1. A newly admitted client is apathetic and exhibits an inappropriate affect. A diagnosis of acute schizophrenic reaction is made. Considering the diagnosis, a symptom the nurse would expect to observe in the clients behaviour or communication is:

a. Logical delusionsb. Suicidal preoccupationc. Absence of self-criticismd. Autistic magical thinking

Answer: D, these clients are threatened by reality, withdrawal from reality and the use of magical thinking reduces anxiety. A is impossible bcoz of loosening associative that occurs in schizo. B,Common in clients with severe depression. C, scizos have low self-esteem and usually have feelings of guilt and self blame

2. A 30-year-old female graduate student, who has become increasingly withdrawn and neglectful of her studies and personal hygiene, is brought to the psychiatric hospital by her roommate. After a detailed assessment, a diagnosis of schizophrenia is made. It is unlikely that the client will demonstrate:

a. A weak egob. A low self-esteemc. Concrete thinkingd. Effective self-boundaries

3. A client with schizophrenia sees a group of visitors sitting together talking. The client tells the nurse, “I know they are talking about me.” Which altered thought process should the nurse identify?

a. Flight of ideasb. Ideas of referencec. Grandiose delusiond. Thought broadcasting

4. A client with schizophrenia repeatedly says to the nurse, “No moley, jandu!” The nurse understands that this is called:

a. Echolaliab. Concretismc. Neologismsd. Perseveration

Answer: C, are words invented and understood only by the person using them. A, repeating exactly what is heard. B, absence of abstractions. D, disturbed system of thinking manifested by repetitive verbalizations or motions, or persistent repetition of same idea to different questions.

5. A female client with acute schizophrenia tells the nurse, “Everyone hates me.” The best response by the nurse is:

a. “Tell me more about this.”b. “Everyone does not hate you.”c. “That feeling is part of your illness.”d. “You may. Be doing something to promote this feeling.”

Answer: A, explores more fully the client’s ideas experiences, or relationships w/c promotes communication. B, arguing about delusions diminish trust and increase anxiety. C, denies feeling and

implies the client is wrong w/c may cause the client to defend further. D, puts the blame on the client and implies the feelings are true.

6. Breaks in reality, such as those experienced by clients with schizophrenia, necessitate that the nurse first realize that:

a. Extended institutional care is necessaryb. Clients believe what they feel they are experiencing is realc. Electroconvulsive therapy produces remission most clients with schizophreniad. The clients’ families must cooperate in the maintenance of the psychotherapeutic plan

Answer: B, failure to accept the client and the client’s fears establishes a barrier to effective communication. A, today mental health therapy is directed toward returning the client to the community as rapidly as possible. C, ECT is not the treatment of choice for clients with schizophrenia. D, is helpful but not an absolute necessity.

7. A man is admitted to the psychiatric unit after attempting suicide. The client’s history reveals that his first child died of SIDS 2 years ago, he has been unable to work since the death of the child, and he attempted suicide before was never hospitalized. When talking with the nurse he states, “I hear my son telling me to come over to the other side.” The nurse recognizes that this statement would be most reflective of a:

a. Religious delusionb. Somatic delusionc. False hallucinationd. Command hallucination

Answer: D, auditory hallus that give verbal msgs to do harm either to self or others; giving an identity to the hallucinated voice increases thie risk for compliance. C, there is no false hallucination, it is always real to the client.

8. By recognizing common behaviors exhibited by the client who has a diagnosis of schizophrenia, the nurse can anticipate:

a. Disorientation, forgetfulness, and anxietyb. Grandiosity, arrogance, and distractibilityc. Withdrawal, regressed behaviour, and lack of social skillsd. Slumped posture, pessimistic outlook, and flight of ideas

Answer: C, classic behaviors exhibited by clients with schizo. A, associated with dementia. B, bipolar, manic phase. D, depression.

9. The nurse is aware that a common nursing diagnosis for clients with a schizophrenic disorder is:a. Social isolation related to impaired ability to trustb. Risk for other-directed violence related to hallucinationsc. Disturbed sleep pattern related to impaired thinking abilityd. Impaired physical mobility related to fear of loss of control of hostile impulses

Answer:A, the client cannot reach out to others because of lack of trust withdrawal is used to defend against interpersonal threats, and results in isolation. B, most schizos are not violent. C, not common bec clients tend to use sleep to withdraw from reality. D, not associated with this disorder.

10. An intermediate goal for a paranoid male client who has unjustifiably accused his wife of having many extramarital affairs would be the client will develop:

a. Faith in his wifeb. Better self-controlc. Feelings of self-worthd. Insight into his behaviour

Answer: C, helping the client to develop feelings of self-worth would reduce the client’s need to use pathologic defenses. A, faith or lack of faith is not the basic underlying problem but merely a symptom of it. B, same as A. D, insight can develop only when the need to use the defense is reduced

11. A 25-year-old male client is being treated for an anxiety disorder and issues related to impaired social interaction. The client accuses the nurses and the physicians of being homosexuals. This behaviour indicates that the client most likely is:

a. Attempting to keep focus off his problemsb. Trying to embarrass those perceived as authority figuresc. Having difficulty handling unacceptable feelings about himselfd. Exploring emotionally charged reactions to threatening situations

Answer: C, by using the defense mechanism of projection, the client is attributing to others those personal feelings that are objectionable to the self. A, no evidence is given to support an interpretation that redirection is being used. B, no evidence.

12. The most appropriate intervention for the nurse to take after finding an acting-out, disturbed male client in the fetal position should be to:

a. “Sit down beside him on the floor and say, “I’m here to spend time with you.”b. Tap him gently on the shoulder to get his attention and then stay with the clientc. Go to him saying, “I’ll be waiting for you by the chairs so please get up and join me.”d. Leave him alone because the behaviour demonstrates he is too regressed to benefit from talking

with nurse.Answer: A, this response accepts the client at the client’s present level and, in addition, allows the client to set the pace of the relationship. B, this approach to any client can be misinterpreted and may precipitate an aggressive response. C, this response asks the client to reach out to the nurse, in the therapeutic relationship the nurse must reach out to the client. D, even if the client is too withdrawn to respond, the nurse’s physical presence can be reassuring.

13. When assessing a client, the nurse identifies that the client is experiencing a hallucination when the client says:

a. “My insides smell like they are rotting away.”b. “I am going to save the world because I am the son of God.”c. “Unless I gamble at least once a week I feel extremely anxious.”d. “It’s crazy, but I keep thinking something terrible will happen to my baby.”

Answer: A, olfactory hallu. B delusion. C, compulsion. D, obsession.

14. The nurse believes an emotionally disturbed client is ready to begin participating in therapeutic activities. The nurse initially should suggest:

a. Drawing pictures with the nurseb. Attending a class on medicationsc. Participating on the softball teamd. Watching television in the dayroom

Answer; A, participating with one trusted individual gradually diminishes the need for withdrawal. B, not appropriate initially because it requires a higher level of functioning than other activities presented. C, fosters competition w/c would not be helpful at this time. D, this would not increase socialization but rather promote withdrawal.

15. A female client with schizophrenia is going to occupational therapy for the first time. She tells the nurse she doesn’t want to go. The nurse’s reply that is most helpful to the client is:

a. “I will go with you to occupational therapy.”b. “It’s only for an hour, and then you will be back.’c. “Try it once. If you don’t like it you need not go back.”d. “The doctor ordered it as a part of your treatment. You should go.”

Answer: A, this statement lets the client know the nurse sees her as a person and is willing to help her face a new experience. B, this will do nothing to allay the client’s anxiety about a new situation. C, even if the client doesn’t like it, as part of the therapy program she should be encouraged to go. D, same as B.

16. A client with a long history of disturbed behaviour is unable to cope with the slightest change in the environment. To best enhance the client’s coping skills, the nurse should plan to:

a. Allow time for compulsive behaviourb. Maintain a low level of environmental stimulic. Provide ample opportunities for intellectual activitiesd. Schedule short independent tasks that are achievable.

Answer: D, providing opportunities to experience success in activities enhances coping abilities. A, reinforces disturbed coping skills. B, a change in activities, not level of stimuli is what causes stress for this client. C, success with tasks, not intellectual activities, enhances coping.

17. To deal with client’s hallucinations therapeutically, the nurse plans to:a. Reinforce the perceptual distortions until the client develops new defensesb. Provide an unstructured environment and assign the client to a private roomc. Avoid helping the client make connections between anxiety-producing situations and

hallucinationsd. Distract the client’s attention by providing a competing stimulus that is stronger than the

hallucinationsAnswer: D, this is helpful in decreasing hallucinations because it provides another stimulus to compete for the client’s attention. A, would foster and support the hallucinations. B, same as A. C, connections should be made to decrease use of hallus.

18. When managing interpersonal relationships with a client who has schizophrenia, the nurse should first:a. Allow the client to be alone when desired but provide quiet activitiesb. Insist that the client join group activities and functions with other clientsc. Establish a one-to-one relationship and then bring the client into group activitiesd. Encourage the client to become dependent but set limits on the extent of this behaviour

Answer:C, to function interpersonally with a group, these individuals must first develop a trusting onetone relp. A, need interaction to increase trust, they will not seek interaction w.o encouragement. B, if forced, these individuals will be too fearful of group to function in it ir benefit by it. D, dependency could have an adverse effecton individuals w/ schizo

19. A newly admitted male client diagnosed with schizophrenia appears to be responding to internal stimuli when laughing and talking to himself. The best initial response by the nurse would be to:

a. Ask the client if he is hearing voicesb. Encourage the client to engage in unit activitiesc. Tell the client the voices he is hearing are not reald. Give the client his prescribed PRN antipsychotic medication

Answer: A, the client is newly admitted, the nurse needs to do a thorough assessment before intervening. B, this may eventually be done but it is not the priority. C, this assumes that the client is hallucinating, this statement is appropriate if the client is hallucinating but only after first recognizing the client’s feelings. D, client’s behaviour does not indicate the need for extra meds, some schizos hallucinate throughout their lives.

20. A male client claims the voices he hears are clearly telling him what actions and decisions to make. It would be most therapeutic for the nurse to:

a. Play soft music when the client starts hearing voicesb. Begin talking to the client when he is hearing the voicesc. Demonstrate to the client that his perceptions are wrongd. Recognize that the client is probably frightened by the voices

Answer: D, the client truly believes the voices are real because the voices are usually accusatory and derogatory and therefore may be frightening. A, after hallucinations have started will not be strong enough to compete for client’s attention. B, too late, competing stimuli must be present to block the occurrence of hallus. C, client can not be talked out of a hallucination.

21. When a client with a diagnosis of schizophrenia talks about being controlled by others, the nurse should:a. Express disbelief about delusionb. Ask questions about the delusionc. Acknowledge the feeling tone of the delusiond. Respond to the verbal content of client’s delusion

Answer: C, this helps the client explore underlying feelings and allows the client to understand the message the verbalizations are communicating. A, denies the client’s feelings rather than accepting and working with them. B, focuses on the delusion rather than the feeling causing the delusion. D, same as B.

22. A 22-year-old client with the diagnosis of schizophrenia has been in a mental health facility for approximately 2 weeks. He has a pass to go to an all-day excursion with his parents. When he returns he is observed pacing in the hall talking loudly to himself. The nurse’s initial intervention should be to:

a. Obtain an order for a tranquilizerb. Ask the client about the events of his dayc. Call the parents to find out what happenedd. Assign a nursing assistant to remain with the client

Answer: B, a broad opening encourages communication that may elicit the client’s perception of the day’s events. A, is premature. C, what is important is the client’s perception of the events not the parents. D, premature and mas appropriate ang B.

23. At mealtime a client with schizophrenia moves to the counter to choose food but is unable to decide what to do next. The nurse, recognizing the client’s ambivalence, assists using:

a. Nonverbal communication

b. Simple declarative statementsc. Basic questions requiring simple choicesd. Reward for each of the food items chosen

Answer: B,ambivalence makes decision making difficult if not impossible, simple, easy-to-follow declarative statements limit the choices available for the indecisive client. A, client will not be able to interpret nonverbal communication and would exp increased confusion and indecision. C, is inappropriate because the pressure to make choices may increase the client’s ambivalence and discomfort. Same as C

24. A client with diagnosis of schizophrenia watches the nurse pour juice for the morning medication from an almost empty pitcher and screams, “That juice is no good! It’s poisoned.” The nurse should:

a. Remark, “You sound frightened.”b. Assure the client, “The juice is not poisoned.”c. Pour the client a glass of juice from a full pitcherd. Take a drink of the juice to show the client that it is alright

Answer:A, this response reflects the client’s feelings and avoids focusing on the delusion. B, this will not change the client’s feelings because the belief is real to the client. C, the other pitcher could also be perceived as poisoned. D, this will not change the client’s feelings as the client would believe that the nurse was not really drinking juice.

25. When a disturbed acting-out client’s condition improves, the physician suggests giving a 1-day pass. The client’s family is worried about what they will do if the client starts to act out. The nurse’s best intervention at this time would be to:

a. Have the social worker talk with the familyb. Cancel the pass until the family is reassuredc. Have the client promise the nurse and family that acting out will not occurd. Discuss this concern at a meeting with both the client and family present

Answer: D, this approach gives the client and family an opportunity to discuss their feelings together and clarifies their expectations. A, this is the nurse’s responsibility and should not be passed to someone else. B, the family may never be reassured. C, this would do little to reassure the family

26. One morning the nurse finds a disturbed client curled up in the fetal position in the corner of the dayroom. The most accurate initial evaluation of the behaviour would be that the client is:

a. Feeling more anxious todayb. Attempting to hide from the nursec. Tired and probably did not sleep well last nightd. Physically ill and experiencing abdominal discomfort

Answer: A, fetal position represents regressed behaviour, regression is a way of responding to overwhelming anxiety. B, this assumes that the nurse controls the client’s behaviour, the client is not responding to the nurse any different than to anyone else who tries to establish contact. C, there are no data to substantiate this. D, same as C.

27. An extremely agitated male client hospitalized in a mental health unit begins to pace around the dayroom. The nurse should:

a. Lock the client in his room to limit external stimulib. Let the client pace in the hall way from other clientsc. Get the client involved in a card game to distract his thoughts

d. Encourage the client to work with another client on a unit taskAnswer: B, this allows the client to work off energy without upsetting other clients. A, this causes isolation and should be used only as a last resort if the client presents an actual danger to himself or others. C, clients current state would limit concentration and prevent interaction with others. D, same as C.

28. The nurse notices a male client sitting alone in the corner smiling and talking to himself. Realizing that the client is hallucinating, the nurse should:

a. Ask the client why he is smilingb. Leave the client alone until he stops talkingc. Invite the client to help to decorate the dayroomd. Tell the client it is not good for him to talk to himself

Answer: C, this provides a stimulus that competes with and reduces hallucinations. A, this is a direct question that the client probably could not answer, it would also increase anxiety. B, if the nurse waits for the client to stop hallucinating, there may be no chance for contact with this client. D, in addition to setting unrealistic standards, this response fails to recognize that the client believes the hallucinations are real.

29. To increase the self-esteem of a client with schizophrenia, the nurse should plan to:a. Reward healthy behaviorsb. Explain the treatment planc. Identify various means of copingd. Encourage participation in community meetings

Answer:A, by realistically rewarding the healthy behaviors, the nurse provides secondary gains and encouraged continued use. B, this would be important but would do little to increase the client’s self esteem. C, same as B. D same as B.

30. The nurse is planning a group session for three chronically ill clients who have the diagnosis of schizophrenia. Understanding the symptoms and general characteristics of schizophrenia and long-term mental illness, one of the most helpful topics for this group is:

a. Relaxation techniquesb. Rational behaviour therapyc. Assertiveness in relationshipsd. Social skills in the group setting

Answer: D, may lack social skills so this topic would be appropriate. A, would be helpful for anyone, however we have a focus. B, rational behaviour helpful for clients dealing with depression. C, ,many chronically ill clients would have difficulty applying the concepts associated with being assertive.

31. One morning a client tells the nurse, “My legs are turning to rubber because I have an incurable disease called schizophrenia.” The nurse recognizes that this is an example of:

a. Hallucinationsb. Paranoid thinkingc. Depersonalizationd. Autistic verbalization

Answer: C, the state in w/c the client feels unreal or believes that parts of the body are distorted is known as depersonalization or loss of personal identity. A, sensory experience w/o stimulus. B, does not indicate any feelings of paranoia. D is not.

32. A client with schizophrenia, who has auditory hallucination, is withdrawn and apathetic. To best involve this client ina an activity, the nurse should say to the client:

a. “I need a partner when I go for my walk today.”b. “You will receive a reward if you go to the gym.”c. “The voices you hear would like it if you did a little exercise.”d. “There is a positive relationship between exercise and mental health.”

Answer: A, declarative statement invites the client to walk and the client can comply w/o making a verbal decision, a client w/ schizophrenia is often ambivalent and decision making difficult. B, withdrawn, apathetic, to best involve this client in an activity, the nurse should say to client. C, saying that voices want the client to exercise supports the client’s hallus. D, same as B.

33. When interacting with a confused, delirious female client the most therapeutic nursing intervention should be to:

a. Reassure the client that she will get betterb. Direct the client’s daily activities on the unitc. Help the client to clarify her experience and gain insight into her behaviourd. Provide the client with solutions to past and current problems experienced

Answer: B, deciding on and directing activities for the client are needed until delirium and confusion clear. A, false reassurance. C, unable to develop insight bcoz of delirium. D, this not therapeutic and does not solve the issue.

34. A male client in a mental health facility is tugging on his ear during a unit meeting. When the nurse comments about it, the client replies, “You know, it’s that microcomputer those foreign agents implanted in my ear.” Based on this statement, the nurse determines that the client is experiencing:

a. Illusionsb. Hallucinationsc. Delusional thoughtsd. Neologistic thinking

Answer: C, the statement depicts the cognitive disturbance called a delusion. A, misperception of actual envtal stimuli. B, no stimuli. Neologisms are made-up words understood only by the speaker.

35. The nurse recognizes that paranoid delusions are related to the defense mechanism of:a. Projectionb. Regressionc. Repressiond. Identification

Answer: A, mechanism in w/c inner thoughts and feelings are projected onto the envt seeming to come from outside the self rather than from within. B, use of behavioural characterisitics appropriate to an earlier level of devt. C, involuntary exclusion of painful or conflicting thoughts from awareness. D, taking on of the thoughts and mannperisms of an individual who is admired or idealized,

36. When establishing a plan of care, the nurse should understand that a male client’s delusion that he is an important government adviser is most likely related to:

a. A psychotic loss of touch with his real identityb. An attempt at wish fulfilment created to manipulate others

c. A need to feel a sense of importance within his environmentd. An attempt to compensate for feelings of depression about his problems

Answer: C, client is fearful and suspicious, the feeling of being in a powerful position helps the client deal with anxiety. A, client not out of touch with self-identity, real identity has been given an important role. B, client is compensating for feelings of inadequacy. D, same as B.

37. During the admission procedure, a client who has paranoid ideation refuses to answer the nurse’s questions, stating, “You are in a conspiracy to kill me.” The nurse understands these feelings are related to the client’s:

a. Low self-esteemb. Need to be alonec. Need for attentiond. Lack of acceptance

Answer: A, client’s use structured delusional system to justify and compensate for their feelings of worthlessness and low self-esteem. B, clients experiencing delusions of a paranoid nature are isolated and need contact with people to increase contact with reality. C, not a purpose of delusional system. D, no data to indicate.

38. During a one-to-one interaction with a client with schizophrenia, paranoid type, the client says to the nurse, “I figured out how foreign agents have infiltrated the news media. They wang to shut me up before I spill the beans.” This statement can best be described as:

a. A nihilistic delusionb. A delusion of grandeurc. An auditory hallucinationd. An overevaluation of the self

Answer: thoughts of being pursued by some powerful agent or agents bcoz of one’s special attributes or powers are fixed false beliefs referred to as delusions of grandeur.

39. A disturbed client is admitted to the hospital for psychiatric evaluation. When taking the client’s history, the nurse asks why the client came to the hospital. The client states, “They lied about me. They said I murdered my mother. You killed her. She died before I was born.” The nurse recognizes that the client is experiencing:

a. Ideas of grandeurb. Confusing illusionsc. Persecutory delusionsd. Auditory hallucinations

Answer: C, client’s verbalization reflects feelings others are blaming the client for negative actions. A, no data for client’s feelings of greatness of power. B, no data for misinterpretations.

40. A nursing approach that may be helpful when planning the care of clients diagnosed with schizophrenia of the paranoid type is:

a. Exploring prominent life eventsb. Limiting exploration to recent situationsc. Providing a nonthreatening environmentd. Exploring the content of their delusions

Answer: C, these clients are hypersensitive to external stimuli and respond with less anxiety to a minimally threatening envt. A,too threatening an pproach. B, not therapeutic, would tend to trigger suspisciousness and hostility. D, focusing on delusional materials tend to reinforce delusional system.

41. The nurse planning to establish a trusting relationship with a client who is using paranoid ideation should begin by:

a. Seeking the client out frequently to spend long blocks of time togetherb. Sitting in the unit and observing the client’s behaviour throughout the dayc. Being available on the unit continuously and waiting for the client to approachd. Calling the client into the office to establish a contract for regular therapy sessions

Answer: C, recommended approach for suspicious clients is to allow them to set the pace for the relationship. A, this would be threatening and add feelings of paranoia. B same as A. D same as A.

42. Lunch is being served and the clients must walk to the dining room. The nurse finds one client sitting alone with the head slightly tilted as if listening to something. The nurse should state:

a. “I know you’re busy. However, it’s lunch time.”b. “Lunchtime, let’s go! We don’t want to miss it.”c. “It’s lunchtime, I’ll walk with you to the dining room.”d. “Those voices bothering you again! I’ll help you get ready for lunch.”

Answer: C, this statement sets limits and provide support, hallucinations can be frightening and the nurse’s presence provides support while not actually focusing on the hallucination. A, does not recognize the client’s need for support and direction. B same as A, makes a judgment w/ insufficient evidence and focuses on hallus, it fails to recognize the clients need for support and direction.

43. A client recently admitted to the hospital with the diagnosis of schizophrenia, paranoid type, says to the nurse, “I know they’re spying on me in here, too. I’m not safe anywhere!” the most therapeutic response by the nurse should be:

a. “Nobody’s spying on you in here.”b. “Why do you feel they’d want follow you here?”c. “You don’t feel safe anywhere, not even in the hospital?”d. “You are safe in the hospital; nothing can happen to you here.”

Answer: C, rephrasing allows further communication, expresses understanding, and does not belittle the client’s feelings. A, presenting reality reality only raises anxiety and client will defend delusion. B, why makes clients defensive and reinforces the delusion. D, false reassurance, and additionaly a client will not believe the nurse.

44. When a disturbed client who has a history of using neologisms says to the nurse should respond by:a. Trying to learn the language of the clientb. Telling the client that these words are not understoodc. Communicating in simple terms directed toward the clientd. Recognizing that the client needs a nurse who can understand the fantasies expressed

Answer: B, this is a simple statement that the client is not understood, it provides feedback and points out rekality. A, neologisms have symbolic meaning only for the client. C, although this should be done, it does not present reality. D, only the client can understand neologistic fantasies.

45. A client sits huddled in a chair and leaves it only to crouch in a corner. The nurse, observing this realizes that this behaviour is classified as:

a. Reactiveb. Regressivec. Dissociatived. Hallucinatory

Answer: B, reflects the early fetal position, the individual curls up for both protection and security. A, it is not a response to observable stimulus. C, does not indicate. D, no data for hallucinations.

46. When caring for a withdrawn, reclusive, psychotic client, the priority goal would be for the client to develop:

a. Trustb. Self-worthc. A sense of identityd. An ability to socialize

Answer: A, is basic to all therapies, w/o trust a therapeutic relatqionship cannot be established. B, is a long term goal, trust is the priority. C, no indication of loss of sense of identity. D, is not a priority

47. The nurse, finding a client with schizophrenia lying under a bench in the hall, could best respond to the client’s statement, “God told me to lie here,” by stating:

a. “I didn’t hear anyone talking. Come with me to your room.”b. “What you heard was in your head; it was your imagination.”c. “Come to the dayroom and watch television. You will feel better.”d. “God would not tell you to lie in the hall. God would want you to behave reasonably.”

Answer: A, focusing on reality and redirecting and refocusing client’s attention. B, too blunt and belittling, this approach is rarely effective. C, false reassurance. D, belittling and irrational.

48. A young adult client is admitted to the hospital with a diagnosis of schizophrenia, paranoid type. The client’s family is concerned about the client’s safety and well-being because the client has been stating, “The voices are telling me to kill myself.” The priority nursing diagnosis for this client is:

a. Chronic low self-esteemb. Disturbed sensory perceptionc. Risk for self-directed violenced. Impaired verbal communication

Answer: C

49. A client is receiving an antipsychotic drug twice a day. Two thirds of the daily dose is given in the evening, one-third in the morning. This is done to:

a. Maintain diurnal rhythmsb. Help the client sleep at nightc. Reduce sedation during daytimed. Decrease assaultiveness in the evening

Answer: C, antipsychotics tend to make the client listless or drowsy and can interfere with the ability to participate in the therapeutic regimen. A, antipsychotics don’t affect diurnal rhythms. B, antipsychotics do not induce sleep, just listlessness. D, assaultiveness is associated w/ increased anxiety and is unrelated to time.

50. To begin to establish a therapeutic relationship with withdrawn, reclusive client, the nurse must:a. Obtain a complete history from the familyb. Plan to keep the client’s anxiety at a minimumc. Ascertain what topics are of most interest to the clientd. Protect the client from self-destructive tendencies

Answer: B, when a client who is unable to cope feels that someone is assuming control, it promotes a feeling of security; as this continues a sense of trust in this individual is established. A, important in panning care but not establishing a therap rel. C, is less important in the beginning phase of the relationship. D, no data to say that client is self-destructive.

51. A 30 years old client was admitted to the psychiatric ward because of religious preoccupation, deterioration in self-care and disturbed thoughts. He believes that he has committed a lot of sins. He is threatened by people reaching out to him. His fasting for several days was not sufficient for him to feel forgiven. The client is demonstrating:

a. Religious delusionb. Delusion of grandeurc. Somatic delusiond. Delusion of grandeur

52. A delusion is defined as a fixed set of false beliefs, which is a:a. Psychomotor disturbanceb. Mood disturbancec. Disturbance of thoughtd. Disturbance of perception

53. A nursing goal for clients exhibiting religious delusions is:a. Have him see a priest for confessionb. Help him develop a positive self imagec. Encourage him to pray to atone for his sinsd. Socialize him with a group to keep him in touch with reality

54. As the client talks about his sins that he believes make people look down upon him, it is best to:a. Explore the nature of his sinsb. Explain that he is depreciating himself too muchc. Acknowledge how he feels and focus on reality oriented topicsd. Agree with him and sympathize how sinful he has really been

55. The psychosocial task that a client with religious delusion needs to work on is a sense of:a. Identityb. Trustc. Autonomyd. Intimacy

56. One of the long-time schizophrenic patients on the inpatient unit has developed involuntary movements of his tongue. The nurse assesses that this patient has developed:

a. Acute dystonic reactionb. Tardive dyskinesiac. Neuroleptic malignant syndromed. Laryngospasm

57. Schizophrenia is a clinical syndrome of variable, but profoundly disruptive, psychopathology that involvesa. Cognitionb. Emotionc. Perceptiond. All of the above

58. Also, patients diagnosed with schizophrenia often experience hallucinations. What is a proper initial intervention for a newly admitted patient experiencing an auditory hallucination?

a. Present reality and have the patient go to his roomb. Acknowledge, present reality and distract the patient to a new activityc. Elicit from the patient information about the hallucinationd. Ignore the patient as he is just acting out

59. Drugs for schizophrenia include atypical antipsychotics like Clozaril. The nurse knows that Clozaril has a dangerous side effect. What should the nurse watch out for?

a. Postural hypotensionb. Tardive dyskinesiac. Sore throatd. Extra pyramidal symptoms

60. Hallucinations and illusions are common symptoms of schizophrenia. The nurse explains that the difference between an illusion and a hallucination is that an illusion could be exemplified by

1) A car backfiring being perceived as gunfire.2) The TV news being perceived as someone talking to them.3) Hearing God’s voice direct you to drive your car off the road.4) Seeing your dead spouse smile at you from a flower.5) A spot on the wall being perceived as a spider.

a. 1, 2, 4, 5b. 5 onlyc. 1, 2, 5d. All of the above

61. During the assessment stage, the client with schizophrenia leaves his hands in the air after the nurse takes his blood pressure. His actions show evidence of?

a. Somatic delusionsb. Waxy flexibilityc. Neologismsd. Arthritis

62. A nurse is caring for a client who is experiencing false sensory perceptions that have no basis in reality. These perceptions are known as:

a. Delusionsb. Illusionsc. Hallucinationsd. Neologisms

63. A client with paranoid schizophrenia believes his room is bugged by the NBI and that his roommate is a spy. The client has never had a romantic relationship, has no contact with his family and hasn’t been employer in 14 years. Based on Erikson’s theories, the nurse should recognize that this client is in which stage of psychosocial development?

a. Intimacy vs Isolationb. Generativiyty vs Stagnationc. Ego integrity vs Despaird. Trust vs Mistrust

64. A client with schizophrenia displays lack of interest in activities, reduced affect and poor ability to perform activities of daily living. What term would be used to describe this clustering of symptoms?

a. Positive symptomsb. Negative symptomsc. Physiologic symptomsd. Extrapyramidal symptoms

65. After 3 days of taking haloperidol, the client shows an inability to sit still, is restless and fidgety, and paces around the unit. Of the following extrapyramidal adverse reactions, the client is showing signs of:.

a. Dystonia.. b. Akathisia c. Parkinsonis.d. Tardive dyskinesia.

66. Neuroleptic Malignant Syndrome is characterized by:a. Hypertension, hyperthermia, flushed and dry skin.b. Hypotension, hypothermia, flushed and dry skin.c. Hypertension, hyperthermia, diaphoresisd. Hypertension, hypothermia, diaphoresis

67. The nurse is caring for a male client with schizophrenia. Which outcome is the least desirable?a. The client spends more time by himselfb. The client doesn’t engage in delusional thinkingc. The client doesn’t harm himself or othersd. The client demonstrates the ability to meet his own self-care needs

68. A client with paranoid schizophrenia has persecutory delusions and auditory hallucinations and is extremely agitated. He has been given a PRN dose of Thorazine IM. Which of the following would indicate to the nurse that the medication is having the desired effect?

a. Complains of dry mouthb. State he feels restless in his bodyc. Stops pacing and sits with the nurse

d. Exhibits increase activity and speech

69. Which information is most essential in the initial teaching session for the family of a young adult recently diagnosed with schizophrenia?

a. Symptoms of this disease imbalance in the brainb. Genetic history is an important factor related to the development of schizophreniac. Schizophrenia is a serious disease affecting every aspect of a person’s functioningd. The distressing symptoms of this disorder can respond to treatment with medications

70. Malou with schizophrenia tells Nurse Melinda, “My intestines are rotted from worms chewing on them.” This statement indicates a:

a. Jealous delusionb. Somatic delusionc. Delusion of grandeurd. Delusion of persecution

71. A client with schizophrenia and delusions tells a nurse, “There is a man wearing a red coat who’s out to get me.” The client exhibits increasing anxiety when focusing on the delusion. Which response by the nurse is appropriate

a. “The subject seems troubling you. Let’s walk to the activity room.”b. “Describe the man who’s out to get you. What does he look like?”c. “There is no reason to be afraid of that man. The hospital is very secure.”d. “There is no need to be concerned about a man who isn’t even real.”

72. A psychotic client tells the evening nurse that the day nurse put something suspicious in his water with his medication. The nurse replies, “You are worried about your medication?” The nurse’s communication is:

a. An example of presenting realityb. Reinforcing the client’s delusionsc. Focusing in emotional contentd. A technique called mind reading

73. A client with active psychosis is admitted to the psychiatric unit. The physician diagnosed schizophrenia after ruling out several other conditions. Schizophrenia is characterized by:

a. Loss of identity and self-esteemb. Multiple personalities and decreased self-esteemc. Disturbance in affect, perception, and thought content and formd. Persistent memory impairment and confusion

74. Superpogiastig Derek Duarte, a well-known actor suffers a psychotic break and is admitted to the psychiatric unit. A large group of reporters with cameras is camped out in the hospital parking lot. As a nurse walks to the employee parking after her shift, a reporter asks if she knows anything about the client’s condition. What is the most appropriate response?

a. “I didn’t have an opportunity to assess this client.”b. “All I can say is that the client is safe and stable.”c. “Get away from me and don’t take any pictures.”d. “I can’t answer your questions.”

75. One day after a client with schizophrenia began treatment with haloperidol, a nurse notices that he is holding his head to one side and complaining of neck and jaw spasms. What would the nurse do?

a. Assume that the client is posturingb. Tell the client to lie down and relaxc. Evaluate the client for adverse reactions to haloperidold. Put the client on the list for the physician to see the following day

76. A client with schizophrenia is taking the atypical antipsychotic medication clozapine (Clozaril). Which signs and symptoms indicate the presence of adverse effects associated with this medication?

1) Sore throat2) Pill-rolling movements3) Polyuria4) Fever5) Polydipsia6) Orthostatic hypotension

a. 1, 3, 4, 5b. 1, 2, 4, 6c. 1, 4d. 1, 6

77. A client with schizophrenia displays a lack of interest in activities, reduced affect, and poor ability to perform ADLs. What term would be used to describe this clustering of symptoms?

a. Positive symptomsb. Negative symptomsc. Physiologic symptomsd. Extrapyramidal symptoms

78. A client with diagnosis of delusions of grandeur is admitted to the facility. This client’s diagnosis reflect that one is:

a. Highly important or famousb. Being persecutedc. Connected to events unrelated to oneselfd. Responsible for all the evil in the world

79. Rapsa Sami, 26 years old, is aloof in relating with other patients and members of the staff. She claims that the medications being given to her are meant to poison her. She is also suspicious about the food being served to her. Basically, Rapsa is suspicious because of her inability to develop a sense of:

a. Intimacyb. Generativityc. Trustd. Initiative

80. Suspicious clients often utilize the defense mechanism projection. This means that they:a. Unconsciously refuses to accept a feeling, thought or impulse and attributes it to

someone elseb. Justifies behaviour, attitudes and feelings with excusesc. Involuntarily refuses to acknowledge realityd. Involuntarily excludes wishes, impulses, memories and feelings of awareness.

81. Which of these nursing approaches is the most appropriate for the nurse to begin with for a client who is suspicious?

a. Engage client for atleast one hour in a one-on-one interaction dailyb. Invite her to socialize with other patientsc. Make self available while maintaining distance until patient shows readiness to

interactd. Refer her for activity therapy

82. When suspicious clients resists to take their medication, it is best to:a. Let them read the drug literature to convince her that it is therapeuticb. Force them to take the drug to maintain therapeutic effectiveness of the drugc. Have the same nurse, who they interact with administer the drugd. Request the doctor to give the medication

83. Laboratory work is prescribed for a client who has been experiencing delusions. When the nurse approaches the client to obtain a specimen of the client’s blood, the client begins to shout “You are all vampires. Let me out of here!” The appropriate nursing response is:

a. “What makes you thing I am a vampire?”b. “I’ll leave and come back later for your blood.”c. “I am not going to hurt you; I am going to help you.”d. “It must be frightening to think that others want to hurt you.”

Answer: D, helps the client focus on the emotion and does not focus on the delusion. A, places the client in a position that requires a response. B, avoids the client. C, is an attempt to convince the client to believe another thought and may strengthen the delusion.

84. A mental health nurse notes that a client with schizophrenia is exhibiting an immobile facial expression and a blank look. Which of the following should the nurse document in the client’s record?

a. The client has an inappropriate affectb. The client has a flat affectc. The client is exhibiting bizarre behaviourd. The client’s emotional responses exhibit a blunted affect

Answer:B, manifested by immobile facial expression or blank look. Am refers to an emotional response that is incongruent with the tone of the situation. C, such as grimacing, laughing and self-directed mumbling meaning client is unable to relate logically to the envt. D, minimal emo response or outward affect that doesn’t coincide with the clients emotions.

85. A hospitalized client is receiving clozapine (Clozaril) for the treatment of a schizophrenic disorder. The nurse determines that the client may be having an adverse reaction to the medication if abnormalities are noted on which of the following laboratory studies?

a. Cholesterol levelb. Blood urea nitrogen (BUN)c. White blood cell (WBC) countd. Platelet count

86. A client with schizophrenia says to the nurse, “Will you protect me from the Grand Duchess?” and points to an older client who is sitting reading a book. Which of the following is the therapeutic response by the nurse?

a. “Where is she? I’ll talk to her.”b. “The Grand Duchess huh? Well, I’m the Queen and I will order her to stay away from

you.”c. “You will be safe here. Your thinking will be clearer after your medication starts to

work.”d. “I can see no Grand Duchess, You will need to trust me on that.”

Answer: C, supportive and protective intervention. A, feeds psychosis. B, sarcastic and belittling. D, although begins with reality, it does not demonstrate any real support for the client’s concern with safety

87. A nurse is performing a mental status examination on a client and the client states, “Glass breaks if you throw stones or shoot at it with a gun. My cousin shoots guns at the police all the time at target practice. People who live in glass houses shouldn’t throw stones.” Which of the following interpretations by the nurse is appropriate?

a. Speech is distractible and contains flight of ideasb. Speech is incoherent and tangentialc. Speech is pressured and contains clang associationsd. Speech is illogical and loosely associated

Answer: D, some association but lack of logical relationship. A, quickly switching topics w/o associations. B, inappropriate response to a statement. C, rhyming

88. A nurse is caring for a client with schizophrenia who states, “I decided not to take my medication because I realize that it really can’t help me. Only I can help me.” Which of the following nursing responses would be therapeutic?

a. “Only you can help?”b. “You decide not to take your medication?”c. “Your doctor wants you to continue with this medication because it is helping you. Do

you recall needing to be hospitalized because you stopped your medication?”d. “If you can make this wise observation, you probably don’t need your medication any

longer.”Answer: C, noncompliance w/ antipsychotic meds is 1 of the main reasons for relapses. A and B, is employing restating w/c is therapeutic but not useful. D, is judgmental and biased.

89. Important teaching for women in their childbearing years who are receiving antipsychotic medications includes which information?

a. Occurrence of increased libidob. Increased incidence of dysmenorrhea while taking the drugc. The need for continuing previous use of contraception during periods of amenorrhead. Instruction that amenorrhea is reversible

Answer: C, amenorrhea is reversible and doesn’t indicate cessation of evaluation, therefore continue use of contraceptives. B, is not an adverse effect of antipsychotics. A, libido is decreased due to depressant effect.

90. For which type of schizophrenia should the nurse expect to provide the most physical care?a. Hebephrenic typeb. Catatonic typec. Paranoid typed. Undifferentiated type

Answer: B, exhibits little reaction to the envt w/periods of excitement plus bizarre postures and inability to feed, wash and dress oneself are also evident in the catatonic type.

91. A nurse is interviewing a client admitted to the facility with a diagnosis of schizophrenia. The client states, “I run apple, train, glass, window.” This response is known as:

a. Echopraxiab. A word saladc. Flight of ideasd. Neologisms

Answer:B, illogical word grouping. A, involuntary repetition of movements. C, rapid succession of unrelated ideas.

92. The definition of nihilistic delusions is:a. A false belief about the functioning of the bodyb. A belief that the body is deformed or defective in a specific way

c. False ideas about self, others, or the worldd. The inability to carry out motor activities

Answer: C. A, somatic delusion. B, body dysmorphic disorder. D, apraxia

93. A psychotic client reports to the evening nurse that the day nurse put something suspicious in his water with his medication. The nurse replies “You’re worried about your medication?” The nurse’s communication is:

a. An example of presenting realityb. Reinforcing the client’s delusionsc. Focusing on emotional contentd. A nontherapeutic technique called probing

Answer: C. A, may lead to confrontation. B is agreeing. D, is wrong

94. The etiology of schizophrenia is best described by:a. Genetics due to faulty dopamine receptorb. Environmental factors and poor parentingc. Structural and neurobiological factorsd. A combination of biological and environmental factors

Answer: D, while a reliable genetic marker hasn’t been determined. Studied of twins strongly implicate a genetic predisposition. Excessive dopamine activity has also suggested causal factor. Communication and the family system have been studied as a contributing factors in the devt of schizo.

95. A nurse is caring for a client who exhibits magical thinking. Which of the following best describes magical thinking?

a. Strong positive and negative thoughts that cause conflictb. Returning to an earlier developmental stagec. Meaningless repetition of wordsd. The beliefs that thoughts or wishes can control other people or events

Answer: D, example “i wish the plane falls from the sky”. A, ambivalence. B, regression. C, echolalia

96. A client diagnosed as having catatonic excitement has been pacing rapidly nonstop for several hours and is not eating or drinking. The nurse recognizes that in this situation:

a. There is a need to encourage verbalization of feelingsb. The client will soon demonstrate a catatonic stuporc. There is an urgent need for physical and medical controld. There is an urgent need to obtain a physical restraint order

Answer: C, physical restraints may plus medications may be needed as they may be violent to others or collapse from complete exhaustion.

97. A nurse is planning to care for hallucinating and delusional client who has been rescued from a suicide attempt. The nurse plans to:

a. Check the client’s location every 15 minutesb. Begin suicide precautions with 30-minute checksc. Initiate a one-to-one suicide precautions immediatelyd. Ask the client to report suicidal thoughts immediately

Answer: C, hallus and deluss increase risk for unpredictable behaviour, decreased judgment and risk for suicide. A,B,D do not provide the constant supervision necessary for this client

98. A nurse is caring for a client who has been diagnosed with schizophrenia. The client is unable to speak, although there is no known pathological dysfunction. The nurse documents that the client is experiencing:

a. Mutismb. Verbigerationc. Pressured speechd. Poverty speech

Answer: A, absence of verbal speech. B, purposeless repetition of words, phrases and actions. C, rapidity of speech that reflects the client’s racing thoughts. D, involves diminished amounts of speech or monotonic replies

99. A client tells the nurse, “I am spy for the NBI. I am an eye, an eye in the sky.” The nurse recognizes that this is an example of:

a. Echolaliab. Word saladc. Clang associationsd. Loosened associations

100. Who coined the term “Schizophrenia”?a. Eugene Armstrongb. Eugene Bleulerc. Eugene Schitzd. Eugene Stuart