramine (Benadryl).
D) chlorpromazine (Thorazine).

Question 31

A patient with schizophrenia begins to talk about creatures called "volmers" hiding in the warehouse where he works and undoing his work each night.The term "volmers" most likely represents:

A) a neologism.
B) clanging.
C) anhedonia.
D) alogia.

Question 32

A patient standing in the dining room screams,"You are going to kill me!" He is very agitated and seems extremely frightened.He is mumbling to himself,and his eyes are darting as if tracking an unseen person.He then says repeatedly,"No! I can't! No!" Put the nursing interventions in the order they should be undertaken.

A) Send other staff to report the situation and obtain PRN medication.
B) Assure the patient that staff will make sure that everyone stays safe.
C) Clear the dining room of other patients and unnecessary personnel.
D) Explain that the medication will stop the voices,then administer it.

Question 33

A patient with schizophrenia tells the nurse "I don't know,it's just all the same.You never know.It comes,it goes,it blows away.Get it?" The best response for the nurse to make would be:

A) "Nothing you are saying is clear;you are not making sense."
B) "Yes,life can be like that sometimes,very confusing."
C) "Try to organize your thoughts and then tell me again."
D) "I am having difficulty understanding what you are saying."

Question 34

A patient with schizophrenia tells the nurse,"Everyone must listen to me.I am the redeemer.I will bring peace to the world." From this the nurse can determine that an appropriate nursing diagnosis is:

A) Disturbed sensory perception: auditory.
B) Risk for other-directed violence.
C) Chronic low self-esteem.
D) Nonadherence: medication.

Question 35

The nurse spends several sessions with a patient with paranoid schizophrenia and the patient's family to help them understand the importance of antipsychotic medication in controlling his illness.The patient repeatedly states he isn't sick and the pills make him stiff,and family members say he doesn't think the medication helps him.They indicate that their efforts to promote adherence only lead to a hostile response from the patient.Which options should the nurse discuss with the patient's prescribing provider? Select all that apply.

A) Using a long-acting injectable antipsychotic medication
B) Adding medications to reduce the patient's side effects
C) Adding a benzodiazepine such as diazepam (Valium)
D) Tying medication use to meeting the patient's own goals
E) Increasing discussion and problem solving regarding side effects

Question 36

Select the outcomes most appropriate for a patient in the third (maintenance)phase of treatment for schizophrenia."The patient will _________." Select all that apply.

A) take all medications as ordered
B) maintain a regular sleep pattern
C) use alcohol and caffeine as desired
D) participate in a support group
E) express satisfaction with his life

Question 37

A patient with schizophrenia has been stabilized in the Crisis Center and is about to be discharged.He will be living with his family,but the family knows nothing about the patient's illness,its treatment,or the role they can play in his recovery.Which activity would be most beneficial for the family to attend?

A) Psychoanalytic group
B) Psychoeducational group
C) Individual counseling
D) Family therapy

Question 38

A patient receiving risperidone (Risperdal)reports severe muscle stiffness midmorning.During lunch he has difficulty swallowing food and speaking,and when vital signs are taken 30 minutes later,he is noted to be stuporous and diaphoretic,with a temperature of 38.8° C,pulse of 110 beats/min,and blood pressure of 150/90 mm Hg.The nurse should suspect _________ and should ______________.

A) neuroleptic malignant syndrome…place him in a cooling blanket and transfer to ICU
B) anticholinergic toxicity…check vital signs and prepare to use a cooling blanket stat
C) relapse of his psychosis…administer PRN antipsychotic drugs and notify his physician
D) agranulocytosis…hold his antipsychotic and draw blood for a complete blood count

Question 39

A patient with schizophrenia who admits to auditory hallucinations anxiously tells the nurse,"The voice is telling me to do things." Which of the following responses should the nurse make next?

A) "Do you recognize the voice you hear?'
B) "How long has this been happening?"
C) "Does what the voice tells you to do frighten you?"
D) "What is the voice telling you to do?"

Question 40

A patient with schizophrenia who has received chlorpromazine (Thorazine)200 mg PO four times daily for 4 weeks has symptoms of a shuffling,propulsive gait,a masklike face,and drooling.Which nursing response would be most appropriate? Select all that apply.

A) Advise the patient to be patient,since these side effects are only temporary.
B) Seek a physician order for a PRN IM antiparkinsonian medication.
C) Suggest carrying a towel to catch any drool,and initiate fall precautions.
D) Administer PRN trihexyphenidyl (Artane)PO to suppress the side effects.
E) Suggest administering half the medicine in the morning and half at bedtime.