Schizophrenia NCLEX Questions and
Answers | Psychiatric Nursing Practice
Test 100% Accurate
1. 1. Question
A 26-year-old client is admitted to the psychiatric unit with acute onset of
schizophrenia. His physician prescribes the phenothiazine chlorpromazine
(Thorazine), 100 mg by mouth four times per day. Before administering the drug,
the nurse reviews the client’s medication history. Concomitant use of which drug
is likely to increase the risk of extrapyramidal effects?
A. guanethidine (Ismelin)
B. droperidol (Inapsine)
Correct answer
C. lithium carbonate (Lithonate)
D. Alcohol
Correct Answer: B. droperidol (Inapsine)
When administered with any phenothiazine, droperidol may increase the risk of
extrapyramidal effects. Despite being a low-potency drug, chlorpromazine can
still cause extrapyramidal side effects (EPS) such as acute dystonia, akathisia,
parkinsonism, and tardive dyskinesia (TD). The evolution of EPS side effects can
occur through hours to days. Acute dystonia refers to muscle stiffness or spasm
of the head, neck, and eye muscles that can start hours after starting the
medication. Akathisia includes restlessness and fast pacing. Parkinsonism includes
bradykinesia, “cogwheel” rigidity, and shuffling gait.
2. 2. Question
A client, age 36, with paranoid schizophrenia believes the room is bugged by the
Central Intelligence Agency and that his roommate is a foreign spy. The client has
never had a romantic relationship, has no contact with family members, and
hasn’t been employed in the last 14 years. Based on Erikson’s theories, the nurse
should recognize that this client is in which stage of psychosocial development?
Page 1 of 33
, A. Autonomy versus shame and doubt
B. Generativity versus stagnation
C. Integrity versus despair
D. Trust versus mistrust
Correct Answer: D. Trust versus mistrust
This client’s paranoid ideation indicates difficulty trusting others. Erikson believed
that early patterns of trust help children build a strong base of trust that’s crucial
for their social and emotional development. If a child successfully develops trust,
they will feel safe and secure in the world. You’re essentially shaping their
personality and determining how they will view the world.
3. 3. Question
During a group therapy session in the psychiatric unit, a client constantly
interrupts with impulsive behavior and exaggerated stories that cast her as a hero
or princess. She also manipulates the group with attention-seeking behaviors,
such as sexual comments and angry outbursts. The nurse realizes that these
behaviors are typical of:
A. Paranoid personality disorder
B. Avoidant personality disorder
C. Histrionic personality disorder
Correct answer
D. Borderline personality disorder
Correct Answer: C. Histrionic personality disorder
This client’s behaviors are typical of histrionic personality disorder, which is
marked by excessive emotionality and attention seeking. The client constantly
seeks and demands attention, approval, or praise; may be seductive in behavior,
appearance, or conversation; and is uncomfortable except when she is the center
of attention. Histrionic personality disorder, or dramatic personality disorder, is a
psychiatric disorder distinguished by a pattern of exaggerated emotionality and
attention-seeking behaviors. Histrionic personality disorder falls within the
“Cluster B” of personality disorders.
4. 4. Question
Page 2 of 33
, The nurse is teaching a psychiatric client about her prescribed drugs,
chlorpromazine, and benztropine. Why is benztropine administered?
A. To reduce psychotic symptoms.
B. To reduce extrapyramidal symptoms.
Correct answer
C. To control nausea and vomiting.
D. To relieve anxiety.
Correct Answer: B. To reduce extrapyramidal symptoms
Benztropine is an anticholinergic medication, administered to reduce the
extrapyramidal adverse effects of chlorpromazine and other antipsychotic
medications. Consequently, it reduces central cholinergic effects by blocking
muscarinic receptors that appear to improve the symptoms of Parkinson’s
disease. Thus, benztropine blocks the cholinergic muscarinic receptor in the
central nervous system. Therefore, it reduces the cholinergic effects significantly
during Parkinson’s disease which becomes more pronounced in the nigrostriatal
tract because of reduced dopamine concentrations.
5. 5. Question
A client is admitted to the psychiatric unit with a tentative diagnosis of psychosis.
Her physician prescribes the phenothiazine thioridazine (Mellaril) 50 mg by
mouth three times per day. Phenothiazine’s differ from central nervous system
(CNS) depressants in their sedative effects by producing:
A. Deeper sleep than CNS depressants.
B. Greater sedation than CNS depressants.
C. A calming effect from which the client is easily aroused.
Correct answer
D. More prolonged sedative effects, making the client more difficult to
arouse.
Correct Answer: C. A calming effect from which the client is easily aroused.
Shortly after phenothiazine administration, a quieting and calming effect occurs,
but the client is easily aroused, alert, and responsive and has good motor
coordination. The precise mechanism of action exhibited by phenothiazine’s is
Page 3 of 33
, not entirely known. Yet, phenothiazine’s act primarily through inhibiting the
dopamine receptor at the mesolimbic pathway with a selective activity at the D2
receptor. This inhibition antagonizes the hyperactivity of dopamine at the
synapse and reduces positive symptoms such as delusions and hallucinations
associated with schizophrenia.
6. 6. Question
A woman is admitted to the psychiatric emergency department. Her significant
other reports that she has difficulty sleeping, has poor judgment, and is
incoherent at times. The client’s speech is rapid and loose. She reports being a
special messenger from the Messiah. She has a history of depressed mood for
which she has been taking an antidepressant. The nurse suspects which
diagnosis?
A. Schizophrenia
B. Paranoid personality
C. Bipolar illness
D. Obsessive-compulsive disorder (OCD)
Correct Answer: C. Bipolar illness
Bipolar illness is characterized by mood swings from profound depression to
elation and euphoria. Delusions of grandeur along with pressured speech are
common symptoms of mania. The bipolar affective disorder is a chronic and
complex disorder of mood that is characterized by a combination of manic
(bipolar mania), hypomanic and depressive (bipolar depression) episodes, with
substantial subsyndromal symptoms that commonly present between major
mood episodes.
7. 7. Question
A client with paranoid schizophrenia is admitted to the psychiatric unit of a
hospital. Nursing assessment should include careful observation of the client’s:
A. Thinking, perceiving, and decision-making skills
Correct answer
B. Verbal and nonverbal communication processes
C. Affect and behavior
Page 4 of 33
Answers | Psychiatric Nursing Practice
Test 100% Accurate
1. 1. Question
A 26-year-old client is admitted to the psychiatric unit with acute onset of
schizophrenia. His physician prescribes the phenothiazine chlorpromazine
(Thorazine), 100 mg by mouth four times per day. Before administering the drug,
the nurse reviews the client’s medication history. Concomitant use of which drug
is likely to increase the risk of extrapyramidal effects?
A. guanethidine (Ismelin)
B. droperidol (Inapsine)
Correct answer
C. lithium carbonate (Lithonate)
D. Alcohol
Correct Answer: B. droperidol (Inapsine)
When administered with any phenothiazine, droperidol may increase the risk of
extrapyramidal effects. Despite being a low-potency drug, chlorpromazine can
still cause extrapyramidal side effects (EPS) such as acute dystonia, akathisia,
parkinsonism, and tardive dyskinesia (TD). The evolution of EPS side effects can
occur through hours to days. Acute dystonia refers to muscle stiffness or spasm
of the head, neck, and eye muscles that can start hours after starting the
medication. Akathisia includes restlessness and fast pacing. Parkinsonism includes
bradykinesia, “cogwheel” rigidity, and shuffling gait.
2. 2. Question
A client, age 36, with paranoid schizophrenia believes the room is bugged by the
Central Intelligence Agency and that his roommate is a foreign spy. The client has
never had a romantic relationship, has no contact with family members, and
hasn’t been employed in the last 14 years. Based on Erikson’s theories, the nurse
should recognize that this client is in which stage of psychosocial development?
Page 1 of 33
, A. Autonomy versus shame and doubt
B. Generativity versus stagnation
C. Integrity versus despair
D. Trust versus mistrust
Correct Answer: D. Trust versus mistrust
This client’s paranoid ideation indicates difficulty trusting others. Erikson believed
that early patterns of trust help children build a strong base of trust that’s crucial
for their social and emotional development. If a child successfully develops trust,
they will feel safe and secure in the world. You’re essentially shaping their
personality and determining how they will view the world.
3. 3. Question
During a group therapy session in the psychiatric unit, a client constantly
interrupts with impulsive behavior and exaggerated stories that cast her as a hero
or princess. She also manipulates the group with attention-seeking behaviors,
such as sexual comments and angry outbursts. The nurse realizes that these
behaviors are typical of:
A. Paranoid personality disorder
B. Avoidant personality disorder
C. Histrionic personality disorder
Correct answer
D. Borderline personality disorder
Correct Answer: C. Histrionic personality disorder
This client’s behaviors are typical of histrionic personality disorder, which is
marked by excessive emotionality and attention seeking. The client constantly
seeks and demands attention, approval, or praise; may be seductive in behavior,
appearance, or conversation; and is uncomfortable except when she is the center
of attention. Histrionic personality disorder, or dramatic personality disorder, is a
psychiatric disorder distinguished by a pattern of exaggerated emotionality and
attention-seeking behaviors. Histrionic personality disorder falls within the
“Cluster B” of personality disorders.
4. 4. Question
Page 2 of 33
, The nurse is teaching a psychiatric client about her prescribed drugs,
chlorpromazine, and benztropine. Why is benztropine administered?
A. To reduce psychotic symptoms.
B. To reduce extrapyramidal symptoms.
Correct answer
C. To control nausea and vomiting.
D. To relieve anxiety.
Correct Answer: B. To reduce extrapyramidal symptoms
Benztropine is an anticholinergic medication, administered to reduce the
extrapyramidal adverse effects of chlorpromazine and other antipsychotic
medications. Consequently, it reduces central cholinergic effects by blocking
muscarinic receptors that appear to improve the symptoms of Parkinson’s
disease. Thus, benztropine blocks the cholinergic muscarinic receptor in the
central nervous system. Therefore, it reduces the cholinergic effects significantly
during Parkinson’s disease which becomes more pronounced in the nigrostriatal
tract because of reduced dopamine concentrations.
5. 5. Question
A client is admitted to the psychiatric unit with a tentative diagnosis of psychosis.
Her physician prescribes the phenothiazine thioridazine (Mellaril) 50 mg by
mouth three times per day. Phenothiazine’s differ from central nervous system
(CNS) depressants in their sedative effects by producing:
A. Deeper sleep than CNS depressants.
B. Greater sedation than CNS depressants.
C. A calming effect from which the client is easily aroused.
Correct answer
D. More prolonged sedative effects, making the client more difficult to
arouse.
Correct Answer: C. A calming effect from which the client is easily aroused.
Shortly after phenothiazine administration, a quieting and calming effect occurs,
but the client is easily aroused, alert, and responsive and has good motor
coordination. The precise mechanism of action exhibited by phenothiazine’s is
Page 3 of 33
, not entirely known. Yet, phenothiazine’s act primarily through inhibiting the
dopamine receptor at the mesolimbic pathway with a selective activity at the D2
receptor. This inhibition antagonizes the hyperactivity of dopamine at the
synapse and reduces positive symptoms such as delusions and hallucinations
associated with schizophrenia.
6. 6. Question
A woman is admitted to the psychiatric emergency department. Her significant
other reports that she has difficulty sleeping, has poor judgment, and is
incoherent at times. The client’s speech is rapid and loose. She reports being a
special messenger from the Messiah. She has a history of depressed mood for
which she has been taking an antidepressant. The nurse suspects which
diagnosis?
A. Schizophrenia
B. Paranoid personality
C. Bipolar illness
D. Obsessive-compulsive disorder (OCD)
Correct Answer: C. Bipolar illness
Bipolar illness is characterized by mood swings from profound depression to
elation and euphoria. Delusions of grandeur along with pressured speech are
common symptoms of mania. The bipolar affective disorder is a chronic and
complex disorder of mood that is characterized by a combination of manic
(bipolar mania), hypomanic and depressive (bipolar depression) episodes, with
substantial subsyndromal symptoms that commonly present between major
mood episodes.
7. 7. Question
A client with paranoid schizophrenia is admitted to the psychiatric unit of a
hospital. Nursing assessment should include careful observation of the client’s:
A. Thinking, perceiving, and decision-making skills
Correct answer
B. Verbal and nonverbal communication processes
C. Affect and behavior
Page 4 of 33
