eBay:testbanks_and_xanax

eBay: testbanks_and_xanax

Chapter 12: Schizophrenia Spectrum Disorders

Halter: Varcarolis’ Foundations of Psychiatric Mental Health Nursing: A Clinical Approach, 8th Edition

Multiple Choice

1. A patient has had difficulty keeping a job because of arguing with co-workers and accusing them of conspiracy. Today this patient 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. “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.”

ANS: B

Resist focusing on content; instead, focus on the feelings the patient is expressing. This strategy prevents arguing about the reality of delusional beliefs. Such arguments increase patient anxiety and the tenacity with which the patient holds to the delusion. The other options focus on content and provide opportunity for argument.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 12-45, 46, 99 (Box 12-4) TOP: Nursing Process: Implementation

MSC: Client Needs: Psychosocial Integrity

2. A newly admitted patient diagnosed with 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. an idea of reference. c. a delusion of infidelity. d. an auditory hallucination.

ANS: B

Ideas of reference are misinterpretations of the verbalizations or actions of others that give special personal meanings to these behaviors; for example, when seeing two people talking, the individual assumes they are talking about him or her. The other terms do not correspond with the scenario.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Page 12-70 (Table 12-1) TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity a. Disorganized b. Dangerous c. Supportive d. Bizarre

3. A patient diagnosed with 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?

ANS: B

The patient sees the world as hostile and dangerous. This assessment is important because the nurse can be more effective by using empathy to respond to the patient. Data are not present to support any of the other options.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 12-20, 74 (Table 12-3) | Pages 12-99 (Box 12-4)

TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 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

4. When a patient diagnosed with schizophrenia was discharged 6 months ago, haloperidol was prescribed. The patient now says, “I stopped taking those pills. They made me feel like a robot.” What are common side effects the nurse should validate with the patient?

ANS: A

Typical antipsychotic drugs often produce sedation and extrapyramidal side effects such as stiffness and gait disturbance, effects the patient might describe as making him or her feel like a “robot.” The side effects mentioned in the other options are usually not associated with typical antipsychotic therapy or would not have the effect described by the patient.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 12-50, 51, 85 (Table 12-5) TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity

5. Which hallucination necessitates the nurse to implement safety measures? The patient says, a. “I hear angels playing harps.” b. “The voices say everyone is trying to kill me.” c. “My dead father tells me I am a good person.” d. “The voices talk only at night when I’m trying to sleep.”

ANS: B

The correct response indicates the patient is experiencing paranoia. Paranoia often leads to fearfulness, and the patient may attempt to strike out at others to protect self. The distracters are comforting hallucinations or do not indicate paranoia.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Pages 12-20, 74 (Table 12-3) TOP: Nursing Process: Planning

MSC: Client Needs: Psychosocial Integrity a. Detachment and overconfidence b. Darting eyes, tilted head, mumbling to self c. Euphoric mood, hyperactivity, distractibility d. Foot tapping and repeatedly writing the same phrase

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

ANS: B eBay: testbanks_and_xanax

Clues to hallucinations include eyes looking around the room as though to find the speaker, tilting the head to one side as though listening intently, and grimacing, mumbling, or talking aloud as though responding conversationally to someone.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 12-21, 45, 72 (Table 12-2) TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity a. Clozapine b. Ziprasidone c. Olanzapine d. Aripiprazole

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

ANS: D

Aripiprazole is a third-generation atypical antipsychotic effective against both positive and negative symptoms of schizophrenia. It causes little or no weight gain and no increase in glucose, high- or low-density lipoprotein cholesterol, or triglycerides, making it a reasonable choice for a patient with obesity or heart disease. Clozapine may produce agranulocytosis, making it a poor choice as a first-line agent. Ziprasidone may prolong the QT interval, making it a poor choice for a patient with cardiac disease. Olanzapine fosters weight gain.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Pages 12-48, 54, 84 (Table 12-5) TOP: Nursing Process: Planning

MSC: Client Needs: Physiological Integrity 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.”

8. A patient diagnosed with schizophrenia tells the nurse, “I eat skiller. Tend to end. Easter. It blows away. Get it?” Select the nurse’s most therapeutic response.

ANS: D

When a patient’s speech is loosely associated, confused, and disorganized, pretending to understand is useless. The nurse should tell the patient that he or she is having difficulty understanding what the patient is saying. If a theme is discernible, ask the patient to talk about the theme. The incorrect options tend to place blame for the poor communication with the patient. The correct response places the difficulty with the nurse rather than being accusatory.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 12-18, 46, 47 TOP: Nursing Process: Implementation

MSC: Client Needs: Psychosocial Integrity a. Self-esteem b. Psychosocial c. Physiological d. Self-actualization

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

ANS: C

Physiological needs must be met to preserve life. A patient with waxy flexibility must be fed by hand or tube, toileted, given range-of-motion exercises, and so forth to preserve physiological integrity. Waxy flexibility may also precipitate a risk for falls; therefore, safety is a concern. Higher level needs are of lesser concern.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Pages 12-23, 29, 74 (Table 12-3) TOP: Nursing Process: Planning

MSC: Client Needs: Physiological Integrity

10. A patient diagnosed with schizophrenia demonstrates little spontaneous movement and has waxy flexibility. The patient’s activities of daily living are severely compromised. An appropriate outcome would be 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.

ANS: B

Outcomes related to self-care deficit nursing diagnoses should deal with increasing ability to perform self-care tasks independently, such as feeding, bathing, dressing, and toileting. Performing the tasks with coaching by nursing staff denotes improvement over the complete inability to perform the tasks. The incorrect options are not directly related to self-care activities, difficult to measure, and unrelated to maintenance of nutrition.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 12-30, 31, 74 (Table 12-3)

TOP: Nursing Process: Outcomes Identification

MSC: Client Needs: Physiological Integrity a. Echolalia b. Waxy flexibility c. Depersonalization d. Thought withdrawal

11. A nurse observes a catatonic patient 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?

ANS: B

Waxy flexibility is the ability to hold distorted postures for extended periods of time, as though the patient were molded in wax. Echolalia is a speech pattern. Depersonalization refers to a feeling state. Thought withdrawal refers to an alteration in thinking.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 12-23, 29 TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity a. Constipation b. Gynecomastia c. Visual changes d. Photosensitivity

12. A nurse leads a psychoeducational group about first-generation antipsychotic medications with six adult men diagnosed with schizophrenia. The nurse will monitor for concerns regarding body image with respect to which potential side effect of these medications?

ANS: B

FGAs (first-generation antipsychotic) stimulate release of prolactin, which can result in gynecomastia (enlargement of the breasts) as well as other changes in sexual function. Men may experience disturbances in body image as a result of gynecomastia. Other side effects of FGAs may be disturbing to other aspects of the patient’s physical health but are not likely to bother body image.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Page 12-52 TOP: Nursing Process: Nursing Diagnosis

MSC: Client Needs: Physiological Integrity a. Suggest analogies that might apply to a common daily problem. b. Assign each participant a problem to solve independently and present to the group. c. Ask each patient to read aloud a short segment from a book about problem solving. d. Invite participants to come up with solution to getting incorrect change for a purchase.

13. A nurse leads a psychoeducational group about problem solving with six adults diagnosed with schizophrenia. Which teaching strategy is likely to be most effective?

ANS: D

Concrete thinking, an impaired ability to think abstractly resulting in interpreting or perceiving things in a literal manner, is evident in many patients diagnosed with schizophrenia. People who think concretely benefit from concrete situations during education. Finding a solution in order to get incorrect change for a purchase is an example of a concrete situation. Analogies require abstract thinking and insight. Independently solving a problem and presenting it to the group may be intimidating. All participants may or may not be literate.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Pages 12-25, 44, 45

MSC: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Implementation a. “I will need higher and higher doses of my medication as time goes on.” b. “I need to store my medication in a cool dark place, such as the refrigerator.” c. “Taking this medication regularly will reduce the severity of my symptoms.” d. “If I run out or stop taking my medication, I will experience withdrawal symptoms.”

14. A nurse educates a patient about the antipsychotic medication regime. Afterward, which comment by the patient indicates the teaching was effective?

ANS: C eBay: testbanks_and_xanax

Antipsychotic drugs provide symptom control and allow most patients diagnosed with schizophrenia to live and be treated in the community. Dosing is individually determined. Antipsychotics are not addictive; however, they should be discontinued gradually to minimize a discontinuation syndrome.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 12-48, 49

MSC: Client Needs: Physiological Integrity

TOP: Nursing Process: Evaluation 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.”

15. A newly admitted patient diagnosed with schizophrenia says, “The voices are bothering me. They yell and tell me I am bad. I have got to get away from them.” Select the nurse’s most helpful reply.

ANS: C

Staying with a distraught patient who is hearing voices serves several purposes: ongoing observation, the opportunity to provide reality orientation, a means of helping dismiss the voices, the opportunity of forestalling an action that would result in self-injury, and general support to reduce anxiety. Asking if the patient hears voices is not particularly relevant at this point. Asking if the patient plans to “get away from the voices” is relevant for assessment purposes but is less helpful than offering to stay with the patient while encouraging a focus on their discussion. Suggesting playing cards with other patients shifts responsibility for intervention from the nurse to the patient and other patients.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 12-45, 74 (Table 12-3), 95 (Box 12-3)

TOP: Nursing Process: Implementation

MSC: Client Needs: Psychosocial Integrity a. Neuroleptic malignant syndrome b. Hepatocellular effects c. Pseudoparkinsonism d. Akathisia

16. A patient diagnosed with schizophrenia has taken fluphenazine 5 mg po bid for 3 weeks. The nurse now observes a shuffling propulsive gait, a mask-like face, and drooling. Which term applies to these symptoms?

ANS: C

Pseudoparkinsonism induced by antipsychotic medication mimics the symptoms of Parkinson’s disease. It frequently appears within the first month of treatment and is more common with first-generation antipsychotic drugs. Hepatocellular effects would produce abnormal liver test results. Neuroleptic malignant syndrome is characterized by autonomic instability. Akathisia produces motor restlessness.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 12-51, 83 (Table 12-4)

MSC: Client Needs: Physiological Integrity

TOP: Nursing Process: Assessment a. An acute dystonic reaction b. Tardive dyskinesia c. Waxy flexibility d. Akathisia

17. A patient diagnosed with schizophrenia is very disturbed and violent. After several doses of haloperidol, 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 thrust forward, and drooling. Which problem is most likely?

ANS: A

Acute dystonic reactions involve painful contractions of the tongue, face, neck, and back. Opisthotonos and oculogyric crisis may be observed. Dystonic reactions are considered emergencies requiring immediate intervention. Tardive dyskinesia involves involuntary spasmodic muscular contractions that involve the tongue, fingers, toes, neck, trunk, or pelvis. It appears after prolonged treatment. Waxy flexibility is a symptom seen in catatonic schizophrenia. Internal and external restlessness, pacing, and fidgeting are characteristics of akathisia.

PTS: 1

DIF: Cognitive Level: Analyze (Analysis)

REF: Pages 12-51, 83 (Table 12-4), 85 (Table 12-6)

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity a. Administer diphenhydramine 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 5 mg orally at the next regularly scheduled medication administration time. d. Administer atropine sulfate 2 mg subcut from the prn medication administration record.

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

ANS: A

Diphenhydramine, trihexyphenidyl, benztropine, and other anticholinergic medications may be used to treat dystonias. Swallowing will be difficult or impossible; therefore, oral medication is not an option. Medication should be administered immediately, so the intramuscular route is best. In this case, the best option given is diphenhydramine.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Pages 12-51, 83 (Table 12-4), 85 (Table 12-6)

TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity