1. Schizophrenia is most often characterized by which of the following assessment findings?
A) Thought disturbances and hallucinations
B) Mood swings
... [Show More] and hostility
C) Separate personalities
D) Preoccupation with somatic symptoms
Ans: A Chapter: 30
Client Needs: C-2 Cognitive level: Knowledge
Concepts & Processes: Nursing process Difficulty: Easy
Objective: 01
Feedback: Common features of schizophrenia include thought disturbances and preoccupation with frightening inner experiences (eg, delusions and hallucinations), affect disturbances (eg, flat or inappropriate affect), and behavioral or social disturbances (eg, unpredictable, bizarre behavior or social isolation).
Page: 3
2. Which of the following groups of theories is currently believed to explain the etiology of schizophrenia?
A) Behavioral
B) Cognitive
C) Family system
D) Biologic
Ans: D Chapter: 30
Client Needs: C-2 Cognitive level: Knowledge
Concepts & Processes: Nursing Process Difficulty: Moderate
Objective: 03
Feedback: Schizophrenia is thought to have multiple etiologies. The overwhelming body of scientific evidence suggests that schizophrenia is a brain disease. Computed tomography scanning and magnetic resonance imaging have shown frequent enlargement of the lateral
cerebral brain ventricles in people with schizophrenia. Page: 5
3. Which of the following constitutes a negative symptom associated with schizophrenia?
A) Hostility
B) Poverty of speech
C) Bizarre behavior
D) Formal thought disorder
Ans: B Chapter: 30
Client Needs: C-2
Cognitive level: Comprehension Concepts & Processes: Nursing process Difficulty: Moderate
Objective: 04
Feedback: The DSM-IV-TR (APA, 2000) lists three negative characteristic symptoms of schizophrenia: alogia, affective blunting, and avolition. Other common negative symptoms include anhedonia and attentional impairment.
Page: 19-20
4. A client with schizophrenia states that he is God's messenger and his mission is to become president. The nurse documents these comments as evidence of the client's
A) delusional thinking.
B) hallucinatory experiences.
C) bizarre behavior.
D) formal thought disorder.
Ans: A Chapter: 30
Client Needs: C-2
Cognitive level: Comprehension Concepts & Processes: Documentation Difficulty: Moderate
Objective: 05
Feedback: Delusions involve disturbances in thought content. They are firmly held false beliefs that reasoning cannot correct and for which there is no support in reality.
Page: 18
5. The relationships and associations among the words used to express thoughts are markedly disturbed in clients with schizophrenia. This disturbance is characterized by
A) disorganized speech.
B) auditory hallucinations.
C) flight of ideas.
D) paucity of speech.
Ans: A Chapter: 30
Client Needs: C-2
Cognitive level: Comprehension Concepts & Processes: Nursing process Difficulty: Moderate
Objective: 04
Feedback: The lack of a logical relationship between thoughts and ideas may be manifested by speech that is vague, diffuse, unfocused (loose associations), or incoherent (eg, using words that are totally unrelated - “word salad”) or by a client's inability to get to the point (tangentiality).
Page: 15
6. The nurse notes that a client with schizophrenia sits in a chair rocking back and forth. The nurse recognizes this as
A) a side effect of medication.
B) catatonic stupor.
C) catatonic excitement.
D) a sign of anxiety.
Ans: C Chapter: 30
Client Needs: C-2
Cognitive level: Comprehension Concepts & Processes: Nursing process Difficulty: Moderate
Objective: 04
Feedback: In catatonic excitement clients may show uncontrolled and aimless motor activity. They may engage in repetitive stereotypic movements with no apparent purpose, such as rock ing back and forth for hours. Clients also may manifest normal mannerisms out of context, such as grimacing for no reason.
Page: 16-17
7. A 20-year-old has been hospitalized for the first time with schizophrenia. He begins taking chlorpromazine (Thorazine). The nurse is teaching the client and his mother about his medication. Which of the following statements reflects accurate information about chlorpromazine?
A) “This medication is less likely to cause extrapyramidal symptoms than an atypical antipsychotic.”
B) “This medication is particularly effective against the negative symptoms of schizophrenia.”
C) “This medication is particularly effective against the positive symptoms of schizophrenia.”
D) “This medication is used to treat the extrapyramidal side effects of your other medications.”
Ans: C Chapter: 30
Client Needs: D-2 Cognitive level: Application
Concepts & Processes: Teaching/learning Difficulty: Moderate
Objective: 06
Feedback: Two types of antipsychotics are used to treat schizophrenia: traditional and atypical. Traditional antipsychotics, of which Thorazine is an example, have been available since 1952 and are successful in treating schizophrenia manifested by mostly positive symptoms. Associated side effects (especially extrapyramidal side effects), however, are numerous and distressing, and they often cause clients to become noncompliant.
Page: 30
8. A client with a long history of schizophrenia has managed well on trifluoperazine (Stelazine). She calls her case manager to report that she keeps feeling like she wants to stick out her tongue and stare up at the ceiling. The nurse interprets the client's comments to mean she has
A) signs of tardive dyskinesia (TD) associated with neuroleptic medication.
B) psychomotor agitation associated with schizophrenia.
C) the typical bizarre behavior associated with schizophrenia.
D) an anticholinergic side effect associated with neuroleptic medications.
Ans: A Chapter: 30
Client Needs: D-2
Cognitive level: Comprehension Concepts & Processes: Nursing process Difficulty: Moderate
Objective: 06
Feedback: TD is a type of extrapyramidal side effect characterized by abnormal, involuntary, irregular, choreoathetoid (writhing) movements, which may include lip smacking, neck twisting, facial grimacing, and tongue and chewing movements. TD can occur after several months to
years of therapy with traditional antipsychotics. Page: 31
9. A client with schizophrenia displays poverty of speech, unchanging facial expression, and physical anergia. The nurse anticipates that the client would be prescribed
A) a stimulant.
B) an antidepressant.
C) a traditional antipsychotic.
D) an atypical antipsychotic.
Ans: D Chapter: 30
Client Needs: D-2 Cognitive level: Application
Concepts & Processes: Nursing process Difficulty: Moderate
Objective: 06
Feedback: Atypical antipsychotics relieve both the positive and negative symptoms (eg, alogia, affective blunting, avolition, anhedonia, and attentional impairment) of schizophrenia, and are less likely to cause distressing extrapyramidal side effects typically seen with traditional antipsychotics.
Page: 32
10. In managing the milieu for clients with schizophrenia, the nurse considers which of the following the highest priority?
A) Client and family education
B) Recreational activities
C) Client safety
D) Social skills training
Ans: C Chapter: 30
Client Needs: C-2 Cognitive level: Application
Concepts & Processes: Nursing process Difficulty: Moderate
Objective: 08
Feedback: Milieu management refers to providing an environment rich with therapeutic possibility. The inpatient client with a thought disorder likely has impaired judgment and reality testing. Also, safety needs are paramount. Healthcare staff members assume responsibility for the
client's well-being and physical care when he or she cannot meet those basic needs. Page: 34
11. The nurse is developing a plan for group therapy sessions for several adult clients with schizophrenia. Which of the following goals is best for this group?
A) Members will gain insight into unconscious factors that contribute to their illness.
B) Members will demonstrate better social skills.
C) Members will explore situations that trigger hostility and anger.
D) Members will learn to manage delusional thinking.
Ans: B Chapter: 30
Client Needs: C-2 Cognitive level: Application
Concepts & Processes: Nursing process Difficulty: Moderate
Objective: 08
Feedback: Group therapy sessions focus on social skills, concentrating on appropriate interpersonal interaction. The therapist role-plays with the client, modeling and identifying suitable social actions and responses.
Page: 35
12. A client with schizophrenia and a history of repeated hospitalizations and homelessness is ready for discharge. The nurse is developing a plan for his continued care in the community. Given the client's history, the nurse would recommend which of the following plans?
A) Intensive case management
B) Monthly follow-up in the community mental health clinic
C) Referral to a vocational counselor
D) Family education about relapse prevention
Ans: A Chapter: 30
Client Needs: C-2 Cognitive level: Application
Concepts & Processes: Self-care Difficulty: Moderate
Objective: 07
Feedback: Community-based care for those with schizophrenia includes assertive community treatment, intensive case management, ongoing medication management, and housing, rehabilitation, social, and vocational supports.
Page: 38
13. The nurse is evaluating the plan of care for a client with schizophrenia. Which of the following observations best suggests that the plan has been effective?
A) The client no longer believes that she has special powers.
B) The client has resumed employment and has been attending social functions at the community center.
C) The client reports that she no longer has hallucinations.
D) The client has been compliant with taking her medications and attending therapy sessions.
Ans: B Chapter: 30
Client Needs: C-2 Cognitive level: Application
Concepts & Processes: Self-care Difficulty: Moderate
Objective: 04
Feedback: Major goals for the care of a client with schizophrenia are to experience improved thought pro cesses and fewer psychotic symptoms, to not engage in violent behavior, to acquire improved social skills and engage in satisfying social interaction, and to gain knowledge about the disease process and treatment.
Page: 44
14. A client with schizophrenia walks up to the nurse with his arm outstretched and says, “My arm went away. Dog, dog, dog.” How should the nurse respond?
A) Ignore the comments and redirect the client's attention.
B) Ask the client if he is trying to say that something is wrong with his arm.
C) Ask the client if he is having visual hallucinations.
D) Tell the client that he or she can see the arm, and no dogs are around.
Ans: B Chapter: 30
Client Needs: C-2 Cognitive level: Application
Concepts & Processes: Communication Difficulty: Moderate
Objective: 08
Feedback: The client's illogical, symbolic, and disorganized speech often holds a message that he or she cannot express clearly. The nurse listens for themes and reflects back to the client the meaning that the nurse has deciphered. The nurse does not dismiss the client's verbal and
nonverbal behaviors as meaningless or nonsense. In effect, the nurse tries to decode the communication that the client offers and validate its meaning.
Page: 45
15. A client tells the nurse she has bugs in her brain and asks the nurse if she can see them. Which of the following responses by the nurse is most therapeutic?
A) “No, I don't see any bugs. Are you seeing bugs or hearing unusual sounds or voices?”
B) “No, I don't see any bugs. That sounds scary for you.”
C) “Your thinking is a little illogical. I wouldn't be able to see bugs if they were inside your brain. Would you like to talk more about this?”
D) “You have a thought disorder and only think you have bugs in your brain. There really aren't any. You don't have to worry because we would give you medicine for any medical problems.”
Ans: B Chapter: 30
Client Needs: C-2 Cognitive level: Application
Concepts & Processes: Communication Difficulty: Moderate
Objective: 08
Feedback: The person who hallucinates is preoccupied and frightened by what he or she hears or sees. The hallucination is real to the client, and the nurse cannot argue away, dismiss, or ignore it. Although the hallucination is real to the client, nurses make it clear that they do not hear the voices or see the visual images. Nurses do, however, communicate concern that the client is bothered, upset, or frightened by the hallucination.
Page: 46
16. Which of the following is an appropriate intervention for a client having auditory hallucinations?
A) Encourage the client to discuss the content of the hallucinations with staff as they occur.
B) Ask the client to keep a journal about what the voices tell him and to bring the journal to therapy sessions.
C) Encourage the client to spend quiet time alone until hallucinations cease.
D) Tell the client to talk back to the voices and tell them to go away.
Ans: D Chapter: 30
Client Needs: C-2 Cognitive level: Application
Concepts & Processes: Nursing process
Difficulty: Moderate Objective: 08
Feedback: Interventions for managing hallucinations include dismissal intervention (ie, telling the voices to go away), various coping strategies (eg, jogging, telephoning, playing games, seeking out others, employing relaxation techniques), or competing stimuli (eg, listening to music or another's or one's own voice to overcome auditory hallucinations and visual stimuli to overcome visual hallucinations).
Page: 46
17. The nurse is assessing a client with schizophrenia who is actively hallucinating, restless, and exhibiting extremely disorganized speech. Although the client has a history of successfully managing her disease and is an employed scientist, she has few social activities and, when well, has a flat affect and tone of voice that put people off. The nurse identifies improved social skills as an important therapeutic goal. How should the nurse implement this plan?
A) Enter the client in the ongoing social skills training program on the unit. Have her begin on the following day.
B) Wait a few days to enter her in the social skills training program.
C) Enter her in a social skills training program when acute psychosis subsides.
D) Refer her to a social skills training program after discharge.
Ans: D Chapter: 30
Client Needs: C-2 Cognitive level: Application
Concepts & Processes: Nursing process Difficulty: Difficult
Objective: 08
Feedback: Although severe psychotic symptoms of schizophrenia can subside with pharmacologic treatment, many clients still have severely restricted social lives. Impaired communication, lack of motivation, inattention to self-care, and difficulty establishing and maintaining relationships leave them socially isolated. Psychosocial approaches can help clients improve social functioning and enjoy a better quality of life. These interventions usually are not implemented, however, until psychotic symptoms are controlled.
Page: 47
18. The nurse observes a client with schizophrenia staring at a staff member. The client has a history of unexpected violence that typically is preceded by restlessness and staring at someone. How should the nurse manage this situation?
A) Tell the client it is time for his medication and give him sedating medications as needed.
B) Prepare a room with four-point restraints set up because the client has required emergency
restraining in the past.
C) Have two large male staff members escort the client to his room.
D) Alert other staff to the client's behavior and have them engage the client in physical activity such as playing basketball.
Ans: D Chapter: 30
Client Needs: A-2 Cognitive level: Application
Concepts & Processes: Nursing process Difficulty: Moderate
Objective: 08
Feedback: The nurse makes other team members aware of a client's potential for violence, because protecting the client and others from serious harm is a priority. Measures such as breathing and relaxation exercises, imagery, nutritional improvement, and aerobic exercise are useful stress management techniques to improve coping skills.
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