NCLEX Schizophrenia & Other Similar Disorders

Question 1

A newly admitted patient has the diagnosis of catatonic schizophrenia. Which behavior observed in the patient supports that diagnosis?

a. Uses a rhyming form of speech
b. Refuses to eat any unwrapped foods
c. Laughs when watching a sad movie
d. Maintains an immobilized state for hours

Answer 1

ANS: D
Catatonic schizophrenia is characterized by extremes of psychomotor activity ranging from frenzied behavior to immobilization and may include echopraxia and posturing. Paranoid thinking is characteristic of paranoid schizophrenia. Inappropriate affect and clanging are seen in disorganized schizophrenia. (pg. 274)

Question 2

What would be an appropriate short-term outcome for a patient diagnosed with residual schizophrenia who exhibits ambivalence?

a. Decide their own daily schedule.
b. Decide which unit groups they will attend.
c. Choose which clinic staff member to work with.
d. Choose between two outfits to wear each morning.

Answer 2

ANS: D
An early step would be to make choices about nonthreatening matters when presented with limited alternatives. The remaining options represent decisions that are too complicated for the patient to make initially. (pg. 285)

Question 3

What is the priority nursing diagnosis for a catatonic patient?

a. Ineffective coping
b. Impaired physical mobility
c. Impaired social interaction
d. Risk for deficient fluid volume

Answer 3

ANS: D
The highest priority for the patient is maintenance of basic physiologic needs, such as hydration. Mobility is of lesser physiological importance than fluid volume. The remaining options do not have priority over a physiological need.
(pg. 275)

Question 4

Which nursing diagnosis is appropriate for a patient who insists being called “Your Highness” and demonstrates loosely associated thoughts?

a. Risk for violence
b. Defensive coping
c. Impaired memory
d. Disturbed thought processes

Answer 4

ANS: D
Delusions and loose associations suggest disturbed thought processes. The other options are not supported by data in the scenario. (pg. 278)

Question 5

Which initial short-term outcome would be appropriate for a patient who was admitted expressing delusional thoughts?

a. Accept that delusion is illogical.
b. Distinguish external boundaries.
c. Explain the basis for the delusions.
d. Engage in reality-oriented conversation.

Answer 5

ANS: D
Delusions are not reality oriented; thus an appropriate outcome would be that patient will engage in reality-oriented conversation rather than discussing delusional beliefs. Delusions are fixed, false beliefs. Patients rarely accept anyone using logic to dispute them. Data are not present to suggest boundary disturbance. Explaining the delusion is not progress; it suggests the patient still holds to the belief. (pg. 2860

Question 6

Which of the following interventions should the nurse plan to use to reduce patient focus on delusional thinking?

a. Confronting the delusion
b. Refuting the delusion with logic
c. Exploring reasons the patient has the delusion
d. Focusing on feelings suggested by the delusion

Answer 6

ANS: D
Focusing on feelings suggested by the delusion will help meet patient needs and help the patient stay based in reality. This technique fosters rapport and trust while discouraging the belief without challenging or refuting it.
(pg. 286)

Question 7

Which assessment observation supports a patient’s diagnosis of disorganized schizophrenia?

a. Reports suicidal ideations
b. Last relapse was 6 years ago
c. Consistent inappropriate laughing
d. Believes that “the government is out to get me”

Answer 7

ANS: C
The presence of disorganization and inappropriate affect identifies this disorder as disorganized schizophrenia. The symptoms of residual schizophrenia have long periods of remission. Schizoaffective disorder presents with severe mood disorders along with symptoms of schizophrenia. Paranoid schizophrenia is characterized by persecutory or grandiose delusions. (pg. 274)

Question 8

A patient tried to gouge out his eye in response to auditory hallucinations commanding, “If thine eye offends thee, pluck it out.” The nurse would analyze this behavior as indicating:

a. Derealization
b. Inappropriate affect
c. Impaired impulse control
d. Inability to manage anger

Answer 8

ANS: C
Command hallucinations may be so intense that the patient cannot control the impulse to do what the hallucination tells him to do; thus the patient has impaired impulse control. This is not an anger management problem. Derealization is a feeling that the environment is distorted or unreal and not suggested in the scenario. No evidence of inappropriate affect is given. (pg. 278)

Question 9

An appropriate intervention for a patient with an identified nursing diagnosis of situational low self-esteem would be:

a. Providing large muscle activities to relieve stress
b. Attempting to determine triggers to hallucinations
c. Engaging patient in activities designed to permit success
d. Encouraging verbalization of feelings in a safe environment

Answer 9

ANS: C
All are useful interventions for a patient with schizophrenia; however, engaging the patient in specifically designed activities is the only option that addresses improving self-esteem. (pg. 285)

Question 10

A 19-year-old patient is admitted for the second time in 9 months and is acutely psychotic with a diagnosis of undifferentiated schizophrenia. The patient sits alone rubbing her arms and smiling. She tells the nurse her thoughts cause earthquakes and that the world is burning. The nurse assesses the primary deficit associated with the patient’s condition as:

a. Social isolation
b. Disturbed thinking
c. Altered mood states
d. Poor impulse control

Answer 10

ANS: B
The nurse interprets the patient’s statements that were not reality-based as indicating disturbed thought processes. Social isolation is not the primary patient problem. No data exist to support the other options. (pg. 278-279)

Question 11

A patient has been admitted with disorganized type schizophrenia. The nurse observes blunted affect and social isolation. He occasionally curses or calls another patient a “jerk” without provocation. The nurse asks the patient how he is feeling, and he responds, “Everybody picks on me. They frobitz me.” The patient’s communication exhibits:

a. A neologism
b. Loose associations
c. Delusional thinking
d. Circumstantial speech

Answer 11

ANS: A
A newly coined word having meaning only for the patient is called a neologism (meaning, new word). It is associated with autistic thinking. The patient’s speech does not show associative looseness or circumstantiality. The use of a neologism is not delusional in and of itself, but it suggests delusional thinking may be present. (pg. 278)

Question 12

A patient has been admitted with disorganized type schizophrenia. The nurse asks the patient how he is feeling, and he responds, “Everybody picks on me. They frobitz me.” The best response for the nurse to make would be:

a. “That”s really too bad that you are being treated that way.”
b. “Who do you mean when you say ‘everybody’?”
c. “What difference does frobitzing make?”
d. “Why do they frobitz?”

Answer 12

`ANS: B
This response will help clarify the patient’s thinking and change the focus from global to specific. In this situation, sympathizing with the patient is a nonproductive response. The remaining options appear to accept the neologism thus supporting the patient’s delusional thinking. (Pg. 286)

Question 13

Which patient behavior would support the diagnosis of residual schizophrenia with negative symptoms?

a. Communicating using only rhyming phases
b. Claims that “worms are crawling in my brain”
c. Maintaining both arms suspended awkwardly overhead
d. Shows no emotion when telling the story of a sister’s recent death

Answer 13

ANS: D

Blunted affect is considered a negative symptom. The other symptoms would be classified as positive symptoms. (pg. 280)

Question 14

By discharge, which outcome is appropriate for a patient who hears voices telling him he is evil?

a. Respond verbally to the voices.
b. Verbalize the reason the voices say he is evil.
c. Identify events that increase anxiety and promote hallucinations.
d. Integrate the voices into his personality structure in a positive manner.

Answer 14

ANS: C
An appropriate outcome for a patient with hallucinations is recognition of events that precede the onset of hallucinations. Trigger events or situations usually cause increased feelings of anxiety. The remaining options are neither desirable nor appropriate. (pg. 277)

Question 15

Which response by the nurse would best assist a patient in de-escalating aggressive behavior?

a. “Tell me what’s going on.”
b. “Why are you getting so upset?”
c. “If you throw something, you will be restrained.”
d. “It’s time for group therapy. You can talk there.”

Answer 15

ANS: A
Using how, what, and when to gather information is a nonthreatening approach. It will promote patient verbalization and explanation of events without causing the patient to become defensive. Mentioning restraints sounds threatening even though it may be meant to remind the patient of limits. Why questions are demanding and threatening to patients. Sending the patient into group therapy sidesteps the problem.
(Pg. 292-293)

Question 16

A 34-year-old male admitted with catatonic schizophrenia has been mute and motionless for several days while at home prior to admission. He still appears stuporous in the hospital. Which nursing intervention would be an initial priority?

a. Orienting the patient to the unit
b. Reinforcing reality with the patient
c. Establishing a nonthreatening relationship
d. Assessing the patient for physical problems

Answer 16

ANS: D
Patients who are mute and motionless and inattentive to environmental stimuli are at risk for a number of physical problems. Further, they are unable to communicate existing problems. The nurse must make thorough and astute assessments before creating plans to meet the patient’s needs. A patient who is stuporous may not be able to attend to information given about unit rules and protocols. While establishing a therapeutic nurse-patient relationship is an important intervention, it does not have priority according to Maslow’s hierarchy. Because the patient is mute, one can only suspect lack of reality orientation. While an appropriate intervention, it is not the priority according to Maslow’s hierarchy.
(Pg. 275)

Question 17

Which response is appropriate when a patient’s mother expresses guilt over “causing my child to be schizophrenic”?

a. “I can see how you would be upset over this turn of events.”
b. “New findings suggest this disorder is biological in nature.”
c. “Don’t be so hard on yourself; your daughter needs you to be strong.”
d. “It’s difficult to see what produces stress for the child at the time it’s occurring.”

Answer 17

ANS: B
Many individuals in the mental health field attribute the development of schizophrenia to multiple causes centering on biological theories. The remaining options do little to provide the mother with new information. (Pg. 265)

Question 18

Which response demonstrates both empathy and understanding of the relationship genetics has to the development of schizophrenia in twins?

a. “In fraternal twins, the chance of the other twin developing the disorder is quite small.”
b. “Studies show that 50% of twins develop schizophrenia when it is present in the other twin.”
c. “No one can say what will happen, so we will hope for the best for you and both of your sons.”
d. “You poor woman! I wish I could tell you that your other son he will be free of the disorder.”

Answer 18

ANS: A
Current research supports the correct option, whereas the remaining options are not factual and show expressed sympathy rather than empathy. (pg. 266)

Question 19

The wife of a patient diagnosed with paranoid schizophrenia asks, “I’ve been told that my husband’s illness is probably related to imbalanced brain chemicals. Can you be more specific?” The response based on the dopamine hypothesis is:

a. “Breakdown of dopamine produces LSD, which in large amounts produces psychosis.”
b. “An increase in the brain chemical dopamine explains the presence of delusions and hallucinations.”
c. “Decreased amounts of the brain chemical dopamine explain the presence of delusions and hallucinations.”
d. “An increase in the brain chemical dopamine explains the presence of lack of motivation and disordered affect.”

Answer 19

ANS: B
The statement is correctly based on the dopamine hypotheses while the remaining options are neither known to be true nor based on that theory. (Pg. 266)

Question 20

What is the basis for the reduction in disturbed thought processes when a patient is administered haloperidol (Haldol)?

a. Reduction in the number of brain cells that crave dopamine
b. Dopamine receptors are blocked, making dopamine less available
c. Dopamine receptors are enhanced, making more dopamine available
d. Medication causes an increased cellular production of dopamine

Answer 20

ANS: B
Excess dopamine is responsible for symptoms of psychosis such as delusions and hallucinations. Blocking dopamine receptors will result in reduction of primary symptoms. The other options do not reflect the action of typical antipsychotic medications. (pg. 266)

Question 21

During a treatment team meeting, the point is made that a patient with schizophrenia has recovered from the acute psychosis but continues to demonstrate apathy, avolition, and blunted affect. The nurse who relates these symptoms to serotonin (5HT2) excess will suggest that the patient receive:

a. Haloperidol (Haldol)
b. Chlorpromazine (Thorazine)
c. Olanzapine (Zyprexa)
d. Phenelzine (Nardil)

Answer 21

ANS: C
Olanzapine is an atypical antipsychotic. Atypical antipsychotic medications are more effective than typical antipsychotics in blocking serotonin receptors and reducing the negative symptoms of schizophrenia. Haloperidol (Haldol) and chlorpromazine (Thorazine) are typical antipsychotic medications while phenelzine (Nardil) is an MAOI antidepressant.
(pg. 287, 289)

Question 22

What response would be anticipated when a patient who received chlorpromazine (Thorazine) for 15 years to treat schizophrenia is switched to Seroquel (quetiapine)?

a. Development of pseudoparkinsonism
b. Development of dystonic reactions
c. Improvement in tardive dyskinesia
d. Worsening of anticholinergic symptoms

Answer 22

ANS: C
Atypical antipsychotics have been noted to block oral dyskinesia and improve tardive dyskinesia as well as improve both positive and negative symptoms of schizophrenia. Pseudoparkinsonism and dystonic reactions are associated with typical antipsychotic medication. Anticholinergic symptoms are not intense with the use of atypical antipsychotic medication. (Pg. 287, 289)

Question 23

A patient admitted with the diagnosis of schizophreniform disorder R/O organic pathology. Based on this information, the nurse can expect that the patient will:

a. Be scheduled for a magnetic resonance imaging (MRI) test
b. See a mental health specialist for extensive psychological testing
c. Have an immunologic assay performed within 2 days of the admission
d. Participate in a dexamethasone suppression test (DST) administered by the staff

Answer 23

ANS: A
The MRI will reveal structural changes in the brain that might be responsible for symptoms of psychosis (e.g., abscess, tumor). Psychologic testing may be performed but will be less definitive in ruling out organic pathology. Immunologic studies are not indicated. The DST is related to depression. (pg. 269)

Question 24

In planning aftercare for a patient with schizophrenia and whose insurance benefits have been exhausted, the nurse who is concerned about overcoming negative symptoms will make provisions for the patient to have stimulation, structure, socialization, and support. Which option would best incorporate these factors?

a. Day hospitalization
b. Attending a psychosocial club
c. Living with his elderly mother
d. Spending free time in the mall

Answer 24

ANS: B
A psychosocial club is organized to provide the 4 S’s and is not costly to patients. Day hospitalization would not be possible because of the lack of insurance benefits. Living with his mother might fall short of stimulation and support. Spending time in the mall lacks structure, socialization, and support. (pg. 291)

Question 25

A patient with catatonic schizophrenia has been standing with his left arm upraised and his right foot off the floor for the majority of the last 20 hours, eating only when allowed to eat standing up. Which nursing intervention has priority for this patient?

a. Providing high-calorie drinks hourly
b. Assessing for lower extremity edema bid
c. Taking the patient to activities therapy once daily
d. Encouraging the patient to sit or lie down for 30 minutes hourly

Answer 25

ANS: B
Patients who maintain one position for long periods of time should be assessed for dependent edema. In this case, the nurse would look for edema of the lower extremities and would be concerned about the pressure exerted by standing on one foot for long periods of time. Such encouragement would probably be met with resistance by the patient. High-calorie drinks would be necessary if the patient failed to eat at meals. The patient probably would not be able to cognitively process what is required to participate in activities.
(Pg. 275)

Question 26

Which nursing action best addresses the needs of a paranoid patient who believes the food is poisoned?

a. Explaining that others eat the food and are not harmed
b. Allowing the patient to select food from vending machines
c. Encouraging the patient to discuss why someone would poison the food
d. Taking steps to prevent the patient from verbalizing the delusional thoughts

Answer 26

ANS: B
Patients who think hospital food is being poisoned will sometimes eat wrapped foods that have not been opened, and occasionally, they may eat food brought from the outside by a trusted person. Delusions are fixed, false beliefs that cannot be refuted by logic. The patient will probably state that the others have been given the antidote to the poison. Encouraging discussion about the delusion is not therapeutic. Although it is wise to minimize the amount of discussion about delusions, refusing to allow the patient to speak about the delusions will not foster a therapeutic alliance. (Pg. 273)

Question 27

Prior to discharge, the nurse plans to teach the patient and family about relapse. Which items will the nurse include in the teaching?

a. Recognizing warning signs of relapse
b. Using street drugs judiciously and only in small amounts
c. Lowering medication dosage to manage emerging side effects
d. Notifying the nurse of warning signs present for more than one month

Answer 27

ANS: A
The patient and family must be aware of signs of impending relapse. These signs are usually similar to those that the patient experienced prior to hospitalization and will be patient-specific. The nurse should be notified ASAP, rather than waiting two weeks. Patients should never adjust medication dosage. Street drug use often precipitates relapse since many street drugs are dopaminergic. (Pg. 277)

Question 28

Because of the cognitive disturbances associated with schizophrenia, which technique will be useful as the nurse teaches a patient about self-management?

a. Use only verbal instruction.
b. Teach material in small segments.
c. Offer opportunities for making numerous choices.
d. Plan the teaching for a time when the patient has been recently medicated.

Answer 28

ANS: B
Patients with cognitive disturbances should be taught small blocks of information at a time and given frequent reinforcement. Both verbal and visual materials should be used since processing of verbal stimuli may be more impaired. Teaching should be scheduled when the patient is most alert. A large number of choices may be confusing for the person, but a few simple choices may be included. (Pg. 279)

Question 29

The wife of a patient newly diagnosed with paranoid schizophrenia is concerned that her husband “will be this sick for the rest of his life.” What information can the nurse provide to the wife?

a. “This disorder generally responds well with treatment and follow-up.”
b. “All types of schizophrenia by their nature are chronic relapsing disorders.”
c. “Outcomes are related to the patient’s pre-hospital symptoms of disorganization.”
d. “The typical outcome for this diagnosis is that total remission is not achievable.”

Answer 29

ANS: A
The prognosis for paranoid schizophrenia is good with appropriate treatment and effective follow-up. The remaining options are not correct when considering this type of schizophrenia. (Pg. 274)

Question 30

A patient is exhibiting auditory hallucinations in addition to being forgetful and easily confused. Which diagnosis does the nurse base this patient’s interventions on?

a. Social isolation
b. Deficient knowledge
c. Situational low self-esteem
d. Impaired cognitive functioning

Answer 30

ANS: D
Schizophrenia may alter cognitive functioning, including memory, retention, attention, and the processing of incoming information. Altered cognition accounts for many of the symptoms mentioned in the scenario. Knowing that cognition is altered, the nurse can adjust plans to take the deficits into account. The patient is not exhibiting symptoms that would warrant any of the other options. (Pg. 263)

Question 31

A patient experiences intrusive, insulting auditory hallucinations. Which independent behavioral technique can the nurse teach the patient to employ when the voices are troublesome?

a. Introduce a distraction like reading.
b. Use positive talk to offset the insults.
c. Sing or whistle to compete with the voices.
d. Increase the daily dose of an antipsychotic medication.

Answer 31

ANS: C
This action provides an alternative to listening to the voices and gives the patient a sense of control. The patient should not adjust medication independently. Reading will not be particularly effective, because the voices are uncontested in a quiet atmosphere. Positive talk is generally used to positively affect self-esteem. (Pg. 279)

Question 32

A patient with schizophrenia tells the nurse as they sit in the day room, “I hear voices telling me bad things.” The most therapeutic response the nurse can make is:

a. “Tell me what the voices are saying.”
b. “I believe you hear voices, but I don’t hear them myself.”
c. “The voices are not real. They’re a product of your imagination.”
d. “Do you think the voices would go away if we went into your room to talk?”

Answer 32

ANS: B
By voicing his or her own reality related to the voices, the nurse does not deny the patient’s experiences but helps the patient distinguish actual voices from those resulting from internal stimulation. Discussing what the voices are saying serves only to validate the reality of the voices. Challenging the voices will cause the patient to defend his perceptions and thereby reinforce the importance of the hallucination. Asking to move validates the reality of the voices and is not a helpful action since the voices go where the patient goes. (Pg. 277., 283)

Question 33

A patient tells the nurse, When I’m in the day room, I hear people whispering about me, and that makes me want to punch them.” What direction will the nurse provide the staff regarding interacting with this patient?

a. “To minimize the need to whisper, utilize nonverbal techniques when possible.”
b. “Stay physically close to this patient and use touch as a tool to interact with him.”
c. “Treat this patient matter-of-factly. Be direct; don’t talk about him or others in his presence.”
d. “Interact with this patient only when necessary. The fewer interactions, the fewer misinterpretations there will be.”

Answer 33

ANS: C
This approach is important when providing care for a patient who is misinterpreting reality and is suspicious of the motives of others. Ostracizing the patient is non-therapeutic. Patients often misinterpret touch as threatening. This might promote loss of control. Using nonverbal communication techniques would be nontherapeutic as it would increase patient anxiety and promote loss of control. (Pg. 286)

Question 34

A patient with schizophrenia is medication compliant and has well-controlled symptoms. He has, however, never been successful in holding a job because of poor social skills and lack of understanding of basic job skills. The nurse case manager should consider referring the patient:

a. For cognitive therapy
b. To assertiveness training
c. To a day hospital program
d. For psychosocial rehabilitation

Answer 34

ANS: D
Psychosocial rehabilitation helps patients readjust to community living by promoting development of necessary skills. Social skills training and job skills training programs are usually available. The patient does not need the more intensive services found in a day hospital. Cognitive therapy will not offer the needed community living skills training. Assertiveness training is only a small portion of the community living skills the patient needs. (Pg. 288)

Question 35

A patient prescribed an antipsychotic medication develops a high fever, unstable blood pressure, and muscle rigidity. Her next dose of medication is due. The nurse should:

a. Administer the medication and monitor the vital signs every 4 hours.
b. Give a lower dose of the medication for 24 hours and monitor the blood pressure.
c. Prepare to administer a prn dose of the anticholinergic drug benztropine (Cogentin).
d. Hold the medication and immediately describe the patient’s symptoms to the doctor.

Answer 35

ANS: D
These symptoms could be related to a possibly fatal disorder called neuroleptic malignant syndrome (NMS), and the nurse should hold the medication and contact the doctor immediately. The other options are inappropriate in light of the seriousness of the situation. (Pg. 289)

Question 36

Which interventions will the nurse implement to preserve milieu safety when a patient becomes agitated? Select all that apply.

a. Project confidence and control.
b. Provide a show of force when appropriate.
c. Ask the agitated patient why they are feeling so aggressive.
d. Move to within 5 feet of the patient to help contain their movement.
e. Provide the patient with several options as means of de-escalating the crisis.

Answer 36

ANS: A, B, E
The correct options demonstrate that the staff is in control without unnecessarily challenging the patient. Asking ‘why’ is often interpreted as being challenging and often serves to future agitate the patient. Eight feet is considered to be the therapeutic distance between patient and staff in this type of situation. (Pg. 293)

Question 37

Which interventions will the nurse implement to assure effective staff crises management skills? Select all that apply.

a. Schedule regular staff crises simulations.
b. Encourage the staff to discuss the details of unit crises.
c. Attempt to identify staff who are ineffective during crises.
d. Review documentation that describe the details of unit crises.
e. Review unit crises management policies for needed updates.

Answer 37

ANS: A, B, D, E
The correct options empower the staff while improving/maintaining their crises management skills. The failures of the process should be identified without blaming staff for ineffective crises management. (Pg. 293)