Jam Mikka G.

Rodriguez

NCM 105 - CARE OF CLIENTS WITH MALADAPTIVE PATTERNS OF BEHAVIOR

INSTRUCTION:
Please choose the correct answer. Color RED your chosen answer. Add rationalization to your chosen answer and color it
BLUE.Everyone must send their answers to my email add on or before 4:00 PM today (March 17, 2020). Thank you.

EXAMPLE:
The biochemical theory of schizophrenia known as the Dopamine hypothesis refers to:
A. Insufficient Dopamine activity
B. Contaminated Dopamine
C. Excess Dopamine activity
D. Allergic sensitivity to Dopamine
Dopamine Hypothesis: A theory which argues that the symptoms of schizophrenia are related to excess activity of the
neurotransmitter dopamine

1. Which of the following rationales is most important to understand when working with schizophrenic patients?
A. Environmental stimulation can improve thought process.
B. Providing external control assists their self-control.
C. Increasing daily social contacts increases their self-esteem.
D. Non-structured group therapy enhances their energy level.
Use external controls, as necessary, to calm the patient.

2. Previous to being hospitalized, a patient diagnosed with schizophrenia was reported to be unresponsive, mute and
refusing food for several days. What is the highest priority for this patient upon admission to the hospital?
A. Contacting family members
B. List of current medications
C. Assessment of intake and output
D. Assign patient to a room near the nurses’ station
This is important in order to have a basis if the patient has problems in nutrition, hydration and fluid and electrolytes.

3. Which symptoms of schizophrenia are most amenable to treatment with both low- and high-potency antipsychotic
medications?
A. Hallucinations and delusions
B. Lack of motivation and initiative
C. Inadequate hygiene and grooming
D. Social withdrawal and isolation
Typical antipsychotics sometimes referred to as first-generation antipsychotics, are a class of psychotropic drug used to
treat the symptoms of psychosis. Psychosis is defined as a behavior in which a person loses touch with reality, often
manifesting with hallucinations and delusions.

4. A patient with paranoid schizophrenia is delusional, unkempt and annoying to other patients. The priority intervention
for this patient is to:
A. encourage the patient to maintain ADLs.
B. provide a safe environment.
C. determine the frequency of the delusions.
D. assess need for a private room.
As a nurse, it is always a priority to ensure the safety of the patient especially a paranoid schizophrenic patient’s
environment.

5. Which nursing diagnosis is universally applicable to patients with schizophrenia?

A. Noncompliance
B. Disturbed body image
C. Disturbed thought processes
D. Risk for other-directed violence
Disturbed thought process as a nursing diagnosis for schizophrenia. Patients usually exhibit disturbed perception and
delusions that greatly affect their thought process.

6. Situation: A 42-year old male client, is admitted in the ward because of bizarre behaviors. He is given a diagnosis of
schizophrenia paranoid type. The client should have achieved the developmental task of:
A. Trust vs. mistrust
B. Industry vs. inferiority
C. Generativity vs. stagnation
D. Ego integrity vs. despair
The client belongs to the middle adulthood stage (30 to 65 yrs.) The developmental task generativity is characterized by
concern and care for others. It is a productive and creative stage. (A) Infancy stage (0 – 18 mos.) is concerned with
gratification of oral needs (B) School Age child (6 – 12 yrs.) is characterized by acquisition of school competencies and
social skills (C) Late adulthood ( 60 and above) Concerned with reflection on the past and his contributions to others and
face the future.

7. Clients who are suspicious primarily use projection for which purpose:
A. deny reality
B. to deal with feelings and thoughts that are not acceptable
C. to show resentment towards others
D. manipulate others
Projection is a defense mechanism where one attributes ones feelings and inadequacies to others to reduce anxiety. A.
This is not true in all instances of projection C and D. This focuses on the self rather than others

8. The client says “the FBI is out to get me.” The nurse’s best response is:
A. “The FBI is not out to catch you.”
B. “I don’t believe that.”
C. “I don’t know anything about that. You are afraid of being harmed.”
D. “What made you think of that.”
This presents reality and acknowledges the clients feeling A and B. are not therapeutic responses because these disagree
with the client’s false belief and makes the client feel challenged D. unnecessary exploration of the false.

9. The client on Haldol has pill rolling tremors and muscle rigidity. He is likely manifesting:
A. tardive dyskinesia
B. Pseudo-parkinsonism
C. Akinesia
D. Dystonia
Pseudoparkinsonism is a side effect of antipsychotic drugs characterized by mask-like facies, pill rolling tremors, muscle
rigidity A. Tardive dyskinesia is manifested by lip smacking, wormlike movement of the tongue C. Akinesia is
characterized by feeling of weakness and muscle fatigue D. Dystonia is manifested by torticollis and rolling back of the
eyes

10. The client is very hostile toward one of the staff for no apparent reason. The client is manifesting:
A. Splitting
B. Transference
C. Countertransference
D. Resistance
Transference is a positive or negative feeling associated with a significant person in the client’s past that are
unconsciously assigned to another A. Splitting is a defense mechanism commonly seen in a client with personality
disorder in which the world is perceived as all good or all bad C. Countertransference is a phenomenon where the nurse
shifts feelings assigned to someone in her past to the patient D. Resistance is the client’s refusal to submit himself to the
care of the nurse.

11. Gia told his nurse that the FBI is monitoring and recording his every movement and that microphones have been
plated in the unit walls. Which action would be the most therapeutic response?
A. Confront the delusional material directly by telling Gia that this simply is not so.
 B. Tell Gia that this must seem frightening to him but that you believe he is safe here.
C. Tell Gia to wait and talk about these beliefs in his one-on-one counselling sessions.
D. Isolate Gia when he begins to talk about these beliefs.
The nurse must realize that these perceptions are very real to the client. Acknowledging the client’s feelings provides
support; explaining how the nurse sees the situation in a different way provides reality orientation. Confronting the
delusional material directly will not work with this client and may diminish trust. Telling the client to wait and talk about
these beliefs in his one-on-one counselling session will reinforce the delusion. Isolation will increase anxiety. Distraction
with a radio or activities would be a better approach.

12. Which of the following client behaviors documented in Gia’s chart would validate the nursing diagnosis of Risk for
other-directed violence?
A. Gia’s description of being endowed with superpowers
B. Frequent angry outburst noted toward peers and staff
C. Refusal to eat cafeteria food
D. Refusal to join in group activities
Anger is an important factor that indicated the potential for acting out. Because the client is angry with both peers and
staff, any acting out would probably be directed toward others. The client’s description of being endowed with
superpowers and his refusal to eat cafeteria food indicate that he may have delusional beliefs, but not necessarily a risk for
violence. Refusal to join in group activities indicates discomfort with a group, however, no threat of violence is apparent.

13. The family of a schizophrenic client asks the nurse if there is a genetic cause of this disorder. To answer the family,
which fact would the nurse cite?
A. Conclusive evidence indicates a specific gene transmits the disorder.
B. Incidence of this disorder is variable in all families.
C. There is a little evidence that genes play a role in transmission.
D. Genetic factors can increase the vulnerability for this disorder.
Research shows that family history statistically increases the risk for development of schizophrenia. However, no single
gene has yet been identified. Options B and and C are both incorrect because genetics plays a role in the etiology of
schizophrenia.

14. Ramsay is diagnosed with schizophrenia paranoid type and is admitted in the psychiatric unit of Nurses Medical
Center. Which of the following nursing interventions would be most appropriate?
A. Establishing a non-demanding relationship
B. Encouraging involvement in group activities
C. Spending more time with Ramsay
D. Waiting until Ramsay initiates interaction
A nonthreatening, non demanding relationship helps decrease the mistrust that is common in a client with paranoid
schizophrenia. Encouraging involvement in group activities and spending more time with the client would be threatening
for a client who is suspicious of other people’s motives. This client is unlikely to initiate interaction; the nurse is
responsible for initiating a relationship with the client.

15. Upon Sam’s admission for acute psychiatric hospitalization, Nurse Jona documents the following: Client refuses to
bathe or dress, remains in room most of the day, speaks infrequently to peers or staff. Which nursing diagnosis would be
the priority at this time?
A. Anxiety
B. Decisional conflict
C. Self-care deficit
D. Social isolation
These behaviors indicate the client’s withdrawal from others and possible fear or mistrust of relationships. There is no
indication of Anxiety or Decisional conflict in the information provided. Although the client refuses to bathe or dress,
Self-care deficit would not be the priority nursing diagnosis in this situation.

16. Which information is most essential in the initial teaching session for the family of a young adult recently diagnosed
with schizophrenia?
A. Symptoms of this disease imbalance in the brain.
 B. Genetic history is an important factor related to the development of schizophrenia.
C. Schizophrenia is a serious disease affecting every aspect of a person’s functioning.
D. The distressing symptoms of this disorder can respond to treatment with medications.
This statement provides accurate information and an element of hope for the family of a schizophrenic client. Although
the remaining statements are true, they do not provide the empathic response the family needs after just learning about the
diagnosis. These facts can become part of the ongoing teaching.

17. A nurse is working with a client who has schizophrenia, paranoid type. Which of the following outcomes related to the
client’s delusional perceptions would the nurse establish?
A. The client will demonstrate realistic interpretation of daily events in the unit.
B. The client will perform daily hygiene and grooming without assistance.
C. The client will take prescribed medications without difficulty.
D. The client will participate in unit activities.
A client with schizophrenia, paranoid type, has distorted perceptions and views people, institutions, and aspects of the
environment as plotting against him. The desired outcome for someone with delusional perceptions would be to have a
realistic interpretation of daily events. The client with a distorted perception of the environment would not necessarily
have impairments affecting hygiene and grooming skills. Although taking medications and participating in unit activities
may be appropriate outcomes for nursing intervention, these responses are not related to client perceptions.

18. Prior to administering chlorpromazine (Thorazine) to an agitated client, the nurse should:
A. Assess skin color and sclera
B. Assess the radial pulse
C. Take the client’s blood pressure
D. Ask the client to void
A client with schizophrenia, paranoid type, has distorted perceptions and views people, institutions, and aspects of the
environment as plotting against him. The desired outcome for someone with delusional perceptions would be to have a
realistic interpretation of daily events. The client with a distorted perception of the environment would not necessarily
have impairments affecting hygiene and grooming skills. Although taking medications and participating in unit activities
may be appropriate outcomes for nursing intervention, these responses are not related to client perceptions.

19. A 19-year-old woman who is a college student is brought to the clinic by her roommate because she has been acting
strangely during the past six months. During the past month, the patient has been describing how another person's
thoughts have been entering into her mind. The patient's grades have been slipping, and she does not talk as much as she
did previously. The roommate says that when the patient does talk, she strays from the topic and is hard to follow. During
the interview, the patient says a television reporter told her that the government had a special message for her and she
should listen to the radio for further instructions. Which of the following conditions is the most likely cause of this
patient's symptoms?
A. Delusional disorder
B. Schizoaffective disorder
C. Schizophrenia
D. Schizophreniform disorder
The patient has had classic symptoms of schizophrenia for at least six months, including hallucinations (voices speaking
to her), social dysfunction affecting grades and friendships, and disorganized speech. Although the patient is somewhat
young for schizophrenia (peak incidence in women is between 25 and 35 years), her symptoms meet the DSM criteria for
the condition.

20. A 37-year-old man comes to the office after he experienced what he says was a nervous breakdown. The patient says
that after he recently declared bankruptcy, losing his home and his business, he became very depressed. During this time,
he began to hear voices telling him that he was useless and should kill himself. The patient says his symptoms stopped
after approximately one week. He has had no similar episodes. Medical history includes no psychiatric conditions.
Physical examination shows no abnormalities, and results of laboratory studies are within normal limits. Which of the
following is the most likely diagnosis?
A. Brief psychotic disorder
B. Major depressive disorder with psychotic features
C. Schizophrenia
 D. Schizophreniform disorder
Essential features of brief psychotic disorder include sudden onset of one or more of the following symptoms: delusions,
hallucinations, disorganized speech, disorganized behavior, and catatonia. Brief psychotic disorder is also characterized
by duration of symptoms for at least one day but less than one month followed by return to premorbid level of
functioning. The disorder is not associated with a medical condition or the effect of illicit substances such as
hallucinogens.

21. A client with schizophrenia, disorganized type admitted to the inpatient unit. He frequently giggles and mumbles to
himself. He hasn’t taken a shower for the last 3 days, presenting a disheveled, unkempt appearance and other clients are
beginning to complain. Which statement would be most appropriate for the nurse to use in persuading the client to
shower?
A. “Clients on this unit take showers daily.”
B. “It’s time to shower. I will help you.”
C. “You’ll feel better if you shower.”
D. “Would you like to take a shower?”
Clients with schizophrenia, disorganized type, need direction and limit-setting when performing activities.
Communication must be clear, simple, and directed at the client's level of functioning. Thus, telling the client that it is
time to shower and that the nurse will assist is the most appropriate statement. Stating that clients on this unit take
showers is demanding and not therapeutic. Additionally, the client may be unable to understand the implications of this
statement as it affects him. Because of the client's current symptoms, the client will most likely be unable to comprehend
the significance of feeling better if he showers. Additionally, this statement could be viewed as false reassurance. Also, in
light of the client's current symptoms, he is unable to make decisions; therefore, asking him if he would like to take a
shower would be inappropriate.

22. A new client is being admitted to a care facility. The client is a 22-year-old Caucasian male who has been diagnosed
with paranoid schizophrenia. The nurse expects to assess which of the following in a client with the diagnosis of
schizophrenia, paranoid type?
A. Anger, auditory hallucinations, persecutory delusions
B. Abnormal motor activity, frequent posturing, autism
C. Flat affect, anhedonia, alogia
D. Silly behavior, poor personal hygiene, incoherent speech
Clients with schizophrenia, paranoid type, tend to experience persecutory or grandiose delusions and auditory
hallucinations in addition to behavioral changes such as anger, hostility, or violent behavior. Abnormal motor activity,
posturing, autism, stupor, and echolalia are associated with schizophrenia, catatonic type. Flat affect, anhedonia, and
alogia are negative symptoms associated with schizophrenia in general. Schizophrenia, disorganized type, is characterized
by withdrawal, incoherent speech, and lack of attention to personal.

23. The client experiences a disintegration of personality and is withdrawn. Speech may be incoherent. Behavior is
uninhibited, along with a lack of attention to personal hygiene and grooming. Which type of schizophrenia best describes
the above symptoms?
A. Catatonic type
B. Paranoid type
C. Undifferentiated type
D. Disorganized type
The most appropriate outcome for a client with disturbed thought processes from delusions would be the client's ability to
talk about concrete events without talking about delusions. This would indicate that the client is in touch with reality.
Stating three symptoms of stress is unrelated to the problem involving thought processes. Identifying two personal
interventions to decrease delusions would be more appropriate for a nursing diagnosis of deficient knowledge associated
with controlling delusions. Using distracting techniques would be appropriate for a nursing diagnosis of ineffective
coping.

24. A patient is experiencing auditory hallucinations in the form of the voice of his deceased mother. Which nursing
response would be most appropriate when a client talks about hearing voices?
A. “I do not hear the voices that you say you hear.”
B. “Those voices will disappear as soon as the medicine works.”
 C. “Try to think about positive things instead of voices.”
D. “Voices are only in your imagination.”
When a client reports that he or she is hearing voices, it is important for the nurse to understand that the voices have
meaning to the client, yet acknowledge to the client that the nurse does not hear the voices. Telling the client that the
voices will disappear with medication, telling the client to think about positive things, or stating that the voices are the
client's imagination ignores the importance or significance of the voices for the client.

25. During a community meeting, a client with schizophrenia begins to shout and gesture in an angry manner frightening
the audience. Which nursing intervention would be the priority?
A. Determining reasons for the client’s agitation
B. Encouraging appropriate behavior in a group
C. Facilitating group process in responding to the client
D. Maintaining safety of the client and others
In any situation, but especially one in which a client begins to show anger and possible loss of control, the nurse is
responsible for maintaining the safety of the client and others first. Once safety is addressed and the situation is stabilized,
then the nurse can address other areas such as reasons, group behavior, and group process.

26. After a class on schizophrenia and its phases, the nursing students identify the following phases of schizophrenia.
Place the phases in the correct sequence from the first to last. (use number 1-5)
A. Prodromal - 2
B. Premorbid - 1
C. Residual - 5
D. Progressive - 4
E. Onset – 3
The five phases of schizophrenia, in order of occurrence, are premorbid, prodromal, onset, progressive and residual.

27. Nurse Wynona educates the family about symptom management for when the schizophrenic client becomes upset or
anxious. Which of the following would Nurse Wynona state is helpful?
A. Call the therapist to request a medication change.
B. Encourage the use of learned relaxation techniques.
C. Request that the client be hospitalized until the crisis is over.
D. Wait before the anxiety worsens before intervening.
The client with schizophrenia can learn relaxation techniques, which help reduce anxiety. The family can be supportive
and helpful by encouraging the client to use these techniques. Anxiety is a common experience for everyone, and is no
reason to change medication. Handling anxiety is a learned skill that is important to reinforce. There is no indication that
the client is in crisis. It is much easier to intervene early in anxiety rather than waiting until escalation occurs.

28. Diego who has had auditory hallucinations for many years tells Nurse Kelly that the voices prevent his participation in
a social skills training program at the community health center. Which intervention is most appropriate?
A. Let Diego analyze the content of the voices.
B. Advise Diego to participate in the program when the voices cease.
C. Advise Diego to take his medications as prescribed.
D. Teach Diego to use thought stopping techniques.
Clients with long-lasting auditory hallucinations can learn to use thought stopping measures to accomplish tasks.
Analyzing the content of the voices may be indicated when hallucinations first occur to establish whether the voices are
threatening to the client or instructing him to harm others. However, focusing on their content at this point would
reinforce this symptom. The voices have lasted many years; the client should participate despite the voices. There is no
indication that the client is not taking medication as prescribed.

29. A nurse is working with a client who has schizophrenia, paranoid type. Which of the following outcomes related to the
client’s delusional perceptions would the nurse establish?
A. The client will demonstrate realistic interpretation of daily events in the unit.
B. The client will perform daily hygiene and grooming without assistance.
C. The client will take prescribed medications without difficulty.
D. The client will participate in unit activities.
A client with schizophrenia, paranoid type, has distorted perceptions and views people, institutions, and aspects of the
environment as plotting against him. The desired outcome for someone with delusional perceptions would be to have a
realistic interpretation of daily events. The client with a distorted perception of the environment would not necessarily
have impairments affecting hygiene and grooming skills. Although taking medications and participating in unit activities
may be appropriate outcomes for nursing intervention, these responses are not related to client perceptions.

30. A 23-year-old client has been admitted with a diagnosis of schizophrenia says to the nurse “Yes, its march, March is
little woman”. That’s literal you know”. These statements illustrate:
A. Neologisms
B. Echolalia
C. Flight of ideas
D. Loosening of association
Loose associations are thoughts that are presented without the logical connections usually
necessary for the listening to interpret the message.

31.Ben is assigned in a psychiatric ward; he notices that one of the patients would follow every move he would make.
When he moves his hand, the patient would also move his hand. This is:
A. Waxy Flexibility
B. Echolalia
C. Perseveration
D. Echopraxia
Echopraxia is a negative symptom wherein the patient would copy other’s movements. It is an involuntary movement in
general.

32.During an interview, Rona notices that the client’s response is similar to what she says. This is:
A. Waxy Flexibility
B. Echolalia
C. Perseveration
D. Echopraxia
Echolalia means that the person is repeating the words being spoken by the other person during a conversation. It is
common in autism.

33.While making rounds, Mary noticed one of her clients saying the following line: “I have money, want to study. Daddy
wants honey, honey honey bee…This is an example of?
A. Neologism
B. Word Salad
C. Flight of ideas
D. Clang association
Clang association is group of words the client says that includes rhyming.

34.Ana approached a client and asked “Hi, Mr. Chase how’s your day? Mr. Chase: “This is a wonderful ……” (No
response was heard after. This is:
A. Perseveration
B. Clang association
C. Neologism
D. Blocking
Blocking means abrupt cessation in train of thought before a though or idea is completed.

35.“Handy dandy, this is my work. I want to shop. Apple pie. Custard pie.” This is:
A. Neologism
B. Word Salad
C. Flight of ideas
D. Clang association
Word Salad is a manifestation of client that involves train of words that does not have a relation but the client keeps on
saying it.
36.Britney said to her nurse one day, “You know what, that medication nurse would always give medicines in a cup.
Don’t you know that the cup contains the blood of a sacrificed animal? She wants us to drink it. Can you help me stop
her?”
A. Phobia
B. Delusion of reference
C. Paranoia
D. Delusion of grandeur
This is an example of a paranoid thought content. Phobia means being fearful of certain things that are present.

37.“I am the heir of the Ayala land, they only taken it away from my father.” Claimed by a patient in the psychiatric ward,
this is an example of:
A. Delusion of jealousy
B. Delusion of paranoia
C. Delusion of persecution
D. Delusion of grandeur
Delusion of grandeur means having a false belief of being an important person rather than what he or she really is.

38.A person seeing a design on the floor thought it was a fossil, this is an example of:
A. Illusion
B. Delusion
C. Hallucination
D. Idea of reference
Illusion is a thought process wherein the image seen by the naked eye may not be really what it is.

39.“That man wants to kill me, he keeps on stalking me for almost three months now.” This is:
A. Illusion
B. Delusion
C. Hallucination
D. Idea of reference
Delusion is a belief that something is going to happen to him or her but actually not. The above example is actually an
example of delusion of persecution.

40.During the impeachment trial, a client happened to watch one of the episodes of the senate hearing. The client shouted:
“They are asking me to tell the truth. They are looking for me now.”
This is an example of:
A. Illusion
B. Delusion
C. Hallucination
D. Idea of reference
Idea of reference is a type of thought that an external source which is no way in relation to the person may pertain
something to the person in personal level. The client may thought that he or she is being talked or asked about when in
reality it is not him or her.

41.Bryan is a nurse assigned in a psychiatric ward; he takes note that the most common type of hallucination is:
A. Visual
B. Olfactory
C. Auditory
D. Tactile
Auditory hallucination is the most common type of hallucination among patients.

42.Which of the following is an appropriate nursing action to a patient with a delusion?

A. Isolate the patient as he or she may harm other people.
B. Do not challenge the patient in proving the delusion
C. Promise that antipsychotic drugs in order to improve the though content
 D. Make it to a point to challenge the patient in proving the delusion
Avoiding challenging the thought content of the patient can lessen the production of thought content which as delusion in
nature. Isolating the patient would not be a correct nursing action since it is dangerous to leave the patient with a delusion
alone. Giving a promise is simply not a therapeutic response.

43. The nurse should expect that a client who cheeks the medication is a non-complaint patient. Knowing the non-
compliance is the single most important factor for exacerbation and re-hospitalization, the doctor ordered Prolixin
[FluphenazineDecanoate]. The nurse knows that is it given:
A. Orally
B. Sublingually
C. IV
D. IM
Fluphenazine decanoate is usually administered by deep intramuscular (IM) injection into the gluteal region.

44. A 22-year-old female hears voices asking her to do em¬phasizing thing like sleep with the person sitting next to her
and she does so. She is a schizophrenic on treat¬ment with chlorpromazine for the past 10 years. The in¬tensity of the
voice decreases but persists. She is to be treated with:
A. Clozapine
B. Haloperidol
C. Tianeptine
D. Sulpiride
Clozapine is effective in management of treatment- resistant schizophrenia.

45. A client tells the nurse that psychotropic medicines are dangerous and refuses to take them. Which intervention should
the nurse use first?
A. Ask the client about any previous problems with psychotropic medications.
B. Ask the client if an injection is preferable.
C. Insist that the client takes medication as prescribed.
D. Withhold the medication until the client is less suspicious.
The nurse needs to clarify the client's previous experience with psychotropic medication in order to understand the
meaning of the client's statement. Asking the client if an injection is preferable may add to the client’s suspicion and
feeling threatened. Withholding medication prescribed to relieve delusional beliefs will likely intensify paranoid thinking.
Insisting that the client take medication can be a violation of his right to refuse treatment.

46. A client on an in-patient psychiatric unit refuses to take medications because, “The pill has a special code written on it
that will make it poisonous.” What kind of delusion is this client experiencing?
A. A somatic delusion.
B. An erotomanic delusion.
C. A grandiose delusion.
D. A persecutory delusion.
A persecutory delusion is one in which the individual believes he or she is being treated maliciously. This situation
reflects this type delusion.

47. 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
Option D: Retinal pigmentation may occur if the thioridazine dosage exceeds 800 mg per day. Options A, B, and C: The
other options don’t occur as a result of exceeding this dose.

48. 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
Option D: Although most phenothiazines produce some effects within minutes to hours, their antipsychotic effects may
take several weeks to appear.

49. 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.
Option C: Because haloperidol can cause photosensitivity and precipitate severe sunburn, the nurse should instruct the
client to apply a sunscreen before exposure to the sun. Options A, B, and D: 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.

50. 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
Option B: Risperdal has a lower incidence of extrapyramidal effects than the typical antipsychotics. Option A: Risperdal
does produce anticholinergic effects and neuroleptic malignant syndrome can occur. Option C: Photosensitivity isn’t an
advantage.

51. 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)
Option A: 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). Option B: 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. Option C: Clonazepam, a benzodiazepine drug that depresses the CNS, is administered to
control seizure activity. Option D: Diazepam, a benzodiazepine drug, is administered to reduce anxiety.

52. A client with schizophrenia is receiving antipsychotic medication. Which nursing diagnosis may be appropriate for
this client?
A. Ineffective protection related to blood dyscrasias
B. Urinary frequency related to adverse effects of
C. Risk for injury related to a severely decreased level of consciousness
D. Risk for injury related to electrolyte disturbances
Option A: Antipsychotic medications may cause neutropenia and granulocytopenia, life-threatening blood dyscrasias, that
warrant a nursing diagnosis of Ineffective protection related to blood dyscrasias. These medications also have
anticholinergic effects, such as urine retention, dry mouth, and constipation. Option B: Urinary frequency isn’t an
approved nursing diagnosis. Option C: Although antipsychotic medications may cause sedation, they don’t severely
decrease the level of consciousness. Option D: These drugs don’t cause electrolyte disturbances.
53. A client with persistent, severe schizophrenia has been treated with phenothiazines for the past 17 years. Now the
client’s speech is garbled as a result of drug-induced rhythmic tongue protrusion. What is another name for this
extrapyramidal symptom?
A. Dystonia
B. Akathisia
C. Pseudoparkinsonism
D. Tardive dyskinesia
Option D: An adverse reaction to phenothiazines, tardive dyskinesia refers to choreiform tongue movements that
commonly are irreversible and may interfere with speech. Option A: Dystonia refers to involuntary contraction of a
muscle group. Option B: Akathisia is restlessness or inability to sit still. Option C: Pseudoparkinsonism describes a group
of symptoms that mimic those of Parkinson’s disease.

54. A client with a history of medication noncompliance is receiving outpatient treatment for chronic undifferentiated
schizophrenia. The physician is most likely to prescribe which medication for this client?
A. chlorpromazine (Thorazine)
B. imipramine (Tofranil)
C. lithium carbonate (Lithane)
D. fluphenazinedecanoate (ProlixinDecanoate)
Option D: Fluphenazine decanoate is a long-acting antipsychotic agent given by injection. Because it has a 4-week
duration of action, it’s commonly prescribed for outpatients with a history of medication noncompliance. Option A:
Chlorpromazine, also an antipsychotic agent, must be administered daily to maintain adequate plasma levels, which
necessitates compliance with the dosage schedule. Options B and C: Imipramine, a tricyclic antidepressant, and lithium
carbonate, a mood stabilizer, are rarely used to treat clients with chronic schizophrenia.

55. Propranolol (Inderal) is used in the mental health setting to manage which of the following conditions?
A. Antipsychotic-induced akathisia and anxiety
B. The manic phase of bipolar illness as a mood stabilizer
C. Delusions for clients suffering from schizophrenia
D. Obsessive-compulsive disorder (OCD) to reduce ritualistic behavior
Option A: Propranolol is a potent beta-adrenergic blocker and produces a sedating effect; therefore, it’s used to treat
antipsychotic induced akathisia and anxiety. Option B: Lithium (Lithobid) is used to stabilize clients with bipolar illness.
Option C: Antipsychotics are used to treat delusions. Option D: Some antidepressants have been effective in treating
OCD.

56. The nurse is teaching a psychiatric client about her prescribed drugs, chlorpromazine and benztropine. Why is
benztropine administered?
A. To reduce psychotic symptoms
B. To reduce extrapyramidal symptoms
C. To control nausea and vomiting
D. To relieve anxiety
Option B: Benztropine is an anticholinergic medication, administered to reduce the extrapyramidal adverse effects of
chlorpromazine and other antipsychotic medications. Options A, C, and D: Benztropine doesn’t reduce psychotic
symptoms, relieve anxiety, or control nausea and vomiting.

57. The nurse is aware that antipsychotic medications may cause which of the following adverse effects?
A. Increased production of insulin
B. Lower seizure threshold
C. Increased coagulation time
D. Increased risk of heart failure
Option B: Antipsychotic medications exert an effect on brain neurotransmitters that lowers the seizure threshold and can,
therefore, increase the risk of seizure activity. Options A and C: Antipsychotics don’t affect insulin production or
coagulation time. Option D: Heart failure isn’t an adverse effect of antipsychotic agents.

Situation: Dennis 40 y/o married man, an electrical engineer was admitted with the diagnosis of paranoid disorders. He
has become suspicious and distrustful 2 months before admission. Upon admission, he kept on saying, “my wife has been
planning to kill me.” (58-62)
58. A paranoid individual who can’t accept the guilt demonstrate one of the following defense mechanism:
A. Denial
B. Projection
C. Rationalization
D. Displacement
Projection is a mechanism in which inner thoughts and feelings are projected onto the environment, seeming to come from
outside the self rather than from within.

59. One morning, Dennis was seen tilting his head as if he was listening to someone. An appropriate nursing intervention
would be:
A. Tell him to socialize with other patient to diverts his attention
B. Involve him in group activities
C. Address him by name to ask if he is hearing voices again
D. Request for an order of antipsychotic medicine
Ask the person to tell you what is happening. Ask whether he or she is afraid or confused.

60. When he says, “these voices are telling me my wife is going to kill me.” A therapeutic communication of the nurse is
which one of the following:
A. “I do not hear the voices you say you hear.”
B. “Are you really sure you heard those voices?”
C. “I do not think you heard those voices?”
D. “Whose voices are those?”
Tell the person that he or she is having a hallucination and that you do not see or hear what he or she does.

61. The nurse confirms that Dennis is manifesting auditory hallucination. The appropriate nursing diagnosis she identifies
is:
A. Sensory perceptual alteration
B. Self-esteem disturbance
C. Ineffective individual coping
D. Defensive copin
State in which an individual experiences a change in the amount or type of stimuli received, accompanied decrease
towards exaggeration or disorder of the response to such stimuli.

62. Most appropriate nursing intervention for a client with suspicious behavior is one of the following:
A. Talk to the client constantly to reinforce reality
B. Involve him in competitive activities
C. Use of Non-Judgmental and Consistent approach
D. Project cheerfulness in interacting with the patient
Because using this approach makes people more likely to be honest, with less hostile conversation, and can open your
mind to other peoples thoughts and viewpoints

63. During psychiatric interview patient retains a constellation of ideas long after they have ceased to be appropriate. E.g.
“where do you live?”, “London”, “How old are you”, “London. The term used to explain the condition is:
A. Perseveration
B. Clang association
C. Circumstantiality
 D. Tangentiality
Perseveration according to psychology, psychiatry, and speech-language pathology, is the repetition of a particular
response such as a word, phrase, or gesture regardless of the absence or cessation of a stimulus. It is usually caused by a
brain injury or other organic disorder.

64. The best approach for the mental health nurse to take when a client thinks his food is poisoned is to
A. assure the client that all food served on the hospital is safe to eat.
B. obtain an order for a tube feeding for the client.
C. provide the client with food in unopened containers.
D. tell the client that irrational thinking is detrimental to good health.
So client assure that the food has not been touch or has not been put with anything that could harm her/him.

65. A patient is taking Chlorpromazing and Biperidine Hydrochloride (Akineton). Which of these statements by the
patient would indicate that Akineton has achieved its desired effect?
A. “I’m sleeping better.”
B. “I know now that I only imagined that the Police were following me.”
C. “I’m beginning to feel comfortable with people.”
D. “My muscles are less stiff.”
This medication Tablet is an anticholinergic antiparkinson agent used to treat the stiffness, tremors, spasms, and poor
muscle control of Parkinson's disease.

66. One of the following actions should be avoided because it can increase anxiety and suspiciousness:
A. Initiating a one-on-one conversation
B. Staying with the patient for a short time during the day
C. Talking with the family members within hearing distance from the patient
D. Whispering with others which can be observed by the patient
Talking with others that is not near to the patient will make the patient think that you are talking about him/her.

67. A patient on antipsychotic drug has been found to exhibit bizarre facial and tongue movements. Based on these
findings the patient is manifesting:
A. Akinesia
B. Pseudoparkinsonism
C. Tardive Dyskinesia
D. Oculogyric crisis
Tardive dyskinesia is a side effect of antipsychotic medications. These drugs are used to treat schizophrenia and other
mental health disorders. TD causes stiff, jerky movements of your face and body that you can't control. You might blink
your eyes, stick out your tongue, or wave your arms without meaning to do so.

68. Of the following responses, which would be your best response to the client regarding the snake?
A. “Don’t worry; I’ll get rid of it.”
B. “I don’t see a snake; what else do you see that isn’t there?”
C. “I don’t see a snake. It is time for your group meeting. I’ll walk with you to the meeting room.”
D. “Where is it? I hate snakes. Let’s get out of here.”
You have to present the reality and assure patients safety.

69. A client is telling the nurse about his perception of his thought patterns. Which of the following statements, if made by
the client, would validate the diagnosis of schizophrenia?
A. “I can’t get the same thoughts out of my head.”
B. “I know I sometimes feel on top of the world, then suddenly down.”
C. “Sometimes I look up and wonder where I am.”
D. “It’s clear that this is an alien laboratory and I am in charge.”
This is a sign that a person is having delusion which is false beliefs that are not based in reality.

70. Alexi states that she can’t eat because her body melts when she swallows water. An appropriate nursing diagnosis
would be one of the following:
 A. Sensory perceptual disturbances
B. Altered thought process
C. Impaired social interaction
D. Ineffective individual coping
Disturbed Thought Processes: The state in which an individual experiences a disruption in such mental activities as
conscious thought, reality orientation, problem-solving, judgment, and comprehension related to coping, personality,
and/or mental disorder.

71. A psychiatrist is making morning rounds, and after examining one of the adult male clients who continues to exhibit
flat affect, isolation, poverty of speech and lack of motivation, the doctor then writes an order to change from Haloperidol
(Haldol) to Risperidone (Risperdal). The dosage ordered is 1 mg BID for 3 days. It is most important that the nurse:
A. Monitor the client for mood changes and suicidal tendencies especially during early therapy
B. Assess the side effects of sedation, restlessness and muscle spasm once the drug has been administered
C. Determine if the morning dosage of Haldol had been given and then start the initial dose of Riperdal at bedtime
D. Review the medication sheet to determine the time of the last dose of Haldol before administering the correct
dosage of Risperdal at 2 pm
To evaluate the response of the patient while taking this drug.

72. After 2 weeks of drug therapy, the nurse notices that the client has become jaundiced. The nurse continues to give the
neuroleptic until the psychiatrist can be consulted. In situations like this:
A. Jaundice is a benign side effect and has little significance
B. Jaundice is sufficient reason to discontinue the neuroleptic
C. The blood level of neuroleptics must be maintained once established
D. The psychiatrist’s order for the neuroleptic should be reduced by the nurse
It is a sign that the patient is having liver injury.

73. Mr. Savy was diagnosed with schizophrenia a week ago and he was given Haloperidol 10 mg BID as his take home
medication. As a community health nurse, you visited Mr. Savy and you noticed that he is very warm to touch and has
muscle rigidity. You are suspecting him to be experiencing:
A. Dystonia
B. Pseudoparkinsonism
C. Neuroleptic Malignant Syndrome (NMS)
D. Agranulocytosis
Neuroleptic malignant syndrome (NMS) is a rare reaction to antipsychotic drugs that treat schizophrenia, bipolar disorder,
and other mental health conditions. It affects the nervous system and causes symptoms like a high fever and muscle
stiffness.

74. Antipsychotic medications have certain side effects. Which of the following drugs can potentially cause weight gain?
A. Thioridazine (Mellaril)
B. Trifluoperazine (Stelazine)
C. Thiothixene (Navane)
D. Olanzapine (Zyprexia)
Its side effect is weight gain because it stimulate appetite so that people feel hungry, eat more food and take in more
calories.

75. The nurse is caring for a client with delusional schizophrenia. The patient is responding well to the therapy but has had
limited social contact with others. Which of the following interventions is most appropriate?
A. Discourage the patient from interacting with others because if his efforts fail it will be traumatic for the patient
B. Encourage the patient to attend a party thrown for the residents of the facility
C. Encourage the patient to participate in one-on-one interactions
D. Encourage the patient to place a personal advertisement in the local newspaper but not to reveal his disability
As a nurse you have to promote social skills to the patient.