September 29, 2018

Psychotic Disorders

Adapted from

NCLEX Review 4000

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1. A client with schizophrenia hears a voice telling him that he is evil and must die. The nurse understands
that this client is experiencing:
A delusion
Flight of ideas
Ideas of reference
A hallucination
2. A client with schizophrenia tells a nurse he hears the voices of his dead parents. To help the client
ignore the voices, the nurse should recommend that he:
Sit in a quiet, dark room and concentrate on the voices
Listen to a personal stereo through headphones and sing along with the music
Call a friend and discuss the voices and his feelings about them
Engage in strenuous exercise
3. A client with paranoid schizophrenia repeatedly uses profanity during an activity therapy session. Which
response by the nurse is appropriate?
“Your behavior won’t be tolerated. Go to your room immediately.”
“You’re just doing this to get back at me for making you come to therapy.”
“Your cursing is interrupting the activity. Take time out in your room for 10 minutes.”
“I’m disappointed in you. You can’t control yourself for even a few minutes.”
4. A client with schizophrenia states, “I hear the voice of King Tut.” Which response by the nurse is
therapeutic?
“I don’t hear the voice, but I know you hear what sounds like a voice.”
“You shouldn’t focus on that voice.”
“Don’t worry about the voice as long as it doesn’t belong to anyone real.”
“King Tut has been dead for years.”
5. A client with schizophrenia and delusions tells a nurse, “There is a man wearing a red coat who’s out to
get me.” The client exhibits increasing anxiety when focusing on the delusion. Which response by the
nurse is appropriate?
“This subject seems to be troubling you. Let’s walk to the activity room.”
“Describe the man who’s out to get you. What does he look like?”
“There is no reason to be afraid of that man. This hospital is very secure.”
“There is no need to be concerned about a man who isn’t even real.”
6. Which condition or characteristic is related to the cluster of symptoms associated with disorganized
schizophrenia?
Odd beliefs
Flat affect
Waxy flexibility
Systematized delusions
7. The nurse is facilitating a group of clients with schizophrenia when one client says, “I like to drive my
car, bar, tar, far.” This client is exhibiting:
Clang association
Echolalia
Echopraxia

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Neologisms
8. A client with active psychosis is admitted to the psychiatric unit . The physician diagnoses schizophrenia
after ruling out several other conditions. Schizophrenia is characterized by:
Loss of identity and self-esteem
Multiple personalities and decreased self-esteem
Disturbances in affect, perception, and thought content and form
Persistent memory impairment and confusion
9. A client with chronic undifferentiated schizophrenia is admitted to the psychiatric unit of a local hospital.
During the next several days, the client is seen laughing, yelling, and talking to himself. This behavior
is characteristic of:
Delusion
Looseness of association
Illusion
Hallucination
10. A client with disorganized-type schizophrenia has been hospitalized for the past 2 years on a unit
for chronic mentally ill clients. The client’s behavior is labile and fluctuates from childishness and
incoherence to loud yelling to slow but appropriate interaction. The client needs assistance with all
activities of daily living. Which behavior is characteristic of disorganized-type schizophrenia?
Extreme social impairment
Suspicious delusions
Waxy flexibility
Elevated affect
11. A client with a diagnosis of catatonic schizophrenia is admitted to the psychiatric hospital. During the
physical examination, the client’s arm remains outstretched after the nurse obtains his pulse and
blood pressure readings, and the nurse must reposition his arm. This client is exhibiting:
Suggestibility
Negativity
Waxy flexibility
Retardation
12. A man is brought to the hospital by his wife, who states that he has refused all meals for the past week
and accused her of trying to poison him. During the initial interview, the client’s speech, only partly
comprehensible, reveals that his thoughts are controlled by delusions that he is possessed by the devil.
A physician diagnoses paranoid schizophrenia. Paranoid schizophrenia is best described as a disorder
characterized by:
Preoccupation with persecutory delusions, anxiety, anger, and potential for violence
Severe mood swings and periods of low to high activity
Multiple personalities, one of which is more destructive than the others
Auditory and tactile hallucinations
13. A client with paranoid schizophrenia has been experiencing auditory hallucinations for many years. One
approach that has proven to be effective is for hallucinating clients to:
Take an as-needed dose of psychotropic medication whenever they hear voices
Practice saying, “Go away” or “Stop” when they hear voices
Sing loudly to drown out the voices and provide a distraction for themselves

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Go to their room until they can’t hear the voices

14. A client with paranoid schizophrenia is admitted to the psychiatric unit of a hospital. Nursing assessment
should include careful observation of the client’s:
Thinking, perceiving, and decision-making skills
Verbal and nonverbal communication processes
Affect and behavior
Psychomotor activity
15. A nurse is preparing for the discharge of a client who has been hospitalized for paranoid schizophrenia.
The client’s husband expresses concern over whether his wife will continue to take her daily ordered
medication. The nurse should inform him that:
His concern is valid, but his wife is an adult and has the right to make her own decisions
He can easily mix the medication in his wife’s food if she stops taking it
His wife can be given a long-acting medication that is administered every 1 to 4 weeks
His wife knows she must take her medication as ordered to avoid future hospitalizations

16. While looking out the window at trees, a client with schizophrenia remarks, “That school across the street
has creatures in it that are waiting for me.” Which term best describes what the creatures represent?
Anxiety attack
Projection
Hallucination
Delusion
17. A client with schizophrenia tells the nurse, “My intestines are rotted from the worms chewing on them.”
This statement indicates a:
Delusion of persecution
Delusion of grandeur
Somatic delusion
Jealous delusion
18. A client has refused to take a shower since being admitted 4 days earlier. He tells a nurse, “There are
poison crystals hidden in the showerhead. They’ll kill me if I take a shower.” Which nursing action is
most appropriate?
Dismantling the showerhead and showing the client that there is nothing in it
Explaining that other clients are complaining about the client’s body odor
Asking a security officer to assist in giving the client a shower
Accepting these fears and allowing the client to take a sponge bath
19. Positive symptoms of schizophrenia include:
Hallucinations, delusions, and disorganized thinking.
Somatic delusions, echolalia, and a flat affect.
Waxy flexibility, alogia, and apathy.
Flat affect, avolition, and anhedonia.
20. Schizophrenia is caused by:
Genetic factors leading to a faulty dopamine receptor.
Environmental factors and poor parenting.

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Structural and neurobiological factors.

A combination of biological, psychologic, and environmental factors.
21. When teaching the family of a client with schizophrenia, the nurse should provide which information?
Relapse can be prevented if the client takes his medication
Support is available to help family members meet their own needs
Improvement should occur if the client is provided with a stimulating environment
Stressful family situations can precipitate a relapse
22. Which group of characteristics should a nurse expect to see in the client with schizophrenia?
Loose associations, grandiose delusions, and auditory hallucinations
Periods of hyperactivity and irritability alternating with depression
Delusions of jealousy and persecution, paranoia, and mistrust
Sadness, apathy, feelings of worthlessness, anorexia, and weight loss
23. During the initial interview, a client with schizophrenia suddenly turns to the empty chair beside him
and whispers, “Now just leave. I told you to stay home. There isn’t enough work here for both of us!”
What is the nurse’s best initial response?
“When people are under stress, they may see things or hear things that others don’t. Is that
what just happened?”
“I’m having a difficult time hearing you. Please look at me when you talk.”
“There is no one else in the room. What are you doing?”
“Who are you talking to? Are you hallucinating?”
24. While pacing in the hall, a client with paranoid schizophrenia runs to a nurse and asks, “Why are you
poisoning me? I know you work for Central Thought Control! You can keep my thoughts. Give me back
my soul!” How should the nurse respond during the early stage of the therapeutic process?
“I’m a nurse. I’m not poisoning you. That would be a violation of the nursing code of ethics.”
“I’m a nurse, and you’re a client in the hospital. I’m not going to harm you.”
“I’m not poisoning you. And how could I possibly steal your soul?”
“I sense anger. Are you feeling angry today?”
25. Every day for the past 2 weeks, a client with schizophrenia has stood during group therapy and screamed,
“Get out of here right now! The elevator bombs are going to explode in 3 minutes!” The next time this
happens, how should the nurse respond?
“Why do you think there is a bomb in the elevator?”
“That is the same thing you said in yesterday’s session.”
“I know you think there are bombs in the elevator, but there aren’t.”
“If you have something to say, you must do it according to our group rules.”
26. A nurse is caring for a client who experiences false sensory perceptions that have no basis in reality.
These perceptions are known as:
Delusions
Hallucinations
Loose associations
Neologisms
27. A client with a diagnosis of delusions of grandeur is admitted to the facility. This client’s diagnosis
reflects a belief that one is:

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Highly important or famous

Being persecuted
Connected to events unrelated to oneself
Responsible for the evil in the world
28. A client is experiencing an acute schizophrenic episode. His vivid hallucinations are making him agitated.
The nurse’s best response at this time is to:
Take the client’s vital signs
Explore the content of the client’s hallucinations
Tell the client his fear is unrealistic
Engage the client in reality-oriented activities
29. A client with paranoid schizophrenia becomes angry and tells a nurse to leave him alone. The nurse
should:
Tell the client that she’ll leave but will return soon
Ask the client if it’s OK if she sits quietly with him
Ask the client why he wants her to leave him alone
Assure the client that she won’t let anything happen to him
30. A nurse is providing care to a client with a catatonic type of schizophrenia who exhibits extreme nega-
tivism. To help the client meet his basic needs, the nurse should:
Ask the client which activity he would prefer to do first
Negotiate a time when the client will perform activities
Tell the client specifically and concisely what needs to be done
Prepare the client ahead of time for the activity
31. A client with a diagnosis of paranoid schizophrenia is admitted to the inpatient unit of the mental health
center. He’s shouting that the government of France is trying to assassinate him. Which response is
most appropriate?
“I think you’re wrong. France is a friendly country. The French government wouldn’t try to
kill you.”
“I don’t see evidence that a foreign government or anyone else is trying to hurt you. You must
feel frightened by this.”
“You’re wrong. Nobody is trying to kill you.”
“A foreign government is trying to kill you? Please tell me more about it.”
32. A nurse is planning care for a client with a diagnosis of paranoid schizophrenia who has been admitted
to the psychiatric unit. Which nursing diagnosis should receive the highest priority?
Risk for other-directed violence
Imbalanced nutrition: Less than body requirements
Compromised family coping
Impaired verbal communication
33. A nurse is caring for a client with schizophrenia. Which outcome requires revising the client’s care plan?
The client spends more time by himself
The client doesn’t engage in delusional thinking
The client doesn’t harm himself or others
The client demonstrates the ability to meet his own self-care needs

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34. A nurse is caring for a client with schizophrenia who experiences auditory hallucinations. The client
appears to be listening to someone who isn’t visible. He gestures, shouts angrily, and stops shouting in
mid-sentence. Which nursing intervention is appropriate?
Approach the client and touch him to get his attention
Encourage the client to go to his room where he’ll experience fewer distractions
Acknowledge that the client is hearing voices but make it clear that the nurse doesn’t hear
these voices
Ask the client to describe what the voices are saying
35. During the assessment stage, a client with schizophrenia leaves his arm in the air after the nurse has
taken his blood pressure. His action shows evidence of:
Somatic delusions
Waxy flexibility
Neologisms
Nihilistic delusions

36. A client with paranoid schizophrenia started risperidone (Risperdal) 2 weeks ago. Today, he tells the
nurse he feels like he has the flu. The nurse’s assessment reveals the following: temperature 104.4◦ F
(40.2◦ C), respirations 24 breaths/minute, blood pressure 130/102 mm Hg, pulse rate 120 beats/minute.
The nurse also notes muscle stiffness and pain, excessive sweating and salivation, and changes in mental
status. The nurse suspects the client is experiencing:
The flu
Malignant hyperthermia
Neuroleptic malignant syndrome
Septicemia
37. A client with schizophrenia displays a lack of interest in activities, reduced affect, and poor ability to
perform activities of daily living. What term would be used to describe this clustering of symptoms?
Positive symptoms
Negative symptoms
Physiologic symptoms
Extrapyramidal symptoms
38. A nurse observes that a client diagnosed with schizophrenia is staring into space and doesn’t acknowledge
the presence of others. The client moves rapidly at times but then stops and remains in one posture for
long periods. What form of schizophrenia is the nurse observing?
Paranoid
Disorganized
Undifferentiated
Catatonic
39. A client with a diagnosis of paranoid schizophrenia asks the nurse, “How do I know what is really in
those pills?” The best response is to:
say, “You know this is your medicine.”
allow the client to open the individual medication wrappers.
say, “Don’t worry about what’s in the pills. It’s what the doctor ordered.”
ignore the client’s comment because it’s probably a joke.

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