PARANOID SCHIZOPRENIA

1. A paranoid client presents with bizarre behaviors, neologisms, and thought insertion.
Which nursing action should be prioritized to maintain this client's safety?
A. Assess for medication noncompliance
B. Note escalating behaviors and intervene immediately
C. Interpret attempts at communication
D. Assess triggers for bizarre, inappropriate behaviors
ANS: B
The nurse should note escalating behaviors and intervene immediately to maintain this
client's safety. Early intervention may prevent an aggressive response and keep the
client and others safe.

2. A client diagnosed with schizo affective disorder is admitted for social skills
training. Which information should be taught by the nurse?
A. The side effects of medications
B. Deep breathing techniques to decrease stress
C. How to make eye contact when communicating
D. How to be a leader
ANS: C
The nurse should plan to teach the client how to make eye contact when
communicating. Social skills, such as making eye contact, can assist clients in
communicating needs and maintaining connectedness.

3. A 16-year-old-client diagnosed with paranoid schizophrenia experiences

command hallucinations to harm others. The client's parents ask a nurse, "Where
do the voices come from?" Which is the appropriate nursing reply?
A. "Your child has a chemical imbalance of the brain which leads to altered
thoughts."
B. "Your child's hallucinations are caused by medication interactions."
C. "Your child has too little serotonin in the brain causing delusions and
hallucinations."
D. "Your child's abnormal hormonal changes have precipitated auditory
hallucinations."

ANS: A
The nurse should explain that a chemical imbalance of the brain leads to altered
thought processes. Hallucinations, or false sensory perceptions, may occur in all five
senses. The client who hears voices is experiencing an auditory hallucination.

4. Parents ask a nurse how they should reply when their child, diagnosed with
paranoid schizophrenia, tells them that voices command him to harm others.
Which is the appropriate nursing reply?
A. "Tell him to stop discussing the voices."
B. "Ignore what he is saying, while attempting to discover the underlying cause."
C. "Focus on the feelings generated by the hallucinations and present reality."
D. "Present objective evidence that the voices are not real."
ANS: C
The most appropriate response by the nurse is to instruct the parents to focus on the
feelings generated by the hallucinations and present reality. The parents should
maintain an attitude of acceptance to encourage communication but should not
reinforce the hallucinations by exploring details of content. It is inappropriate to present
logical arguments to persuade the client to accept the hallucinations as not real.

5. A nurse is assessing a client diagnosed with paranoid schizophrenia. The

nurse asks the client, "
Do you receive special messages from certain sources, such
as the television or radio?" Which
potential symptom of this disorder is the nurse
assessing?
A. Thought insertion
B. Paranoid delusions
C. Magical thinking
D. Delusions of reference
ANS: D
The nurse is assessing for the potential symptom of delusions of reference. A client who
believes that he or she receives messages through the radio is experiencing delusions
of reference. When a client experiences these delusions, he or she interprets all events
within the environment as personal references.

6.A client diagnosed with schizophrenia tells a nurse, "The 'Shopatouliens' took
my shoes out of my room last night." Which is an appropriate charting entry to
describe this client's statement?
A. "The client is experiencing command hallucinations."
B. "The client is expressing a neologism."
C. "The client is experiencing a paranoid delusion."
D. "The client is verbalizing a word salad."
ANS: B
The nurse should describe the client's statement as experiencing a neologism. A
neologism is when a client invents a new word that is meaningless to others but may
have symbolic meaning to the client. Word salad refers to a group of words that are put
together randomly.

7. During an admission assessment, a nurse asks a client diagnosed with

schizophrenia, "Have you ever felt that certain objects or persons have control
over your behavior?" The nurse is assessing for which type of thought
disruption?
A. Delusions of persecution
B. Delusions of influence
C. Delusions of reference
D. Delusions of grandeur
ANS: B
The nurse is assessing the client for delusions of influence when asking if the client has
ever felt that objects or persons have control of the client's behavior. Delusions of
control or influence are manifested when the client believes that his or her behavior is
being influenced. An example would be if a client believes that a hearing aid receives
transmissions that control personal thoughts and behaviors.

8. A client diagnosed with schizophrenia states, "Can't you hear him? It's the
devil. He's telling
me I'm going to hell." Which is the most appropriate nursing reply?
A. "Did you take your medicine this morning?"
B. "You are not going to hell. You are a good person."
C. "I'm sure the voices sound scary. The devil is not talking to you. This is part of
your illness."
D. "The devil only talks to people who are receptive to his influence."

ANS: C
The most appropriate reply by the nurse is to reassure the client with an accepting
attitude while not reinforcing the hallucination. Reminding the client that "the voices" are
a part of his or her illness is a way to help the client accept that the hallucinations are
not real.

9. A client diagnosed with psychosis NOS (not otherwise specified) tells a nurse
about voices telling him to kill the president. Which nursing diagnosis should the
nurse prioritize for this client?
A. Disturbed sensory perception
B. Altered thought processes
C. Risk for violence: directed toward others
D. Risk for injury
ANS: C
The nurse should prioritize the diagnosis risk for violence: directed toward others. A
client who hears voices telling him to kill someone is at risk for responding and reacting
to the command hallucination. Other risk factors for violence include aggressive body
language, verbal aggression, catatonic excitement, and rage reactions.

10. Which nursing intervention would be most appropriate when caring for an
acutely agitated client diagnosed with paranoid schizophrenia?
A. Provide neon lights and soft music.
B. Maintain continual eye contact throughout the interview.
C. Use therapeutic touch to increase trust and rapport.
D. Provide personal space to respect the client's boundaries.
ANS: D
The most appropriate nursing intervention is to provide personal space to respect the
client's boundaries. Providing personal space may serve to reduce anxiety and thus
reduce the client's risk for violence.