Deck 49: Care of Patients With Thought and Personality Disorders

Question 1

When the paranoid schizophrenic states that his whole family has conspired to have him put in the hospital and that the medical staff is part of the conspiracy,the nurse's most therapeutic response would be:

A)"I'm not like that. I want to help you."
B)"You know your family is concerned about you."
C)"I'm sorry you feel that way. I'll be around if you want to talk about your feelings."
D)"The doctors are trying to help you feel better. They have your best interest in mind."

Answer 1

"I'm sorry you feel that way. I'll be around if you want to talk about your feelings."

Question 2

During report,the nurse is told that a patient has Cluster B group type of personality disorder.When assessing the patient,which type of behaviors can be anticipated?

A)Paranoia
B)Avoidance
C)Antisocial
D)Obsessive-compulsive

Answer 2

Antisocial

Question 3

The nurse is aware the patient with borderline personality disorder did not have a family visit this week.The nurse adds an intervention to address the patient's probable perception of abandonment.Which intervention would be most appropriate?

A)Schedule patient for pet therapy visit.
B)Arrange for remote activity during next visiting time.
C)Assess daily for evidence of self-mutilation.
D)Assign a young CNA to his care.

Answer 3

Assess daily for evidence of self-mutilation.

Question 4

The nurse is talking with a patient who voices concerns about the incidence of schizophrenia in her family.The patient states that she is worried the condition will be inherited by her teenage daughter.What response by the nurse is most appropriate?

A)"Unfortunately, schizophrenia does run in families."
B)"There is no exact cause known for schizophrenia but there are some familial factors."
C)"Your daughter would be showing some evidence of the condition by this point in her life so there is no real reason to worry."
D)"As long as your home environment is warm and loving she will be fine."

Question 5

The family of a patient being treated for a recent diagnosis of schizophrenia voices concerns to the nurse.They report the patient just told them that the pepper flakes on his potatoes were crawling bugs.What response by the nurse is most appropriate?

A)"At this stage it is most important to humor him and agree that you see them as well."
B)"To reduce his stress, just throw out the food."
C)"It is important to tell him that you do not see the bugs."
D)"The best thing to do in this case is to confront him and let him know that he is mistaken."

Question 6

The CNA reports that a patient has been caught smoking in his room for the third time this week.The behavior has been addressed with a contract indicating that further infractions will result in the patient's smoking materials being taken and locked in the nurse's station and smoking will only be possible with supervision.The nurse should say:

A)"Why are you smoking in your room when you know it is not allowed?"
B)"Larry, the contract was, if you smoke in your room, you must give me your smoking materials. Let me have them, please."
C)"Okay, Larry, give me your cigarettes and lighter now."
D)"I am going to give you one more chance, Larry. Let's see if you can live up to the contract."

Question 7

The delusional patient has become agitated and angry.The patient reports that the cook put tacks in his cereal.He is pacing back and forth in the crowded dining room and cursing the cook.The best intervention by the nurse would be:

A)keeping distance from the patient, say, "Can we go to the dayroom and talk about this, Carl?"
B)touching the patient's arm, say, "Calm down, Carl. I'm sure we can straighten this out."
C)call experienced CNAs to restrain the patient.
D)standing calmly, say, "This behavior is unacceptable. Sit down and eat, Carl."

Question 8

The nurse is aware that interventions for the negative symptoms of schizophrenia are based on:

A)establishment of trust.
B)getting the patient to accept medication protocols.
C)supporting patient in interpersonal social activities.
D)promoting conversation with the patient.

Question 9

The nurse adds an intervention to the nursing care plan for a patient on neuroleptics to:

A)increase fluid intake to compensate for the side effect of diarrhea.
B)encourage snacks to prevent weight loss.
C)monitor vital signs for hypertension.
D)assess urinary output for evidence of urinary retention.

Question 10

The nurse documents a schizophrenic's delusion of persecution when the patient says:

A)"Did you know that I own this hospital and pay all these people to work for me?"
B)"My doctor talked to all the other patients, but not to me. He doesn't want me to get well."
C)"The president's speech tonight is going to give me a coded message."
D)"I am going to wait in front of the hospital this morning for my limousine to pick me up and take me to my private jet."

Question 11

The nurse is aware that it is estimated that approximately _____% of the United States population is affected with schizophrenia.

A)1
B)2
C)3
D)4

Question 12

The nurse observes a withdrawn schizophrenic sitting alone and moving her lips as if she is talking,but there is no audible sound.The nurse speaks to the patient by name,but the patient does not seem to hear.What action by the nurse is indicated initially?

A)Hug the patient's shoulders, say, "Hey, Mary! Are you praying?"
B)Document patient's nonresponsiveness and continued detached behavior.
C)Sit down in the chair next to the patient and touch her arm, say, "I am right here, Mary."
D)Touch the patient's shoulder, then join another group of patients.

Question 13

The nurse explains that depression is thought to be the result of a deficit of:

A)norepinephrine.
B)serotonin.
C)acetylcholine.
D)dopamine.

Question 14

The nurse is changing the dressing on self-inflicted cigarette burns on a patient with borderline personality disorder.When providing the care,which action by the nurse would be most therapeutic?

A)Perform the actions while being nurturing and caring to keep patient from feeling abandoned.
B)Approach the interventions with a matter-of-fact demeanor to decrease secondary gains of sympathy.
C)Present a stern attitude to underscore the seriousness of the act.
D)Interact in a professional and distant manner to diminish the opportunity for manipulation.

Question 15

The nurse is receiving beginning-of-shift report.During report,it is communicated that a schizophrenic patient has been admitted to the unit displaying waxy flexibility.Which behavior can the nurse anticipate finding when assessing the patient?

A)Sitting and staring at the wall without speaking
B)Arranging self in several seated postures on the couch
C)Marching stiffly up and down the center of the dayroom
D)Holding his arm over his head with the fist clenched for 1 hour

Question 16

The manipulative patient approaches the nurse and says,"I know it's too early to give me my pain medication,but you are the only one who seems to care.Could you give me my pain medication now?" The best response would be:

A)"The charge nurse is really tough about scheduled medications. She would be very angry with me if I gave you the medication now."
B)"I know how it is when you are in pain. I'll give you your medication early."
C)"Your medication is due in 2 hours. I will be glad to give it to you on schedule."
D)"It makes me feel good to know you are appreciative of our care. Here is your medication."

Question 17

A student nurse questions the nurse about the frequency of administration of antipsychotics,such as risperidone (Risperdal).The nurse responds by explaining that risperidone (Risperdal)is a newer medication that is effective and has the advantage that it:

A)does not cause photosensitivity.
B)has fewer serious side effects.
C)is less expensive.
D)does not cause drowsiness.

Question 18

The nurse is caring for a schizophrenic patient who has been prescribed large doses of thioridazine (Mellaril).Which manifestation may signal an overdose of the medication?

A)The patient walking with a shuffling gait and drooling
B)Lethargy during the day and taking frequent daytime naps
C)Disorganized thought processes
D)Extreme excitability with periods of mania and crying

Question 19

The nurse documents episodes of echolalia when,after the nurse has asked a catatonic patient,"Where is your hat?" the patient:

A)excitedly says, "Hat, cat, rat, fat, scat, splat!"
B)begins to cry and says, "I had a hat when my mother drove her yellow car."
C)repeatedly says, "Your hat, your hat, your hat."
D)places his hands on his head, saying, "Where is your hat?"

Question 20

By using clear,direct communication with people with borderline personality disorder,the nurse can:

A)avoid having an intense reaction to the patient.
B)eliminate the possibility of manipulation.
C)decrease the probability of the patient reacting emotionally.
D)role model good communication.

Question 21

The wife of a patient being treated for a recent diagnosis of schizophrenia asks how long it will be until her husband is cured.What response by the nurse is most appropriate?

A)"Unfortunately there is no cure but the condition can be managed."
B)"It will take approximately 1 to 2 months of medication therapy to alleviate the symptoms being experienced by your husband."
C)"We cannot consider your husband cured until he has been symptom free for at least 1 year."
D)"There is no way to predict his outcome during his initial episode."

Question 22

The paranoid schizophrenic who is taking a neuroleptic is brought to the emergency department with acute muscle spasm of the face and neck with eyes that are fixed in an upward stare.The nurse recognizes the condition of ________.

Question 23

The nurse takes into consideration that the characteristics of personality disorders include: (Select all that apply)

A)impaired cognition.
B)maladaptive response to life's events.
C)inability to maintain relationships.
D)poor impulse control.
E)inappropriate emotional responses.

Question 24

The delusional patient rushes up to the nurse and begins to brush her uniform with his hands,saying,"I must get the weegos off of you!" The nurse recognizes that the word "weegos" is a(n)________.

Question 25

The nurse points out that negative symptoms of schizophrenia are more difficult to modify.Examples of negative symptoms are: (Select all that apply.)

A)avolition.
B)hallucination.
C)psychomotor retardation.
D)delusions.
E)anhedonia.

Question 26

The nurse is aware that schizophrenia is a thought disorder that is characterized by psychotic features,which include: (Select all that apply.)

A)hallucinations.
B)sexual dysfunction.
C)delusions.
D)disorganized speech.
E)disorganized behavior.

Question 27

The nurse explains that neuroleptic drugs such as chlorpromazine (Thorazine)are very effective in treating positive symptoms of schizophrenia by: (Select all that apply.)

A)stopping hallucinations.
B)stimulating effective interpersonal relationships.
C)enabling organized thought.
D)increasing activity level.
E)eliminating delusional systems.

Question 28

Milieu therapy is a therapeutic application for people with personality disorders in which the therapy is based on: (Select all that apply.)

A)maintaining a structured environment.
B)participating as a member of the structured environment.
C)practicing appropriate social behavior.
D)actively attempting to modify behavior.
E)learning to modify feelings and emotional responses.
F)None of the above.