Chapter 24: Schizophrenia and Related Disorders: Nursing Care of Persons with Thought Disorders

Format: Multiple Choice

Client Needs: Psychosocial Integrity

Cognitive Level: Understand

Integrated Process: Nursing Process

Objective: 10

Page and Header: 403, Schizoaffective Disorder

1. A client who has a major depressive episode has been hearing voices and feeling followed by someone. A history reveals that the client has had these alternating symptoms before. The client also has experienced time free from these symptoms and has been able to function adequately. The nurse interprets these findings as suggesting which disorder?

A) Paranoid schizophrenia

B) Undifferentiated schizophrenia

C) Brief psychotic disorder

D) Schizoaffective disorder

Page and Header: 403, Schizoaffective Disorder

2. A nurse is caring for a client who was diagnosed with schizoaffective disorder. Based on an understanding of this disorder, the nurse develops a plan of care to address which issue as the top priority?

A) Suicide

B) Aggression

C) Substance abuse

D) Eating disorder

Page and Header: 373, Internal and External Risk Factors

3. A family member of a client diagnosed with schizophrenia disorder asks a nurse what causes the disorder. The nurse integrates understanding of schizophrenia and related disorders such as schizoaffective disorder when responding to the family member. Which response by the nurse would be most appropriate?

A) “Dysfunctional family dynamics has been identified as a strong link.”B) “Research has suggested that the cause is predominately genetic.”

C) “Dopamine, a substance in the brain, appears to be underactive.”

D) “Studies have indicated that birth order is strongly associated with this disorder.”

Page and Header: 390, Medication Interventions: Antipsychotics; 391–392, Box 24.9

4. The nurse is caring for a client who was just admitted with a diagnosis of schizoaffective disorder with depression. Which agent would the nurse anticipate as being prescribed for this client?

A) Lithium

B) Haloperidol

C) Chlorpromazine

D) Clozapine

Page and Header: 386, Stress and Coping Patterns

5. The nurse is assessing a newly admitted client diagnosed with schizoaffective disorder. The nurse assesses the client’s level of anxiety and reactions to stressful situations, obtaining this information for which reason?

A) To help determine the client’s outcomes after treatment

B) To help identify whether or not the client’s mental competency is intact

C) To act as a predictor of the client’s risk for a suicide attempt

D) To provide a basis for evaluating the client’s social skills

Page and Header: 404, Delusional Disorder

6. A nurse is caring for a client diagnosed with a delusional disorder. While assessing this client, which would a nurse expect to find?

A) History of chronic major depression

B) Consistent disruptive behavior patterns

C) Verbalization of bizarre delusions

D) Living with one or more delusions for a period of time

Page and Header: 404, Delusional Disorder

7. A nurse is preparing to interview a client who has a delusional disorder. Which assessment would the nurse expect?

A) Cognitive impairment

B) Normal behavior

C) Labile affect

D) Evidence of motor symptoms

Page and Header: 390, Medication Interventions: Antipsychotics; 391–392, Box 24.9

8. A client diagnosed with schizoaffective disorder is prescribed clozapine to treat symptoms. Which instructions would the nurse provide?

A) “Keep a record of how often and how long you experience the side effect of dry mouth.”

B) “Monitor your urinary output and notify your health-care provider if your urine changes color.”

C) “Keep an eye on your weight, and if you gain weight rapidly, notify your health-care provider.”

D) “If you experience any drowsiness, discontinue taking this medication.”

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9. After teaching a group of students about the epidemiology of schizoaffective disorder (SAD), the instructor determines that the education was successful when the students agree with what statement?

A) “The disorder occurs often in children.”

B) “It has a better prognosis that schizophrenia.”

C) “Most persons are African Americans.”

D) “The disorder is rare in family relatives.”

Page and Header: 404, Delusional Disorder

10. While being interviewed, a client diagnosed with a delusional disorder states, “I have this really strange odor coming out of my mouth. I stop to brush my teeth almost every hour and then rinse with mouthwash every half hour to get rid of this smell. I’ve seen so many doctors, and they can’t tell me what’s wrong.” The nurse interprets the client’s statement as reflecting which type of delusion?

A) Erotomanic

B) Grandiose

C) Somatic

D) Jealous

Page and Header: 404, Schizophreniform Disorder

11. When obtaining a client’s history, a nurse determines that the client has been experiencing delusions and hallucinations for the past 3 months, which has caused some problems in the client’s ability to function at work. The client also is exhibiting catatonic excitement, echopraxia, loose associations, and pressured speech. The nurse suspects which condition?

A) Schizophrenia

B) Schizoaffective disorder

C) Brief psychotic disorder

D) Schizophreniform disorder

Page and Header: 372, Disorganized Thinking

12. A nurse is caring for a client in an inpatient mental health setting. The nurse notices that when the client is conversing with other clients, the client repeats what they are saying word for word. The nurse interprets this finding and documents it using which term?

A) Echola

B) Neologisms

C) Tangentiality

D) Echolalia

Page and Header: 372, Disorganized Thinking

13. While caring for a hospitalized client diagnosed with schizophrenia, a nurse observes that the client is listening to the radio. The client tells the nurse that the radio commentator is speaking directly to the client. The nurse interprets this finding as which type of thinking?

A) Autistic

B) Concrete

C) Referential

D) Illusional

Page and Header: 382, Psychosocial Assessment, Box 24.4

14. A client has been diagnosed with schizophrenia. Assessment reveals that the client lives alone. The client’s clothing is disheveled, the client’s hair is uncombed and matted, and the client’s body has a strange odor. During an interview, the client’s family members voice a desire for the client to live with them when the client is discharged. Based on the assessment findings, which nursing diagnosis would be the priority?

A) Ineffective role performance related to symptoms of schizophrenia

B) Social isolation related to auditory hallucinations

C) Dysfunctional family processes related to psychosis

D) Bathing self-care deficit related to symptoms of schizophrenia

Page and Header: 392, Monitoring Extrapyramidal Side Effects

15. A nurse is caring for an older adult client who has been taking an antipsychotic medication for 1 week. The nurse notifies the primary care provider that the client has muscle rigidity that resembles Parkinson’s disease. Which agent would the nurse expect the primary health-care provider to prescribe?

A) Anticholinergic

B) Anxiolytic

C) Benzodiazepine

D) Beta-blocker

Page and Header: 392, Monitoring Extrapyramidal Side Effects

16. A nurse is caring for a hospitalized client who has been diagnosed with schizophrenia. The client has been taking antipsychotic medications for 1 week when the nurse observes that the client’s eyes are fixed on the ceiling. The nurse documents this finding using which term?

A) Akathisia

B) Oculogyric crisis

C) Retrocollis

D) Tardive dyskinesia

Page and Header: 392, Monitoring Extrapyramidal Side Effects

17. A hospitalized client diagnosed with schizophrenia is receiving antipsychotic medications. While assessing the client, a nurse identifies signs and symptoms of a dystonic reaction. Which agent would the nurse expect to administer?

A) Diphenhydramine

B) Propranolol

C) Risperidone

D) Aripiprazole

Page and Header: 392, Monitoring Extrapyramidal Side Effects

18. A nurse is caring for a client who has been treated for schizophrenia with a first-generation antipsychotic medication for the past year. It would be essential for the nurse to monitor the client for which side effect?

A) Weight loss

B) Torticollis

C) Hypoglycemia

D) Tardive dyskinesia

Page and Header: 394, Monitoring Other Side Effects

19. A client hospitalized for treatment of schizophrenia has been receiving olanzapine for the past 2 months. A nurse should be especially alert for which side effect?

A) Weight loss

B) Hypertension

C) Diarrhea

D) Diabetes

Page and Header: 394, Monitoring Other Side Effects

20. A nurse is caring for a client who has been taking clozapine for 2 weeks. The client tells the nurse, “My throat is sore, and I feel weak.” The nurse assesses the client’s vital signs and finds that the client has a fever. The nurse notifies the physician, expecting an order to obtain which laboratory test?

A) White blood cell count

B) Liver function studies

C) Serum potassium concentration

D) Serum sodium concentration

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21. A client is being released from the inpatient psychiatric unit with a diagnosis of schizophrenia and treatment with antipsychotic medications. After teaching the client and family about managing the disorder, the nurse determines that the education was effective when they state that which should be reported immediately?

A) Elevated temperature

B) Tremor

C) Decreased blood pressure

D) Weight gain

Page and Header: 395, Teaching Points

22. A nurse is preparing an in-service program about schizophrenia for a group of psychiatric–mental health nurses. Which would the nurse include as a major reason for relapse?

A) Lack of family support

B) Accessibility to community resources

C) Non-adherence to prescribed medications

D) Stigmatization of mental illness

Page and Header: 370, Positive Symptoms of Schizophrenia

23. While being assessed, a client diagnosed with schizophrenia states, “Everywhere I turn, the government is watching me because I know too much. They are afraid that I might go public with the information about all those conspiracies.” The nurse interprets this statement as indicating which type of delusion?

A) Grandiose

B) Nihilistic

C) Persecutory

D) Somatic

Page and Header: 372, Disorganized Thinking

24. A nurse is interviewing a client diagnosed with schizophrenia when the client begins to say, “Kite, night, right, height, fright.” The nurse documents this behavior using which term?

A) Clang association

B) Stilted language

C) Verbigeration

D) Neologisms

Page and Header: 389, Fluid Balance

25. A nurse is providing care to a client recently diagnosed with schizophrenia during an inpatient hospital stay. Throughout the day, the nurse observes the client drinking from the water fountain quite frequently, as well as carrying cans of soda and bottles of water everywhere. Upon entering the client’s room, the nurse sees numerous empty cups that had been filled with fluids on the bedside table and in the trash can. The room has an odor of urine. The nurse suspects which cause of this behavior?

A) Type 2 diabetes

B) Disturbed fluid and electrolyte balance

C) Tardive dyskinesia

D) Orthostatic hypotension

Page and Header: 375, Dopamine Dysregulation

26. A group of nursing students is reviewing the various theories related to the etiology of schizophrenia. The students demonstrate understanding of the information when they identify which neurotransmitter as being responsible for hallucinations and delusions?

A) Dopamine

B) Serotonin

C) Norepinephrine

D) Gamma-aminobutyric acid (GABA)

Page and Header: 390, Medication Interventions: Antipsychotics

27. After teaching a class on antipsychotic agents, the instructor determines that the education was successful when the class identifies which as an example of a second-generation antipsychotic agent?

A) Fluphenazine

B) Thiothixene

C) Quetiapine

D) Chlorpromazine

Page and Header: 389, Fluid Balance

28. When educating a client with schizophrenia induced polydipsia, the nurse teaches the client to self-monitor urine specific gravity and which vital sign?

A) Respirations

B) Blood pressure

C) Temperature

D) Weight

Page and Header: 399, Therapeutic Interactions

29. A client diagnosed with schizophrenia tells the nurse, “I’m being watched constantly by the Federal Bureau of Investigation because of my job.” Which response by the nurse would be most appropriate?

A) “Tell me more about how you are being watched.”

B) “It must be frightening to feel like you’re always being watched.”

C) “You’re not being watched; it’s all in your mind.”

D) “You are experiencing a delusion because of your illness.”

Page and Header: 394, Monitoring Other Side Effects

30. A client diagnosed with schizophrenia is prescribed clozapine because other prescribed medications have been ineffective. After educating the client and family about the drug, the nurse determines that the education was successful when they agree with which statement?

A) “The client needs to have an electrocardiogram periodically when taking this drug.”

B) “We’ll need to make sure that the client has the client’s blood count checked at least weekly.”

C) “The client might develop toxic levels of the drug if the client smokes cigarettes.”

D) “We need to watch to make sure that the client doesn’t lose too much weight.”

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31. To promote recovery, what would be most important for a nurse to keep in mind when establishing a nurse–client relationship with a client who has schizophrenia?

A) The relationship typically develops over a short period of time.

B) Decisions about care are the responsibility of an interdisciplinary team.

C) Short, time-limited interactions are best for a client experiencing psychosis.

D) Typically, clients with schizophrenia readily engage in a therapeutic relationship.

Page and Header: 399, Teaching Strategies

32. A nurse is developing an education plan for a client diagnosed with schizophrenia. Which method would the nurse use to be most effective?

A) Engaging the client with trial-and-error learning

B) Having the client write down information after directly being given the correct information

C) Asking the client questions that encourage the client to guess the correct answer

D) Using visual aids that are very colorful and full of descriptive graphic images

Page and Header: 383, Hallucinations

33. Assessment of a client diagnosed with schizophrenia reveals that the client is hearing voices. The client feels watched and is experiencing illusions. When developing the plan of care for this client, which nursing diagnosis would be most appropriate?

A) Impaired memory

B) Risk for self-directed violence

C) Disturbed sensory perception

D) Ineffective coping

Page and Header: 402, Continuum of Care

34. A nursing instructor is preparing a class lecture about schizophrenia and appropriate outcomes focusing on recovery. Which would the instructor include as a major goal?

A) Continuity of care

B) Shorter inpatient stays

C) Immediate crisis stabilization

D) Social engagement

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35. A nursing instructor is developing an education plan for a group of students about schizophrenia and schizoaffective disorders. The instructor identifies that in addition to psychosis, what other condition must be present at the same time for a diagnosis of schizoaffective disorder?

A) Substance abuse

B) Mood disturbance

C) Delirium

D) Anxiety

Page and Header: 71, Schizophreniform disorder

36. A group of nursing students is reviewing information about other psychotic disorders. The students demonstrate a need for additional review when they identify what information about schizophreniform disorder?

A) The duration of the illness is usually less than 6 months.

B) Symptoms must be present for at least 1 month for the diagnosis.

C) The majority of individuals with the disorder recover completely.

D) The individual experiences hallucinations and/or delusions.

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37. A client is receiving antipsychotic therapy as treatment for schizoaffective disorder. The nurse is reviewing the client’s medical record. Which drug, if noted on the record, would cause the nurse to be concerned?

A) Acetaminophen

B) Furosemide

C) Quinapril

D) Lithium

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38. After assessing a client with schizophrenia, a nurse suspects that the client is experiencing an anticholinergic crisis. What would the nurse most likely have assessed? Select all that apply.

A) Dilated, reactive pupils

B) Blurred vision

C) Ataxia

D) Coherent speech

E) Facial pallor

F) Disorientation

Page and Header: 370, Negative Symptoms of Schizophrenia; 400, Social Skills Training

39. A client diagnosed with schizoaffective disorder is working with the nurse on social skills training. What client behaviors would show that the training has been effective? Select all that apply.

A) Ability to resolve conflicts

B) Limited compromising

C) Expression of negative feelings

D) Ability to negotiate

E) Restricted coping skills