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 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? a. Disorganized b. Dangerous c. Supportive d. Bizarre 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 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? 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 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.‖