CLNS 101 Adaptive Quiz Psychosis UPGRADED

A delusional client has refused to eat for the past 24 hours because, he says, "the food is poisoned." How should the nurse respond? 1 "Why do you think that the food is poisoned?" Correct2 "You feel worried that someone wants to poison you?" 3 "This feeling is a symptom of your illness. It's not real." 4 "You'll be safe with me. I won't let anyone poison you." It is important to help the client focus on feelings, and "You feel worried that someone wants to poison you?" is the only response that helps achieve this goal. Why questions call for a conclusion rather than an exploration of the issue; the client may not have the answer. Although stating that the feeling is a symptom of the client's illness is true, it is not something that the client is ready to understand; also, it is a closed statement. "You'll be safe with me. I won't let anyone poison you" is false reassurance and is not realistic; the client still is concerned about what will happen when the nurse is not there. 60%of students nationwide answered this question correctly. View Topics Confidence: Skipped Stats Issue with this question? 22. A client on the psychiatric unit tells the nurse, "The voices have told me that I'm in danger. They say I'll be safe only if I stay in this room, wear these clothes, and avoid stepping on the cracks between the floor tiles." What is the best initial response by the nurse? 1 "Don't worry. You're safe here. Are you afraid that I'll let someone hurt you?" Correct2 "I know that these voices are real to you, but I want you to know that I don't hear them." 3 "Tell me more about the voices. Are they male or female? How many voices do you hear?" 4 "You need to leave this room and get your mind occupied so the voices don't bother you anymore." "I know that these voices are real to you, but I want you to know that I don't hear them" demonstrates recognition and acceptance of the client's feelings and also points out reality. "Don't worry. You're safe here. Are you afraid that I will let someone hurt you?" provides false reassurance; the client has no reason to trust that the nurse can provide protection. Focusing on the content of the delusion will reinforce the delusion. Encouraging the client to focus on hallucinations tends to strengthen and confirm them. "You need to leave this room and get your mind occupied so the voices don't bother you anymore" denies the client's feelings and may increase anxiety. 61%of students nationwide answered this question correctly. View Topics Confidence: Skipped Stats Issue with this question? 23. A couple arrives at the mental health clinic for counseling because the husband consistently believes that his wife is having multiple affairs. After several sessions a delusional disorder is diagnosed. What specific subtype of the delusion does the nurse identify? Correct1 Jealousy 2 Somatic 3 Grandiose 4 Persecutory A client who is convinced that a mate is unfaithful exhibits delusional jealousy. Somatic delusions concern preoccupation with the body, including complaints of disfigurement, nonfunctioning body parts, insect infestation, and presence of a serious illness. In a grandiose delusion, the client seeks a position of power by expressing an exaggerated belief in his or her importance or identity. Clients with persecutory delusions believe that they are being conspired against, spied on, drugged, or poisoned. 55%of students nationwide answered this question correctly. View Topics Confidence: Skipped Stats Issue with this question? 24. A nurse is managing the care of a client with recently diagnosed schizophrenia. Effective therapeutic communication will directly affect which client-focused outcomes? Select all that apply. 1 The client will become capable of part-time employment. Correct 2 The client will effectively express emotional and physical needs. 3 The client will demonstrate wellness reflective of physical potential. Correct 4 The client will demonstrate an understanding of the mental health disorder. Correct 5 The client will recognize the issues most important to managing this disorder. Therapeutic communication facilitates the exchange of information between the nurse and the client that focuses on the client's attaining health and wellness. This information can be directed towards the client's health needs such as the effective expression of the client's physical and emotional needs, the understanding of the cause and prognosis of the current mental health problem, and the recognition of issues important to the management of the client's health issues. The client's ability to maintain part-time employment and the client's physical health potential are minimally affected by therapeutic communication. 48%of students nationwide answered this question correctly. View Topics Confidence: Skipped Stats Issue with this question? 25. A client exhibiting manic behavior is admitted to the psychiatric hospital. Which room assignment is the most appropriate for this client? 1 With a client who is very quiet Correct2 Alone in a sparsely furnished room 3 Alone in a room at the end of the hall 4 With a client exhibiting similar behavior Overactive individuals are stimulated by environmental factors; one responsibility of the nurse is to simplify their surroundings as much as possible. The quiet client may become the target of this client's overactivity. The client should be placed in a room near the nursing staff to prevent harm to self and others. Two overactive clients together will produce excessive stimuli for each other. 69%of students nationwide answered this question correctly. View Topics Confidence: Skipped Stats Issue with this question? 26. A client with the diagnosis of schizophrenia who has been hospitalized on a mental health unit for 2 weeks is to be discharged home. The client is vacillating between being happy and sad about going home. What term best describes these conflicting emotions? 1 Double bind Correct2 Ambivalence 3 Loose association 4 Inappropriate affect The simultaneous existence of two conflicting emotions, impulses, or desires is known as ambivalence. A single communication containing two conflicting messages is known as a double-bind message. A lack of connections between thoughts is known as loose associations. Inappropriate affect is not two conflicting emotions but instead the inappropriate expression of emotions. 57%of students nationwide answered this question correctly. View Topics Confidence: Skipped Stats Issue with this question? 27. Olanzapine (Zyprexa) is prescribed for a client with bipolar disorder, manic episode. What cautionary advice should the nurse give the client? Correct1 Sit up slowly. 2 Report double vision. 3 Expect increased salivation. 4 Take the medication on an empty stomach. Olanzapine (Zyprexa), a thienobenzodiazepine, can cause orthostatic hypotension. Blurred, not double, vision may occur. Decreased salivation is an effect of olanzapine. It may also cause nausea and other gastrointestinal upsets and should be taken with fluid or food. 62%of students nationwide answered this question correctly. View Topics Confidence: Skipped Stats Issue with this question? 28. A client who has been admitted with a diagnosis of schizophrenia says to the nurse, "Yes, it's March. March is Little Women. That's literal, you know." These statements illustrate: 1 Echolalia 2 Neologisms 3 Flight of ideas Correct4 Loosening of associations Loose associations are thoughts that are presented without the logical connections that are usually necessary for the listener to interpret the message. Echolalia is the purposeless repetition of words spoken by others or repetition of overheard sounds. Neologisms are new meaningless words coined by the client or new, unique meanings given to old words. Flight of ideas is the rapid skipping from one thought to another; these thoughts usually have only superficial or chance relationships. 54%of students nationwide answered this question correctly. View Topics Confidence: Skipped Stats Issue with this question? 29. A client with schizophrenia, paranoid type, is delusional, withdrawn, and negativistic. The nurse should plan to: Correct1 Invite the client to play a game of cards or board game. 2 Explain to the client the benefits of joining a group activity. 3 Encourage the client to become involved in group activities. 4 Mention to the client that the psychiatrist has ordered increased activity. Activities that require limited interpersonal contact are less threatening. Individuals with schizophrenia, paranoid type, usually do not respond to an authoritarian approach because they do not trust others, particularly those who act in an aggressive manner. Group activities require interaction with other people, which is threatening to individuals with paranoid feelings. 53%of students nationwide answered this question correctly. View Topics Confidence: Just a guess Stats Issue with this question? 30. During an assessment the nurse realizes that the client is experiencing a hallucination when the client says: 1 "I am going to save the world because I am God." Correct2 "My insides smell like they're going to just rot away." 3 "Unless I gamble at least once a week I feel extremely anxious." Incorrect4 "It's crazy, but I keep thinking that something terrible will happen to my baby." The response "My insides smell like they're going to just rot away" is an example of an olfactory hallucination, a sense of perception for which no external stimulus exists. The response "I am going to save the world because I am God" is an example of a delusion of grandeur. A delusion is a fixed false belief held to be true by the person even in the presence of evidence to the contrary. The response "Unless I gamble at least once a week I feel extremely anxious" is an example of a compulsion. A compulsion is a repetitive, intrusive urge to perform an act contrary to one's ordinary wishes or standards. The response "It's crazy, but I keep thinking that something terrible will happen to my baby" is an example of an obsession. An obsession is an insistent, painful, intrusive idea, impulse, or emotion that arises from within and cannot be suppressed or ignored. A client paces back and forth across the floor, speaks incoherently, and continually talks to and verbally fights with people who are not present. What is the nurse's initial therapeutic intervention? 1 Setting limits on the client's verbal aggression 2 Isolating the client to decrease the aggressive behavior 3 Establishing a relationship to reduce the client's loneliness Correct4 Providing emotional support while demonstrating acceptance of the client Clients who have lost contact with reality can be helped to reestablish contact with reality when the nurse demonstrates respect and focuses on the client; this distracts the client's attention from the hallucinations. This client is responding to voices, not reality; setting limits is reality oriented and is usually ineffective unless it involves directing the client to dismiss the voices. The client represents no immediate threat to the self or others; isolating the client will decrease contact with reality and will probably worsen the hallucinations. Although this may lessen the hallucinations, it takes a long time to establish such a relationship and the client needs immediate help. 53%of students nationwide answered this question correctly. View Topics Confidence: Skipped Stats Issue with this question? 12. A nurse is caring for a client who is delusional and talking about people who are plotting to do harm. The staff members notice that the client is pacing more than usual, and the primary nurse concludes that the client is beginning to lose control. What is the most therapeutic nursing intervention? Correct1 Moving the client to a quiet place 2 Urging the client sit down for a short time 3 Encouraging the client to use a punching bag 4 Allowing the client to continue pacing under supervision Clients losing control feel frightened and threatened; they need external controls and a reduction in external stimuli. The client will be unable to sit at this time; the agitation is building. Encouraging the client to use a punching bag is helpful for pent-up aggressive behavior but not for agitation associated with delusions. The pacing is not adequately relieving the client's agitation. Another intervention is needed to prevent acting-out behaviors. Test-Taking Tip: The night before the examination you may wish to review some key concepts that you believe need additional time, but then relax and get a good night’s sleep. Remember to set your alarm, allowing yourself plenty of time to dress comfortably (preferably in layers, depending on the weather), have a good breakfast, and arrive at the testing site at least 15 to 30 minutes early. 72%of students nationwide answered this question correctly. View Topics Confidence: Skipped Stats Issue with this question? 13. A client who has been on a psychiatric unit for several weeks continually talks about delusional topics. What response by the nurse is most therapeutic? 1 Asking the client to explain the delusion 2 Allowing the client to maintain the delusion Correct3 Encouraging the client to focus on reality issues 4 Explaining to the client why the thoughts are not true Discussing reality-based issues helps decrease delusional and hallucinatory activity by reducing feelings of isolation and competition for sensory awareness. Asking the client to explain the delusions or allowing him to maintain them will support and reinforce the delusions and validate them. Explaining why the delusions are not true is a judgmental response that may decrease the client's trust and increase anxiety. 59%of students nationwide answered this question correctly. View Topics Confidence: Skipped Stats Issue with this question? 14. A nurse is planning activities for a withdrawn client who is hallucinating. What is the most therapeutic activity for this client? Correct1 Going for a walk with the nurse 2 Watching a movie with other clients 3 Playing a board game with a group of clients 4 Playing a game of cards alone in the dayroom Walking with the nurse facilitates one-on-one interaction and the development of a trusting relationship. Watching a movie will allow the client to withdraw further. Playing a game with others is beyond the client's ability at this time. Playing cards alone will allow the client to withdraw further. 73%of students nationwide answered this question correctly. View Topics Confidence: Skipped Stats Issue with this question? 15. A client who has a diagnosis of paranoid schizophrenia and has been violent in the past is admitted to the psychiatric unit. What should the nurse do before conducting an admission interview? 1 Move to the client's side and sit down. 2 Alert the assault response team about the client's history. 3 Have two other staff members present when talking with the client. Correct4 Enter the room with another staff member while remaining between the client and the door. Making sure to stay between the client and the door provides safety for the nurse and the other staff member because it will enable them to make a rapid exit. Moving to the client and sitting down invades the client's territory and may precipitate an aggressive client response. Alerting the assault response team is premature; the team is alerted when a client is out of control, harming self or others, and cannot be managed by the staff on the unit. Having two other staff members present may be viewed by the client as confrontational and may precipitate an aggressive response. 62%of students nationwide answered this question correctly. View Topics Confidence: Skipped Stats Issue with this question? 16. A client with schizophrenia, paranoid type, is readmitted to the hospital at the insistence of the family. While exploring her feelings about the readmission, the client angrily shouts, "You're one of them. Leave me alone." How should the nurse respond? 1 "Try not to be afraid. I won't hurt you." 2 "I'm not one of them—I'm here to help you." 3 "Your family and the staff are trying to help you." Correct4 "I can see that you're upset. We can talk more later." Acknowledging the client's feelings and offering an opportunity to talk in the future shows that the nurse cares and is not abandoning the client. Pursuing the topic while the client is angry may result in an escalation of the client's anger, jeopardizing the safety of the nurse and others. The nurse's telling the client that she is not one of "them" and that the client's family and staff are trying to help her requires trust on the part of the client, which may or may not be justified at this time; the client feels betrayed and is angry. 49%of students nationwide answered this question correctly. View Topics Confidence: Skipped Stats Issue with this question? 17. A nurse is caring for a client who is experiencing auditory hallucinations. What is the most therapeutic response by the nurse? 1 "Those voices you hear aren't real." Correct2 "I don't hear the voices you're hearing." 3 "Try to focus your attention on other things." 4 "You won't hear the voices when you get better." "I don't hear the voices you're hearing" points out reality without being demeaning or arguing with the client. The voices are real to the client, and stating otherwise will not be believed. Trying to focus the client's attention on other things is probably impossible. The client will be unable to focus on the future when attempting to cope with the frightening experience of hearing voices in the present; also, it may be false reassurance. 66%of students nationwide answered this question correctly. View Topics Confidence: Skipped Stats Issue with this question? 18. 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 want to shut me up before I spill the beans." How should the nurse describe this statement? 1 Nihilistic delusion Correct2 Delusion of grandeur 3 Auditory hallucination 4 Overvaluation of the self Thoughts of being pursued by some powerful agent or agents because of one's special attributes or powers are fixed false beliefs and referred to as delusions of grandeur. There is no evidence to indicate that a delusion of total or partial nonexistence is being used. There is no evidence to indicate that a sensory-perceptual disturbance is present. Delusions of grandeur are usually used to deny unconscious feelings of low self-esteem. 57%of students nationwide answered this question correctly. View Topics Confidence: Skipped Stats Issue with this question? 19. A nurse is caring for a client with the diagnosis of schizophrenia. What should the nurse plan to do to increase the self-esteem of this client? Correct1 Reward healthy behaviors. 2 Explain the treatment plan. 3 Identify various means of coping. 4 Encourage participation in community meetings. By realistically rewarding the healthy behaviors, the nurse provides secondary gains and encourages the continued use of healthy behaviors. Explaining the treatment plan, identifying various means of coping, and encouraging participation in community meetings are important but will do little to increase the client's self-esteem. 61%of students nationwide answered this question correctly. View Topics Confidence: Skipped Stats Issue with this question? 20. When being admitted to a mental health facility, a young male adult tells the nurse that the voices he hears frighten him. The nurse knows that clients tend to hallucinate more vividly: 1 Before meals Correct2 After going to bed 3 During group activities 4 While watching television Auditory hallucinations are most troublesome when environmental stimuli are diminished and there are few competing distractions. Before meals, during group activities, and during television watching are all times of relatively high, competing environmental stimuli. A client with an inoperable temporal lobe tumor is experiencing frightening audio hallucinations, especially when alone. How can the nurse best help the client cope with these hallucinations? 1 By moving the client to a four-bed room closer to the nurses' station Correct2 By suggesting that the client turn on the radio or television when alone 3 By working out a schedule for visitors so the client will never be alone 4 By having family or friends remain with the client until the hallucinations stop Stimuli such as a television or radio encourage the client to remain reality oriented; research has shown that competing stimuli are useful in controlling hallucinations. Moving the client to a four-bed room closer to the nurses' station does not ensure that the client's needs will be met. Working out a schedule for visitors so the client will never be alone or having family or friends remain with the client until hallucinations stop is not realistic and fosters greater dependency; both solutions are focused on the client's inability to cope with the problem and will increase the client's fear of being alone. 50%of students nationwide answered this question correctly. View Topics Confidence: Skipped Stats Issue with this question? 2. A nurse plans to establish a trusting relationship with a client who is using paranoid ideation. How should the nurse begin to accomplish this? Correct1 By being available on the unit but waiting for the client to approach 2 By seeking the client out frequently to spend long blocks of time together 3 By sitting on the unit and observing the client's behavior throughout the day 4 By calling the client into the office to establish a contract for regular therapy sessions The recommended approach for working with suspicious clients is to allow them to set the pace of the relationship. It is less threatening if they are the one to initiate contact. Seeking the client out frequently to spend long blocks of time together, sitting and watching the client, and calling the client into the office may all be perceived as threatening and may add to feelings of paranoia. 53%of students nationwide answered this question correctly. View Topics Confidence: Skipped Stats Issue with this question? 3. A hospitalized psychiatric client with the diagnosis of histrionic personality disorder demands a sleeping pill before going to bed. After being refused the sleeping pill, the client throws a book at the nurse. The nurse identifies this behavior as: 1 Exploitive Correct2 Acting out 3 Manipulative 4 Reaction formation Acting out is the process of expressing feelings behaviorally. The action is not exploitive, because no evidence is provided to demonstrate that anyone has been used to get what the client wants. The action is not manipulative, because no evidence is provided to demonstrate that anyone has been influenced against his or her wishes. The action is not disguising unacceptable feelings by expressing opposite emotions. 69%of students nationwide answered this question correctly. View Topics Confidence: Skipped Stats Issue with this question? 4. A client with schizophrenia repeatedly says to the nurse, "No moley, jandu!" The nurse determines that the client is exhibiting: 1 Echolalia Correct2 Neologism 3 Concretism 4 Perseveration Neologisms are words that are invented and understood only by the person using them. Echolalia is the verbal repeating of exactly what is heard. Concretism is a pattern of speech characterized by the absence of abstractions or generalizations. Perseveration is a disturbed system of thinking manifested by repetitive verbalizations or motions or by persistent repetition of the same idea in response to different questions. 72%of students nationwide answered this question correctly. View Topics Confidence: Skipped Stats Issue with this question? 5. A nurse greets a client who has been experiencing delusions of persecution and auditory hallucinations by saying, "Good evening. How are you?" The client, who has been referring to himself as "the man," answers, "The man is bad." Of what is this an example? Correct1 Dissociation 2 Transference 3 Displacement 4 Identification Speaking in the third person reflects poor ego boundaries and dissociation from the real self. Transference is the movement of emotional energy and feelings that one has for one person to another person. Displacement is an attempt to reduce anxiety by transferring the emotions associated with one object or person to another. Identification is an attempt to increase selfesteem by acquiring the attributes or characteristics of an admired individual. 55%of students nationwide answered this question correctly. View Topics Confidence: Skipped Stats Issue with this question? 6. A female client is admitted to the acute care psychiatric unit with a diagnosis of panic disorder with agoraphobia. During the initial assessment phase the nurse should focus on: Correct1 Easing the client's anxiety so further interviewing may be done 2 Learning about the client's home life to facilitate the planning future care 3 Suggesting to the client that she rest for a while before taking her health history 4 Helping the client identify the source of her anxiety so the source may be avoided The client will be unable to concentrate or focus on the interview if anxiety is not reduced. Learning about the client's home life to facilitate the planning of care is not the priority at this time; anxiety must be reduced and the client's level of comfort increased. The client will not rest until anxiety is reduced. Helping the client identify the source of her anxiety so the source can be avoided is not the priority at this time; anxiety must be reduced and the client's level of comfort increased. A nurse is assigned to care for a client with the diagnosis of schizophrenia who is hallucinating. What is the first consideration in trying to establish a trusting relationship? 1 Family members must be included in the plan of care. 2 The client cannot be distracted from the hallucinations. Correct3 The client adamantly believes what is being experienced. 4 Electroconvulsive therapy should be explained in simple terms. Because the client believes the hallucinations, initially the nurse should validate the client's feelings, but not the experience of the hallucinations, to begin to build trust. Including family member's in the plan of care is not the priority; this may be done later with the client's permission. Distraction can help clients with schizophrenia pay less attention to hallucinations, but this is not done initially. Because electroconvulsive therapy usually is not that effective for schizophrenia, there is no reason to explain its use. 69%of students nationwide answered this question correctly. View Topics Confidence: Skipped Stats Issue with this question? 22. A client with schizophrenia has been experiencing hallucinations. During what client behaviors should the nurse expect the hallucinations to be more frequent? Correct1 Rest 2 Playing sports 3 Watching television 4 Interacting with others Hallucinations occur most often when sensory stimulation is diminished because there is less competition for attention. Sports, television-watching, and interacting with others compete for sensory attention, thereby diminishing hallucinations. Test-Taking Tip: Stay away from other nervous students before the test. Stop reviewing at least 30 minutes before the test. Take a walk, go to the library and read a magazine, listen to music, or do something else that is relaxing. Go to the test room a few minutes before class time so that you are not rushed in settling down in your seat. Tune out what others are saying. Crowd tension is contagious, so stay away from it. 59%of students nationwide answered this question correctly. View Topics Confidence: Skipped Stats Issue with this question? 23. A client with the diagnosis of schizophrenia is given one of the antipsychotic drugs. The nurse understands that antipsychotic drugs can cause extrapyramidal side effects. Which effect is cause for the greatest concern? 1 Akathisia Correct2 Tardive dyskinesia 3 Parkinsonian syndrome 4 Acute dystonic reaction Tardive dyskinesia, an extrapyramidal response characterized by vermicular movements and protrusion of the tongue, chewing and puckering movements of the mouth, and puffing of the cheeks, is often irreversible, even when the antipsychotic medication is withdrawn. Akathisia, motor restlessness, usually can be treated with antiparkinsonian or anticholinergic drugs while the antipsychotic medication is continued. Parkinsonian syndrome (a disorder featuring signs and symptoms of Parkinson disease such as resting tremors, muscle weakness, reduced movement, and festinating gait) can usually be treated with antiparkinsonian or anticholinergic drugs while the antipsychotic medication is continued. Dystonia, impairment of muscle tonus, can usually be treated with antiparkinsonian or anticholinergic drugs while the antipsychotic medication is continued. 67%of students nationwide answered this question correctly. View Topics Confidence: Skipped Stats Issue with this question? 24. A nurse is assessing an adolescent client with the diagnosis of schizophrenia, undifferentiated type. Which signs and symptoms should the nurse expect the client to experience? 1 Paranoid delusions and hypervigilance 2 Depression and psychomotor retardation Correct3 Loosened associations and hallucinations 4 Ritualistic behavior and obsessive thinking Loosened associations and hallucinations are the primary behaviors associated with a thought disorder such as schizophrenia. Paranoid delusions and hypervigilance are more common in paranoid-type schizophrenia than in the undifferentiated type. Depression and psychomotor retardation are not characteristic of schizophrenia. Ritualistic behavior and obsessive thinking are generally associated with obsessive-compulsive disorders, not schizophrenia. 59%of students nationwide answered this question correctly. View Topics 5 Confidence: Skipped Stats Issue with this question? 25. A mother complains to the nurse that her 4-year-old child partially awakens from sleep, sweats profusely, and screams in the night. What is the best nursing action in this situation? 1 Recommend that the mother take her child into her own bed. 2 Ask the child to describe the dream that he or she saw last night. 3 Advise the mother to accept the child’s dream as a real fear of the child. Correct4 Advise the mother to observe her child for a few minutes until the child is calm. Sleep terrors are characterized by partially awakening from sleep accompanied by screaming, perspiration, and increased heart rate. During the terror, the child screams but calms down later. The nurse advises the mother to avoid disturbing the child and to watch carefully until the child calms down. A child will generally not have trouble returning to sleep after a night terror and will not remember the details, so it is not necessary to bring the child into the parent’s bed, and it would be of no benefit to ask the child to describe the dream or accept it as real. Test-Taking Tip: Make certain that the answer you select is reasonable and obtainable under ordinary circumstances and that the action can be carried out in the given situation. 52%of students nationwide answered this question correctly. View Topics Confidence: Skipped Stats Issue with this question? 26. A female client and a nurse are standing next to each other in the mental health clinic when the client gets down on her hands and knees and says, "I'm a table." What is the best response by the nurse? 1 State, "You were never a table before; you're not a table now." 2 Respond, "You're safe here in the clinic; you don't need to be a table." 3 Touch her arm while saying, "You must be very frightened to feel this way." Correct4 Hold out a hand to help her up while saying, "You're not a table; you're a person." The response "You're not a table; you're a person" simply states reality without attempting to argue the client out of the delusion; actual physical contact should be initiated by the client. The response "You were never a table before; you aren't a table now" denies the client's feelings and directly attacks the delusion, forcing the client to defend it. The response "You're safe here in the clinic; you don't need to be a table" is false reassurance; the client does not feel safe, and saying this does not make it so. Touching the client's arm could be frightening and overwhelming. 65%of students nationwide answered this question correctly. View Topics Confidence: Skipped Stats Issue with this question? 27. A client with schizophrenia who has auditory hallucinations is withdrawn and apathetic. What should the nurse say to involve this client in an activity? 1 "You'll get a reward if you go to the gym." Correct2 "Would you like to participate in the group walk today?" 3 "Those voices you hear would like it if you did a little exercise." 4 "There's a positive relationship between exercise and good mental health." "Would you like to participate in the group walk today?" is a declarative statement invites the client to walk, and the client can comply without making a verbal decision. A client with schizophrenia is often ambivalent, rendering decision-making difficult. A withdrawn, apathetic clients probably will not internalize or appreciate rationales for interventions. Saying that the voices want the client to exercise supports the client's hallucinations. 54%of students nationwide answered this question correctly. View Topics Confidence: Skipped Stats Issue with this question? 28. A client with schizophrenia is speaking made-up words that have no meaning to other people. What term should the nurse use to document these verbalizations? 1 Avolition 2 Echolalia 3 Anhedonia Correct4 Neologisms Neologisms are unique words with personal meanings only to the client. Avolition is the lack of motivation associated with a reduced emotional expression (flat affect). Echolalia is parrotlike echoing of spoken words or sounds. Anhedonia is the loss of enjoyment in things that were formerly enjoyed. 72%of students nationwide answered this question correctly. View Topics Confidence: Skipped Stats Issue with this question? 29. A client with schizophrenia sees a group of visitors sitting together talking. The client tells the nurse, "I know they're talking about me." Which altered thought process should the nurse identify? 1 Flight of ideas Correct2 Ideas of reference 3 Grandiose delusion 4 Thought broadcasting Ideas of reference, seen with psychotic thinking, is a delusional belief that others are talking about the client. Flight of ideas is the rapid thinking seen in clients in a manic state. Grandiose delusions are irrational beliefs that overestimate one's ability or worth. Thought broadcasting is the delusional belief that others can read one's thoughts. 49%of students nationwide answered this question correctly. View Topics Confidence: Just a guess Stats Issue with this question? 30. A client has been actively hallucinating for several days. What is the most therapeutic nursing intervention? 1 Asking the client who is speaking Correct2 Involving the client in simple activities on the unit 3 Allowing the client to continue without interruption Incorrect4 Having the client frequently repeat what the voices are saying The nursing goal is to promote reality; simple activities do not place demands on the client. Asking the client who is speaking implies that the client is talking to a real person. Allowing the client to continue without interruption allows further withdrawal rather than orienting the client to reality. The client should be asked occasionally to repeat what the voices are saying so the nurse can identify command hallucinations; once a day or when there is a change in the client's behavior is sufficient. It should not be done frequently because it may reinforce the hallucinations. The nurse is assigned to work with a 20-year-old client on an inpatient unit. In assessing the woman, the nurse notes that she is mute, does not show any type of movement, is unresponsive, and appears unaware of her surroundings. What is the best term for the nurse to use to describe these symptoms? 1 Alogia Correct2 Catatonia 3 Echopraxia 4 Affective flattening Catatonia is the term to describe stupor, rigidity, or extreme flexibility of the limbs; excitability; confusion; and lack of verbal expression. Alogia is a term used to describe an inability to speak or near-absence of speech. Echopraxia is the term for the mimicking or repetition of the actions of another person. Affective flattening is the term for blunted or constricted facial expression. Study Tip: Study goals should set out exactly what you want to accomplish. Do not simply say, “I will study for the exam.” Specify how many hours, what day and time, and what material you will cover. 65%of students nationwide answered this question correctly. View Topics Confidence: Skipped Stats Issue with this question? 12. A client who is hallucinating actively approaches the nurse and reports, "I'm hearing voices that are saying bad things about me." What should the nurse do? 1 Respond, "I don't hear the voices." 2 Suggest that the client join other clients in playing cards. 3 Encourage the client not to listen to what the voices are saying. Correct4 Reply, "I'll stay with you for a while because you seem frightened." When the client's perceptions are especially frightening, the nurse must let the client know that the fears are recognized as real and frightening, even if the nurse does not share these perceptions. Staying with the client will convey concern and reduce the fears. Responding, "I don't hear the voices" is nontherapeutic; the voices are real to the client. The client will be unable to play cards because of a reduced ability to concentrate when the voices are speaking. Encouraging the client not to listen to what the voices are saying is nontherapeutic; the client is unable to separate the voices from reality. 63%of students nationwide answered this question correctly. View Topics Confidence: Skipped Stats Issue with this question? 13. A client with paralysis of the legs is found to have somatoform disorder, conversion type. What must the nurse consider when formulating a plan of care for this client? Correct1 The illness is very real to the client and requires appropriate nursing care. 2 Although the client believes that there is an illness, there is no cause for concern. 3 There is no physiological basis for the illness; therefore only emotional care is needed. 4 Nursing intervention is needed even though the nurse understands that the client is not ill. Individuals who have somatoform disorders are really ill; they need care in a nonthreatening environment. The client requires physiological and emotional care for treatment of motor or sensory functional deficits. 64%of students nationwide answered this question correctly. View Topics Confidence: Skipped Stats Issue with this question? 14. A client in the mental health clinic has a phobia about closed spaces. Which desensitization method should the nurse expect to be used successfully with this client? Correct1 Imagery 2 Contracting 3 Role playing 4 Assertiveness training Imagery is a therapeutic approach that is used to facilitate positive self-talk; mental pictures under the control of and initiated by the client may correct faulty cognitions. Contracting, role play, and assertiveness training are all useful general behavioral approaches, but none is a desensitization technique. 69%of students nationwide answered this question correctly. View Topics Confidence: Skipped Stats Issue with this question? 15. A client with an obsessive-compulsive disorder continually walks up and down the hall, touching every other chair. When he is unable to do this, the client becomes upset. What should the nurse do? 1 Distract the client, which will help the client forget about touching the chairs 2 Encourage the client to continue touching the chairs as long as he wants until fatigue sets in 3 Remove chairs from the hall, thereby relieving the client of the necessity of touching every other one Correct4 Allow the behavior to continue for a specified time, letting the client help set the time limits to be imposed It is important to set limits on the behavior, but it is also important to involve the client in the decision-making. Distracting the client, which will help the client forget about touching the chairs, is nontherapeutic; rarely can a client be distracted from a ritual when anxiety is high. Encouraging the client to continue touching the chairs for as long he desires until fatigue sets in is a nontherapeutic approach; some limits must be set by the client and nurse together. Removing chairs from the hall, thereby relieving the client of the necessity of touching every other one, will increase the client's anxiety because he client uses the ritual as a defense against anxiety. 66%of students nationwide answered this question correctly. View Topics Confidence: Skipped Stats Issue with this question? 16. A client with schizophrenia plans an activity schedule with the help of the treatment team. A written copy is posted in the client's room. What should the nurse say when it is time for the client to go for a walk? Correct1 "It's time for you to go for a walk now." 2 "Do you want to take your scheduled walk now?" 3 "When would you like to go for your walk today?" 4 "You're supposed to be going for your walk now." Telling the client that it is time to take a walk is concise and does not require decision-making; it is therefore less likely to increase anxiety. "Do you want to take your scheduled walk now?" asks the client to make a decision when a refusal is unacceptable. Requiring the client to make a decision when acutely ill may increase anxiety; also, it permits the unacceptable answer of "never." "You're supposed to be going for your walk now" is somewhat accusatory; it may increase anxiety by placing responsibility on the client. 53%of students nationwide answered this question correctly. View Topics Confidence: Skipped Stats Issue with this question? 17. A client tells the nurse, "That man on the television is talking only to me." What should the nurse document that the client is exhibiting? 1 Illusion 2 Hallucination Correct3 Idea of reference 4 Autistic thinking An idea of reference, also called a delusion of reference, is a fixed, false personal belief that public events and people are connected directly to the client. An illusion is a misinterpretation of a sensory stimulus. A hallucination is a perceived experience that occurs in the absence of an actual sensory stimulus. Autistic thinking is a distortion in the thought process that is associated with schizophrenic disorders. 50%of students nationwide answered this question correctly. View Topics Confidence: Skipped Stats Issue with this question? 18. A client on a medical unit refuses to eat and says, "The food is poisoned." The nurse should: 1 Ask the client what foods he wants so they can be ordered. 2 Encourage the client's family to bring favorite foods from home. Correct3 Suggest going to the cafeteria and selecting foods that the client feels safe eating. 4 Go with the client to the cafeteria and taste the food to show him that it is not poisoned. Clients with paranoia often feel safer selecting foods from a cafeteria-type display that is prepared for the general population than they do eating from a tray specifically prepared for them. The other options will not provide security because part of the food may still be viewed as poisoned. 52%of students nationwide answered this question correctly. View Topics Confidence: Skipped Stats Issue with this question? 19. A client with schizophrenia says to the nurse, "I've been here 5 days. There are five players on a basketball team. I like to play the piano." How should the nurse document this cognitive disorder? 1 Word salad Correct2 Loose association 3 Thought blocking 4 Delusional thinking These ideas are not well connected and there is no clear train of thought. This is an example of loose association. Word salad is incoherent expressions containing jumbled words. This client's thoughts are coherent but not connected. Thought blocking occurs when the client loses the train of thinking and ideas are not completed. Each of the client's thoughts is complete but not linked to the next thought. These statements are reality based and not reflective of delusional thinking. 72%of students nationwide answered this question correctly. View Topics Confidence: Skipped Stats Issue with this question? 20. A client is experiencing hallucinations. What therapeutic intervention should the nurse plan to help the client cope with the hallucinations? 1 Reinforcing the perceptual distortions until the client develops new defenses 2 Providing an unstructured environment and assigning the client to a private room 3 Avoiding helping the client make connections between anxiety-producing situations and hallucinations Correct4 Distracting the client's attention by providing a competing stimulus that is stronger than the hallucinations Distracting the client by providing a competing stimulus that is stronger than the hallucinations is helpful in easing hallucinations. Connections should be made to decrease the use of hallucinations. Reinforcing the distortions, providing an unstructured environment, and assigning the client to a private room will foster the hallucinations. Chart/Exhibit 1 A male client with a history of schizophrenia who responds poorly to medicatio n is now being treated for acute depression. In light of the information elicited from the medication list and laboratory results, the nurse educates the client to: Correct1 Come in for weekly blood tests to monitor for drug induced agranulocytosis. 2 Report incidents of unusual bleeding or easy bruising while taking fluoxetine (Prozac). 3 Understand that he will be prescribed only 1 week's supple of fluoxetine (Prozac) at a time. 4 Consume a high-protein diet to offset the risk of anemia while he is taking clozapine (Clozaril). The antipsychotic medication clozapine (Clozaril) poses a risk for the development of agranulocytosis, especially when combined with a selective serotonin reuptake inhibitor such as fluoxetine (Prozac). The client's neutrophil and WBC counts are borderline and therefore suggestive of the disorder. Weekly blood testing to monitor these blood values in required. The client's platelet count is in the low normal range, but fluoxetine is not generally considered a factor in bleeding disorders. Clozapine, not fluoxetine, would likely be prescribed on a week-byweek basis to both help manage side effects and encourage weekly visits for labwork. Clozapine is not generally considered a factor in the development of anemia. 63%of students nationwide answered this question correctly. View Topics Confidence: Skipped Stats Issue with this question? 2. A psychotic male client is admitted to the hospital for evaluation. While obtaining the history, the nurse asks why he was brought to the hospital by his parents. The client states, "They lied about me. They said I murdered my mother. You killed her. She died before I was born." What does the nurse recognize that the client is experiencing? 1 Ideas of grandeur 2 Confusing illusions Correct3 Persecutory delusions 4 Auditory hallucinations The client's verbalization reflects feelings that others are blaming the client for negative actions. There are no data to demonstrate the client is having feelings of greatness or power. There are no data to demonstrate the client is experiencing confusing misinterpretations of stimuli. There are no data to demonstrate the client is hearing voices at this time. 61%of students nationwide answered this question correctly. View Topics Confidence: Skipped Stats Issue with this question? 3. A confused hallucinating client says, "My arms are turning to stone." What is the most therapeutic response by the nurse? 1 "May I examine your arms?" 2 "When did this feeling first start?" 3 "That's a rather unusual sensation." Correct4 "It can be frightening to feel that way." Depersonalization communication is the result of a high anxiety level; projecting empathy to the client will facilitate exploration of concerns. The response "May I examine your arms?" does not acknowledge the frightening experience for the client and supports the client's hallucination. When the feeling started is irrelevant; the nurse must address what the client is experiencing now. The response "That's a rather unusual sensation" belittles the client's feelings and may make establishment of a therapeutic relationship difficult. 52%of students nationwide answered this question correctly. View Topics Confidence: Skipped Stats Issue with this question? 4. A nurse is caring for a client with the diagnosis of schizophrenia. During assessment the nurse identifies both positive (type I) and negative (type II) signs and symptoms. Which clinical findings should the nurse document as positive? Select all that apply. 1 Anergy 2 Flat affect 3 Social withdrawal Correct 4 Disorganized thoughts Correct 5 Auditory hallucinations Disorganized thoughts (e.g., derailment, tangentiality, illogicality, incoherence, and circumstantiality) are a positive sign of schizophrenia. Positive signs and symptoms, referred to as "florid psychotic symptoms," are related to alterations in thinking, speech, perception, and behavior. They usually respond to antipsychotic medications. Positive symptoms reflect an excess or distortion of function and include delusions, hallucinations, increased speech production with associations, and bizarre behavior. A lack of energy (anergy) is a negative symptom associated with schizophrenia. Negative symptoms reflect a lessening or loss of normal function. A lack of emotional expression (flat affect) is a negative sign associated with schizophrenia. Inadequate social skills leading to withdrawal and isolation are negative symptoms associated with schizophrenia. 51%of students nationwide answered this question correctly. View Topics Confidence: Skipped Stats Issue with this question? 5. A client recently admitted to the psychiatric unit is found to be experiencing command auditory hallucinations. The nurse conducts an initial one-on-one session centered on the development of trust. What is the next important nursing intervention? Correct1 Identifying the content of the messages in the auditory hallucinations 2 Determining whether the command hallucinations are frightening to the client 3 Helping the client determine whether the voices are outside or inside the client's head 4 Determining the client's ability to refrain from listening to the messages from the voices During the acute phase it is important to have the client describe the content of hallucinations so safety issues may be identified. Determining whether the command hallucinations are frightening to the client is not the priority; most clients find hallucinations frightening. Helping the client recognize whether the voices are outside or inside the client's head is not the priority. Determining the client's ability to refrain from listening to the messages from the voices is important, but it is not the priority at this time. 67%of students nationwide answered this question correctly. View Topics Confidence: Skipped Stats Issue with this question? 6. A 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. Which characteristic is unlikely to be demonstrated by this client? 1 Neologisms 2 Low self-esteem 3 Concrete thinking Correct4 Organized speech and thoughts A person with this disorder will not always have organized speech or thought process. Neologisms, words that have meaning only to the patient, are associated with schizophrenia. Low self-esteem is associated with schizophrenia because these people often experience internal stimulation, such as auditory hallucinations, that can be demeaning, as well as distortions of reality. Concrete thinking is symptomatic of schizophrenia. 55%of students nationwide answered this question correctly. View Topics Confidence: Skipped Stats Issue with this question? 7. A nurse who is working on a psychiatric unit notes that a client with schizophrenia is beginning to pace around the lounge while glaring at other clients. How should the nurse respond to this behavior? 1 By pointing out the behavior to the client Correct2 By walking with the client to a quiet area on the unit 3 By suggesting that the client go to the gym to work out 4 By arranging for an additional staff member to be present in the vicinity of the client. The client is demonstrating signs of agitation, and stimuli from the environment must be reduced. Pointing out the behavior is confrontational may increase the client's agitation. The client should not be left unattended at this time; aggressive physical activity at this time may increase the agitation. Arranging for the presence of another staff member will not interrupt the client's behavior, which is the priority at this time. 71%of students nationwide answered this question correctly. View Topics Confidence: Skipped Stats Issue with this question? 8. The nurse is interviewing the family about the onset of problems in a young client with the diagnosis of schizophrenia. In what stage of development does the nurse expect that the client's difficulties with reality testing began? 1 Puberty Correct2 Adolescence 3 Late childhood 4 Early childhood The usual age of onset of schizophrenia is adolescence or early adulthood. Signs and symptoms usually do not appear earlier in life. 53%of students nationwide answered this question correctly. View Topics Confidence: Skipped Stats Issue with this question? 9. A client with the diagnosis of paranoid schizophrenia refuses to eat at mealtime. What nursing action is most beneficial? 1 Sitting with the client at mealtime Correct2 Giving the client food in unopened packages 3 Reminding the client repeatedly to eat the food 4 Explaining to the client the importance of eating Clients with paranoia often have delusions that the food is poisoned. Providing packaged foods may make them feel less suspicious and more likely to eat. Just sitting with the client will not ensure that the client eats. The client needs to feel a sense of control over the food to be eaten. The client will be unable or unwilling to follow directions because of the nature of the illness, and an explanation will be of little value to this client for the same reason. 58%of students nationwide answered this question correctly. View Topics Confidence: Skipped Stats Issue with this question? 10. A young client is admitted to the hospital with a diagnosis of acute schizophrenia. The family reports that one day the client looked at a linen sheet on a clothesline and thought it was a ghost. What is the most appropriate conclusion to make about what the client was experiencing? Correct1 Illusion 2 Delusion 3 Hallucination 4 Confabulation An illusion is a misinterpretation of an actual sensory stimulus. A delusion is a false, fixed belief. A hallucination is a false sensory perception that occurs with no stimulus. Confabulation is a filling in of blanks in memory. client with schizophrenia is speaking made-up words that have no meaning to other people. What term should the nurse use to document these verbalizations? 1 Avolition 2 Echolalia 3 Anhedonia Correct4 Neologisms Neologisms are unique words with personal meanings only to the client. Avolition is the lack of motivation associated with a reduced emotional expression (flat affect). Echolalia is parrotlike echoing of spoken words or sounds. Anhedonia is the loss of enjoyment in things that were formerly enjoyed. A client has been actively hallucinating for several days. What is the most therapeutic nursing intervention? 1 Asking the client who is speaking Correct2 Involving the client in simple activities on the unit 3 Allowing the client to continue without interruption 4 Having the client frequently repeat what the voices are saying The nursing goal is to promote reality; simple activities do not place demands on the client. Asking the client who is speaking implies that the client is talking to a real person. Allowing the client to continue without interruption allows further withdrawal rather than orienting the client to reality. The client should be asked occasionally to repeat what the voices are saying so the nurse can identify command hallucinations; once a day or when there is a change in the client's behavior is sufficient. It should not be done frequently because it may reinforce the hallucinations. 53%of students nationwide answered this question correctly. View Topics Confidence: Skipped Stats Issue with this question? 22. What is most important for the nurse to do when caring for a client who is experiencing a paranoid delusion? 1 Touch the client's arm gently to convey concern. Correct2 Maintain eye contact when talking with the client. 3 Attempt to disprove the client's delusional thoughts. 4 Speak softly when talking with others near the client. Eye contact focuses the client's attention on the nurse; it also conveys caring and tells the client that the nurse considers him important. The nurse should respect the client's personal space; touching the client, particularly without warning, may reinforce suspicious thoughts or precipitate agitation. Attempting to disprove the client's delusional thoughts is useless because a delusion is real to the client. Whispering or laughing in the presence of a paranoid delusional client may reinforce the delusional state and further agitate the client. 60%of students nationwide answered this question correctly. View Topics Confidence: Skipped Stats Issue with this question? 23. A client recently admitted to the psychiatric unit is found to be experiencing command auditory hallucinations. The nurse conducts an initial one-on-one session centered on the development of trust. What is the next important nursing intervention? Correct1 Identifying the content of the messages in the auditory hallucinations 2 Determining whether the command hallucinations are frightening to the client 3 Helping the client determine whether the voices are outside or inside the client's head 4 Determining the client's ability to refrain from listening to the messages from the voices During the acute phase it is important to have the client describe the content of hallucinations so safety issues may be identified. Determining whether the command hallucinations are frightening to the client is not the priority; most clients find hallucinations frightening. Helping the client recognize whether the voices are outside or inside the client's head is not the priority. Determining the client's ability to refrain from listening to the messages from the voices is important, but it is not the priority at this time. 67%of students nationwide answered this question correctly. View Topics Confidence: Skipped Stats Issue with this question? 24. A client tells the nurse, "A man is speaking to me from the corner of the room. Can you hear him?" How should the nurse respond? 1 "What's he saying to you? Does it make any sense?" 2 "Yes, I hear him, but I can't understand what he's saying." 3 "I don't hear him. There's no one in the corner of the room." Correct4 "No, I don't hear him, but is it making you uncomfortable to hear him?" The statement "No, I don't hear him, but is it making you uncomfortable to hear him?" points out reality, identifies potential feelings, and prevents the nurse from supporting the hallucination. Asking what the man is saying to the client and whether it makes any sense is nontherapeutic because it supports and focuses on the hallucination. "Yes, I hear him, but I can't understand what he is saying" is nontherapeutic because it supports and focuses on the hallucination; also, it is not truthful. Although denying hearing the voice and pointing out that there is no one else in the room points out reality, this statement does not focus on the client's feelings. 54%of students nationwide answered this question correctly. View Topics Confidence: Skipped Stats Issue with this question? 25. What clinical manifestation best indicates to the nurse that the mental status of a client with the diagnosis of schizophrenia, paranoid type, is improving? 1 Absence of mild to moderate anxiety 2 Development of insight into the problem 3 Decreased need to use defense mechanisms Correct4 Ability to function effectively in activities of daily living A person who can handle the activities of daily living and function in society is considered mentally stable. Some anxiety is necessary and unavoidable; anxiety causes problems when it is overwhelming for an extended period. Insight into one's problems is of no use if one is unable to function in society. Everyone uses defense mechanisms; the extent to which they are used helps determine mental health. 57%of students nationwide answered this question correctly. View Topics Confidence: Skipped Stats Issue with this question? 26. A client with schizophrenia says to the nurse, "I've been here 5 days. There are five players on a basketball team. I like to play the piano." How should the nurse document this cognitive disorder? 1 Word salad Correct2 Loose association 3 Thought blocking 4 Delusional thinking These ideas are not well connected and there is no clear train of thought. This is an example of loose association. Word salad is incoherent expressions containing jumbled words. This client's thoughts are coherent but not connected. Thought blocking occurs when the client loses the train of thinking and ideas are not completed. Each of the client's thoughts is complete but not linked to the next thought. These statements are reality based and not reflective of delusional thinking. 72%of students nationwide answered this question correctly. View Topics Confidence: Skipped Stats Issue with this question? 27. A nurse is caring for a client who is experiencing auditory hallucinations. What is the most therapeutic response by the nurse? 1 "Those voices you hear aren't real." Correct2 "I don't hear the voices you're hearing." 3 "Try to focus your attention on other things." 4 "You won't hear the voices when you get better." "I don't hear the voices you're hearing" points out reality without being demeaning or arguing with the client. The voices are real to the client, and stating otherwise will not be believed. Trying