Focused Exam Schizophrenia 2025/2026 – BSN 266 HESI
Exam Package with Solution Updated 2025/2026 Complete
Nursing Course Study Resource
250 high-yield, HESI/NCLEX-style schizophrenia questions • Correct answers are marked in the choice list with a green tick inside an
empty box.
Human brain: major regions (original schematic)
Cerebrum
Cerebellum
Brainstem
Use with questions on neuroanatomy, cognition, and differential assessment.
Dopamine pathways relevant to antipsychotic effects (original schematic)
Nigrostriatal
Mesocortical
Mesolimbic
Tuberoinfundibular
Dopamine blockade can reduce psychosis but may contribute to EPS and prolactin elevation.
Important authenticity note: HESI/Elsevier proctored exam items are proprietary. This PDF does not claim to reproduce a live or leaked HESI exam. The
questions are original exam-style items built around high-yield psychiatric nursing concepts and the public HESI/BSN 266 topic signals available online.
Elsevier describes HESI preparation as including clinical-judgment questions and psychiatric nursing content. Publicly posted BSN 266 previews also show
schizophrenia, antipsychotic adverse effects, and other med-surg/psychiatric nursing concepts.
Visual note: no source photograph was supplied with the request, so the PDF uses original clinical schematics rather than pretending an
illustrative/generated image is a real patient photograph.
BSN 266 • Schizophrenia Focused Exam Package Page 1
,Core assessment
1. Which finding most strongly supports schizophrenia?
A single panic attack
Persistent hallucinations with disorganized thinking and functional decline
Brief sadness after a loss
Occasional nervousness before an exam
2. A client says, “The television is sending me secret messages.” Which symptom is this?
Neologism
Echolalia
Delusion of reference
Flight of ideas
3. Which assessment question best explores auditory hallucinations?
“You do not really hear voices, correct?”
“Why are you imagining things?”
“Can you stop hearing them?”
“What do you hear, and what do the voices tell you to do?”
4. Which finding requires the most immediate follow-up?
A voice commands the client to kill another person
The client reports low energy
The client prefers to stay alone
The client has poor eye contact
5. Which history element is most important when evaluating new psychosis?
Usual shoe size
Recent substance or medication exposure
Favorite foods
Preferred television shows
6. A nurse notes a marked decline in self-care, social interaction, and speech. These are primarily which symptom
domain?
Autonomic symptoms
Extrapyramidal symptoms
Negative symptoms
Positive symptoms
7. Which statement best differentiates a hallucination from a delusion?
A hallucination is always a false belief
A delusion is always a visual experience
A delusion is a normal sensory perception
A hallucination is a perception without an external stimulus
8. Which finding is most consistent with disorganized speech?
Loose associations and incoherent responses
A fixed false belief
Hearing a voice
Flat facial expression
9. Which client statement reflects a negative symptom?
“The radio is speaking directly to me.”
“I have no interest in talking to anyone anymore.”
“Someone implanted a transmitter in my tooth.”
“I hear a man calling my name.”
BSN 266 • Schizophrenia Focused Exam Package Page 2
,10. Why is collateral information useful in schizophrenia assessment?
It proves every delusion is false
It eliminates the need for a mental-status exam
It helps identify changes in functioning and treatment adherence
It replaces the client interview
Communication
11. Which response is therapeutic when a client says, “The staff are poisoning my food”?
“That is ridiculous.”
“You must eat it anyway.”
“I understand that you are frightened; I do not see evidence that your food is poisoned.”
“Yes, the staff are probably poisoning it.”
12. A client reports hearing voices. What should the nurse do first?
Tell the client to ignore the voices
Argue that the voices are not real
Leave the client alone
Assess what the voices are saying and whether they command harm
13. Which approach is best with a highly suspicious client?
Use a calm, consistent approach and avoid whispering with others
Use humor to reduce tension
Stand very close to the client
Frequently change staff
14. Which statement best communicates reality without validating a delusion?
“Tell me exactly why you are right.”
“I know this feels real to you, but I do not share that belief.”
“You are correct; everyone is watching you.”
“Stop thinking that way.”
15. A client is experiencing thought blocking. What is the best nursing response?
Finish every sentence for the client
Challenge the client to speak faster
Allow extra time for the client to organize thoughts
Rapidly ask several questions
16. Which communication style is most appropriate during acute psychosis?
Long explanations with abstract language
Frequent changes of topic
Sarcasm and figurative language
Short, clear, concrete statements
17. A client becomes increasingly agitated. Which action is best?
Reduce environmental stimulation and speak calmly
Crowd around the client
Raise the nurse’s voice
Argue about the client's beliefs
18. Which question best assesses suicidal thinking?
“You would never hurt yourself, correct?”
“Have you had thoughts of killing yourself?”
“You are not suicidal, are you?”
“Why would you want to die?”
BSN 266 • Schizophrenia Focused Exam Package Page 3
, 19. A client refuses to participate in group therapy. What is the best response?
“You will lose privileges.”
“Your refusal proves you are psychotic.”
“You may choose not to attend; we can discuss what would feel manageable.”
“You must attend.”
20. Which statement demonstrates validation without agreeing with a hallucination?
“The voice is definitely real.”
“There is nothing to be afraid of.”
“Everyone hears voices sometimes.”
“That sounds frightening. Let’s find a way to help you feel safer.”
Safety
21. Which finding places a client with schizophrenia at highest immediate risk?
Mild social withdrawal
Flat affect
Difficulty choosing clothing
Command hallucinations to harm self with intent to act
Extrapyramidal-symptom recognition map (original schematic)
Acute dystonia hours–dayssustained spasms; airway risk
Akathisia days–weeks
inner restlessness
Parkinsonism weeks rigidity/bradykinesia
Tardive dyskinesia
months–years
repetitive oral movements
NMS acute emergency
fever + rigidity + autonomic instability
22. What is the priority for a client who is severely agitated and threatening others?
Protect the client and others while initiating the least restrictive safety measures
Complete a lengthy psychosocial history
Encourage a large group discussion
Offer several complex choices
23. Which environmental intervention is appropriate for acute psychosis?
Move the client between rooms frequently
Decrease noise, crowding, and unnecessary stimulation
Keep the television on continuously
Encourage many visitors
24. A client says, “I have a gun at home and the voices told me to use it.” What should the nurse do?
Tell the client to ignore the voices
Wait until the next scheduled assessment
Immediately escalate the safety concern and initiate suicide/violence precautions per policy
Promise to keep the statement secret
25. Which observation is most concerning after starting an antipsychotic?
Mild dry mouth
Increased appetite
Occasional drowsiness
New severe muscle rigidity with fever and altered mental status
BSN 266 • Schizophrenia Focused Exam Package Page 4
Exam Package with Solution Updated 2025/2026 Complete
Nursing Course Study Resource
250 high-yield, HESI/NCLEX-style schizophrenia questions • Correct answers are marked in the choice list with a green tick inside an
empty box.
Human brain: major regions (original schematic)
Cerebrum
Cerebellum
Brainstem
Use with questions on neuroanatomy, cognition, and differential assessment.
Dopamine pathways relevant to antipsychotic effects (original schematic)
Nigrostriatal
Mesocortical
Mesolimbic
Tuberoinfundibular
Dopamine blockade can reduce psychosis but may contribute to EPS and prolactin elevation.
Important authenticity note: HESI/Elsevier proctored exam items are proprietary. This PDF does not claim to reproduce a live or leaked HESI exam. The
questions are original exam-style items built around high-yield psychiatric nursing concepts and the public HESI/BSN 266 topic signals available online.
Elsevier describes HESI preparation as including clinical-judgment questions and psychiatric nursing content. Publicly posted BSN 266 previews also show
schizophrenia, antipsychotic adverse effects, and other med-surg/psychiatric nursing concepts.
Visual note: no source photograph was supplied with the request, so the PDF uses original clinical schematics rather than pretending an
illustrative/generated image is a real patient photograph.
BSN 266 • Schizophrenia Focused Exam Package Page 1
,Core assessment
1. Which finding most strongly supports schizophrenia?
A single panic attack
Persistent hallucinations with disorganized thinking and functional decline
Brief sadness after a loss
Occasional nervousness before an exam
2. A client says, “The television is sending me secret messages.” Which symptom is this?
Neologism
Echolalia
Delusion of reference
Flight of ideas
3. Which assessment question best explores auditory hallucinations?
“You do not really hear voices, correct?”
“Why are you imagining things?”
“Can you stop hearing them?”
“What do you hear, and what do the voices tell you to do?”
4. Which finding requires the most immediate follow-up?
A voice commands the client to kill another person
The client reports low energy
The client prefers to stay alone
The client has poor eye contact
5. Which history element is most important when evaluating new psychosis?
Usual shoe size
Recent substance or medication exposure
Favorite foods
Preferred television shows
6. A nurse notes a marked decline in self-care, social interaction, and speech. These are primarily which symptom
domain?
Autonomic symptoms
Extrapyramidal symptoms
Negative symptoms
Positive symptoms
7. Which statement best differentiates a hallucination from a delusion?
A hallucination is always a false belief
A delusion is always a visual experience
A delusion is a normal sensory perception
A hallucination is a perception without an external stimulus
8. Which finding is most consistent with disorganized speech?
Loose associations and incoherent responses
A fixed false belief
Hearing a voice
Flat facial expression
9. Which client statement reflects a negative symptom?
“The radio is speaking directly to me.”
“I have no interest in talking to anyone anymore.”
“Someone implanted a transmitter in my tooth.”
“I hear a man calling my name.”
BSN 266 • Schizophrenia Focused Exam Package Page 2
,10. Why is collateral information useful in schizophrenia assessment?
It proves every delusion is false
It eliminates the need for a mental-status exam
It helps identify changes in functioning and treatment adherence
It replaces the client interview
Communication
11. Which response is therapeutic when a client says, “The staff are poisoning my food”?
“That is ridiculous.”
“You must eat it anyway.”
“I understand that you are frightened; I do not see evidence that your food is poisoned.”
“Yes, the staff are probably poisoning it.”
12. A client reports hearing voices. What should the nurse do first?
Tell the client to ignore the voices
Argue that the voices are not real
Leave the client alone
Assess what the voices are saying and whether they command harm
13. Which approach is best with a highly suspicious client?
Use a calm, consistent approach and avoid whispering with others
Use humor to reduce tension
Stand very close to the client
Frequently change staff
14. Which statement best communicates reality without validating a delusion?
“Tell me exactly why you are right.”
“I know this feels real to you, but I do not share that belief.”
“You are correct; everyone is watching you.”
“Stop thinking that way.”
15. A client is experiencing thought blocking. What is the best nursing response?
Finish every sentence for the client
Challenge the client to speak faster
Allow extra time for the client to organize thoughts
Rapidly ask several questions
16. Which communication style is most appropriate during acute psychosis?
Long explanations with abstract language
Frequent changes of topic
Sarcasm and figurative language
Short, clear, concrete statements
17. A client becomes increasingly agitated. Which action is best?
Reduce environmental stimulation and speak calmly
Crowd around the client
Raise the nurse’s voice
Argue about the client's beliefs
18. Which question best assesses suicidal thinking?
“You would never hurt yourself, correct?”
“Have you had thoughts of killing yourself?”
“You are not suicidal, are you?”
“Why would you want to die?”
BSN 266 • Schizophrenia Focused Exam Package Page 3
, 19. A client refuses to participate in group therapy. What is the best response?
“You will lose privileges.”
“Your refusal proves you are psychotic.”
“You may choose not to attend; we can discuss what would feel manageable.”
“You must attend.”
20. Which statement demonstrates validation without agreeing with a hallucination?
“The voice is definitely real.”
“There is nothing to be afraid of.”
“Everyone hears voices sometimes.”
“That sounds frightening. Let’s find a way to help you feel safer.”
Safety
21. Which finding places a client with schizophrenia at highest immediate risk?
Mild social withdrawal
Flat affect
Difficulty choosing clothing
Command hallucinations to harm self with intent to act
Extrapyramidal-symptom recognition map (original schematic)
Acute dystonia hours–dayssustained spasms; airway risk
Akathisia days–weeks
inner restlessness
Parkinsonism weeks rigidity/bradykinesia
Tardive dyskinesia
months–years
repetitive oral movements
NMS acute emergency
fever + rigidity + autonomic instability
22. What is the priority for a client who is severely agitated and threatening others?
Protect the client and others while initiating the least restrictive safety measures
Complete a lengthy psychosocial history
Encourage a large group discussion
Offer several complex choices
23. Which environmental intervention is appropriate for acute psychosis?
Move the client between rooms frequently
Decrease noise, crowding, and unnecessary stimulation
Keep the television on continuously
Encourage many visitors
24. A client says, “I have a gun at home and the voices told me to use it.” What should the nurse do?
Tell the client to ignore the voices
Wait until the next scheduled assessment
Immediately escalate the safety concern and initiate suicide/violence precautions per policy
Promise to keep the statement secret
25. Which observation is most concerning after starting an antipsychotic?
Mild dry mouth
Increased appetite
Occasional drowsiness
New severe muscle rigidity with fever and altered mental status
BSN 266 • Schizophrenia Focused Exam Package Page 4
