MENTAL HEALTH
The nurse is caring for a client with schizophrenia. Which of the following outcomes is
the least desirable?
A) The client spends more time by himself
B) The client doesn't engage in delusional thinking
C) The client doesn't harm himself or others
D) The client demonstrates ability to meet his own self-care needs
The client with schizophrenia is commonly socially isolated and withdrawn; therefore, having the
client spend more time by himself wouldn't be a desirable outcome. Rather, a desirable
outcome would specify that the client spend more time with other clients and staff on the unit.
Delusions are false personal beliefs. Reducing or eliminating delusional thinking using talking
therapy and antipsychotic medications would be a desirable outcome. Protecting the client and
others from harm is a desirable client outcome achieved by close observation, removing any
dangerous objects, and administering medications. Because the client with schizophrenia may
have difficulty meeting his or her own self-care needs, fostering the ability to perform self-care
independently is a desirable client outcome.
The nurse formulates a nursing diagnosis of Impaired verbal communication for a client
with schizotypal personality disorder. Based on this nursing diagnosis, which nursing
intervention is most appropriate?
A) Helping the client to participate in social interactions
B) Establishing a one-on-one relationship with the client
C) Establishing alternative forms of communication
D) Allowing the client to decide when he wants to participate in verbal communication
with the nurse
By establishing a one-on-one relationship, the nurse helps the client learn how to interact with people in
new situations. The other options are appropriate but should take place only after the nurse-client
relationship is established.
Since admission 4 days ago, a client has refused to take a shower, stating, "There are
poison crystals hidden in the showerhead. They'll kill me if I take a shower." Which
nursing action is most appropriate?
A) Dismantling the showerhead and showing the client that there is nothing in it
,B) Explaining that other clients are complaining about the client's body odor
C) Asking a security officer to assist in giving the client a shower
D) Accepting these fears and allowing the client to take a sponge bath
By acknowledging the client's fears, the nurse can arrange to meet the client's hygiene needs in
another way. Because these fears are real to the client, providing a demonstration of reality (as
in option A) wouldn't be effective at this time. Options B and C would violate the client's rights by
shaming or embarrassing the client.
Drug therapy with thioridazine (Mellaril) shouldn't exceed a daily dose of 800 mg to prevent which
adverse reaction?
A) Hypertension
B) Respiratory arrest
C) Tourette Syndrome
D) Retinal pigmentation
Retinal pigmentation may occur if the thioridazine dosage exceeds 800 mg per day. The other options
don't occur as a result of exceeding this dose.
A client with paranoid personality disorder is admitted to a psychiatric facility. Which
remark by the nurse would best establish rapport and encourage the client to confide in
the nurse?
A) "I get upset once in a while, too."
B) "I know just how you feel. I'd feel the same way in your situation."
C) "I worry, too, when I think people are talking about me."
D) "At times, it's normal not to trust anyone."
Sharing a benign, nonthreatening, personal fact or feeling helps the nurse establish rapport and
encourages the client to confide in the nurse. The nurse can't know how the client feels. Telling
the client otherwise, as in option B, would justify the suspicions of a paranoid client; furthermore,
the client relies on the nurse to interpret reality. Option C is incorrect because it focuses on the
nurse's feelings, not the client's. Option D wouldn't help establish rapport or encourage the client
to confide in the nurse.
How soon after chlorpromazine (Thorazine) administration should the nurse expect to see a client's
delusional thoughts and hallucinations eliminated?
,A) Several minutes
B) Several hours
C) Several days
D) Several weeks
Although most phenothiazines produce some effects within minutes to hours, their antipsychotic effects
may take several weeks to appear.
A client is about to be discharged with a prescription for the antipsychotic agent
haloperidol (Haldol), 10 mg by mouth twice per day. During a discharge teaching session,
the nurse should provide which instruction to the client?
A) Take the medication 1 hour before a meal.
B) Decrease the dosage if signs of illness decrease
C)Apply a sunscreen before being exposed to the sun.
D) Increase the dosage up to 50 mg twice per day if signs of illness don't decrease.
Because haloperidol can cause photosensitivity and precipitate severe sunburn, the nurse
should instruct the client to apply a sunscreen before exposure to the sun. The nurse also
should teach the client to take haloperidol with meals — not 1 hour before — and should instruct
the client not to decrease or increase the dosage unless the physician orders it.
A client with paranoid schizophrenia repeatedly uses profanity during an activity therapy
session. Which response by the nurse would be most appropriate?
A) "Your behavior won't be tolerated. Go to your room immediately."
B) "You're just doing this to get back at me for making you come to therapy."
C) "Your cursing is interrupting the activity. Take time out in your room for 10 minutes."
D) "I'm disappointed in you. You can't control yourself even for a few minutes."
The nurse should set limits on client behavior to ensure a comfortable environment for all clients.
The nurse should accept hostile or quarrelsome client outbursts within limits without becoming
personally offended, as in option A. Option B is incorrect because it implies that the client's
actions reflect feelings toward the staff instead of the client's own misery. Judgmental remarks,
such as option D, may decrease the client's self-esteem.
Which of the following is one of the advantages of the newer antipsychotic medication risperidone
(Risperdal)?
A) The absence of anticholinergic effects
B) A lower incidence of extrapyramidal effects
, C) Photosensitivity and sedation
D) No incidence of neuroleptic malignant syndrome
Risperdal has a lower incidence of extrapyramidal effects than the typical antipsychotics. Risperdal does
produce anticholinergic effects and neuroleptic malignant syndrome can occur. Photosensitivity isn't an
advantage.
The etiology of schizophrenia is best described by:
A) genetics due to a faulty dopamine receptor.
B) environmental factors and poor parenting.
C) structural and neurobiological factors.
D) a combination of biological, psychological, and environmental factors.
A reliable genetic marker hasn't been determined for schizophrenia. However, studies of twins
and adopted siblings have strongly implicated a genetic predisposition. Since the mid-19th
century, excessive dopamine activity in the brain has also been suggested as a causal factor.
Communication and the family system have been studied as contributing factors in the
development of schizophrenia. Therefore, a combination of biological, psychological, and
environmental factors are thought to cause schizophrenia.
A client with schizophrenia who receives fluphenazine (Prolixin) develops pseudoparkinsonism and
akinesia. What drug would the nurse administer to minimize extrapyramidal symptoms?
A) benztropine (Cogentin)
B) dantrolene (Dantrium)
C) clonazepam (Klonopin)
D) diazepam (Valium)
Benztropine is an anticholinergic drug administered to reduce extrapyramidal adverse effects in
the client taking antipsychotic drugs. It works by restoring the equilibrium between the
neurotransmitters acetylcholine and dopamine in the central nervous system (CNS). Dantrolene,
a hydantoin drug that reduces the catabolic processes, is administered to alleviate the
symptoms of neuroleptic malignant syndrome, a potentially fatal adverse effect of antipsychotic
drugs. Clonazepam, a benzodiazepine drug that depresses the CNS, is administered to control
seizure activity. Diazepam, a benzodiazepine drug, is administered to reduce anxiety.
A client with a diagnosis of paranoid schizophrenia comments to the nurse, "How do I
know what is really in those pills?" Which of the following is the best response?
A) Say, "You know it's your medicine."
B) Allow him to open the individual wrappers of the medication.
C) Say, "Don't worry about what is in the pills. It's what is ordered."
D) Ignore the comment because it's probably a joke.
The nurse is caring for a client with schizophrenia. Which of the following outcomes is
the least desirable?
A) The client spends more time by himself
B) The client doesn't engage in delusional thinking
C) The client doesn't harm himself or others
D) The client demonstrates ability to meet his own self-care needs
The client with schizophrenia is commonly socially isolated and withdrawn; therefore, having the
client spend more time by himself wouldn't be a desirable outcome. Rather, a desirable
outcome would specify that the client spend more time with other clients and staff on the unit.
Delusions are false personal beliefs. Reducing or eliminating delusional thinking using talking
therapy and antipsychotic medications would be a desirable outcome. Protecting the client and
others from harm is a desirable client outcome achieved by close observation, removing any
dangerous objects, and administering medications. Because the client with schizophrenia may
have difficulty meeting his or her own self-care needs, fostering the ability to perform self-care
independently is a desirable client outcome.
The nurse formulates a nursing diagnosis of Impaired verbal communication for a client
with schizotypal personality disorder. Based on this nursing diagnosis, which nursing
intervention is most appropriate?
A) Helping the client to participate in social interactions
B) Establishing a one-on-one relationship with the client
C) Establishing alternative forms of communication
D) Allowing the client to decide when he wants to participate in verbal communication
with the nurse
By establishing a one-on-one relationship, the nurse helps the client learn how to interact with people in
new situations. The other options are appropriate but should take place only after the nurse-client
relationship is established.
Since admission 4 days ago, a client has refused to take a shower, stating, "There are
poison crystals hidden in the showerhead. They'll kill me if I take a shower." Which
nursing action is most appropriate?
A) Dismantling the showerhead and showing the client that there is nothing in it
,B) Explaining that other clients are complaining about the client's body odor
C) Asking a security officer to assist in giving the client a shower
D) Accepting these fears and allowing the client to take a sponge bath
By acknowledging the client's fears, the nurse can arrange to meet the client's hygiene needs in
another way. Because these fears are real to the client, providing a demonstration of reality (as
in option A) wouldn't be effective at this time. Options B and C would violate the client's rights by
shaming or embarrassing the client.
Drug therapy with thioridazine (Mellaril) shouldn't exceed a daily dose of 800 mg to prevent which
adverse reaction?
A) Hypertension
B) Respiratory arrest
C) Tourette Syndrome
D) Retinal pigmentation
Retinal pigmentation may occur if the thioridazine dosage exceeds 800 mg per day. The other options
don't occur as a result of exceeding this dose.
A client with paranoid personality disorder is admitted to a psychiatric facility. Which
remark by the nurse would best establish rapport and encourage the client to confide in
the nurse?
A) "I get upset once in a while, too."
B) "I know just how you feel. I'd feel the same way in your situation."
C) "I worry, too, when I think people are talking about me."
D) "At times, it's normal not to trust anyone."
Sharing a benign, nonthreatening, personal fact or feeling helps the nurse establish rapport and
encourages the client to confide in the nurse. The nurse can't know how the client feels. Telling
the client otherwise, as in option B, would justify the suspicions of a paranoid client; furthermore,
the client relies on the nurse to interpret reality. Option C is incorrect because it focuses on the
nurse's feelings, not the client's. Option D wouldn't help establish rapport or encourage the client
to confide in the nurse.
How soon after chlorpromazine (Thorazine) administration should the nurse expect to see a client's
delusional thoughts and hallucinations eliminated?
,A) Several minutes
B) Several hours
C) Several days
D) Several weeks
Although most phenothiazines produce some effects within minutes to hours, their antipsychotic effects
may take several weeks to appear.
A client is about to be discharged with a prescription for the antipsychotic agent
haloperidol (Haldol), 10 mg by mouth twice per day. During a discharge teaching session,
the nurse should provide which instruction to the client?
A) Take the medication 1 hour before a meal.
B) Decrease the dosage if signs of illness decrease
C)Apply a sunscreen before being exposed to the sun.
D) Increase the dosage up to 50 mg twice per day if signs of illness don't decrease.
Because haloperidol can cause photosensitivity and precipitate severe sunburn, the nurse
should instruct the client to apply a sunscreen before exposure to the sun. The nurse also
should teach the client to take haloperidol with meals — not 1 hour before — and should instruct
the client not to decrease or increase the dosage unless the physician orders it.
A client with paranoid schizophrenia repeatedly uses profanity during an activity therapy
session. Which response by the nurse would be most appropriate?
A) "Your behavior won't be tolerated. Go to your room immediately."
B) "You're just doing this to get back at me for making you come to therapy."
C) "Your cursing is interrupting the activity. Take time out in your room for 10 minutes."
D) "I'm disappointed in you. You can't control yourself even for a few minutes."
The nurse should set limits on client behavior to ensure a comfortable environment for all clients.
The nurse should accept hostile or quarrelsome client outbursts within limits without becoming
personally offended, as in option A. Option B is incorrect because it implies that the client's
actions reflect feelings toward the staff instead of the client's own misery. Judgmental remarks,
such as option D, may decrease the client's self-esteem.
Which of the following is one of the advantages of the newer antipsychotic medication risperidone
(Risperdal)?
A) The absence of anticholinergic effects
B) A lower incidence of extrapyramidal effects
, C) Photosensitivity and sedation
D) No incidence of neuroleptic malignant syndrome
Risperdal has a lower incidence of extrapyramidal effects than the typical antipsychotics. Risperdal does
produce anticholinergic effects and neuroleptic malignant syndrome can occur. Photosensitivity isn't an
advantage.
The etiology of schizophrenia is best described by:
A) genetics due to a faulty dopamine receptor.
B) environmental factors and poor parenting.
C) structural and neurobiological factors.
D) a combination of biological, psychological, and environmental factors.
A reliable genetic marker hasn't been determined for schizophrenia. However, studies of twins
and adopted siblings have strongly implicated a genetic predisposition. Since the mid-19th
century, excessive dopamine activity in the brain has also been suggested as a causal factor.
Communication and the family system have been studied as contributing factors in the
development of schizophrenia. Therefore, a combination of biological, psychological, and
environmental factors are thought to cause schizophrenia.
A client with schizophrenia who receives fluphenazine (Prolixin) develops pseudoparkinsonism and
akinesia. What drug would the nurse administer to minimize extrapyramidal symptoms?
A) benztropine (Cogentin)
B) dantrolene (Dantrium)
C) clonazepam (Klonopin)
D) diazepam (Valium)
Benztropine is an anticholinergic drug administered to reduce extrapyramidal adverse effects in
the client taking antipsychotic drugs. It works by restoring the equilibrium between the
neurotransmitters acetylcholine and dopamine in the central nervous system (CNS). Dantrolene,
a hydantoin drug that reduces the catabolic processes, is administered to alleviate the
symptoms of neuroleptic malignant syndrome, a potentially fatal adverse effect of antipsychotic
drugs. Clonazepam, a benzodiazepine drug that depresses the CNS, is administered to control
seizure activity. Diazepam, a benzodiazepine drug, is administered to reduce anxiety.
A client with a diagnosis of paranoid schizophrenia comments to the nurse, "How do I
know what is really in those pills?" Which of the following is the best response?
A) Say, "You know it's your medicine."
B) Allow him to open the individual wrappers of the medication.
C) Say, "Don't worry about what is in the pills. It's what is ordered."
D) Ignore the comment because it's probably a joke.
