Deck 48: Care of Patients with Thought and Personality Disorders

Question 1

The nurse observes a withdrawn schizophrenic.The patient is sitting alone and moving her lips as if she is talking,but there is no audible sound.The nurse speaks to the patient by name,but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 should the nurse do first?

A) Hug the patient's shoulders, refer to the patient by name, and ask if she's praying.
B) Document the patient's nonresponsiveness and continued detached behavior.
C) Sit down in the chair next to the patient, touch her arm, and speak softly.
D) Touch the patient's shoulder and then join another group of patients.

Answer 1

Sit down in the chair next to the patient, touch her arm, and speak softly.

Question 2

Approximately what percentage of the U.S.population is affected with schizophrenia?

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

Answer 2

1%

Question 3

The nurse explains that depression is thought to be the result of a deficit of which neurotransmitter?

A) Norepinephrine
B) Serotonin
C) Acetylcholine
D) Dopamine

Answer 3

Serotonin

Question 4

The nurse has asked a catatonic patient,"Where is your hat?" Which response should cause the nurse to document episodes of echolalia?

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

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

What effect does the nurse desire to achieve by using clear,direct communication with patients with borderline personality disorder?

A) Avoid generating an intense reaction from the patient.
B) Eliminate the possibility of manipulation.
C) Decrease the probability of the patient reacting emotionally.
D) Provide a role model for good communication.

Question 7

A student nurse questions the nurse about the frequency of administration of antipsychotics,such as risperidone (Risperdal).Which advantage is true of newer antipsychotics like risperidone (Risperdal)?

A) Decreased photosensitivity
B) Fewer serious side effects
C) Less expensive
D) Decreased incidence of headaches

Question 8

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

A) Schedule the 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.

Question 9

During report,the nurse is told that a patient has Cluster B group type of personality disorder.Which type of behavior can the nurse anticipate?

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

Question 10

After signing a contract that he will no longer smoke in his room,the patient violates the contract.The contract consequences include confiscation of smoking materials and mandatory supervision for future smoke breaks.How should the nurse appropriately address the patient's behavior?

A) "Why are you smoking in your room when you know it is not allowed?"
B) "The contract states that 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 11

Which statement causes the nurse to document a schizophrenic patient's delusion of persecution?

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 12

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) "Although some familial factors exist, there is no exact known cause for schizophrenia."
C) "Your daughter would show 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 13

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.How should the nurse respond?

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

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 is most therapeutic?

A) Change the dressings while being nurturing and caring to keep patient from feeling abandoned.
B) Approach the dressing change 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 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 walks with a shuffling gait and drooling.
B) The patient is lethargic and takes frequent naps.
C) The patient exhibits disorganized thought processes.
D) The patient exhibits extreme excitability with periods of mania.

Question 16

When receiving report,the nurse learns that a schizophrenic patient has been displaying waxy flexibility.Which behavior is consistent with this report?

A) The patient sits and stares at the wall without speaking.
B) The patient arranges himself in several seated postures on the couch.
C) The patient marches stiffly up and down the center of the dayroom.
D) The patient holds his arm over his head with his fist clenched for an hour.

Question 17

The nurse is aware that interventions for the negative symptoms of schizophrenia are based on which factor?

A) Establishment of trust
B) Acceptance of medication protocols
C) Support in interpersonal social activities
D) Promotion of conversation with the patient

Question 18

The nurse adds an intervention to the nursing care plan for a patient on neuroleptics.Which intervention is most appropriate?

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 19

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?" Which response is best?

A) "The charge nurse is very stringent 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 20

The paranoid schizophrenic patient states that his whole family has conspired to have him put in the hospital and that the medical staff are part of the conspiracy.Which is the nurse's most therapeutic response?

A) "I promise 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."

Question 21

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 22

Which characteristic(s)of personality disorders should the nurse consider?

A) Impaired cognition
B) Maladaptive response to life's events
C) Inability to maintain relationships
D) Poor impulse control
E) Inappropriate emotional responses

Question 23

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 24

Which psychotic feature(s)is/are characteristic of schizophrenia?

A) Hallucinations
B) Sexual dysfunction
C) Delusions
D) Disorganized speech
E) Disorganized behavior

Question 25

The nurse explains that neuroleptic drugs such as chlorpromazine (Thorazine)are very effective in treating specific symptoms of schizophrenia.Which effect(s)should chlorpromazine have?

A) Eliminating hallucinations
B) Stimulating effective interpersonal relationships
C) Enabling organized thought
D) Increasing activity level
E) Eliminating delusional systems

Question 26

Milieu therapy is a therapeutic application for people with personality disorders.What principle(s)underscore(s)the basis of this method?

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 above

Question 27

Which characteristic(s)is/are an example of a negative symptom of schizophrenia?

A) Avolition
B) Hallucination
C) Psychomotor retardation
D) Delusions
E) Anhedonia

Question 28

The nurse is caring for a patient with a recent diagnosis of schizophrenia.His wife 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 your husband's symptoms."
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."