Chapter 12: Schizophrenia Spectrum Disorders PDF

*wnloaded by: cklabrack \| cklabrack\@gmail.com* *Distribution of this document is illegal* *Want to earn \$1.236* *extra per year?* *Stuvia.com - The Marketplace to Buy and Sell your Study Material* *Chapter 12: Schizophrenia Spectrum Disorders Halter: Varcarolis' Foundations of* *Psychiatric...

*wnloaded by: cklabrack \| cklabrack\@gmail.com* *Distribution of this document is illegal* *Want to earn \$1.236* *extra per year?* *Stuvia.com - The Marketplace to Buy and Sell your Study Material* *Chapter 12: Schizophrenia Spectrum Disorders Halter: Varcarolis' Foundations of* *Psychiatric-Mental Health Nursing: A Clinical Approach, 9th Edition* *MULTIPLE CHOICE* *1. A client has had difficulty keeping a job because of arguing with co-workers and accusing* *them of conspiracy. Today this client shouts, "They're all plotting to destroy me. Isn't that* *true?" what is the nurse's most therapeutic response?* *a. "Everyone here is trying to help you. No one wants to harm you."* *b. "Feeling that people want to destroy you must be very frightening."* *c. "That is not true. People here are trying to help you if you will let them."* *d. "Staff members are health care professionals who are qualified to help you."* *ANS: B* *Resist focusing on content; instead, focus on the feelings the client is expressing. This* *strategy prevents arguing about the reality of delusional beliefs. Such arguments increase* *client anxiety and the tenacity with which the client holds to the delusion. The other options* *focus on content and provide opportunity for argument.* *PTS: 1 DIF: Cognitive Level: Apply (Application) TOP: Nursing Process:* *Implementation MSC: Client Needs: Psychosocial Integrity* *2. A newly admitted client diagnosed with schizophrenia is hypervigilant and constantly scans* *the environment. The client states, "I saw two doctors talking in the hall. They were plotting* *to kill me." The nurse may correctly assess this behavior using which term? a. echolalia.* *b. paranoia* *c. a delusion of infidelity.* *d. an auditory hallucination.* *ANS: B* *Paranoia is an irrational fear, ranging from mild (being suspicious, wary, guarded) to* *profound (believing irrationally that another person intends to kill you).; for example, when* *seeing two people talking, the individual assumes they are talking about him or her. The* *other terms do not correspond with the scenario.* *PTS: 1 DIF: Cognitive Level: Understand (Comprehension)* *TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity* *3. A client diagnosed with schizophrenia says, "My co-workers are out to get me. I also saw two* *doctors plotting to kill me." How does this client perceive the environment?* *a. Disorganized* *b. Dangerous* *c. Supportive* *d. Bizarre* *Downloaded by: cklabrack \| cklabrack\@gmail.com* *Distribution of this document is illegal* *Want to earn \$1.236* *extra per year?* *Stuvia.com - The Marketplace to Buy and Sell your Study Material* *ANS: B* *The client sees the world as hostile and dangerous. This assessment is important because the* *nurse can be more effective by using empathy to respond to the client. Data are not present* *to support any of the other options.* *PTS: 1 DIF: Cognitive Level: Understand (Comprehension)* *TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity* *4. When a client diagnosed with schizophrenia was discharged 6 months ago, haloperidol was* *prescribed. The client now says, "I stopped taking those pills. They made me feel like a* *robot." What are common side effects the nurse should validate with the client?* *a. Sedation and muscle stiffness* *b. Sweating, nausea, and diarrhea* *c. Mild fever, sore throat, and skin rash* *d. Headache, watery eyes, and runny nose* *ANS: A* *Typical antipsychotic drugs often produce sedation and extrapyramidal side effects such as* *stiffness and gait disturbance, effects the client might describe as making him or her feel like* *a "robot." The side effects mentioned in the other options are usually not associated with* *typical antipsychotic therapy or would not have the effect described by the client.* *PTS: 1 DIF: Cognitive Level: Apply (Application)* *TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity* *5. Which hallucination expressed by a client necessitates the nurse to implement safety* *measures?* *a. "I hear angels playing harps."* *b. "The voices say everyone is trying to kill me."* *c. "My dead father tells me I am a good person."* *d. "The voices talk only at night when I'm trying to sleep."* *ANS: B* *The correct response indicates the client is experiencing paranoia. Paranoia often leads to* *fearfulness, and the client may attempt to strike out at others to protect self. The distracters* *are comforting hallucinations or do not indicate paranoia.* *PTS: 1 DIF: Cognitive Level: Analyze (Analysis)* *TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity* *6. A client's care plan includes monitoring for auditory hallucinations. Which assessment* *findings suggest the client may be hallucinating?* *a. Detachment and overconfidence* *b. Darting eyes, tilted head, mumbling to self* *c. Euphoric mood, hyperactivity, distractibility* *Downloaded by: cklabrack \| cklabrack\@gmail.com* *Distribution of this document is illegal* *Want to earn \$1.236* *extra per year?* *Stuvia.com - The Marketplace to Buy and Sell your Study Material* *d. Foot tapping and repeatedly writing the same phrase* *ANS: B* *Clues to hallucinations include eyes looking around the room as though to find the speaker,* *tilting the head to one side as though listening intently, and grimacing, mumbling, or talking* *aloud as though responding conversationally to someone.* *PTS: 1 DIF: Cognitive Level: Understand (Comprehension)* *TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity* *7. A health care provider considers which antipsychotic medication to prescribe for a client* *diagnosed with schizophrenia who has auditory hallucinations and poor social function. The* *client is also overweight and hypertensive. Which drug should the nurse advocate? a.* *Clozapine* *b. Ziprasidone* *c. Olanzapine* *d. Aripiprazole* *ANS: D* *Aripiprazole is a third-generation atypical antipsychotic effective against both positive and* *negative symptoms of schizophrenia. It causes little or no weight gain and no increase in* *glucose, high- or low-density lipoprotein cholesterol, or triglycerides, making it a reasonable* *choice for a client with obesity or heart disease. Clozapine may produce agranulocytosis,* *making it a poor choice as a first-line agent. Ziprasidone may prolong the QT interval, making* *it a poor choice for a client with cardiac disease. Olanzapine fosters weight gain.* *PTS: 1 DIF: Cognitive Level: Analyze (Analysis)* *TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity* *8. A client diagnosed with schizophrenia tells the nurse, "I eat skiller. Tend to end. Easter. It* *blows away. Get it?" What is the nurse's most therapeutic response?* *a. "Nothing you are saying is clear."* *b. "Your thoughts are very disconnected."* *c. "Try to organize your thoughts and then tell me again."* *d. "I am having difficulty understanding what you are saying."* *ANS: D* *When a client's speech is loosely associated, confused, and disorganized, pretending to* *understand is useless. The nurse should tell the client that he or she is having difficulty* *understanding what the client is saying. If a theme is discernible, ask the client to talk about* *the theme. The incorrect options tend to place blame for the poor communication with the* *client. The correct response places the difficulty with the nurse rather than being accusatory.* *PTS: 1 DIF: Cognitive Level: Apply (Application) TOP: Nursing Process:* *Implementation MSC: Client Needs: Psychosocial Integrity* *Downloaded by: cklabrack \| cklabrack\@gmail.com* *Distribution of this document is illegal* *Want to earn \$1.236* *extra per year?* *Stuvia.com - The Marketplace to Buy and Sell your Study Material* *9. A client diagnosed with schizophrenia exhibits little spontaneous movement and* *demonstrates catatonia. Which client needs are of priority importance?* *a. Self-esteem* *b. Psychosocial* *c. Physiological* *d. Self-actualization* *ANS: C* *Physiological needs must be met to preserve life. A client with catatonia must be fed by hand* *or tube, toileted, given range-of-motion exercises, and so forth to preserve physiological* *integrity. Cattonia may also precipitate a risk for falls; therefore, safety is a concern. Higher* *level needs are of lesser concern.* *PTS: 1 DIF: Cognitive Level: Analyze (Analysis)* *TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity* *10. A client diagnosed with schizophrenia demonstrates little spontaneous movement and has* *catatonia. The client's activities of daily living are severely compromised. What will be an* *appropriate outcome for this client?* *a. demonstrates increased interest in the environment by the end of week 1.* *b. performs self-care activities with coaching by the end of day 3.* *c. gradually takes the initiative for self-care by the end of week 2.* *d. accepts tube feeding without objection by day 2.* *ANS: B* *Outcomes related to self-care deficit nursing diagnoses should deal with increasing ability to* *perform self-care tasks independently, such as feeding, bathing, dressing, and toileting.* *Performing the tasks with coaching by nursing staff denotes improvement over the complete* *inability to perform the tasks. The incorrect options are not directly related to self-care* *activities, difficult to measure, and unrelated to maintenance of nutrition.* *PTS: 1 DIF: Cognitive Level: Apply (Application)* *TOP: Nursing Process: Outcomes Identification* *MSC: Client Needs: Physiological Integrity* *11. A nurse observes a catatonic client standing immobile, facing the wall with one arm* *extended in a salute. The client remains immobile in this position for 15 minutes, moving* *only when the nurse gently lowers the arm. What is the name of this phenomenon?* *a. Echolalia* *b. Catatonia* *c. Depersonalization* *d. Thought withdrawal* *ANS: B* *Downloaded by: cklabrack \| cklabrack\@gmail.com* *Distribution of this document is illegal* *Want to earn \$1.236* *extra per year?* *Stuvia.com - The Marketplace to Buy and Sell your Study Material* *Catatonia is the ability to hold distorted postures for extended periods of time, as though the* *client were molded in wax. Echolalia is a speech pattern. Depersonalization refers to a feeling* *state. Thought withdrawal refers to an alteration in thinking.* *PTS: 1 DIF: Cognitive Level: Understand (Comprehension)* *TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity* *12. A nurse leads a psychoeducational group about first-generation antipsychotic medications* *with six adult men diagnosed with schizophrenia. The nurse will monitor for concerns* *regarding body image with respect to which potential side effect of these medications? a.* *Constipation* *b. Gynecomastia* *c. Visual changes* *d. Photosensitivity* *ANS: B* *FGAs (first-generation antipsychotic) stimulate release of prolactin, which can result in* *gynecomastia (enlargement of the breasts) as well as other changes in sexual function. Men* *may experience disturbances in body image as a result of gynecomastia. Other side effects of* *FGAs may be disturbing to other aspects of the client's physical health but are not likely to* *bother body image.* *PTS: 1 DIF: Cognitive Level: Analyze (Analysis)* *TOP: Nursing Process: Nursing Diagnosis* *MSC: Client Needs: Physiological Integrity* *13. A nurse leads a psychoeducational group about problem solving with six adults diagnosed* *with schizophrenia. Which teaching strategy is likely to be most effective?* *a. Suggest analogies that might apply to a common daily problem.* *b. Assign each participant a problem to solve independently and present to the group.* *c. Ask each client to read aloud a short segment from a book about problem solving.* *d. Invite participants to come up with solution to getting incorrect change for a purchase.* *ANS: D* *Concrete thinking, an impaired ability to think abstractly resulting in interpreting or* *perceiving things in a literal manner, is evident in many clients diagnosed with schizophrenia.* *People who think concretely benefit from concrete situations during education. Finding a* *solution in order to get incorrect change for a purchase is an example of a concrete situation.* *Analogies require abstract thinking and insight. Independently solving a problem and* *presenting it to the group may be intimidating. All participants may or may not be literate.* *PTS: 1 DIF: Cognitive Level: Analyze (Analysis) TOP: Nursing Process:* *Implementation MSC: Client Needs: Psychosocial Integrity* *14. A nurse educates a client about the antipsychotic medication regime. Afterward, which* *comment by the client indicates the teaching was effective?* *Downloaded by: cklabrack \| cklabrack\@gmail.com* *Distribution of this document is illegal* *Want to earn \$1.236* *extra per year?* *Stuvia.com - The Marketplace to Buy and Sell your Study Material* *a. "I will need higher and higher doses of my medication as time goes on."* *b. "I need to store my medication in a cool dark place, such as the refrigerator."* *c. "Taking this medication regularly will reduce the severity of my symptoms."* *d. "If I run out or stop taking my medication, I will experience withdrawal symptoms."* *ANS: C* *Antipsychotic drugs provide symptom control and allow most clients diagnosed with* *schizophrenia to live and be treated in the community. Dosing is individually determined.* *Antipsychotics are not addictive; however, they should be discontinued gradually to minimize* *a discontinuation syndrome.* *PTS: 1 DIF: Cognitive Level: Apply (Application)* *TOP: Nursing Process: Evaluation MSC: Client Needs: Physiological Integrity* *15. A newly admitted client diagnosed with schizophrenia says, "The voices are bothering me.* *They yell and tell me I am bad. I have got to get away from them." Select the nurse's most* *helpful reply.* *a. "Do you hear the voices often?"* *b. "Do you have a plan for getting away from the voices?"* *c. "I'll stay with you. Focus on what we are talking about, not the voices. "* *d. "Forget the voices and ask some other clients to play cards with you."* *ANS: C* *Staying with a distraught client who is hearing voices serves several purposes: ongoing* *observation, the opportunity to provide reality orientation, a means of helping dismiss the* *voices, the opportunity of forestalling an action that would result in self-injury, and general* *support to reduce anxiety. Asking if the client hears voices is not particularly relevant at this* *point. Asking if the client plans to "get away from the voices" is relevant for assessment* *purposes but is less helpful than offering to stay with the client while encouraging a focus on* *their discussion. Suggesting playing cards with other clients shifts responsibility for* *intervention from the nurse to the client and other clients.* *PTS: 1 DIF: Cognitive Level: Apply (Application) TOP: Nursing Process:* *Implementation MSC: Client Needs: Psychosocial Integrity* *16. A client diagnosed with schizophrenia has taken fluphenazine 5 mg po bid for 3 weeks. The* *nurse now observes a shuffling propulsive gait, a mask-like face, and drooling. Which term* *applies to these symptoms?* *a. Neuroleptic malignant syndrome* *b. Hepatocellular effects* *c. Pseudoparkinsonism* *d. Akathisia* *ANS: C* *Downloaded by: cklabrack \| cklabrack\@gmail.com* *Distribution of this document is illegal* *Want to earn \$1.236* *extra per year?* *Stuvia.com - The Marketplace to Buy and Sell your Study Material* *Pseudoparkinsonism induced by antipsychotic medication mimics the symptoms of* *Parkinson's disease. It frequently appears within the first month of treatment and is more* *common with first-generation antipsychotic drugs. Hepatocellular effects would produce* *abnormal liver test results. Neuroleptic malignant syndrome is characterized by autonomic* *instability. Akathisia produces motor restlessness.* *PTS: 1 DIF: Cognitive Level: Understand (Comprehension)* *TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity* *17. A client diagnosed with schizophrenia is very disturbed and violent. After several doses of* *haloperidol, the client is calm. Two hours later the nurse sees the client's head rotated to* *one side in a stiff position, the lower jaw thrust forward, and drooling. Which problem is* *most likely?* *a. An acute dystonic reaction* *b. Tardive dyskinesia* *c. Waxy flexibility* *d. Akathisia* *ANS: A* *Acute dystonic reactions involve painful contractions of the tongue, face, neck, and back.* *Opisthotonos and oculogyric crisis may be observed. Dystonic reactions are considered* *emergencies requiring immediate intervention. Tardive dyskinesia involves involuntary* *spasmodic muscular contractions that involve the tongue, fingers, toes, neck, trunk, or pelvis.* *It appears after prolonged treatment. Waxy flexibility is a symptom seen in catatonic* *schizophrenia. Internal and external restlessness, pacing, and fidgeting are characteristics of* *akathisia.* *PTS: 1 DIF: Cognitive Level: Analyze (Analysis)* *TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity* *18. An acutely violent client diagnosed with schizophrenia received several doses of haloperidol.* *Two hours later the nurse notices the client's head rotated to one side in a stiffly fixed* *position, the lower jaw thrust forward, and drooling. Which intervention by the nurse is* *indicated?* *a. Administer diphenhydramine 50 mg IM from the prn medication administration record.* *b. Reassure the client that the symptoms will subside. Practice relaxation exercises with the* *client.* *c. Give trihexyphenidyl 5 mg orally at the next regularly scheduled medication* *administration time.* *d. Administer atropine sulfate 2 mg subcut from the prn medication administration record.* *ANS: A* *Diphenhydramine, trihexyphenidyl, benztropine, and other anticholinergic medications may* *be used to treat dystonias. Swallowing will be difficult or impossible; therefore, oral* *medication is not an option. Medication should be administered immediately, so the* *intramuscular route is best. In this case, the best option given is diphenhydramine.* *Downloaded by: cklabrack \| cklabrack\@gmail.com* *Distribution of this document is illegal* *Want to earn \$1.236* *extra per year?* *Stuvia.com - The Marketplace to Buy and Sell your Study Material* *PTS: 1 DIF: Cognitive Level: Analyze (Analysis) TOP: Nursing Process:* *Implementation MSC: Client Needs: Physiological Integrity* *19. A client diagnosed with schizophrenia has received fluphenazine decanoate twice a month* *for 3 years. The clinic nurse notes that the client grimaces and constantly smacks both lips.* *The client's neck and shoulders twist in a slow, snakelike motion. Which problem would the* *nurse suspect?* *a. Agranulocytosis* *b. Tardive dyskinesia* *c. Tourette's syndrome* *d. Anticholinergic effects* *ANS: B* *Fluphenazine decanoate is a first-generation antipsychotic medication. Tardive dyskinesia is a* *condition involving the face, trunk, and limbs that occurs more frequently with* *firstgeneration antipsychotics than second or third generation. Involuntary movements, such* *as tongue thrusting; licking; blowing; irregular movements of the arms, neck, and shoulders;* *rocking; hip jerks; and pelvic thrusts, are seen. These symptoms are frequently not reversible* *even when the drug is discontinued. The scenario does not present evidence consistent with* *the other disorders mentioned. Agranulocytosis is a blood disorder. Tourette's syndrome is a* *condition in which tics are present. Anticholinergic effects include dry mouth, blurred vision,* *flushing, constipation, and dry eyes.* *PTS: 1 DIF: Cognitive Level: Analyze (Analysis)* *TOP: Nursing Process: Evaluation MSC: Client Needs: Physiological Integrity* *20. A nurse sits with a client diagnosed with schizophrenia. The client starts to laugh* *uncontrollably, although the nurse has not said anything funny. What is the nurse's most* *therapeutic response?* *a. "Why are you laughing?"* *b. "Please share the joke with me."* *c. "I don't think I said anything funny."* *d. "You're laughing. Tell me what's happening."* *ANS: D* *The client is likely laughing in response to inner stimuli, such as hallucinations or fantasy.* *Focus on the hallucinatory clue (the client's laughter) and then elicit the client's observation.* *The incorrect options are less useful in eliciting a response: no joke may be involved, "why"* *questions are difficult to answer, and the client is probably not focusing on what the nurse* *said in the first place.* *PTS: 1 DIF: Cognitive Level: Apply (Application) TOP: Nursing Process:* *Implementation MSC: Client Needs: Psychosocial Integrity* *Downloaded by: cklabrack \| cklabrack\@gmail.com* *Distribution of this document is illegal* *Want to earn \$1.236* *extra per year?* *Stuvia.com - The Marketplace to Buy and Sell your Study Material* *21. The nurse assesses a client diagnosed with schizophrenia. Which assessment finding would* *the nurse regard as a negative symptom of schizophrenia?* *a. Auditory hallucinations* *b. Delusions of grandeur* *c. Poor personal hygiene* *d. Psychomotor agitation* *ANS: C* *Negative symptoms include apathy, anhedonia, poor social functioning, and poverty of* *thought. Poor personal hygiene is an example of poor social functioning. The distractors are* *positive symptoms of schizophrenia. See relationship to audience response question.* *PTS: 1 DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing* *Process: Assessment MSC: Client Needs: Psychosocial Integrity* *22. What assessment findings mark the prodromal stage of schizophrenia?* *a. Withdrawal, misinterpreting, poor concentration, and preoccupation with religion* *b. Auditory hallucinations, ideas of reference, thought insertion, and broadcasting* *c. Stereotyped behavior, echopraxia, echolalia, and waxy flexibility* *d. Loose associations, concrete thinking, and echolalia neologisms* *ANS: A* *Withdrawal, misinterpreting, poor concentration, and preoccupation with religion are* *prodromal symptoms, the symptoms that are present before the development of florid* *symptoms. The incorrect options each list the positive symptoms of schizophrenia that might* *be apparent during the acute stage of the illness.* *PTS: 1 DIF: Cognitive Level: Understand (Comprehension)* *TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity* *23. A client diagnosed with schizophrenia says, "Contagious bacteria are everywhere. When* *they get in your body, you will be locked up with other infected people." Which problem is* *evident?* *a. Poverty of content* *b. Concrete thinking* *c. Neologisms* *d. Paranoia* *ANS: D* *The client's unrealistic fear of harm indicates paranoia. Neologisms are invented words.* *Concrete thinking involves literal interpretation. Poverty of content refers to an inadequate* *fund of information.* *PTS: 1 DIF: Cognitive Level: Understand (Comprehension)* *TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity* *Downloaded by: cklabrack \| cklabrack\@gmail.com* *Distribution of this document is illegal* *Want to earn \$1.236* *extra per year?* *Stuvia.com - The Marketplace to Buy and Sell your Study Material* *24. A client diagnosed with schizophrenia begins a new prescription for ziprasidone. The client is* *5\'6\'\' and currently weighs 204 lbs. The client has dry flaky skin, headaches about twice a* *month, and a family history of colon cancer. Which intervention has the highest priority for* *the nurse to include in the client's plan of care?* *a. Skin care techniques* *b. Scheduling a colonoscopy* *c. Weight management strategies* *d. Teaching to limit caffeine intake* *ANS: C* *Ziprasidone is a second-generation antipsychotic medication. The incidence of weight gain,* *diabetes, and high cholesterol is high with second-generation antipsychotic medications. The* *client is overweight now, so weight management will be especially important. The other* *interventions may occur in time, but do not have the priority of weight management.* *PTS: 1 DIF: Cognitive Level: Analyze (Analysis)* *TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity* *25. A client diagnosed with schizophrenia says, "It's beat. Time to eat. No room for the cat."* *What type of verbalization is evident?* *a. Neologism* *b. Idea of reference* *c. Thought broadcasting* *d. Associative looseness* *ANS: D* *Looseness of association refers to jumbled thoughts incoherently expressed to the listener.* *Neologisms are newly coined words. Ideas of reference are a type of delusion. Thought* *broadcasting is the belief that others can hear one's thoughts.* *PTS: 1 DIF: Cognitive Level: Understand (Comprehension)* *TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity* *26. A client diagnosed with schizophrenia has taken a conventional antipsychotic medication for* *a year. Hallucinations are less intrusive, but the client continues to have apathy, poverty of* *thought, and social isolation. The nurse would expect a change to which medication? a.* *Haloperidol* *b. Olanzapine* *c. Chlorpromazine* *d. Diphenhydramine* *ANS: B* *Olanzapine is a second-generation atypical antipsychotic that targets both positive and* *negative symptoms of schizophrenia. Haloperidol and chlorpromazine are conventional* *antipsychotics that target only positive symptoms. Diphenhydramine is an antihistamine.* *Downloaded by: cklabrack \| cklabrack\@gmail.com* *Distribution of this document is illegal* *Want to earn \$1.236* *extra per year?* *Stuvia.com - The Marketplace to Buy and Sell your Study Material* *See relationship to audience response question.* *PTS: 1 DIF: Cognitive Level: Analyze (Analysis)* *TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity* *27. The family of a client diagnosed with schizophrenia is unfamiliar with the illness and family's* *role in recovery. Which type of therapy should the nurse recommend?* *a. Psychoeducational* *b. Psychoanalytic* *c. Transactional* *d. Family* *ANS: A* *A psychoeducational group explores the causes of schizophrenia, the role of medication, the* *importance of medication compliance, support for the ill member, and hints for living with a* *person with schizophrenia. Such a group can be of immeasurable practical assistance to the* *family. The other types of therapy do not focus on psychoeducation.* *PTS: 1 DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation* *MSC: Client Needs: Health Promotion and Maintenance* *28. A client diagnosed with schizophrenia has been stable for a year; however, the family now* *reports the client is tense, sleeps 3 to 4 hours per night, and has difficulty concentrating. The* *client says, "My computer is sending out infected radiation beams." The nurse can correctly* *assess this information as an indication of what?* *a. the need for psychoeducation.* *b. medication nonadherence.* *c. chronic deterioration.* *d. relapse.* *ANS: D* *Signs of potential relapse include feeling tense, difficulty concentrating, trouble sleeping,* *increased withdrawal, and increased bizarre or magical thinking. Medication nonadherence* *may not be implicated. Relapse can occur even when the client is taking medication* *regularly. Psychoeducation is more effective when the client's symptoms are stable. Chronic* *deterioration is not the best explanation.* *PTS: 1 DIF: Cognitive Level: Analyze (Analysis)* *TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity* *29. A client diagnosed with schizophrenia begins to talks about "macnabs" hiding in the* *warehouse at work. The client's use of "macnabs" should be documented using what term?* *a. a neologism.* *b. concrete thinking.* *c. thought insertion.* *d. an idea of reference.* *ANS: A* *A neologism is a newly coined word having special meaning to the client. "Macnabs" is not a* *known common word. Concrete thinking refers to the inability to think abstractly. Thought* *insertion refers to thoughts of others are implanted in one's mind. Ideas of reference are a* *type of delusion in which trivial events are given personal significance.* *PTS: 1 DIF: Cognitive Level: Understand (Comprehension)* *TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity* *30. A client diagnosed with schizophrenia anxiously says, "I can see the left side of my body* *merging with the wall, then my face appears and disappears in the mirror." While listening,* *the nurse should engage in what behavior?* *a. sit close to the client.* *b. place an arm protectively around the client's shoulders.* *c. place a hand on the client's arm and exert light pressure.* *d. maintain a normal social interaction distance from the client.* *ANS: D* *The client is describing phenomena that indicate personal boundary difficulties and* *depersonalization. The nurse should maintain appropriate social distance and not touch the* *client because the client is anxious about the inability to maintain ego boundaries and* *merging or being swallowed by the environment. Physical closeness or touch could* *precipitate panic.* *PTS: 1 DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation* *MSC: Client Needs: Psychosocial Integrity* *31. A client diagnosed with schizophrenia anxiously tells the nurse, "The voice is telling me to do* *things." What is the nurse's priority assessment question?* *a. "How long has the voice been directing your behavior?"* *b. "Does what the voice tell you to do frighten you?"* *c. "Do you recognize the voice speaking to you?'* *d. "What is the voice telling you to do?"* *ANS: D* *Learning what a command hallucination is telling the client to do is important because the* *command often places the client or others at risk for harm. Command hallucinations can be* *terrifying and may pose a psychiatric emergency. The incorrect questions are of lesser* *importance than identifying the command.* *PTS: 1 DIF: Cognitive Level: Apply (Application)* *TOP: Nursing Process: Assessment MSC: Client Needs: Safe, Effective Care Environment* *32. A client receiving risperidone reports severe muscle stiffness at 1030. By 1200, the client has* *difficulty swallowing and is drooling. By 1600, vital signs are 102.8° F; pulse 110; respirations* *26; 150/90. The client is diaphoretic. What is the nurse's best analysis and action?* *a. Agranulocytosis; institute reverse isolation.* *b. Tardive dyskinesia; withhold the next dose of medication.* *c. Cholestatic jaundice; begin a high-protein, high-cholesterol diet.* *d. Neuroleptic malignant syndrome; notify health care provider stat.* *ANS: D* *Taking an antipsychotic medication coupled with the presence of extrapyramidal symptoms,* *such as severe muscle stiffness and difficulty swallowing, hyperpyrexia, and autonomic* *symptoms (pulse elevation), suggest neuroleptic malignant syndrome, a medical emergency.* *The symptoms given in the scenario are not consistent with the medical problems listed in* *the incorrect options.* *PTS: 1 DIF: Cognitive Level: Analyze (Analysis) TOP: Nursing Process:* *Implementation MSC: Client Needs: Physiological Integrity* *33. A nurse asks a client diagnosed with schizophrenia, "What is meant by the old saying 'You* *can't judge a book by looking at the cover.'?" Which response by the client indicates* *concrete thinking?* *a. "The table of contents tells what a book is about."* *b. "You can't judge a book by looking at the cover."* *c. "Things are not always as they first appear."* *d. "Why are you asking me about books?"* *ANS: A* *Concrete thinking refers to an impaired ability to think abstractly. Concreteness is often* *assessed through the client's interpretation of proverbs. Concreteness reduces one's ability* *to understand and address abstract concepts such as love or the passage of time. The* *incorrect options illustrate echolalia, an unrelated question, and abstract thinking.* *PTS: 1 DIF: Cognitive Level: Apply (Application)* *TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity* *34. The nurse is developing a plan for psychoeducational sessions for a small group of adults* *diagnosed with schizophrenia. Which goal is best for this group's members?* *a. gain insight into unconscious factors that contribute to their illness.* *b. explore situations that trigger hostility and anger.* *c. learn to manage delusional thinking.* *d. demonstrate improved social skills.* *ANS: D* *Improved social skills help clients maintain relationships with others. These relationships are* *important to management of the disorder. Most clients with schizophrenia think concretely,* *so insight development is unlikely. Not all clients with schizophrenia experience delusions.* *PTS: 1 DIF: Cognitive Level: Analyze (Analysis)* *TOP: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance* *35. A client says, "Facebook has a new tracking capacity. If I use the Internet, Homeland Security* *will detain me as a terrorist." What is the nurse's best initial action?* *a. Tell the client, "Facebook is a safe website. You don't need to worry about* *Homeland Security."* *b. Tell the client, "You are in a safe place where you will be helped."* *c. Administer a prn dose of an antipsychotic medication.* *d. Tell the client, "You don't need to worry about that."* *ANS: B* *The client is experiencing paranoia and delusional thinking, which leads to fear. Explaining* *that the client is in a safe place will help relieve the fear. It is not therapeutic to disagree or* *give advice. Medication will not relieve the immediate concern.* *PTS: 1 DIF: Cognitive Level: Analyze (Analysis) TOP: Nursing Process:* *Implementation MSC: Client Needs: Psychosocial Integrity* *36. Which finding constitutes a negative symptom associated with schizophrenia?* *a. Hostility* *b. Bizarre behavior* *c. Poverty of thought* *d. Auditory hallucinations* *ANS: C* *Negative symptoms include apathy, anhedonia, poor social functioning, and poverty of* *thought. Poor personal hygiene is an example of poor social functioning. The distracters are* *positive symptoms of schizophrenia. See relationship to audience response question.* *PTS: 1 DIF: Cognitive Level: Understand (Comprehension)* *TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity* *37. A client insistently states, "I can decipher codes of DNA just by looking at someone." Which* *problem is evident?* *a. Visual hallucinations* *b. Magical thinking* *c. Idea of reference* *d. Thought insertion* *ANS: B* *Magical thinking is evident in the client's appraisal of his own abilities. There is no evidence* *of the distractors.* *PTS: 1 DIF: Cognitive Level: Understand (Comprehension)* *TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity* *Downloaded by: cklabrack \| cklabrack\@gmail.com* *Distribution of this document is illegal* *Want to earn \$1.236* *extra per year?* *Stuvia.com - The Marketplace to Buy and Sell your Study Material* *38. A newly hospitalized client experiencing psychosis says, "Red chair out town board." Which* *term should the nurse use to document this finding?* *a. Word salad* *b. Neologism* *c. Anhedonia* *d. Echolalia* *ANS: A* *Word salad is a jumble of words that is meaningless to the listener and perhaps to the* *speaker as well, because of an extreme level of disorganization.* *PTS: 1 DIF: Cognitive Level: Understand (Comprehension)* *TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity* *MULTIPLE RESPONSE* *1. A nurse at the mental health clinic plans a series of psychoeducational groups for persons* *newly diagnosed with schizophrenia. Which two topics take priority? (Select all that apply.)* *a. "The importance of taking your medication correctly"* *b. "How to complete an application for employment"* *c. "How to dress when attending community events"* *d. "How to give and receive compliments"* *e. "Ways to quit smoking"* *ANS: A, E* *Stabilization is maximized by adherence to the antipsychotic medication regimen. Because so* *many persons with schizophrenia smoke cigarettes, this topic relates directly to the clients'* *physiological well-being. The other topics are also important but are not priority topics.* *PTS: 1 DIF: Cognitive Level: Analyze (Analysis)* *TOP: Nursing Process: Planning \| Nursing Process: Outcomes Identification* *MSC: Client Needs: Health Promotion and Maintenance* *2. A client diagnosed with schizophrenia was hospitalized after arguing with co-workers and* *threatening to harm them. The client is aloof, suspicious, and says, "Two staff members I* *saw talking were plotting to kill me." Based on data gathered at this point, which nursing* *diagnoses relate? (Select all that apply.)* *a. Risk for other-directed violence* *b. Disturbed thought processes* *c. Risk for loneliness* *d. Spiritual distress* *e. Social isolation* *ANS: A, B* *Downloaded by: cklabrack \| cklabrack\@gmail.com* *Distribution of this document is illegal* *Want to earn \$1.236* *extra per year?* *Stuvia.com - The Marketplace to Buy and Sell your Study Material* *Delusions of persecution and ideas of reference support the nursing diagnosis of disturbed* *thought processes. Risk for other-directed violence is substantiated by the client's feeling* *endangered by persecutors. Fearful individuals may strike out at perceived persecutors or* *attempt self-harm to get away from persecutors. Data are not present to support the other* *diagnoses.* *PTS: 1 DIF: Cognitive Level: Apply (Application)* *TOP: Nursing Process: Diagnosis \| Nursing Process: Analysis* *MSC: Client Needs: Psychosocial Integrity*