Schizophrenia

Josh, age 21, has been diagnosed with schizophrenia. He has been socially isolated and
hearing voices telling him to kill his parents. He has been admitted to the psychiatric unit from
the emergency department. The initial nursing intervention for Josh is to:
a. Give him an injection of Thorazine
b. Ensure a safe environment for him and others
c. Place him in restraints
d. Order him a nutritious diet

The primary goal in working with an actively psychotic, suspicious client would be to:
a. promote interaction with others
b. decrease his anxiety and increase trust
c. improve his relationship with his parents
d. encourage participation in therapy activities

Brandon, a client on a psychiatric unit, has been diagnosed with schizophrenia. He begins to tell
the nurse about how the CIA is looking for him. The most appropriate response by the nurse is:
a. "That's ridiculous Brandon. No one is going to hurt you"
b. "The CIA isn't interested in people like you, Brandon"
c. "Why do you think the CIA wants to kill you?"
d. "I know you believe that Brandon, but it's really hard for me to believe"

Brandon, a client on a psychiatric unit, has been diagnosed with schizophrenia. He begins to tell
the nurse about how the CIA is looking for him. Brandon's belief is an example of:
a. Delusion of persecution
b. Delusion of reference
c. Delusion of control or influence
d. Delusion of grandeur

A nurse is interviewing a client on a psychiatric unit. The client tilts his head to the side, stops
talking mid sentence and listens intently. The nurse recognizes these signs as the client likely
experiencing:
a. Somatic delusions
b. Catatonic stupor
c. Auditory Hallucinations
d. Pseudoparkinsonism

A nurse is interviewing a client on a psychiatric unit. The client tilts his head to the side, stops
talking mid sentence and listens intently. The nurse recognizes these behaviors as a symptom
of the client's illness. The most appropriate nursing intervention for this symptom is to:
a. Ask the client about his physical symptoms
b. Ask the client to describe what he is hearing
c. Administer a dose of benztropine
d. Call the physician for additional orders

When a client suddenly becomes aggressive and violent on the unit, which of the following
approaches would be best for the nurse to use first?
a) provide large motor activities to relieve the client's pent-up tension
b) administer a dose of PRN chlorpromazine to keep the client calm
c) call for sufficient help to control the situation safely
d) convey to the client that his behavior is unacceptable and will not be permitted

The primary focus of family therapy for clients with schizophrenia and their families is
a. to discuss concrete problem-solving and adaptive behaviors for coping with stress
b. to introduce the family to others with the same problem
c. to keep the client and family in touch with the health-care system
d. to promote family interaction and increase understanding of the illness

A client admitted to the hospital reports to the nurse "I don't know why I was brought here. I was
simply hanging out in my apartment when the police said I had to come with them". This is
example of what symptom of Schizophrenia?
a. Delusions of reference
b. Loose association
c. Anosognosia
d. Auditory Hallucinations

A nurse is caring for a client who has substance-induced psychotic disorder and is experiencing
auditory hallucinations. The client states "The voices wont leave me alone!". Which of the
following statements should the nurse make? (Select all that Apply)
a. "When did you start hearing the voices?"
b. "The voices are not real, otherwise we would both hear them"
c. "It must be scary to hear those voices"
d. "Are the voices telling you to hurt yourself?"
e. "Why are the voices talking to only you?"

A nurse is completing an admission assessment for a client who has schizophrenia. Which of
the following findings should the nurse document as positive symptoms? (Select all that apply)
a. Auditory Hallucinations
b. Lack of motivation
c. Use of clang associations
d. Delusion of persecution
e. Constantly waving arms
f. Flat affect

A nurse is caring for a client who has schizoaffective disorder. Which of the following statements
indicates the client is experiencing depersonalization?
a. "I am a superhero. I am immortal"
b. "I am no one and everyone is me"
c. " I feel monsters pinching me all over"
d. " I know you are stealing my thoughts"

A nurse is caring for a client on an acute mental health unit. The client reports hearing voices
that are telling her to "Kill your doctor". Which of the following actions should the nurse take
first?
a. Use therapeutic communication to discuss the hallucination with the client
b. Initiate one-to-one observation of the client
c. Focus the client on reality
d. Notify the provider of the client's statement
A nurse is speaking with a client with schizophrenia when he suddenly seems to stop focusing
on the nurse's questions and begins looking at the ceiling and talking to himself. Which of the
following actions should the nurse take?
a. Stop the interview at this point, and resume later when the client is better able to concentrate
b. Ask the client "Are you seeing something on the ceiling?"
c. Tell the client "You seem to be looking at something on the ceiling, I see something there
too."
d. Continue the interview without comment to the patient's behavior

What are the negative symptoms of schizophrenia? Select all that apply.
a. Delusions
b. Magical thinking
c. Pacing and rocking
d. Associative looseness
e. Emotional ambivalence

What are the positive symptoms of schizophrenia? Select all that apply
a. Apathy
b. Anergia
c. Echolalia
d. Anhedonia
e. Associative looseness

A nurse considers the suicide risk for a client with schizophrenia spectrum. Which fact
influences this risk assessment?
a. 1 out of 3 clients with this diagnosis attempt suicide.
b. 1 out of 10 clients with this diagnosis attempt suicide
c. Clients with schizophrenia often threaten to commit suicide, but very rarely do.
d. Clients with schizophrenia rarely even think about committing suicide.

Which treatment strategy emphasizes vocational expectations and sheltered workshops that
provide rehabilitation to a client with schizophrenia?
a. Milieu therapy
b. Family therapy
c. Behavior therapy
d. Community support programs

A client tells the nurse, "Brad Pitt is in love with me and often sends me flowers." Which type of
delusion does the nurse document for the client based on this statement?
a. Jealous
b. Grandiose
c. Erotomanic
d. Persecutory

A client in a psychiatric ward has severe psychotic episodes and talks to self. On assessing the
behavior of the client, the nurse talks to the client about place, time, and current activity. What is
the nurse trying to do by implementing this intervention?
a. Orienting the client towards reality
b. Distracting the client from hallucinations
c. Assessing the client's level of cognitive impairment
d. Facilitating trust and understanding with the client

The client is insisting that he is being followed by the Central Intelligence Agency. Which nursing
diagnosis is most appropriate?
a. Disturbed thought processes
b. Risk for self-directed violence
c. Social isolation
d. Disturbed sensory impairment

A client arrives at the emergency department and says the he is God. When the nurse asks
where he lives he replies, "Heaven." Which action is the nurse's next step?
a. Ask family members for information about the client.
b. Firmly tell the client that he is not God and must give a proper name.
c. Instruct the client that the nature of his disease causes him to believe that is God, but he is
not and repeat that he must give his name.
d. Enter "God" into the database and proceed with the assessment

Which symptoms in a client indicate the persecutory type of delusional disorder? Select all that
apply.
a. The feeling of being spied on
b. The feeling of being poisoned
c. The feeling of being plotted against
d. The feeling of a famous person being in love with him or her
e. The feeling of being in relationship with a religious leader

A client tells the nurse: "I can be active only when this tube light is switched on, and I must sleep
whenever the tube light is switched off." Which type of delusion does this behavior of the client
indicate?
a. Somatic delusion
b. Delusion of grandeur
c. Delusion of persecution
d. Delusion of control or influence

A client diagnosed with schizoaffective disorder is admitted for social skills training. Which
information should be taught by the nurse?
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

A 16-year-old-client diagnosed with paranoid schizophrenia experiences command

hallucinations to harm others. The client's parents ask a nurse, "Where do the voices come
from?" Which is the appropriate nursing reply?
A. "Your child has a chemical imbalance of the brain which leads to altered thoughts."
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."

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

A nurse is assessing a client diagnosed with paranoid schizophrenia. The nurse asks the client,
"Do you receive special messages from certain sources, such as the television or radio?" Which
potential symptom of this disorder is the nurse assessing?
A. Thought insertion
B. Paranoid delusions
C. Magical thinking
D. Delusions of reference

A client diagnosed with schizophrenia tells a nurse, "The 'Shopatouliens' took my shoes out of
my room last night." Which is an appropriate charting entry to describe this client's statement?
A. "The client is experiencing command hallucinations."
B. "The client is expressing a neologism."
C. "The client is experiencing a paranoid delusion."
D. "The client is verbalizing a word salad."

A client diagnosed with schizophrenia tells a nurse, "The 'Shopatouliens' took my shoes out of
my room last night." Which is an appropriate charting entry to describe this client's statement?
A. "The client is experiencing command hallucinations."
B. "The client is expressing a neologism."
C. "The client is experiencing a paranoid delusion."
D. "The client is verbalizing a word salad."

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

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

A client diagnosed with paranoid schizophrenia 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
A client diagnosed with schizophrenia is slow to respond and appears to be listening to unseen
others. Which medication should a nurse expect a physician to order to address this type of
symptom?
A. Haloperidol (Haldol) to address the negative symptom
B. Clonazepam (Klonopin) to address the positive symptom
C. Risperidone (Risperdal) to address the positive symptom
D. Clozapine (Clozaril) to address the negative symptom

A client is diagnosed with schizophrenia. 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

A client diagnosed with schizophrenia takes an antipsychotic agent daily. Which assessment
finding should a nurse immediately report to the client's attending psychiatrist?
A. Respirations of 22 beats/minute
B. Weight gain of 8 pounds in 2 months
C. Temperature of 104F (40C)
D. Excessive salivation

A client diagnosed with schizophrenia 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

If clozapine (Clozaril) therapy is being considered, the nurse should evaluate which laboratory
test to establish a baseline for comparison in order to recognize a potentially life-threatening
side effect?
A. White blood cell count
B. Liver function studies
C. Creatinine clearance
D. Blood urea nitrogen

Laboratory results reveal decreased levels of prolactin in a client diagnosed with schizophrenia.
When assessing the client, which symptoms should a nurse expect to observe?(Select all that
apply.)
A. Apathy
B. Social withdrawal
C. Anhedonia
D. Auditory hallucinations
E. Delusions