Deck 17: Schizophrenia Spectrum Disorders

Question 1

A patient diagnosed with paranoid schizophrenia says,"My co-workers are out to get me.I also saw two doctors plotting to kill me." How does this patient perceive the environment?

A)Disorganized
B)Dangerous
C)Supportive
D)Bizarre

Answer 1

Dangerous

Question 2

A patient's care plan includes monitoring for auditory hallucinations.Which assessment findings suggest the patient may be hallucinating?

A)Aloofness,haughtiness,suspicion
B)Darting eyes,tilted head,mumbling to self
C)Elevated mood,hyperactivity,distractibility
D)Performing rituals,avoiding open places

Answer 2

Darting eyes,tilted head,mumbling to self

Question 3

A newly admitted patient diagnosed with paranoid schizophrenia is hypervigilant and constantly scans the environment.The patient states,"I saw two doctors talking in the hall.They were plotting to kill me." The nurse may correctly assess this behavior as:

A)echolalia
B)idea of reference
C)delusion of infidelity
D)auditory hallucination

Answer 3

idea of reference

Question 4

A patient with catatonic schizophrenia is semistuporous,demonstrates little spontaneous movement,and has waxy flexibility.The patient's activities of daily living are severely compromised.An appropriate outcome is that the patient will:

A)demonstrate increased interest in the environment by the end of week 1.
B)perform self-care activities with coaching by the end of day 3.
C)gradually take the initiative for self-care by the end of week 2.
D)accept tube feeding without objection by day 2.

Question 5

A health care provider considers which antipsychotic medication to prescribe for a patient with schizophrenia who has auditory hallucinations and poor social functioning.The patient is also overweight and has hypertension.Which drug should the nurse advocate?

A)clozapine (Clozaril)
B)ziprasidone (Geodon)
C)olanzapine (Zyprexa)
D)aripiprazole (Abilify)

Question 6

A newly admitted patient with schizophrenia says,"The voices are bothering me.They yell and tell me I'm bad.I have got to get away from them." Select the nurse's most helpful reply.

A)"Do you hear the voices often?"
B)"Do you have a plan for getting away from the voices?"
C)"I'll stay with you.Focus on what we are talking about,not the voices."
D)"Forget the voices,and ask some other patients to play cards with you."

Question 7

A patient with schizophrenia has taken fluphenazine (Prolixin)5 mg orally twice daily for 3 weeks.The nurse now assesses a shuffling propulsive gait,a masklike face,and drooling.Which term applies to these symptoms?

A)Neuroleptic malignant syndrome
B)Hepatocellular effects
C)Pseudoparkinsonism
D)Akathisia

Question 8

A person has had difficulty keeping a job because of arguing with co-workers and accusing them of conspiracy.Today the person shouts,"They're all plotting to destroy me.Isn't that true?" Select the nurse's most therapeutic response.

A)"Everyone here is trying to help you.No one wants to harm you."
B)"Feeling that people want to destroy you must be very frightening."
C)"No,that is not true.People here are trying to help you if you will let them."
D)"Staff members are health care professionals who are qualified to help you."

Question 9

A patient has taken trifluoperazine (Stelazine)30 mg/day orally for 3 years.The clinic nurse notes that the patient grimaces and constantly smacks both lips.The patient's neck and shoulders twist in a slow,snakelike motion.Which problem would the nurse suspect?

A)Agranulocytosis
B)Tardive dyskinesia
C)Tourette syndrome
D)Anticholinergic effects

Question 10

A community mental health nurse wants to establish a relationship with a very withdrawn patient diagnosed with schizophrenia.The patient lives at home with a supportive family.Select the nurse's best plan.

A)Visit daily for 4 days,then visit every other day for 1 week;stay with the patient for 20 minutes;accept silence;state when the nurse will return.
B)Arrange to spend 1 hour each day with the patient;focus on asking questions about what the patient is thinking or experiencing;avoid silences.
C)Visit twice daily;sit beside the patient with a hand on the patient's arm;leave if the patient does not respond within 10 minutes.
D)Visit every other day;remind the patient of the nurse's identity;encourage the patient to talk while the nurse works on reports.

Question 11

A patient with schizophrenia tells the nurse,"I eat skiller.Tend to end.Easter.It blows away.Get it?" Select the nurse's best response.

A)"Nothing you are saying is clear."
B)"Your thoughts are very disconnected."
C)"Try to organize your thoughts,and then tell me again."
D)"I am having difficulty understanding what you are saying."

Question 12

When a patient with paranoid schizophrenia was discharged 6 months ago,haloperidol (Haldol)was prescribed.The patient now says,"I stopped taking those pills.They made me feel like a robot." What common side effects should the nurse validate with the patient?

A)Sedation and muscle stiffness
B)Sweating,nausea,and diarrhea
C)Mild fever,sore throat,and skin rash
D)Headache,watery eyes,and runny nose

Question 13

A nurse observes a patient who is in a catatonic state and standing immobile,facing the wall with one arm extended in a salute.The patient remains immobile in this position for 15 minutes,moving only when the nurse gently lowers the arm.What is the name of this phenomenon?

A)Echolalia
B)Waxy flexibility
C)Depersonalization
D)Thought withdrawal

Question 14

A nurse works with a patient with paranoid schizophrenia regarding the importance of medication management.The patient repeatedly says,"I don't like taking pills." Family members say they feel helpless to foster compliance.Which treatment strategy should the nurse discuss with the health care provider?

A)Use of a long-acting antipsychotic preparation
B)Addition of a benzodiazepine,such as lorazepam (Ativan)
C)Adjunctive use of an antidepressant,such as amitriptyline (Elavil)
D)Prolonged hospitalization;this patient is not ready for discharge

Question 15

Which patient with schizophrenia would be expected to have the lowest score in global assessment of functioning?

A)39 years old;paranoid ideation since age 35 years
B)32 years old;diagnosed as catatonic at age 24 years;stable for 3 years
C)19 years old;diagnosed with undifferentiated schizophrenia at age 17
D)40 years old;disorganized schizophrenia since age 18;frequent relapses

Question 16

An acutely violent patient with schizophrenia receives several doses of haloperidol (Haldol).Two hours later the nurse notices the patient's head rotated to one side in a stiffly fixed position;the lower jaw is thrust forward,and the patient is drooling.Which intervention by the nurse is indicated?

A)Administer diphenhydramine (Benadryl)50 mg IM from the PRN medication administration record.
B)Reassure the patient that the symptoms will subside.Practice relaxation exercises with the patient.
C)Give trihexyphenidyl (Artane)5 mg orally at the next regularly scheduled medication administration time.
D)Administer atropine sulfate 2 mg subcut from the PRN medication administration record.

Question 17

Withdrawn patients with schizophrenia:

A)Universally fear sexual involvement with therapists.
B)Are socially disabled by the positive symptoms of schizophrenia.
C)Exhibit a high degree of hostility as evidenced by rejecting behavior.
D)Avoid relationships because they become anxious with emotional closeness.

Question 18

A patient with schizophrenia is acutely disturbed and violent.After several doses of haloperidol (Haldol),the patient is calm.Two hours later the nurse sees the patient's head rotated to one side in a stiff position;the lower jaw is thrust forward,and the patient is drooling.Which problem is most likely?

A)Acute dystonic reaction
B)Tardive dyskinesia
C)Waxy flexibility
D)Akathisia

Question 19

A patient with catatonic schizophrenia exhibits little spontaneous movement and demonstrates waxy flexibility.Which patient needs are of priority importance?

A)Psychosocial
B)Physiologic
C)Self-actualization
D)Safety and security

Question 20

A patient with delusions of persecution about being poisoned has refused all hospital meals for 3 days.Which intervention is most likely to be acceptable to the patient?

A)Allowing the patient to have supervised access to food vending machines
B)Allowing the patient to telephone a local restaurant to deliver meals
C)Offering to taste each portion on the tray for the patient
D)Providing tube feedings or total parenteral nutrition

Question 21

What assessment findings mark the prodromal stage of schizophrenia?

A)Withdrawal,misinterpreting,poor concentration,and preoccupation with religion
B)Auditory hallucinations,ideas of reference,thought insertion,and broadcasting
C)Stereotyped behavior,echopraxia,echolalia,and waxy flexibility
D)Loose associations,concrete thinking,and echolalia neologisms

Question 22

A patient with paranoid schizophrenia is hospitalized after arguing with co-workers and threatening to harm them.The patient is aloof and suspicious and says,"Two staff members I saw talking were plotting to kill me." Based on data gathered at this point,which nursing diagnoses relate? Select all that apply.

A)Risk for other-directed violence
B)Disturbed thought processes
C)Risk for loneliness
D)Spiritual distress
E)Social isolation

Question 23

A patient with schizophrenia anxiously says,"I can see the left side of my body merging with the wall,then my face appears and disappears in the mirror." While listening,the nurse should:

A)sit close to the patient.
B)place an arm protectively around the patient's shoulders.
C)place a hand on the patient's arm and exert light pressure.
D)maintain a normal social interaction distance from the patient.

Question 24

A patient with schizophrenia has been stable for a year;however,the family now reports the patient is tense,sleeps 3 to 4 hours per night,and has difficulty concentrating.The patient says,"Volmers are hiding in the house." The nurse can correctly assess this information as an indication of:

A)need for psychoeducation
B)medication noncompliance
C)chronic deterioration
D)relapse

Question 25

A patient with schizophrenia begins a new prescription for lurasidone HCl (Latuda).The patient is 5',6" tall and currently weighs 204 pounds.Which topic is most important for the nurse to include in the teaching plan related to this medication?

A)How to recognize tardive dyskinesia
B)Weight management strategies
C)Ways to manage constipation
D)Sleep hygiene measures

Question 26

A patient with schizophrenia begins to talks about "volmers" hiding in the warehouse at work.The term "volmers" should be documented as:

A)neologism
B)concrete thinking
C)thought insertion
D)idea of reference

Question 27

A patient with schizophrenia has auditory hallucinations,delusions of grandeur,poor personal hygiene,and motor agitation.Which assessment finding would the nurse regard as a negative symptom of schizophrenia?

A)Auditory hallucinations
B)Delusions of grandeur
C)Poor personal hygiene
D)Motor agitation

Question 28

A patient receiving risperidone (Risperdal)reports severe muscle stiffness at 10:30 AM.By noon,the patient has difficulty swallowing and is drooling.By 4:00 PM,vital signs are body temperature,102.8° F;pulse,110 beats per minute;respirations,26 breaths per minute;and blood pressure,150/90 mm Hg.The patient is diaphoretic.Select the nurse's best analysis and action.

A)Agranulocytosis.Institute reverse isolation.
B)Tardive dyskinesia.Withhold the next dose of medication.
C)Cholestatic jaundice.Begin a high-protein,high-cholesterol diet.
D)Neuroleptic malignant syndrome.Immediately notify the health care provider.

Question 29

Which symptoms are expected for a patient with disorganized schizophrenia?

A)Extremes of motor activity,from excitement to stupor
B)Social withdrawal and ineffective communication
C)Severe anxiety with ritualistic behavior
D)Highly suspicious,delusional behavior

Question 30

A nurse at the mental health clinic plans a series of psychoeducational groups for persons with schizophrenia.Which two topics would take priority?

A)How to complete an application for employment
B)The importance of correctly taking your medication
C)How to dress when attending community events
D)How to give and receive compliments
E)Ways to quit smoking

Question 31

A patient with schizophrenia and auditory hallucinations anxiously tells the nurse,"The voice is telling me to do things." Select the nurse's priority assessment question.

A)"How long has the voice been directing your behavior?"
B)"Does what the voice tells you to do frighten you?"
C)"Do you recognize the voice speaking to you?"
D)"What is the voice telling you to do?"

Question 32

The family of a patient with undifferentiated schizophrenia is unfamiliar with the illness and the family's role in recovery.Which type of therapy should the nurse recommend?

A)Psychoeducational
B)Psychoanalytic
C)Transactional
D)Family

Question 33

A patient diagnosed with disorganized schizophrenia says,"It's beat.Time to eat.No room for the cat." What type of verbalization is evident?

A)Neologism
B)Idea of reference
C)Thought broadcasting
D)Associative looseness

Question 34

A patient diagnosed with paranoid schizophrenia angrily tells a nurse,"You act like a homosexual.No one trusts you or wants to be around you." Select the most likely analysis.The patient:

A)is showing reaction formation in response to feelings of abandonment.
B)is unleashing unconscious,hostile feelings toward the nurse.
C)is dwelling on others' shortcomings,thus placing them on the defensive.
D)may be projecting homosexual urges.

Question 35

A patient with schizophrenia has taken a conventional antipsychotic medication for a year.Hallucinations are less intrusive,but the patient continues to have apathy,poverty of thought,and social isolation.The nurse expects a change to which medication?

A)haloperidol (Haldol)
B)olanzapine (Zyprexa)
C)chlorpromazine (Thorazine)
D)diphenhydramine (Benadryl)

Question 36

A nurse sits with a patient diagnosed with disorganized schizophrenia.The patient starts to laugh uncontrollably,although the nurse has not said anything funny.Select the nurse's best response.

A)"Why are you laughing?"
B)"Please share the joke with me."
C)"I don't think I said anything funny."
D)"You're laughing.Tell me what's happening."

Question 37

The family members of a patient newly diagnosed with paranoid schizophrenia state that they do not understand what has caused the illness.The nurse's response should be based on which models? Select all that apply.

A)Neurobiological
B)Developmental
C)Family theory
D)Genetic
E)Stress

Question 38

A patient with schizophrenia says,"Contagious bacteria are everywhere.When they get in your body,you will be locked up with other infected people." Which problem is evident?

A)Poverty of content
B)Concrete thinking
C)Neologisms
D)Paranoia