Chapter 31: Schizophrenia and Other Psychoses Nursing School Test Banks

Chapter 31: Schizophrenia and Other Psychoses
Test Bank

MULTIPLE CHOICE

1. The client lives so completely in a world of his own that they he is unable to recognize reality, relate to others, or cope with lifes demands. This client is considered:
a. Exotic
b. Anorectic
c. Neurotic
d. Psychotic
ANS: D
Psychosis often prevents individuals from being able to perform activities of daily living. The other options do not cause loss of touch with reality.

DIF: Cognitive Level: Comprehension REF: p. 358 OBJ: 3
TOP: Psychoses in Adolescence KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

2. Schizophrenia in children as young as 5 years:
a. Is a myth
b. Can occur
c. Never occurs
d. Cannot occur
ANS: B
Psychotic disorders can occur in children as young as 5 years of age, with causes including genetics, complications during the pregnancy or birth, and biochemical imbalances.

DIF: Cognitive Level: Knowledge REF: p. 359 OBJ: 3
TOP: Psychoses in Childhood KEY: Nursing Process Step: N/A
MSC: Client Needs: Psychosocial Integrity

3. When people successfully adapt to their environment by using logical thought and socially appropriate ways, they are said to be functioning at the adaptive end of the ____ continuum.
a. Emotional
b. Self-protective
c. Neurobiological
d. Psychobiological
ANS: C
The neurobiological continuum, which is a term used in psychiatry to describe interactions based on the ability to function, change, and adapt in society, is influenced by certain physical brain functions.

DIF: Cognitive Level: Knowledge REF: p. 359 OBJ: 1
TOP: Continuum of Neurobiological Responses
KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

4. Schizophrenia affects approximately ____% of the worlds population.
a. 1
b. 5
c. 9
d. 13
ANS: A
This estimate means that 2.5 million people in the United States are affected, with 10% to 15% of the homeless population in the United States being schizophrenic.

DIF: Cognitive Level: Knowledge REF: p. 362 OBJ: 4
TOP: Schizophrenia KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

5. Theories based on study of the brain and its activities are called:
a. Social
b. Biological
c. Psychological
d. Psychobiological
ANS: B
Biological theories view schizophrenia as a brain disorder. Social theories view schizophrenia to be caused by the effects of the environment; psychological theories view the cause of the disease to be a character flaw combined with poor family relationships; and psychobiological theories do not exist.

DIF: Cognitive Level: Knowledge REF: p. 361 OBJ: 4
TOP: Biological Theories KEY: Nursing Process Step: N/A
MSC: Client Needs: Psychosocial Integrity

6. The client has become unable to recognize formerly familiar objects and people in his environment. The client is experiencing:
a. Affect
b. Agnosia
c. Apraxia
d. Anhedonia
ANS: B
Agnosia is an inability to recognize familiar objects or people; affect is an individuals expression of emotion; apraxia refers to the loss of an individuals ability to carry out purposeful movements, even when having the desire and physical ability to do so; and anhedonia is the inability or decreased ability to experience pleasure in life.

DIF: Cognitive Level: Comprehension REF: p. 363 OBJ: 6
TOP: Signs, Symptoms, and Behaviors KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

7. The client is describing her trip to town. She tells the nurse, I cold town yellow water girl outside below ground. This speech disturbance is called:
a. Neologism
b. Word salad
c. Flight of ideas
d. Verbigeration
ANS: B
Word salad is verbal communication in which a series of unrelated words with no connection is used. Neologism is words or expressions invented by the individual. Flight of ideas refers to rapid flow of speech along with a rapid change of topics; and verbigeration is purposeless repeating of phrases.

DIF: Cognitive Level: Application REF: p. 365 OBJ: 6
TOP: Signs, Symptoms, and Behaviors KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

8. The signs and symptoms of schizophrenia must be present for at least ____ months before a diagnostic label is assigned.
a. 3
b. 6
c. 12
d. 18
ANS: C
The signs and symptoms of schizophrenia must be present for at least 1 year before a diagnostic label is assigned.

DIF: Cognitive Level: Knowledge REF: p. 363 OBJ: 6
TOP: Phases of Becoming Disorganized KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

9. The client in whom schizophrenia has been diagnosed usually is medicated with what class of drugs?
a. Antianxiety
b. Antipsychotic
c. Antidepressant
d. Antihypertensive
ANS: B
Medications used to treat psychoses are called antipsychotic or neuroleptic drugs.

DIF: Cognitive Level: Knowledge REF: p. 366 OBJ: 7
TOP: Pharmacological Therapy KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

10. The client interprets the proverb A rolling stone gathers no moss as As long as the rock keeps moving, it wont turn green. This is an example of:
a. Mutism
b. Flight of ideas
c. Concrete thinking
d. Loose association
ANS: C
Concrete thinking is the inability to identify or describe feelings, experiences, and behaviors abstractly. Mutism is a refusal to speak; flight of ideas is a rapid flow of speech along with a rapid change of topics; and loose association refers to thinking that is characterized by speech that moves from one unrelated idea to another.

DIF: Cognitive Level: Application REF: p. 365 OBJ: 6
TOP: Signs, Symptoms, and Behaviors KEY: Nursing Process Step: N/A
MSC: Client Needs: Psychosocial Integrity

11. The nurse notes that a male client, who is taking an antipsychotic medication, is constantly moving from chair to chair during a group activity, and he complains that he feels nervous and jittery inside. The nurse is aware that this client most likely is experiencing:
a. Akinesia
b. Dystonia
c. Dyskinesia
d. Akathisia
ANS: D
Akathisia is one of the extrapyramidal side effects of antipsychotic medications that the nurse must monitor for and report to the physician. Akinesia refers to the absence of mental or physical movement; dystonia refers to rigidity of muscles; and dyskinesia is involuntary abnormal skeletal muscle movement.

DIF: Cognitive Level: Application REF: p. 367 OBJ: 9
TOP: Special Considerations KEY: Nursing Process Step: Assessment
MSC: Client Needs: Physiological Integrity

12. To cope with the devastating effects of schizophrenia and other serious mental illnesses, family members or significant others and clients will benefit most from:
a. Regular psychoanalysis
b. Intensive short-term therapy
c. Ongoing treatment and support
d. Continued medication adjustments
ANS: C
Continued treatment and support are needed for family members or significant others and clients alike if they are to cope with the devastating effects of psychotic mental illnesses because all aspects of life are affected.

DIF: Cognitive Level: Application REF: p. 370 OBJ: 8
TOP: Special Considerations KEY: Nursing Process Step: Planning
MSC: Client Needs: Psychosocial Integrity

13. The onset of schizophrenia most commonly occurs during the decade of age in the:
a. Teens
b. 20s
c. 30s
d. 40s
ANS: B
This is the usual age of onset, although oftentimes it is not noticed by others, or the condition may not be diagnosed until signs and symptoms become much more prominent.

DIF: Cognitive Level: Knowledge REF: p. 360 OBJ: 3
TOP: Psychoses in Adulthood KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

14. A female client with a psychotic disorder is experiencing olfactory hallucinations. Most likely, she would be complaining of a _____ that is disturbing to her.
a. Vision
b. Sound
c. Smell
d. Sense of touch
ANS: C
Hallucinations are false sensory inputs with no external stimuli that can occur with any of the senses. Olfactory refers to the sense of smell.

DIF: Cognitive Level: Comprehension REF: p. 364 OBJ: 6
TOP: Signs, Symptoms, and Behaviors KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

15. The police bring a man to the emergency department because he is wandering the streets yelling to people. He attempted to attack the police officer because he accused him of being a part of that plot to kill the president and me. Which category of schizophrenia is he exhibiting?
a. Paranoid
b. Catatonic
c. Disorganized
d. Residual
ANS: A
People with paranoid schizophrenia believe someone or something is out to get them. They have complex delusions of grandeur (belief that they are special or better than others). Because they feel they are being persecuted, they are withdrawn, suspicious, guarded, and hostile and may exhibit violent behavior. Catatonic schizophrenia is manifested by motor immobility. Disorganized schizophrenia is manifested by being unable to think, speak, or act in an organized manner. Residual schizophrenics are free of psychosis.

DIF: Cognitive Level: Comprehension REF: p. 362 OBJ: 5
TOP: Subtypes of Schizophrenia KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

16. The family of a client diagnosed with schizophrenia describes her behavior over the last few days as being very docile and non-confrontational. When asked to go and change her shoes to go shopping, she goes to change them, but a when a family member checks on her several minutes later, she appears to be lost in thought. This phase of schizophrenia is the ________ phase.
a. Residual
b. Prodromal
c. Prespsychotic
d. Acute
ANS: C
In the prepsychotic phase, individuals are usually quiet, passive, and obedient, and they prefer to be alone. Family members may report that they can sense the individual slipping away in front of their eyes. The prodromal phase and residual phases begin with withdrawal, a lack of energy, and little motivation. Individuals may appear confused and in a world of their own. They may complain about multiple physical problems or show a new, excessive interest in religion or philosophy. Ideas and beliefs become odd or unusual. Some individuals become agitated or angry. Speech becomes difficult to follow. In the acute phase individuals lose contact with reality and become unable to function even in the most basic ways.

DIF: Cognitive Level: Comprehension REF: p. 365 OBJ: 6
TOP: Phases of Becoming Disorganized KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

17. The mother of a 20-year-old man diagnosed with paranoid schizophrenia is upset by the fact that her child tried to attack her during her daily visit. What is the most appropriate support the nurse can give her after this incident?
a. Your child is working through relationship issues with you and does not know how to express them.
b. You should stop coming for a while, as your visits upset your child.
c. Your childs illness is due to a loss of contact with reality, and not directed to you as his mother.
d. You must make him realize that his behavior toward you is inappropriate.
ANS: C
People with paranoid schizophrenia believe someone or something is out to get them. Violent behaviors are common. In addition, a primary characteristic of any psychotic disorder is an inability to recognize reality. Due to this disconnect with reality, working through relationship issues and correcting behavior are not appropriate at this early point in treatment. Parents suffer the grief of losing a normal child and then must cope with the stigma of having a child who is mentally ill.

DIF: Cognitive Level: Comprehension REF: p. 360 OBJ: 9
TOP: Psychoses in Adulthood KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

18. A woman who delivered a healthy infant three 3 weeks ago is experiencing auditory hallucinations and has not changed her clothes or taken a shower in a week and expresses no interest in her infant. After a short inpatient stay, her symptoms improve and she is back to caring for her herself and her infant. What disorder is this indicative of?
a. Paranoid schizophrenia
b. Dual diagnosis
c. Schizotypal
d. Brief psychotic disorder
ANS: D
A brief psychotic disorder is a psychotic disturbance that lasts for more than 1 day but less than 1 month. The individual has delusions, hallucinations, impaired functioning and speech, and disorganized behavior. They eventually return to their normal state. The episode may have been triggered by stressors or having given birth recently (1 to 4 weeks).

DIF: Cognitive Level: Comprehension REF: p. 366 OBJ: 8
TOP: Other Psychoses KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

MULTIPLE RESPONSE

19. The client who is taking a low-potency antipsychotic medication should be informed by the nurse that the most common side effects are: (Select all that apply.)
a. Dystonia
b. Akathisia
c. Dry mouth
d. Bradykinesia
e. Blurred vision
f. Urinary retention
ANS: C, E, F
Anticholinergic side effects are most common with low-potency antipsychotic medications. The other options are extrapyramidal side effects that are seen most typically with higher-potency and long-term use of antipsychotic medications. However, all clients on antipsychotic medications should be monitored for both categories of side effects.

DIF: Cognitive Level: Knowledge REF: p. 367 OBJ: 9
TOP: Special Considerations KEY: Nursing Process Step: Intervention
MSC: Client Needs: Physiological Integrity

20. Positive symptoms of schizophrenia include: (Select all that apply.)
a. Flat affect
b. Hallucinations
c. Poor grooming
d. Speech problems
e. Bizarre behaviors
f. Withdrawal from others
ANS: B, D, E
Symptoms of schizophrenia fall into two categories: positive symptoms, which relate to maladaptive thoughts and behaviors; and negative symptoms, which relate to lack of adaptive ability. The incorrect answers are examples of the negative symptoms.

DIF: Cognitive Level: Knowledge REF: p. 363 OBJ: 6
TOP: Signs, Symptoms, and Behaviors KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

21. Neuroleptic malignant syndrome (NMS) is a potentially fatal side effect of antipsychotic medications. Which of the following symptoms are indicative of NMS? (Select all that apply.)
a. Hypothermia
b. Hyperthermia
c. Rigid posturing
d. Agitation
e. Tachycardia
f. Diaphoresis
g. Slow, shallow respirations
ANS: B, C, D, E, F
Symptoms of NMS begin with a sudden change in the clients level of consciousness and a rapid onset of rigid muscles. Often there is an associated respiratory difficulty, tremors, and an inability to speak; however, the cardinal sign of NMS is a high body temperature. Temperatures can reach as high as 108 F but usually range between 101 F and 103 F. Hypothermia and slow, shallow respirations are not indicative of NMS.

DIF: Cognitive Level: Knowledge REF: p. 369 OBJ: 7
TOP: Neuroleptic Malignant Syndrome KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

COMPLETION

22. __________ are central nervous system alterations that are characterized by abnormal, involuntary movement disorders caused by antipsychotic medications and leading to an imbalance between two major neurotransmitters (dopamine and acetylcholine) in portions of the brain.

ANS:
Extrapyramidal side effects
The client should be monitored continually for these potentially debilitating and/or life-threatening side effects.

DIF: Cognitive Level: Knowledge REF: p. 367 OBJ: 7
TOP: Special Considerations KEY: Nursing Process Step: Assessment
MSC: Client Needs: Physiological Integrity

23. Schizophrenia is a complex syndrome of maladaptive thoughts and behaviors that affects human functioning in the emotional, spiritual, intellectual, and __________ areas of an individuals life.

ANS:
social
This disorder affects all aspects of a persons life.

DIF: Cognitive Level: Application REF: p. 363 OBJ: 6
TOP: Signs, Symptoms, and Behaviors KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

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