Academic Year 2026–2027 ATI Schizophrenia
Spectrum Disorders and Psychosis | 190+
Practice Questions & Verified Answers | Latest
Study Guide, Test Bank, Psychosis,
Schizophrenia, Antipsychotic Medications &
Nursing Exam Prep
Question 1: A 28-year-old male with a history of schizophrenia presents with a
3-day history of fever, muscle rigidity, diaphoresis, and confusion. His home
medications include risperidone long-acting injection. Which of the following
laboratory findings would be most consistent with the suspected diagnosis?
A. Elevated creatine kinase and leukocytosis
B. Decreased serum sodium and elevated liver enzymes
C. Thrombocytopenia and hyperglycemia
D. Hypokalemia and metabolic acidosis
CORRECT ANSWER: A. Elevated creatine kinase and leukocytosis
Rationale: This patient is exhibiting signs of neuroleptic malignant syndrome (NMS), a
life-threatening reaction to antipsychotic medications. Key features include fever, muscle
rigidity, autonomic instability, and altered mental status. Laboratory findings typically
reveal elevated creatine kinase (CK) due to muscle breakdown and leukocytosis.
Question 2: A nurse is assessing a client diagnosed with schizophrenia who is
exhibiting alogia and affective flattening. The nurse correctly identifies these
symptoms as belonging to which category?
A. Positive symptoms
B. Negative symptoms
C. Cognitive symptoms
D. Affective symptoms
CORRECT ANSWER: B. Negative symptoms
Rationale: Negative symptoms represent a diminution or loss of normal functions and
include alogia (poverty of speech), affective flattening (reduced emotional expression),
avolition, and anhedonia. Positive symptoms involve excess or distortion of normal
functions, such as hallucinations and delusions.
Question 3: A 34-year-old client with paranoid schizophrenia tells the nurse,
"The FBI is monitoring my thoughts through the television." Which nursing
response is most therapeutic initially?
A. "That sounds frightening. Tell me more about what you are experiencing."
B. "That is not true. The FBI does not have that technology."
,C. "You should avoid watching television if it makes you feel this way."
D. "I will check with the television company to see if they are monitoring you."
CORRECT ANSWER: A. "That sounds frightening. Tell me more about what
you are experiencing."
Rationale: This response validates the client's feelings without reinforcing the delusion.
It uses therapeutic communication techniques of empathy and exploring, which builds
trust and allows the client to express their concerns. Arguing or challenging the delusion
is non-therapeutic and can damage the therapeutic alliance.
Question 4: A client diagnosed with schizophrenia is prescribed clozapine.
Which of the following is the most critical adverse effect that requires routine
monitoring?
A. Extrapyramidal symptoms
B. Weight gain
C. Agranulocytosis
D. Tardive dyskinesia
CORRECT ANSWER: C. Agranulocytosis
Rationale: Clozapine carries a black box warning for severe neutropenia and
agranulocytosis, which can be fatal. Therefore, the FDA mandates routine monitoring of
absolute neutrophil counts (ANC) through the Risk Evaluation and Mitigation Strategy
(REMS) program.
Question 5: A client with schizophrenia is experiencing command
hallucinations telling him to harm the staff. What is the nurse's priority action?
A. Place the client in seclusion
B. Notify the provider and prepare for a stat order for medication
C. Ensure the safety of the client and others by maintaining a safe environment and
close observation
D. Ask the client to ignore the voices
CORRECT ANSWER: C. Ensure the safety of the client and others by
maintaining a safe environment and close observation
Rationale: Safety is the top priority. Command hallucinations are dangerous if the client
believes they must obey them. The immediate intervention is to ensure the safety of the
client, staff, and other clients, which includes close observation.
,Question 6: A 42-year-old client with schizoaffective disorder is admitted with
acute mania. Which combination of symptoms is most characteristic of this
diagnosis, differentiating it from schizophrenia?
A. Auditory hallucinations and delusions of grandeur
B. Disorganized speech and catatonic behavior
C. A mood episode occurring concurrently with the active phase of schizophrenia
symptoms
D. Predominantly negative symptoms with minimal cognitive decline
CORRECT ANSWER: C. A mood episode occurring concurrently with the active
phase of schizophrenia symptoms
Rationale: The defining feature of schizoaffective disorder is the presence of a major
mood episode (depressive or manic) that occurs concurrently with the active phase of
schizophrenia (delusions, hallucinations, disorganized speech). This differentiates it from
schizophrenia, where psychotic symptoms are primary and mood episodes are absent or
brief.
Question 7: A client is prescribed haloperidol. The nurse assesses involuntary
rolling back of the eyes (oculogyric crisis). Which medication should the nurse
prepare to administer?
A. Benztropine
B. Clonazepam
C. Diphenhydramine
D. A or C
CORRECT ANSWER: D. A or C
Rationale: Oculogyric crisis is an acute dystonic reaction and a type of extrapyramidal
symptom (EPS) caused by antipsychotics. It is treated with anticholinergic medications
like benztropine (Cogentin) or antihistamines with anticholinergic properties like
diphenhydramine (Benadryl). Both are used to counteract the dopamine blockage in the
nigrostriatal pathway.
Question 8: The nurse is evaluating a client with schizophrenia who is taking
olanzapine. Which side effect is most concerning due to its long-term risk for
metabolic syndrome?
A. Insomnia
B. Weight gain and hyperglycemia
C. Akathisia
D. Dry mouth
CORRECT ANSWER: B. Weight gain and hyperglycemia
, Rationale: Olanzapine is a second-generation (atypical) antipsychotic with a high risk for
metabolic adverse effects, including significant weight gain, hyperglycemia, and
hyperlipidemia. These increase the risk of type 2 diabetes and cardiovascular disease.
Question 9: A client presents with a first episode of psychosis. The family
history is positive for schizophrenia. The client asks, "Will I end up like my
uncle?" What is the nurse's best response?
A. "Your risk is higher, but many people with a family history do not develop
schizophrenia."
B. "Yes, if you have the same genes, the outcome will be similar."
C. "It is completely random; family history does not matter."
D. "You will only develop it if you use drugs."
CORRECT ANSWER: A. "Your risk is higher, but many people with a family
history do not develop schizophrenia."
Rationale: While genetics play a significant role (heritability around 80%), schizophrenia
is a complex disorder influenced by multiple genes and environmental factors. Not
everyone with a family history will develop the disorder. The nurse should provide
accurate, honest, and hope-inspiring information.
Question 10: A client with schizophrenia is being discharged. Which statement
by the client indicates a need for further teaching regarding medication
adherence?
A. "If I feel better, I will stop taking my medication and call the doctor."
B. "I should avoid grapefruit juice while taking my medications."
C. "I need to get my blood drawn regularly since I am on clozapine."
D. "It is important to tell my provider about any side effects I have."
CORRECT ANSWER: A. "If I feel better, I will stop taking my medication and
call the doctor."
Rationale: Clients with schizophrenia often stop their medications once symptoms
subside, leading to relapse. The client must understand that antipsychotics are
maintenance medications and should be continued long-term even when feeling well.
Stopping abruptly is dangerous and should only be done under medical supervision.
Question 11: A client who is experiencing auditory hallucinations suddenly
becomes quiet and states, "The voices are gone." The nurse should assess the
client for which of the following?
A. A decrease in anxiety
B. The onset of sleep
Spectrum Disorders and Psychosis | 190+
Practice Questions & Verified Answers | Latest
Study Guide, Test Bank, Psychosis,
Schizophrenia, Antipsychotic Medications &
Nursing Exam Prep
Question 1: A 28-year-old male with a history of schizophrenia presents with a
3-day history of fever, muscle rigidity, diaphoresis, and confusion. His home
medications include risperidone long-acting injection. Which of the following
laboratory findings would be most consistent with the suspected diagnosis?
A. Elevated creatine kinase and leukocytosis
B. Decreased serum sodium and elevated liver enzymes
C. Thrombocytopenia and hyperglycemia
D. Hypokalemia and metabolic acidosis
CORRECT ANSWER: A. Elevated creatine kinase and leukocytosis
Rationale: This patient is exhibiting signs of neuroleptic malignant syndrome (NMS), a
life-threatening reaction to antipsychotic medications. Key features include fever, muscle
rigidity, autonomic instability, and altered mental status. Laboratory findings typically
reveal elevated creatine kinase (CK) due to muscle breakdown and leukocytosis.
Question 2: A nurse is assessing a client diagnosed with schizophrenia who is
exhibiting alogia and affective flattening. The nurse correctly identifies these
symptoms as belonging to which category?
A. Positive symptoms
B. Negative symptoms
C. Cognitive symptoms
D. Affective symptoms
CORRECT ANSWER: B. Negative symptoms
Rationale: Negative symptoms represent a diminution or loss of normal functions and
include alogia (poverty of speech), affective flattening (reduced emotional expression),
avolition, and anhedonia. Positive symptoms involve excess or distortion of normal
functions, such as hallucinations and delusions.
Question 3: A 34-year-old client with paranoid schizophrenia tells the nurse,
"The FBI is monitoring my thoughts through the television." Which nursing
response is most therapeutic initially?
A. "That sounds frightening. Tell me more about what you are experiencing."
B. "That is not true. The FBI does not have that technology."
,C. "You should avoid watching television if it makes you feel this way."
D. "I will check with the television company to see if they are monitoring you."
CORRECT ANSWER: A. "That sounds frightening. Tell me more about what
you are experiencing."
Rationale: This response validates the client's feelings without reinforcing the delusion.
It uses therapeutic communication techniques of empathy and exploring, which builds
trust and allows the client to express their concerns. Arguing or challenging the delusion
is non-therapeutic and can damage the therapeutic alliance.
Question 4: A client diagnosed with schizophrenia is prescribed clozapine.
Which of the following is the most critical adverse effect that requires routine
monitoring?
A. Extrapyramidal symptoms
B. Weight gain
C. Agranulocytosis
D. Tardive dyskinesia
CORRECT ANSWER: C. Agranulocytosis
Rationale: Clozapine carries a black box warning for severe neutropenia and
agranulocytosis, which can be fatal. Therefore, the FDA mandates routine monitoring of
absolute neutrophil counts (ANC) through the Risk Evaluation and Mitigation Strategy
(REMS) program.
Question 5: A client with schizophrenia is experiencing command
hallucinations telling him to harm the staff. What is the nurse's priority action?
A. Place the client in seclusion
B. Notify the provider and prepare for a stat order for medication
C. Ensure the safety of the client and others by maintaining a safe environment and
close observation
D. Ask the client to ignore the voices
CORRECT ANSWER: C. Ensure the safety of the client and others by
maintaining a safe environment and close observation
Rationale: Safety is the top priority. Command hallucinations are dangerous if the client
believes they must obey them. The immediate intervention is to ensure the safety of the
client, staff, and other clients, which includes close observation.
,Question 6: A 42-year-old client with schizoaffective disorder is admitted with
acute mania. Which combination of symptoms is most characteristic of this
diagnosis, differentiating it from schizophrenia?
A. Auditory hallucinations and delusions of grandeur
B. Disorganized speech and catatonic behavior
C. A mood episode occurring concurrently with the active phase of schizophrenia
symptoms
D. Predominantly negative symptoms with minimal cognitive decline
CORRECT ANSWER: C. A mood episode occurring concurrently with the active
phase of schizophrenia symptoms
Rationale: The defining feature of schizoaffective disorder is the presence of a major
mood episode (depressive or manic) that occurs concurrently with the active phase of
schizophrenia (delusions, hallucinations, disorganized speech). This differentiates it from
schizophrenia, where psychotic symptoms are primary and mood episodes are absent or
brief.
Question 7: A client is prescribed haloperidol. The nurse assesses involuntary
rolling back of the eyes (oculogyric crisis). Which medication should the nurse
prepare to administer?
A. Benztropine
B. Clonazepam
C. Diphenhydramine
D. A or C
CORRECT ANSWER: D. A or C
Rationale: Oculogyric crisis is an acute dystonic reaction and a type of extrapyramidal
symptom (EPS) caused by antipsychotics. It is treated with anticholinergic medications
like benztropine (Cogentin) or antihistamines with anticholinergic properties like
diphenhydramine (Benadryl). Both are used to counteract the dopamine blockage in the
nigrostriatal pathway.
Question 8: The nurse is evaluating a client with schizophrenia who is taking
olanzapine. Which side effect is most concerning due to its long-term risk for
metabolic syndrome?
A. Insomnia
B. Weight gain and hyperglycemia
C. Akathisia
D. Dry mouth
CORRECT ANSWER: B. Weight gain and hyperglycemia
, Rationale: Olanzapine is a second-generation (atypical) antipsychotic with a high risk for
metabolic adverse effects, including significant weight gain, hyperglycemia, and
hyperlipidemia. These increase the risk of type 2 diabetes and cardiovascular disease.
Question 9: A client presents with a first episode of psychosis. The family
history is positive for schizophrenia. The client asks, "Will I end up like my
uncle?" What is the nurse's best response?
A. "Your risk is higher, but many people with a family history do not develop
schizophrenia."
B. "Yes, if you have the same genes, the outcome will be similar."
C. "It is completely random; family history does not matter."
D. "You will only develop it if you use drugs."
CORRECT ANSWER: A. "Your risk is higher, but many people with a family
history do not develop schizophrenia."
Rationale: While genetics play a significant role (heritability around 80%), schizophrenia
is a complex disorder influenced by multiple genes and environmental factors. Not
everyone with a family history will develop the disorder. The nurse should provide
accurate, honest, and hope-inspiring information.
Question 10: A client with schizophrenia is being discharged. Which statement
by the client indicates a need for further teaching regarding medication
adherence?
A. "If I feel better, I will stop taking my medication and call the doctor."
B. "I should avoid grapefruit juice while taking my medications."
C. "I need to get my blood drawn regularly since I am on clozapine."
D. "It is important to tell my provider about any side effects I have."
CORRECT ANSWER: A. "If I feel better, I will stop taking my medication and
call the doctor."
Rationale: Clients with schizophrenia often stop their medications once symptoms
subside, leading to relapse. The client must understand that antipsychotics are
maintenance medications and should be continued long-term even when feeling well.
Stopping abruptly is dangerous and should only be done under medical supervision.
Question 11: A client who is experiencing auditory hallucinations suddenly
becomes quiet and states, "The voices are gone." The nurse should assess the
client for which of the following?
A. A decrease in anxiety
B. The onset of sleep
