Schizophrenia is a mental disorder that generally appears in late adolescence or early adulthood, (between ages 15-25 among men and about 25 to 35 in women) but then, it can rise at whatever point in life.
It affects approximately 1% of the population, affecting almost equally men and women.
1. Nuring Exam or NCLEX Style questions related to Schizophrenia.
2. The audio version of the video, which you can find here: https://s3.amazonaws.com/websiteaudiosempowern/Schizophrenia+Audio.m4a
1. Which of the following is defined as a group of mental disorders characterized by psychotic features, disordered thought processes, and disrupted interpersonal relationships?
D. Obsessive-compulsive personality disorder
Ans.: C. Schizophrenia is a maladaptive disturbance characterized by a number of common behaviours involving disorders of thought content, mood, feeling, perception, communication and interpersonal relationships.
2. Schizophrenia symptoms are grouped into two broad categories. The nurse enumerates them as which of the following?
A. Positive and Negative
B. Overt and Covert
C. Simple and Complex
D. Internal and External
Ans.: A. Symptoms of schizophrenia fall into two broad categories which are positive and negative. Positive symptoms are those that are recognizable while negative symptoms refer to ‘what is missing.’
3. As the nurse segregates the symptoms per category, which of the following falls under the positive symptoms? Select all that apply:
D. Bizarre behavior
Ans.: A, D, E are positive symptoms in schizophrenic clients which are recognizable symptoms.
4. As the nurse segregates the symptoms per category, which of the following falls under negative symptoms? Select all that apply:
D. Blunted affect
E. Disorganized speech
F. Loss of thought
Ans.: A, D, F are negative symptoms. Anhedonia is described as the inability to experience pleasure or joy.
5. The nurse notices that the schizophrenic client is unable to engage in socialization activities. This best describes which of the following negative symptom?
D. Blunted affect
Ans.: A. Amotivation is a frequently occurring negative symptom that leads to the inability to engage in goal-directed activities such as working, running errands, or doing laundry.
6. Which of the following describes the lack of emotion conveyed by a person’s nonverbal behaviours?
B. Grandiose delusion
C. Blunted affect
D. Tactile hallucination
Ans.: C. Blunted affect is similar to flat affect which are terms used to denote the lack of emotion conveyed by a person’s nonverbal behaviour.
7. The client tells the nurse ”I am the president of the universe, I can do whatever I want.” The nurse recognizes this as which of the following delusions?
Ans.:D. Delusion of grandeur is a false belief that one is a powerful and important person.
8. The client states “I am the king of the world!” Which of the following is an appropriate response by the nurse?
A. “And I am your servant.”
B. “Where are your kingsmen?”
C. “You are now at the hospital, and I am your nurse.”
D. “Would his royal highness be so kind to take his medications for the day?”
Ans.: C is an appropriate response because it wound focus the conversation on reality-based topics rather than on the delusion.
9. The schizophrenic client states ”My brain is about to explode of all the knowledge I have acquired through the years. I can feel the cells expanding and my head getting bigger.” This is an example of which of the following delusions
D. Loss of reference
Ans.: C. Somatic delusions happen when the client believes that his body is changing or responding in an unusual way which has no basis in reality.
10. If signs of disturbance are present for more than a month but less than six months, the nurse knows that this type of client can be identified as having which of the following?
A. Psychotic disorder
B. Schizophreniform disorder
C. Mood disorder
Ans.: B. Symptoms presenting for more than a month but not reaching six months would categorize a client as having schizophrenic disorder. Schizophrenia is identified when continuous signs of the disturbance persist for at least six months.
11. The parent of a client with schizophrenia asks the nurse when his son would be completely cured. The nurse responds accurately with which of the following?
A. “Give the medications at least six months for the symptoms to disappear totally.”
B. “Schizophrenia can be treated but not cured.”
C. “It depends on his response to the medication and the support that he is getting.”
D. All of the above
Ans.: B. The nurse should set proper expectation to the family that schizophrenia can be treated but not cured.
12. In treating the client with schizophrenia, the nurse enumerates the factors that contributes to the overall success of the process. Select all that apply:
A. Medication adherence
B. Individual psychotherapy
C. Group psychotherapy
D. Intensive case management
E. Family involvement
Ans.: A, B, C, D, E, F can all contribute to the overall success of treatment in clients with schizophrenia.
13. The schizophrenic client tells the nurse ”I know the aliens have sent you and they’re waiting for the perfect opportunity to abduct me!” Which of the following is an appropriate response by the nurse?
A. “I promise you they will not be able to enter this facility.”
B. “Why do you think they want you?”
C. “You are in a mental health facility and I am your nurse, I am here to help you and not to harm you”
D. “What do you think I would do to you?”
Ans.: C. The nurse should reorient the paranoid client as necessary, reassure the client that the environment is safe and explain what is about to be done to the client to gain his trust.
14. While the schizophrenic client is in a room with the other clients in the facility, he develops active hallucinations and shouts “The zombies are after me, they’re going to eat my brain!” Which intervention is a priority during this situation?
A. Move the client to a separate, quiet room and let him do an easy activity such as drawing.
B. Monitor the client for increasing fear, anxiety or agitation
C. Let the other people touch the client so that he understands that they are not out to get him.
D. Encourage the client to express his feelings.
Ans.: A. When a client is experiencing an active hallucination, safety is a priority and the nurse should decrease stimuli by moving the client to another area where is attention can be diverted or his feelings could be addressed properly. Then nurse should also monitor the client’s symptoms and encourage the client to express his feelings.
15. The nurse is teaching the junior staff on how to establish trust in clients with schizophrenia. All of the following interventions are correct, except:
A. Provide a daily schedule of activities
B. Argue with delusions
C. Do not whisper in the client’s presence
D. Assure the client that he will be safe
Ans.: B. The staff caring for a client with schizophrenia or with paranoid disorders should not argue with delusions but instead refocus conversations to reality-based topics.
16. A nurse should be aware of the treatment options available for client with schizophrenia. Which of the following are first generation antipsychotic medications? Select all that apply:
A. Chlorpromazine (Thorazine)
B. Clozapine (Clozaril)
C. Risperidone (Risperdal)
D. Aripirazole (Abilify)
E. Thiothixene (Navane)
F. Haloperidol (Haldol)
Ans.: A, E, F are included among the first generation antipsychotic medications while Clozaril, Risperdal and Abilify are included in the second generation antipsychotic medications.
17. Clients with szhizophrenia are at greater risk for developing metabolic syndrome. Which of the following antipsychotic medications increases this risk?
A. Chlopromazine (Thorazine)
B. Haloperidol (Haldol)
C. Risperidone (Risperdal)
D. Quetiapine (Seroquel)
Ans.: D. carries a risk of greater metabolic risk. The nurse should monitor for weight gain, waist circumference, blood pressure, baseline fasting blood glucose, lipid and triglyceride levels once a client is started on an atypical antipsychotic .
18. A schizophrenic client has been on Chlopromazine (Thorazine) for a week already. The nurse notices the client to be constantly up and about, walking in a funny way, grimaces and make involuntary eye and body movement. She informs the attending physician immediately because the client is showing which of the following adverse effects of Thorazine?
A. Tardive Dyskinesia
B. Neuroleptic Malignant Syndrome
D. Extrapyramidal Syndrome
Ans.: D. Parkinsonism, Dystonia, Akathisia and Tardive dyskinesia are all signs of extrapyramidal syndrome which is an adverse effect of antipsychotics that the physician should be informed of.
19. The nurse also knows to monitor clients who have started on antipsychotic medications for signs and symptoms of Neuroleptic Malignant Syndrome (NMS). The following are signs and symptoms of NMS, except: Select all that apply:
B. Pale skin
Ans.: C, F are not included in NMS symptoms, instead, fever and polyuria are expected due to elevated white blood cell count and loss of bladder control.
20. The nurse notes that the client who has just had his dosage of antipsychotic medication increased has developed signs and symptoms of neuroleptic malignant syndrome. The following are appropriate interventions, except?
A. Monitor level of consciousness
B. Apply a warming blanket
C. Apply safety and seizure precations
D. Notify the attending physician
Ans.: B. The nurse should use cooling blankets instead of warming blankets as clients with NMS present with fever, increased WBC levels, and increased sweating.
21. The nurse notes that the client taking Chlorpromazine (Thorazine) is showing off his tongue, constantly imitates a chewing motion and presents with involuntary body movements. She recognizes the following as an adverse effect of the medication and reports it as which of the following?
A. Neuroleptic Malignant Syndrome
D. Tardive dyskinesia
Ans.: D. Tardive dyskinesia is an adverse reaction of antipsychotic medications which is manifested by uncontrollable and involuntary movements of the extremities, the mouth and the tongue.
22. The client taking Chlorpromazine (Thorazine)asks the nurse when can he best take the medication. The nurse educates that this medication is best taken:
A. with food
B. prior to eating
C. before sleeping
D. without regards to food
Ans.: A. Antipsychotic medications can cause gastric irritation; therefore they are best taken with food or with milk.
23. Which of the following antipsychotic medications works best in controlling negative symptoms?
A. Pimozide (Orap)
B. Thiothixene (Navane)
C. Haloperidol (Haldol)
Ans.: D. Atypical antipsychotics, or second generation antipsychotics such as Olanzapine (Zyprexa), Aripirazole (Abilify) and Clozapine (Clozaril) are effective in controlling negative symptoms such as avolition, apathy and alogia.
24. The father of a newly diagnosed schizophrenic client tells the nurse “Why don’t I see my son progressing? It has been five days since he has been admitted.” The nurse appropriately responds with which of the following statements?
A. “It depends on every client on how they would respond to treatment.”
B. “The full therapeutic effect of the medication may take place after a week to ten days.”
C. “An observable response to therapy may be seen within 7 to 10 days but the full therapeutic effect may not be seen until 3 to 6 months of treatment.”
D. None of the above
Ans.: C. Clients who have started on antipsychotic treatment are observed with response to treatment within 7 to 10 days but full therapeutic effect may take within 3 to 6 months of continuous medication.
25. During discharge the schizophrenic client tells the nurse “I can’t wait to return home and walk by the beach side near our house.” Based from this statement, which of the following discharge instructions should be given emphasis by the nurse?
A. Restriction from going outdoors during the first month of treatment
B. Wearing of sunscreen, hats and protective clothing when outdoors
C. Monitor for sore throat, fever and body malaise when outdoors
D. Limiting time spent outdoors to prevent communicable diseases
Ans.: B. Based from the client’s statement, the nurse should give emphasis on protective measure while the client is outdoors due to avoid photosensitivity.