Chapter 13: Psychosomatic Medicine
MULTIPLE CHOICE
1. The nurse is assessing a patient who is complaining of hearing voices. What is this patient
experiencing?
a. Delusions
b. Flight of ideas
c. Disorganized thinking
d. Hallucinations
ANS: D
Hallucinations are false sensory perceptions that are experienced without an external stimulus but
seem real to the patient. Auditory hallucinations are prominent in a schizophrenic patient.
Additional sensory hallucinations include those of touch, sight, smell, and body sensation.
Delusions are false beliefs that persist despite evidence to the contrary. Flight of ideas is
characterized by rapid changes in thought from one topic to another. Disorganized thinking is
commonly associated with psychoses and consists of a flight of ideas during which the individual
jumps from one idea or topic to another one.
MSC: NCLEX Client Needs Category: Psychosocial Integrity
2. A patient with schizophrenia has been nonadherent with his home medication regimen. He
requires frequent admissions to the intensive psychiatric unit for treatment of acute psychotic
episodes. Which medication regimen would be appropriate for this patient?
a. Daily home nursing visits to administer the prescribed oral medication
b. Continuous inpatient hospitalization for medication therapy
c. Administration of depot antipsychotic medication
d. Subcutaneous medication administration
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,ANS: C
Depot antipsychotic medications are long acting injections that may be used with noncompliant
patients and may assist in avoiding repeated hospital admissions. Daily home nursing visits are
not an efficient way to ensure medication compliance. Continuous inpatient hospitalization is not
an efficient way to ensure medication compliance. Subcutaneous medication administration is
not an option for this patient.
MSC: NCLEX Client Needs Category: Psychosocial Integrity
3. What is the most common cause of nonadherence to antipsychotic pharmacologic treatment?
a. Expense
b. Increased symptoms of chemical dependency
c. Extrapyramidal effects
d. Inability of the patient to understand the need to take medications
ANS: C
Extrapyramidal effects are the most common reason for nonadherence to antipsychotic therapy.
The four categories of extrapyramidal effects are dystonic reactions, pseudoparkinsonism,
akathisia, and tardive dyskinesia. Although expense may be a concern, it is not the most common
reason for noncompliance. Chemical dependency is not a feature of therapy with antipsychotic
drugs. Although knowledge deficit is a concern, it is not the most common reason for
noncompliance.
4. Which type of adverse effects is present when a patient displays prolonged tonic contractions
of the tongue, oculogyric crisis, and torticollis?
a. Dystonic reactions
b. Pseudoparkinsonism
c. Akathisia
d. Tardive dyskinesia
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, ANS: A
Dystonic reactions are the first extrapyramidal symptoms to occur when a patient is taking
antipsychotic agents. Dystonias are spasmodic movements of muscle groups such as tongue
protrusion, rolling back of the eyes (oculogyric crisis), jaw spasms (trismus), or neck torsion
(torticollis). Pseudoparkinsonism is characterized by tremor and rigidity. Akathisia is
characterized by subjective feelings of anxiety and restlessness, accompanied by pacing and the
inability to remain in one place for extended periods. Tardive dyskinesia is characterized by
persistent involuntary hyperkinetic movements.
5. The nurse is teaching a patient who is taking clozapine (Clozaril) to have weekly blood tests
for the first 6 months of treatment to monitor for which potential complication?
a. Agranulocytosis
b. Vitamin deficiencies
c. Clotting abnormalities
d. Polycythemia
ANS: A
The use of clozapine requires a baseline and weekly white blood cell (WBC) counts because of
the high incidence of agranulocytosis. Clozapine does not cause vitamin deficiencies. Clozapine
does not interfere with clotting abilities. Clozapine does not affect red blood cell volume.
6. A male patient becomes verbally aggressive and insists the nurse is poisoning him as she
attempts to administer haloperidol (Haldol). Which action will the nurse take?
a. Support the patients decision to refuse the medication.
b. Discreetly ask an assistant to put the medication in the patients food.
c. Firmly redirect the patient to take the medication.
d. Speak privately with the patient and reinforce medication action.
ANS: C
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MULTIPLE CHOICE
1. The nurse is assessing a patient who is complaining of hearing voices. What is this patient
experiencing?
a. Delusions
b. Flight of ideas
c. Disorganized thinking
d. Hallucinations
ANS: D
Hallucinations are false sensory perceptions that are experienced without an external stimulus but
seem real to the patient. Auditory hallucinations are prominent in a schizophrenic patient.
Additional sensory hallucinations include those of touch, sight, smell, and body sensation.
Delusions are false beliefs that persist despite evidence to the contrary. Flight of ideas is
characterized by rapid changes in thought from one topic to another. Disorganized thinking is
commonly associated with psychoses and consists of a flight of ideas during which the individual
jumps from one idea or topic to another one.
MSC: NCLEX Client Needs Category: Psychosocial Integrity
2. A patient with schizophrenia has been nonadherent with his home medication regimen. He
requires frequent admissions to the intensive psychiatric unit for treatment of acute psychotic
episodes. Which medication regimen would be appropriate for this patient?
a. Daily home nursing visits to administer the prescribed oral medication
b. Continuous inpatient hospitalization for medication therapy
c. Administration of depot antipsychotic medication
d. Subcutaneous medication administration
HTTPS://PASINGGRADES.COM/
,ANS: C
Depot antipsychotic medications are long acting injections that may be used with noncompliant
patients and may assist in avoiding repeated hospital admissions. Daily home nursing visits are
not an efficient way to ensure medication compliance. Continuous inpatient hospitalization is not
an efficient way to ensure medication compliance. Subcutaneous medication administration is
not an option for this patient.
MSC: NCLEX Client Needs Category: Psychosocial Integrity
3. What is the most common cause of nonadherence to antipsychotic pharmacologic treatment?
a. Expense
b. Increased symptoms of chemical dependency
c. Extrapyramidal effects
d. Inability of the patient to understand the need to take medications
ANS: C
Extrapyramidal effects are the most common reason for nonadherence to antipsychotic therapy.
The four categories of extrapyramidal effects are dystonic reactions, pseudoparkinsonism,
akathisia, and tardive dyskinesia. Although expense may be a concern, it is not the most common
reason for noncompliance. Chemical dependency is not a feature of therapy with antipsychotic
drugs. Although knowledge deficit is a concern, it is not the most common reason for
noncompliance.
4. Which type of adverse effects is present when a patient displays prolonged tonic contractions
of the tongue, oculogyric crisis, and torticollis?
a. Dystonic reactions
b. Pseudoparkinsonism
c. Akathisia
d. Tardive dyskinesia
HTTPS://PASINGGRADES.COM/
, ANS: A
Dystonic reactions are the first extrapyramidal symptoms to occur when a patient is taking
antipsychotic agents. Dystonias are spasmodic movements of muscle groups such as tongue
protrusion, rolling back of the eyes (oculogyric crisis), jaw spasms (trismus), or neck torsion
(torticollis). Pseudoparkinsonism is characterized by tremor and rigidity. Akathisia is
characterized by subjective feelings of anxiety and restlessness, accompanied by pacing and the
inability to remain in one place for extended periods. Tardive dyskinesia is characterized by
persistent involuntary hyperkinetic movements.
5. The nurse is teaching a patient who is taking clozapine (Clozaril) to have weekly blood tests
for the first 6 months of treatment to monitor for which potential complication?
a. Agranulocytosis
b. Vitamin deficiencies
c. Clotting abnormalities
d. Polycythemia
ANS: A
The use of clozapine requires a baseline and weekly white blood cell (WBC) counts because of
the high incidence of agranulocytosis. Clozapine does not cause vitamin deficiencies. Clozapine
does not interfere with clotting abilities. Clozapine does not affect red blood cell volume.
6. A male patient becomes verbally aggressive and insists the nurse is poisoning him as she
attempts to administer haloperidol (Haldol). Which action will the nurse take?
a. Support the patients decision to refuse the medication.
b. Discreetly ask an assistant to put the medication in the patients food.
c. Firmly redirect the patient to take the medication.
d. Speak privately with the patient and reinforce medication action.
ANS: C
HTTPS://PASINGGRADES.COM/
