Deck 15: Schizophrenia Spectrum and Other Psychotic Disorders

Question 1

During an admission assessment,a nurse assesses that a client diagnosed with schizophrenia spectrum disorder has allergies to penicillin,prochlorperazine (Compazine),and bee stings.Based on this assessment data,which antipsychotic medication would be contraindicated?

A)Haloperidol (Haldol),because it is used only in older patients
B)Clozapine (Clozaril),because it is incompatible with desipramine
C)Risperidone (Risperdal),because it exacerbates symptoms of depression
D)Thioridazine (Mellaril),because of cross-sensitivity among phenothiazines

Answer 1

Thioridazine (Mellaril),because of cross-sensitivity among phenothiazines

Question 2

Parents ask a nurse how they should reply when their child,diagnosed with schizophrenia spectrum disorder,tells them that voices command him to harm others.Which is the appropriate nursing response?

A)"Tell him to stop discussing the voices."
B)"Ignore what he is saying,while attempting to discover the underlying cause."
C)"Focus on the feelings generated by the hallucinations and present reality."
D)"Present objective evidence that the voices are not real."

Answer 2

"Focus on the feelings generated by the hallucinations and present reality."

Question 3

A client diagnosed with schizophrenia spectrum disorder states,"Can't you hear him? It's the devil.He's telling me I'm going to hell." Which is the most appropriate nursing response?

A)"Did you take your medicine this morning?"
B)"You are not going to hell.You are a good person."
C)"The voices must sound scary,but the devil is not talking to you.This is part of your illness."
D)"The devil only talks to people who are receptive to his influence."

Answer 3

"The voices must sound scary,but the devil is not talking to you.This is part of your illness."

Question 4

A nurse is caring for a client who is experiencing a flat affect,paranoid delusions,anhedonia,anergia,neologisms,and echolalia.Which statement correctly differentiates the client's positive and negative symptoms of schizophrenia?

A)Paranoid delusions,anhedonia,and anergia are positive symptoms of schizophrenia.
B)Paranoid delusions,neologisms,and echolalia are positive symptoms of schizophrenia.
C)Paranoid delusions,anergia,and echolalia are negative symptoms of schizophrenia.
D)Paranoid delusions,flat affect,and anhedonia are negative symptoms of schizophrenia.

Question 5

A client has been assigned an admission diagnosis of brief psychotic disorder.Which assessment information would alert the nurse to question this diagnosis?

A)The client has experienced impaired reality testing for a 24-hour period.
B)The client has experienced auditory hallucinations for the past 3 hours.
C)The client has experienced bizarre behavior for 1 day.
D)The client has experienced confusion for 3 weeks.

Question 6

A nurse is assessing a client diagnosed with schizophrenia spectrum disorder.The nurse asks the client,"Do you receive special messages from certain sources,such as the television or radio?" The nurse is assessing which potential symptom of this disorder?

A)Thought insertion
B)Paranoid delusions
C)Magical thinking
D)Delusions of reference

Question 7

A 60-year-old client diagnosed with schizophrenia spectrum disorder presents in an ED with uncontrollable tongue movements,stiff neck,and difficulty swallowing.Which medical diagnosis and treatment should a nurse anticipate when planning care for this client?

A)Neuroleptic malignant syndrome treated by discontinuing antipsychotic medications
B)Agranulocytosis treated by administration of clozapine (Clozaril)
C)Extrapyramidal symptoms treated by administration of benztropine (Cogentin)
D)Tardive dyskinesia treated by discontinuing antipsychotic medications

Question 8

A client diagnosed with schizophrenia spectrum disorder is prescribed clozapine (Clozaril).Which client symptoms,related to the side effects of this medication,should prompt a nurse to intervene immediately?

A)Sore throat,fever,and malaise
B)Akathisia and hypersalivation
C)Akinesia and insomnia
D)Dry mouth and urinary retention

Question 9

A client diagnosed with schizophrenia spectrum disorder tells a nurse about voices commanding him to kill the president.Which is the priority nursing diagnosis for this client?

A)Disturbed sensory perception
B)Altered thought processes
C)Risk for violence: directed toward others
D)Risk for injury

Question 10

A paranoid client diagnosed with schizophrenia spectrum disorder states,"My psychiatrist is out to get me.I'm sad that the voice is telling me to stop him." What symptom is the client exhibiting,and what is the nurse's legal responsibility related to this symptom?

A)Magical thinking; administer an antipsychotic medication.
B)Persecutory delusions; orient the client to reality.
C)Command hallucinations; warn the psychiatrist.
D)Altered thought processes; call an emergency treatment team meeting.

Question 11

A nurse is assessing a client diagnosed with substance induced psychotic disorder (SIPD).What would differentiate this client's symptoms from the symptoms of a client diagnosed with brief psychotic disorder (BPD)?

A)Clients diagnosed with SIPD experience delusions,whereas clients diagnosed with BPD do not.
B)Clients diagnosed with BPD experience hallucinations,whereas clients diagnosed with SIPD do not.
C)Catatonic features may be associated with SIPD,whereas BPD has no catatonic features.
D)Catatonic features may be associated with BPD,whereas SIPD has no catatonic features.

Question 12

A client diagnosed with schizophrenia spectrum disorder takes an antipsychotic agent daily.Which assessment finding should a nurse prioritize?

A)Respirations of 22 beats/minute
B)Weight gain of 8 pounds in 2 months
C)Temperature of 104 $\degree$ F (40 $\degree$ C)
D)Excessive salivation

Question 13

Which nursing intervention would be most appropriate when caring for an acutely agitated paranoid client diagnosed with schizophrenia spectrum disorder?

A)Provide neon lights and soft music.
B)Maintain continual eye contact throughout the interview.
C)Use therapeutic touch to increase trust and rapport.
D)Provide personal space to respect the client's boundaries.

Question 14

A paranoid client presents with bizarre behaviors,neologisms,and thought insertion.Which nursing action should be prioritized to maintain this client's safety?

A)Assess for medication nonadherance.
B)Note escalating behaviors and intervene immediately.
C)Interpret attempts at communication.
D)Assess triggers for bizarre,inappropriate behaviors.

Question 15

A 16-year-old client diagnosed with schizophrenia spectrum disorder experiences command hallucinations to harm others.The client's parents ask a nurse,"Where do the voices come from?" Which is the appropriate nursing response?

A)"Your child has a chemical imbalance of the brain,which leads to altered perceptions."
B)"Your child's hallucinations are caused by medication interactions."
C)"Your child has too little serotonin in the brain,causing delusions and hallucinations."
D)"Your child's abnormal hormonal changes have precipitated auditory hallucinations."

Question 16

After taking chlorpromazine (Thorazine)for 1 month,a client presents to an ED with severe muscle rigidity,tachycardia,and a temperature of 105^oF (

A)Neuroleptic malignant syndrome treated by discontinuing Thorazine and administering dantrolene (Dantrium)
B)Neuroleptic malignant syndrome treated by increasing Thorazine dosage and administering an antianxiety medication
C)Dystonia treated by administering trihexyphenidyl (Artane)
D)Dystonia treated by administering bromocriptine (Parlodel)
40.5 $\degree$ C.Which medical diagnosis and treatment should a nurse anticipate when planning care for this client?

Question 17

An aging client diagnosed with schizophrenia spectrum disorder takes an antipsychotic and a beta-adrenergic blocking agent for hypertension.Understanding the combined side effects of these drugs,which statement by a nurse is most appropriate?

A)"Make sure you concentrate on taking slow,deep,cleansing breaths."
B)"Watch your diet and try to engage in some regular physical activity."
C)"Rise slowly when you change position from lying to sitting or sitting to standing."
D)"Wear sunscreen and try to avoid midday sun exposure."

Question 18

A client is diagnosed with schizophrenia spectrum disorder.A physician orders haloperidol (Haldol)50 mg bid,benztropine (Cogentin)1 mg prn,and zolpidem (Ambien)10 mg HS.Which client behavior would warrant the nurse to administer benztropine?

A)Tactile hallucinations
B)Tardive dyskinesia
C)Restlessness and muscle rigidity
D)Reports of hearing disturbing voices

Question 19

Which nursing behavior will enhance the establishment of a trusting relationship with a client diagnosed with schizophrenia spectrum disorder?

A)Establishing personal contact with family members
B)Being reliable,honest,and consistent during interactions
C)Sharing limited personal information
D)Sitting close to the client to establish rapport

Question 20

A client diagnosed with schizoaffective disorder is admitted for social skills training.Which information should be included in the nurse's teaching?

A)The side effects of medications
B)Deep breathing techniques to decrease stress
C)How to make eye contact when communicating
D)How to be a leader

Question 21

A nurse prepares to assess a client using the Abnormal Involuntary Movement Scale (AIMS).Which side effect of antipsychotic medications led to the use of this assessment tool?

A)Dystonia
B)Tardive dyskinesia
C)Akinesia
D)Akathisia

Question 22

___________________________ are false sensory perceptions not associated with real external stimuli and may involve any of the five senses.

Question 23

Order the spectrum of schizophrenic and other psychotic disorders as described by the DSM-5 on a gradient of psychopathology from least to most severe.
________ Delusional disorder
________ Schizotypal personality disorder
________ Schizophrenia
________ Brief psychotic disorder
________ Psychotic disorder associated with another medical condition
________ Catatonic disorder associated with another medical condition
________ Schizoaffective disorder
________ Schizophreniform disorder
________ Substance-induced psychotic disorder

Question 24

Laboratory results reveal decreased levels of prolactin in a client diagnosed with schizophrenia spectrum disorder.Which of the following client symptoms would a nurse expect to observe during assessment? (Select all that apply.)

A)Apathy
B)Social withdrawal
C)Anhedonia
D)Auditory hallucinations
E)Delusions

Question 25

Which of the following components should a nurse recognize as an integral part of a rehabilitative program when planning care for clients diagnosed with schizophrenia spectrum disorder? (Select all that apply.)

A)Group therapy
B)Medication management
C)Deterrent therapy
D)Supportive family therapy
E)Social skills training

Question 26

___________________________ disorder is manifested by schizophrenic behaviors,with a strong element of symptomatology associated with the mood disorders (depression or mania).

Question 27

A nurse is administering risperidone (Risperdal)to a client diagnosed with schizophrenia spectrum disorder.Which of the following client symptoms would most likely decrease because of the therapeutic effect of this medication? (Select all that apply.)

A)Somatic delusions
B)Social isolation
C)Gustatory hallucinations
D)Flat affect
E)Clang associations

Question 28

The diagnosis of catatonic disorder associated with another medical condition is made when the client's medical history,physical examination,or laboratory findings provide evidence that symptoms are directly attributed to which of the following? (Select all that apply.)

A)Hyperthyroidism
B)Hypothyroidism
C)Hyperadrenalism
D)Hypoadrenalism
E)Hyperaphia