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10.
A client diagnosed with schizophrenia demonstrates little spontaneous movement and has
catatonia. The client's activities of daily living are severely compromised. What will be an
appropriate outcome for this client?
a. demonstrates increased interest in the environment by the end of week 1.
b. performs self-care activities with coaching by the end of day 3.
c. gradually takes the initiative for self-care by the end of week 2.
d. accepts tube feeding without objection by day 2.
ANS: B
Outcomes related to self-care deficit nursing diagnoses should deal with increasing ability to
perform self-care tasks independently, such as feeding, bathing, dressing, and toileting.
,Performing the tasks with coaching by nursing staff denotes improvement over the complete
inability to perform the tasks. The incorrect options are not directly related to self-care activities,
difficult to measure, and unrelated to maintenance of nutrition.
A nurse observes a catatonic client standing immobile, facing the wall with one arm
extended in a salute. The client remains immobile in this position for 15 minutes, moving
only when the nurse gently lowers the arm. What is the name of this phenomenon?
a. Echolalia
b. Catatonia
c. Depersonalization
d. Thought withdrawal
ANS: B
Catatonia is the ability to hold distorted postures for extended periods of time, as though the
client were molded in wax. Echolalia is a speech pattern. Depersonalization refers to a feeling
state. Thought withdrawal refers to an alteration in thinking.
A nurse leads a psychoeducational group about first-generation antipsychotic medications
with six adult men diagnosed with schizophrenia. The nurse will monitor for concerns
regarding body image with respect to which potential side effect of these medications?
a. Constipation
b. Gynecomastia
c. Visual changes
d. Photosensitivity
,ANS: B
FGAs (first-generation antipsychotic) stimulate release of prolactin, which can result in
gynecomastia (enlargement of the breasts) as well as other changes in sexual function. Men may
experience disturbances in body image as a result of gynecomastia. Other side effects of FGAs
may be disturbing to other aspects of the client's physical health but are not likely to bother body
image.
13. A nurse leads a psychoeducational group about problem solving with six adults
diagnosed with schizophrenia. Which teaching strategy is likely to be most effective?
a. Suggest analogies that might apply to a common daily problem.
b. Assign each participant a problem to solve independently and present to the group.
c. Ask each client to read aloud a short segment from a book about problem solving.
d. Invite participants to come up with solution to getting incorrect change for a
purchase.
ANS: D
Concrete thinking, an impaired ability to think abstractly resulting in interpreting or perceiving
things in a literal manner, is evident in many clients diagnosed with schizophrenia. People who
think concretely benefit from concrete situations during education. Finding a solution in order to
get incorrect change for a purchase is an example of a concrete situation. Analogies require
abstract thinking and insight. Independently solving a problem and presenting it to the group
may be intimidating. All participants may or may not be literate.
14. A nurse educates a client about the antipsychotic medication regime. Afterward, which
comment by the client indicates the teaching was effective?
a. "I will need higher and higher doses of my medication as time goes on."
, b. "I need to store my medication in a cool dark place, such as the refrigerator."
c. "Taking this medication regularly will reduce the severity of my symptoms."
d. "If I run out or stop taking my medication, I will experience withdrawal
symptoms."
ANS: C
Antipsychotic drugs provide symptom control and allow most clients diagnosed with
schizophrenia to live and be treated in the community. Dosing is individually determined.
Antipsychotics are not addictive; however, they should be discontinued gradually to minimize a
discontinuation syndrome.
15. A newly admitted client diagnosed with schizophrenia says, "The voices are bothering
me. They yell and tell me I am bad. I have got to get away from them." Select the nurse's
most helpful reply.
a. "Do you hear the voices often?"
b. "Do you have a plan for getting away from the voices?"
c. "I'll stay with you. Focus on what we are talking about, not the voices. "
d. "Forget the voices and ask some other clients to play cards with you.
ANS: C
Test bank Varcarolis' Foundations of Psychiatric-Mental Health Nursing 9th Edition 128
Staying with a distraught client who is hearing voices serves several purposes: ongoing
observation, the opportunity to provide reality orientation, a means of helping dismiss the voices,
the opportunity of forestalling an action that would result in self-injury, and general support to
reduce anxiety. Asking if the client hears voices is not particularly relevant at this point. Asking
Exam Questions and 100% Verified Correct
Answers | Comprehensive Study Guide with
Detailed Explanations | Fully Updated 2025
Edition | Already Graded A+ | Brand New Exam
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10.
A client diagnosed with schizophrenia demonstrates little spontaneous movement and has
catatonia. The client's activities of daily living are severely compromised. What will be an
appropriate outcome for this client?
a. demonstrates increased interest in the environment by the end of week 1.
b. performs self-care activities with coaching by the end of day 3.
c. gradually takes the initiative for self-care by the end of week 2.
d. accepts tube feeding without objection by day 2.
ANS: B
Outcomes related to self-care deficit nursing diagnoses should deal with increasing ability to
perform self-care tasks independently, such as feeding, bathing, dressing, and toileting.
,Performing the tasks with coaching by nursing staff denotes improvement over the complete
inability to perform the tasks. The incorrect options are not directly related to self-care activities,
difficult to measure, and unrelated to maintenance of nutrition.
A nurse observes a catatonic client standing immobile, facing the wall with one arm
extended in a salute. The client remains immobile in this position for 15 minutes, moving
only when the nurse gently lowers the arm. What is the name of this phenomenon?
a. Echolalia
b. Catatonia
c. Depersonalization
d. Thought withdrawal
ANS: B
Catatonia is the ability to hold distorted postures for extended periods of time, as though the
client were molded in wax. Echolalia is a speech pattern. Depersonalization refers to a feeling
state. Thought withdrawal refers to an alteration in thinking.
A nurse leads a psychoeducational group about first-generation antipsychotic medications
with six adult men diagnosed with schizophrenia. The nurse will monitor for concerns
regarding body image with respect to which potential side effect of these medications?
a. Constipation
b. Gynecomastia
c. Visual changes
d. Photosensitivity
,ANS: B
FGAs (first-generation antipsychotic) stimulate release of prolactin, which can result in
gynecomastia (enlargement of the breasts) as well as other changes in sexual function. Men may
experience disturbances in body image as a result of gynecomastia. Other side effects of FGAs
may be disturbing to other aspects of the client's physical health but are not likely to bother body
image.
13. A nurse leads a psychoeducational group about problem solving with six adults
diagnosed with schizophrenia. Which teaching strategy is likely to be most effective?
a. Suggest analogies that might apply to a common daily problem.
b. Assign each participant a problem to solve independently and present to the group.
c. Ask each client to read aloud a short segment from a book about problem solving.
d. Invite participants to come up with solution to getting incorrect change for a
purchase.
ANS: D
Concrete thinking, an impaired ability to think abstractly resulting in interpreting or perceiving
things in a literal manner, is evident in many clients diagnosed with schizophrenia. People who
think concretely benefit from concrete situations during education. Finding a solution in order to
get incorrect change for a purchase is an example of a concrete situation. Analogies require
abstract thinking and insight. Independently solving a problem and presenting it to the group
may be intimidating. All participants may or may not be literate.
14. A nurse educates a client about the antipsychotic medication regime. Afterward, which
comment by the client indicates the teaching was effective?
a. "I will need higher and higher doses of my medication as time goes on."
, b. "I need to store my medication in a cool dark place, such as the refrigerator."
c. "Taking this medication regularly will reduce the severity of my symptoms."
d. "If I run out or stop taking my medication, I will experience withdrawal
symptoms."
ANS: C
Antipsychotic drugs provide symptom control and allow most clients diagnosed with
schizophrenia to live and be treated in the community. Dosing is individually determined.
Antipsychotics are not addictive; however, they should be discontinued gradually to minimize a
discontinuation syndrome.
15. A newly admitted client diagnosed with schizophrenia says, "The voices are bothering
me. They yell and tell me I am bad. I have got to get away from them." Select the nurse's
most helpful reply.
a. "Do you hear the voices often?"
b. "Do you have a plan for getting away from the voices?"
c. "I'll stay with you. Focus on what we are talking about, not the voices. "
d. "Forget the voices and ask some other clients to play cards with you.
ANS: C
Test bank Varcarolis' Foundations of Psychiatric-Mental Health Nursing 9th Edition 128
Staying with a distraught client who is hearing voices serves several purposes: ongoing
observation, the opportunity to provide reality orientation, a means of helping dismiss the voices,
the opportunity of forestalling an action that would result in self-injury, and general support to
reduce anxiety. Asking if the client hears voices is not particularly relevant at this point. Asking
