The nurse is caring for a client with schizophrenia. Which of the following outcomes is
the least desirable?
A) The client spends more time by
... [Show More] himself
B) The client doesn't engage in delusional thinking
C) The client doesn't harm himself or others
D) The client demonstrates ability to meet his own self-care needs
The client with schizophrenia is commonly socially isolated and withdrawn; therefore, having the
client spend more time by himself wouldn't be a desirable outcome. Rather, a desirable outcome
would specify that the client spend more time with other clients and staff on the unit. Delusions
are false personal beliefs. Reducing or eliminating delusional thinking using talking therapy and
antipsychotic medications would be a desirable outcome. Protecting the client and others from
harm is a desirable client outcome achieved by close observation, removing any dangerous
objects, and administering medications. Because the client with schizophrenia may have
difficulty meeting his or her own self-care needs, fostering the ability to perform self-care
independently is a desirable client outcome.
The nurse formulates a nursing diagnosis of Impaired verbal communication for a client
with schizotypal personality disorder. Based on this nursing diagnosis, which nursing
intervention is most appropriate?
A) Helping the client to participate in social interactions
B) Establishing a one-on-one relationship with the client
C) Establishing alternative forms of communication
D) Allowing the client to decide when he wants to participate in verbal communication
with the nurse
By establishing a one-on-one relationship, the nurse helps the client learn how to interact with people in
new situations. The other options are appropriate but should take place only after the nurse-client
relationship is established.
Since admission 4 days ago, a client has refused to take a shower, stating, "There are
poison crystals hidden in the showerhead. They'll kill me if I take a shower." Which
nursing action is most appropriate?
A) Dismantling the showerhead and showing the client that there is nothing in it
B) Explaining that other clients are complaining about the client's body odor
C) Asking a security officer to assist in giving the client a shower
D) Accepting these fears and allowing the client to take a sponge bath
By acknowledging the client's fears, the nurse can arrange to meet the client's hygiene needs in
another way. Because these fears are real to the client, providing a demonstration of reality (as
in option A) wouldn't be effective at this time. Options B and C would violate the client's rights by
shaming or embarrassing the client.
Drug therapy with thioridazine (Mellaril)shouldn't exceed a daily dose of 800 mg to prevent which
adverse reaction?
A) Hypertension
B) Respiratory arrest
C) Tourette Syndrome
D) Retinal pigmentation
Retinal pigmentation may occur if the thioridazine dosage exceeds 800 mg per day. The other options
don't occur as a result of exceeding this dose.
A client with paranoid personality disorder is admitted to a psychiatric facility. Which
remark by the nurse would best establish rapport and encourage the client to confide in
the nurse?
A) "I get upset once in a while, too."
B) "I know just how you feel. I'd feel the same way in your situation."
C) "I worry, too, when I think people are talking about me."
D) "At times, it's normal not to trust anyone."
Sharing a benign, nonthreatening, personal fact or feeling helps the nurse establish rapport and
encourages the client to confide in the nurse. The nurse can't know how the client feels. Telling
the client otherwise, as in option B, would justify the suspicions of a paranoid client; furthermore,
the client relies on the nurse to interpret reality. Option C is incorrect because it focuses on the
nurse's feelings, not the client's. Option D wouldn't help establish rapport or encourage the client
to confide in the nurse.
How soon after chlorpromazine (Thorazine) administration should the nurse expect to see a client's
delusional thoughts and hallucinations eliminated?
A) Several minutes
B) Several hours
C) Several days
D) Several weeks
Although most phenothiazines produce some effects within minutesto hours, their antipsychotic effects
may take several weeks to appear.
A client is about to be discharged with a prescription for the antipsychotic agent
haloperidol (Haldol), 10 mg by mouth twice per day. During a discharge teaching session,
the nurse should provide which instruction to the client?
A) Take the medication 1 hour before a meal.
B) Decrease the dosage if signs of illness decrease
C)Apply a sunscreen before being exposed to the sun.
D) Increase the dosage up to 50 mg twice per day if signs of illness don't decrease.
Because haloperidol can cause photosensitivity and precipitate severe sunburn, the nurse
should instruct the client to apply a sunscreen before exposure to the sun. The nurse also
should teach the client to take haloperidol with meals — not 1 hour before — and should instruct
the client not to decrease or increase the dosage unless the physician orders it.
A client with paranoid schizophrenia repeatedly uses profanity during an activity therapy
session. Which response by the nurse would be most appropriate?
A) "Your behavior won't be tolerated. Go to your room immediately."
B) "You're just doing this to get back at me for making you come to therapy."
C) "Your cursing is interrupting the activity. Take time out in your room for 10 minutes."
D) "I'm disappointed in you. You can't control yourself even for a few minutes."
The nurse should set limits on client behavior to ensure a comfortable environment for all
clients. The nurse should accept hostile or quarrelsome client outbursts within limits without
becoming personally offended, as in option A. Option B is incorrect because it implies that the
client's actions reflect feelings toward the staff instead of the client's own misery. Judgmental
remarks, such as option D, may decrease the client's self-esteem.
Which of the following is one of the advantages of the newer antipsychotic medication risperidone
(Risperdal)?
A) The absence of anticholinergic effects
B) A lowerincidence of extrapyramidal effects
C) Photosensitivity and sedation
D) No incidence of neuroleptic malignant syndrome
Risperdal has a lower incidence of extrapyramidal effects than the typical antipsychotics. Risperdal does
produce anticholinergic effects and neuroleptic malignantsyndrome can occur. Photosensitivity isn't an
advantage.
The etiology of schizophrenia is best described by:
A) genetics due to a faulty dopamine receptor.
B) environmental factors and poor parenting.
C) structural and neurobiological factors.
D) a combination of biological, psychological, and environmental factors.
A reliable genetic marker hasn't been determined for schizophrenia. However, studies of twins
and adopted siblings have strongly implicated a genetic predisposition. Since the mid-19th
century, excessive dopamine activity in the brain has also been suggested as a causal factor.
Communication and the family system have been studied as contributing factors in the
development of schizophrenia. Therefore, a combination of biological, psychological, and
environmental factors are thought to cause schizophrenia.
A client with schizophrenia who receivesfluphenazine (Prolixin) develops pseudoparkinsonism and
akinesia. What drug would the nurse administer to minimize extrapyramidal symptoms?
A) benztropine (Cogentin)
B) dantrolene (Dantrium)
C) clonazepam (Klonopin)
D) diazepam (Valium)
Benztropine is an anticholinergic drug administered to reduce extrapyramidal adverse effects in
the client taking antipsychotic drugs. It works by restoring the equilibrium between the
neurotransmitters acetylcholine and dopamine in the central nervous system (CNS). Dantrolene,
a hydantoin drug that reduces the catabolic processes, is administered to alleviate the
symptoms of neuroleptic malignant syndrome, a potentially fatal adverse effect of antipsychotic
drugs. Clonazepam, a benzodiazepine drug that depresses the CNS, is administered to control
seizure activity. Diazepam, a benzodiazepine drug, is administered to reduce anxiety.
A client with a diagnosis of paranoid schizophrenia comments to the nurse, "How do I
know what is really in those pills?" Which of the following is the best response?
A) Say, "You know it's your medicine."
B) Allow him to open the individual wrappers of the medication.
C) Say, "Don't worry about what is in the pills. It's what is ordered."
D) Ignore the comment because it's probably a joke.
Option B is correct because allowing a paranoid client to open his medication can help reduce
suspiciousness. Option A is incorrect because the client doesn't know that it's his medication
and he's obviously suspicious. Telling the client not to worry or ignoring the comment isn't
supportive and doesn't offer reassurance.
A client tells the nurse that people from Mars are going to invade the earth. Which
response by the nurse would be most therapeutic?
A) "That must be frightening to you. Can you tell me how you feel about it?"
B) "There are no people living on Mars."
C) "What do you mean when you say they're going to invade the earth?"
D) "I know you believe the earth is going to be invaded, but I don't believe that."
This response addresses the client's underlying fears without feeding the delusion. Refuting the
client's delusion, as in option B, would increase anxiety and reinforce the delusion. Asking the
client to elaborate on the delusion, as in option C, would also reinforce it. Voicing disbelief about
the delusion, as in option D, wouldn't help the client deal with underlying fears.
A client with schizophrenia tells the nurse he hears the voices of his dead parents. To
help the client ignore the voices, the nurse should recommend that he:
A) sit in a quiet, dark room and concentrate on the voices.
B) listen to a personal stereo through headphones and sing along with the music.
C) call a friend and discuss the voices and his feelings about them.
D) engage in strenuous exercise.
Increasing the amount of auditory stimulation, such as by listening to music through
headphones, may make it easier for the client to focus on external sounds and ignore internal
sounds from auditory hallucinations. Option A would make it harder for the client to ignore the
hallucinations. Talking about the voices, as in option C, would encourage the client to focus on
them. Option D is incorrect because exercise alone wouldn't provide enough auditory
stimulation to drown out the voices.
A client with schizophrenia is receiving antipsychotic medication. Which nursing
diagnosis may be appropriate for this client?
A) Ineffective protection related to blood dyscrasias
B)Urinary frequency related to adverse effects of antipsychotic medication
C) Risk for injury related to a severely decreased level of consciousness
D) Risk for injury related to electrolyte disturbances
Antipsychotic medications may cause neutropenia and granulocytopenia, life-threatening blood
dyscrasias, that warrant a nursing diagnosis of Ineffective protection related to blood dyscrasias.
These medications also have anticholinergic effects, such as urine retention, dry mouth, and
constipation. Urinary frequency isn't an approved nursing diagnosis. Although antipsychotic
medications may cause sedation, they don't severely decrease the level of consciousness,
eliminating option C. These drugs don't cause electrolyte disturbances, eliminating option D.
A client with persistent, severe schizophrenia has been treated with phenothiazines for
the past 17 years. Now the client's speech is garbled as a result of drug-induced
rhythmic tongue protrusion. What is another name for this extrapyramidal symptom?
A) Dystonia
B) Akathisia
C) Pseudoparkinsonism
D) Tardive dyskinesia
An adverse reaction to phenothiazines, tardive dyskinesia refers to choreiform tongue
movements that commonly are irreversible and may interfere with speech. Dystonia refers to
involuntary contraction of a muscle group. Akathisia is restlessness or inability to sit still.
Pseudoparkinsonism describes a group of symptoms that mimic those of Parkinson's disease.
An adverse reaction to phenothiazines, tardive dyskinesia refers to choreiform tongue
movements that commonly are irreversible and may interfere with speech. Dystonia
refers to involuntary contraction of a muscle group. Akathisia is restlessness or inability
to sit still. Pseudoparkinsonism describes a group of symptoms that mimic those of
Parkinson's disease.
A) Meeting all of the client's physical needs
B) Giving the client an opportunity to express concerns
C) Administering lithium carbonate (Lithonate) as prescribed
D) Providing a quiet environment where the client can be alone
Because a client with catatonic schizophrenia can't meet physical needs independently, the
nurse must provide for all of these needs, including adequate food and fluid intake, exercise,
and elimination. This client is incapable of expressing concerns; however, the nurse should try
to verbalize the message conveyed by the client's nonverbal behavior. Lithium is used to treat
mania, not catatonic schizophrenia. Despite the client's mute, unresponsive state, the nurse
should provide nonthreatening stimulation and should spend time with the client, not leave the
client alone all the time. Although aware of the environment, the client doesn't interact with it
actively; the nurse's support and presence can be reassuring.
A client with a history of medication noncompliance is receiving outpatient treatment for chronic
undifferentiated schizophrenia. The physician is most likely to prescribe which medication for this
client?
A) chlorpromazine (Thorazine)
B) imipramine (Tofranil)
C) lithium carbonate (Lithane)
D) fluphenazine decanoate (Prolixin Decanoate)
Fluphenazine decanoate is a long-acting antipsychotic agent given by injection. Because it has
a 4-week duration of action, it's commonly prescribed for outpatients with a history of medication
noncompliance. Chlorpromazine, also an antipsychotic agent, must be administered daily to
maintain adequate plasma levels, which necessitates compliance with the dosage schedule.
Imipramine, a tricyclic antidepressant, and lithium carbonate, a mood stabilizer, are rarely used
to treat clients with chronic schizophrenia.
Propranolol (Inderal) is used in the mental health setting to manage which of the
following conditions?
A) Antipsychotic-induced akathisia and anxiety
B) The manic phase of bipolar illness as a mood stabilizer
C) Delusions for clients suffering from schizophrenia
D) Obsessive-compulsive disorder (OCD) to reduce ritualistic behavior
Propranolol is a potent beta-adrenergic blocker and produces a sedating effect; therefore, it's
used to treat antipsychotic induced akathisia and anxiety. Lithium (Lithobid) is used to stabilize
clients with bipolar illness. Antipsychotics are used to treat delusions. Some antidepressants
have been effective in treating OCD.
Every day for the past 2 weeks, a client with schizophrenia stands up during group
therapy and screams, "Get out of here right now! The elevator bombs are going to
explode in 3 minutes!" The next time this happens, how should the nurse respond?
A) "Why do you think there is a bomb in the elevator?"
B) "That is the same thing you said in yesterday's session."
C) "I know you think there are bombs in the elevator, but there aren't."
D) "If you have something to say, you must do it according to our group rules."
Every day for the past 2 weeks, a client with schizophrenia stands up during group therapy and
screams, "Get out of here right now! The elevator bombs are going to explode in 3 minutes!"
The next time this happens, how should the nurse respond?
A 26-year-old client is admitted to the psychiatric unit with acute onset of schizophrenia.
His physician prescribes the phenothiazine chlorpromazine (Thorazine), 100 mg by
mouth four times per day. Before administering the drug, the nurse reviews the client's
medication history. Concomitant use of which drug is likely to increase the risk of
extrapyramidal effects?
A) guanethidine (Ismelin)
B) droperidol (Inapsine)
C) lithium carbonate (Lithonate)
D) Alcohol
When administered with any phenothiazine, droperidol may increase the risk of extrapyramidal effects.
The other options are incorrect
A client, age 36, with paranoid schizophrenia believes the room is bugged by the Central
Intelligence Agency and that his roommate is a foreign spy. The client has never had a
romantic relationship, has no contact with family members, and hasn't been employed in
the last 14 years. Based on Erikson's theories, the nurse should recognize that this client
is in which stage of psychosocial development?
A) Autonomy versus shame and doubt
B) Generativity versus stagnation
C) Integrity versus despair
D) Trust versus mistrust
This client's paranoid ideation indicates difficulty trusting others. The stage of autonomy versus
shame and doubt deals with separation, cooperation, and self-control. Generativity versus
stagnation is the normal stage for this client's chronologic age. Integrity versus despair is the
stage for accepting the positive and negative aspects of one's life, which would be difficult or
impossible for this client
During a group therapy session in the psychiatric unit, a client constantly interrupts with
impulsive behavior and exaggerated stories that cast her as a hero or princess. She also
manipulates the group with attention-seeking behaviors, such as sexual comments and
angry outbursts. The nurse realizes that these behaviors are typical of:
A) Paranoid personality disorder
B) Avoidant personality disorder
C) Histrionic personality disorder
D) Borderline personality disorder
This client's behaviors are typical of histrionic personality disorder, which is marked by
excessive emotionality and attention seeking. The client constantly seeks and demands
attention, approval, or praise; may be seductive in behavior, appearance, or conversation; and
is uncomfortable except when she is the center of attention. Typically, a client with paranoid
personality disorder is suspicious, cold, hostile, and argumentative. Avoidant personality
disorder is characterized by anxiety, fear, and social isolation. Borderline personality disorder is
characterized by impulsive, unpredictable behavior and unstable, intense interpersonal
relationships.
The nurse isteaching a psychiatric client about her prescribed drugs, chlorpromazine and benztropine.
Why is benztropine administered?
A) To reduce psychotic symptoms
B) To reduce extrapyramidalsymptoms
C) To control nausea and vomiting
D) To relieve anxiety
Benztropine is an anticholinergic medication, administered to reduce the extrapyramidal adverse effects
of chlorpromazine and other antipsychotic medications. Benztropine doesn't reduce psychotic
symptoms, relieve anxiety, or control nausea and vomiting.
A client is admitted to the psychiatric unit with a tentative diagnosis of psychosis. Her
physician prescribes the phenothiazine thioridazine (Mellaril) 50 mg by mouth three
times per day. Phenothiazines differ from central nervous system (CNS) depressants in
their sedative effects by producing:
A) deeper sleep than CNS depressants.
B) greater sedation than CNS depressants.
C) a calming effect from which the client is easily aroused
D) more prolonged sedative effects, making the client more difficult to arouse
Shortly after phenothiazine administration, a quieting and calming effect occurs, but the client is easily
aroused, alert, and responsive and has good motor coordination.
A woman is admitted to the psychiatric emergency department. Her significant other
reports that she has difficulty sleeping, has poor judgment, and is incoherent at times.
The client's speech is rapid and loose. She reports being a special messenger from the
Messiah. She has a history of depressed mood for which she has been taking an
antidepressant. The nurse suspects which diagnosis?
A) Schizophrenia
B) Paranoid personality
C) Bipolar illness
D) Obsessive-compulsive disorder (OCD)
Bipolar illness is characterized by mood swings from profound depression to elation and
euphoria. Delusions of grandeur along with pressured speech are common symptoms of mania.
Schizophrenia doesn't exhibit mood swings from depression to euphoria. Paranoia is
characterized by unrealistic suspiciousness and is often accompanied by grandiosity. OCD is a
preoccupation with rituals and rules.
A client with paranoid schizophrenia is ad..................................................................................CONTINUED....................................................................................DOWNLOAD FOR BEST SCORES [Show Less]