Question 1

An initial short-term outcome for a withdrawn, socially isolated patient diagnosed with schizophrenia is that the patient will:

Accepted Answer

Consistently interacting with one person reduces isolation. One-to-one interaction is the basis for developing trust and a therapeutic nurse-patient relationship. Later, the patient's willingness to participate in activities or discuss feelings indicates progress.

Question 2

Research on neurostructural theories of schizophrenia indicates that pathoanatomic findings often include:

Accepted Answer

Theorists have suggested that type II schizophrenia is the result of pathoanatomy, specifically increased ventricular brain ratios, brain atrophy, and decreased cerebral blood flow. The other alterations are not supported by research findings.

Question 3

A patient diagnosed with schizophrenia expresses fear of being pursued by hostile forces. The patient carries a tablet and writes notes in a code. The patient says, "I'm the only one who understands this code." What is the priority nursing diagnosis?

Accepted Answer

Disturbed thought processes based on thinking not based on reality is a priority diagnosis for a delusional patient. Impaired environmental interpretation is more useful for an individual who has been disoriented for more than 3 months. Risk for violence might be considered if the patient had given any indication of wishing to attack his persecutors or of willingness to fight back if personally attacked. Further investigation is necessary. No information was presented to suggest that the patient feels powerless. This would require further investigation.

Question 4

How long must the symptoms of schizophrenia be present before a diagnosis can be made?

Accepted Answer

To meet diagnostic criteria, signs of schizophrenia must be continuously present for a minimum of 6 months and not caused by substance abuse or a medical disorder.

Question 5

Which therapeutic activity would be most important in helping a patient diagnosed with schizophrenia remain in the work force?

Accepted Answer

Patients with schizophrenia often cannot obtain and hold jobs, not from lack of work skills but from inability to cope socially on the job. Social skills training would therefore be of greatest assistance if work skills are present. This premise is especially true for an individual with residual schizophrenia, since active psychosis is no longer present.

Question 6

A patient diagnosed with schizophrenia expresses fear of being pursued by hostile forces. The patient carries a tablet and writes notes in a code. The patient says, "I'm the only one who understands this code." Select a realistic and desirable outcome for this patient. The patient will:

Accepted Answer

Reporting that he is no longer afraid of harm emanating from hostile forces would suggest a reduction in delusions. Allowing the nurse to read the coded writings or wishing to have a staff member nearby do not necessarily suggest improvement in reality-based thinking. Stating that he needs medication to clear his thinking by day 1 is not realistic, because delusions are fixed beliefs.

Question 7

A patient tells the nurse, "Air Force jets flying overhead are looking for me. They want to capture me." The patient has not previously verbalized this information. The nurse's initial interventions should:

Accepted Answer

A nurse cannot agree with a delusion, but arguing is counterproductive, because it might cause the patient to cling to the idea. Voicing doubt and stating one's own perception of reality is therapeutic. Encouraging discussion of the delusion reinforces it. Because the behavior described is not disruptive, this principle is not relevant.

Question 8

A patient laughs while saying, "My dog died yesterday." The nurse documents this behavior using what terminology?

Accepted Answer

Speaking of a sad topic while laughing exemplifies inappropriate affect. Autism is characterized by having little concern for external reality. Ambivalence is the simultaneous presence of opposite emotions. Associative looseness is characterized by stringing unrelated topics together.

Question 9

Parents of a 17-year-old patient diagnosed with schizophrenia ask the nurse what the future will be like for their child. The nurse's solve
should be based on knowledge that the usual course of illness is:

Accepted Answer

Most patients with schizophrenia experience alternating acute and stable phases throughout life. Complete and permanent remission is rare. The course of the illness might be somewhat different from individual to individual, but the alternating phases are seen more often than any other course.

Question 10

A nurse at the mental health clinic plans a series of psychoeducational groups for persons with schizophrenia. Which topics would take priority?

Accepted Answer

Stabilization is maximized by adherence to the antipsychotic medication regime. Because so many persons with schizophrenia smoke cigarettes, this topic relates directly to the patients' physiologic well-being. The other topics are also important, but are not priority topics.

Question 11

Genetic evidence regarding twins and the risk for schizophrenia supports which fact?

Accepted Answer

Concordancy rates are 50% for monozygotic twins. This rate is 50 times higher than for the general population. The other options are not accurate representations of research data.

Question 12

A patient diagnosed with schizophrenia expresses fear of being pursued by hostile forces. The patient carries a tablet and writes notes in a code. The patient says, "I'm the only one who understands this code." How should the nurse document these findings?

Accepted Answer

Delusions are fixed false beliefs. Paranoid delusions reflect the idea that the person is being persecuted. Grandiose delusions are characterized by the idea that one is of great importance. The scenario does not describe any of the behaviors that would be consistent with the other options.

Question 13

The nurse should focus assessment for a patient with type I schizophrenia primarily on gathering data about:

Accepted Answer

Altered perception includes hallucinations, illusions, and paranoid thinking. These positive symptoms, along with abnormal thoughts, are hallmarks of type I schizophrenia. The other options are more often seen in patients with type II schizophrenia.

Question 14

The family of a patient with type I schizophrenia asks, "Did this illness occur because of all the chaos in our family?" Select the nurse's best response.

Accepted Answer

The concept of disordered family interaction as the cause of schizophrenia is largely outdated. There is more reliance on the dopamine hypothesis or the stress-vulnerability model at present. Two options are dismissive, and the other suggests that the nurse is not qualified to give information.

Question 15

Which type of perceptual alteration is most commonly displayed by patients with schizophrenia?

Accepted Answer

Auditory hallucinations are the most commonly experienced perceptual alteration noted in schizophrenia. Illusions are less common. The other symptoms are not altered perceptions.

Question 16

A patient displays disorganized speech and behavior as well as a flat affect. The patient prefers to sit alone and often appears to be listening and responding to unseen stimuli. To begin a therapeutic relationship, the nurse should:

Accepted Answer

For withdrawn patients, nurses should begin with undemanding one-to-one interactions. Providing a simple activity might help the patient focus on the here and now and provide a basis for reality-oriented communication. Watching television together does nothing to build trust. Medication education might be of little benefit if the patient is hallucinating and unable to pay attention to what is being taught. Asking what the voices are saying time after time is not beneficial to the patient, who needs to be distracted from them and focus on the real world.

Question 17

When a patient experiencing a first episode of type I schizophrenia is hospitalized, the nurse can expect to administer:

Accepted Answer

Delusions, hallucinations, and other symptoms of type I schizophrenia usually respond to the typical antipsychotic medications. Positive symptoms are considered to be the result of a subcortical dopaminergic process. The typical antipsychotics are dopamine blockers.

Question 18

A therapist believes that persons diagnosed with schizophrenia have ego disintegration. This concept is based on which model?

Accepted Answer

The concept of ego disintegration is distinctly freudian. Freud is considered a developmental theorist. This theory is not considered biologic, interpersonal, or stress-vulnerability based.

Question 19

A newly admitted patient is mute, immobile, and holds a fixed body position for long periods. The nurse caring for this patient should:

Accepted Answer

Nurses should explain the need for and purpose of touch to patients before actually touching. This is particularly true for patients who are at highest risk for misinterpreting touch: those who are inattentive to reality or those who are suspicious. The environment should be calm and predictable. A patient who is mute and motionless is incapable of independent social behaviors. The patient's oral intake should be monitored, but the correct response also applies to feeding, if it is necessary.

Question 20

A highly suspicious patient tells the nurse, "When I sit in the dayroom I can see other people whispering about me and laughing. It makes me want to punch them." The direction that the nurse should give staff is:

Accepted Answer

Suspicious patients misinterpret the actions of others as being potentially harmful to self. Be direct and open, and avoid behaviors that can be misinterpreted, such as whispering or laughing. In addition, the suspicious patient needs additional personal space. Leaning close is ill-advised. Touching should be avoided because of the high potential for misinterpretation of staff members' motives by the suspicious patient. To stop laughing abruptly when the patient appears would make the individual even more suspicious.

Quiz 24: Schizophrenia Spectrum and Other Psychotic Disorders