Psychiatric Nursing Practice Exam 7

1. A psychotic client reports to the evening nurse that the day nurse put something suspicious in his water with his medication. The nurse replies, “You’re worried about your medication?” The nurse’s communication is:

1. an example of presenting reality.
2. reinforcing the client’s delusions.
3. focusing on emotional content.
4. a nontherapeutic technique called mind reading.

2. A client is admitted to the inpatient unit of the mental health center with a diagnosis of paranoid schizophrenia. He’s shouting that the government of France is trying to assassinate him. Which of the following responses is most appropriate?

1. “I think you’re wrong. France is a friendly country and an ally of the United States. Their government wouldn’t try to kill you.”
2. “I find it hard to believe that a foreign government or anyone else is trying to hurt you. You must feel frightened by this.”
3. “You’re wrong. Nobody is trying to kill you.”
4. “A foreign government is trying to kill you? Please tell me more about it.”

3. Propranolol (Inderal) is used in the mental health setting to manage which of the following conditions?

1. Antipsychotic-induced akathisia and anxiety
2. The manic phase of bipolar illness as a mood stabilizer
3. Delusions for clients suffering from schizophrenia
4. Obsessive-compulsive disorder (OCD) to reduce ritualistic behavior

4. A client with borderline personality disorder becomes angry when he is told that today’s psychotherapy session with the nurse will be delayed 30 minutes because of an emergency. When the session finally begins, the client expresses anger. Which response by the nurse would be most helpful in dealing with the client’s anger?

1. “If it had been your emergency, I would have made the other client wait.”
2. “I know it’s frustrating to wait. I’m sorry this happened.”
3. “You had to wait. Can we talk about how this is making you feel right now?”
4. “I really care about you and I’ll never let this happen again.”

5. How soon after chlorpromazine (Thorazine) administration should the nurse expect to see a client’s delusional thoughts and hallucinations eliminated

1. Several minutes
2. Several hours
3. Several days
4. Several weeks

6. A client receiving haloperidol (Haldol) complains of a stiff jaw and difficulty swallowing. The nurse’s first action is to:

1. reassure the client and administer as needed lorazepam (Ativan) I.M.
2. administer as needed dose of benztropine (Cogentin) I.M. as ordered.
3. administer as needed dose of benztropine (Cogentin) by mouth as ordered.
4. administer as needed dose of haloperidol (Haldol) by mouth.

7. 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?

1. Say, “You know it’s your medicine.”
2. Allow him to open the individual wrappers of the medication.
3. Say, “Don’t worry about what is in the pills. It’s what is ordered.”
4. Ignore the comment because it’s probably a joke.

8. The 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 the most appropriate?

1. Approach the client and touch him to get his attention.
2. Encourage the client to go to his room where he’ll experience fewer distractions.
3. Acknowledge that the client is hearing voices but make it clear that the nurse doesn’t hear these voices.
4. Ask the client to describe what the voices are saying.

9. Yesterday, a client with schizophrenia began treatment with haloperidol (Haldol). Today, the nurse notices that the client is holding his head to one side and complaining of neck  and jaw spasms. What should the nurse do?

1. Assume that the client is posturing.
2. Tell the client to lie down and relax.
3. Evaluate the client for adverse reactions to haloperidol.
4. Put the client on the list for the physician to see tomorrow

10. A client with paranoid schizophrenia has been experiencing auditory hallucinations for many years. One approach that has proven to be effective for hallucinating clients is to:

1. take an as-needed dose of psychotropic medication whenever they hear voices.
2. practice saying “Go away” or “Stop” when they hear voices.
3. sing loudly to drown out the voices and provide a distraction.
4. go to their room until the voices go away.

11. A client with catatonic schizophrenia is mute, can’t perform activities of daily living, and stares out the window for hours. What is the nurse’s first priority?

1. Assist the client with feeding.
2. Assist the client with showering.
3. Reassure the client about safety.
4. Encourage socialization with peers.

12. A client tells the nurse that the television newscaster is sending a secret message to her. The nurse suspects the client is experiencing:

1. a delusion.
2. flight of ideas.
3. ideas of reference.
4. a hallucination.

13. The nurse knows that the physician has ordered the liquid form of the drug chlorpromazine (Thorazine) rather than the tablet form because the liquid:

1. has a more predictable onset of action.
2. produces fewer anticholinergic effects.
3. produces fewer drug interactions.
4. has a longer duration of action.

14. A client who has been hospitalized with disorganized type schizophrenia for 8 years can’t complete activities of daily living (ADLs) without staff direction and assistance. The nurse formulates a nursing diagnosis of Self-care deficient: Dressing/grooming related to inability to function without assistance. What is an appropriate goal for this client?

1. “Client will be able to complete ADLs independently within 1 month.”
2. “Client will be able to complete ADLs with only verbal encouragement within 1 month.”
3. “Client will be able to complete ADLs with assistance in organizing grooming items and clothing within 1 month.”
4. “Client will be able to complete ADLs with complete assistance within 1 month.”

15. The nurse is planning care for a client admitted to the psychiatric unit with a diagnosis of paranoid schizophrenia. Which nursing diagnosis should receive the highest priority?

1. Risk for violence toward self or others
2. Imbalanced nutrition: Less than body requirements
3. Ineffective family coping
4. Impaired verbal communication

16. The 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 prescribed medication. The nurse should inform him that:

1. his concern is valid but his wife is an adult and has the right to make her own decisions.
2. he can easily mix the medication in his wife’s food if she stops taking it.
3. his wife can be given a long-acting medication that is administered every 1 to 4 weeks.
4. his wife knows she must take her medication as prescribed to avoid future hospitalizations.

17. Benztropine (Cogentin) is used to treat the extrapyramidal effects induced by antipsychotics. This drug exerts its effect by:

1. decreasing the anxiety causing muscle rigidity.
2. blocking the cholinergic activity in the central nervous system (CNS).
3. increasing the level of acetylcholine in the CNS.
4. increasing norepinephrine in the CNS.

18. A client is admitted to the inpatient unit of the mental health center with a diagnosis of paranoid schizophrenia. He’s shouting that the government of France is trying to assassinate him. Which of the following responses is most appropriate?

1. “I think you’re wrong. France is a friendly country and an ally of the United States. Their government wouldn’t try to kill you.”
2. “I find it hard to believe that a foreign government or anyone else is trying to hurt you. You must feel frightened by this.”
3. “You’re wrong. Nobody is trying to kill you.”
4. “A foreign government is trying to kill you? Please tell me more about it.”

19. A dopamine receptor agonist such as bromocriptine (Parlodel) relieves muscle rigidity caused by antipsychotic medication by:

1. blocking dopamine receptors in the central nervous system (CNS).
2. blocking acetylcholine in the CNS.
3. activating norepinephrine in the CNS.
4. activating dopamine receptors in the CNS.

20. Most antipsychotic medications exert which of following effects on the central nervous system (CNS)?

1. Stimulate the CNS by blocking postsynaptic dopamine, norepinephrine, and serotonin receptors.
2. Sedate the CNS by stimulating serotonin at the synaptic cleft.
3. Depress the CNS by blocking the postsynaptic transmission of dopamine, serotonin, and norepinephrine.
4. Depress the CNS by stimulating the release of acetylcholine.

21. A client is admitted to the psychiatric unit of a local hospital with chronic undifferentiated schizophrenia. During the next several days, the client is seen laughing, yelling, and talking to herself. This behavior is characteristic of:

1. delusion.
2. looseness of association.
3. illusion.
4. hallucination.

22. Which of the following medications would the nurse expect the physician to order to reverse a dystonic reaction?

1. prochlorperazine (Compazine)
2. diphenhydramine (Benadryl)
3. haloperidol (Haldol)
4. midazolam (Versed)

23. A schizophrenic client states, “I hear the voice of King Tut.” Which response by the nurse would be most therapeutic?

1. “I don’t hear the voice, but I know you hear what sounds like a voice.”
2. “You shouldn’t focus on that voice.”
3. “Don’t worry about the voice as long as it doesn’t belong to anyone real.”
4. “King Tut has been dead for years.”

24. A psychotic client reports to the evening nurse that the day nurse put something suspicious in his water with his medication. The nurse replies, “You’re worried about your medication?” The nurse’s communication is:

1. an example of presenting reality.
2. reinforcing the client’s delusions.
3. focusing on emotional content.
4. a nontherapeutic technique called mind reading.

25. The 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 the most appropriate?

1. Approach the client and touch him to get his attention.
2. Encourage the client to go to his room where he’ll experience fewer distractions.
3. Acknowledge that the client is hearing voices but make it clear that the nurse doesn’t hear these voices.
4. Ask the client to describe what the voices are saying

26. A client has been receiving chlorpromazine (Thorazine), an antipsychotic, to treat his psychosis. Which findings should alert the nurse that the client is experiencing pseudoparkinsonism?

1. Restlessness, difficulty sitting still, and pacing
2. Involuntary rolling of the eyes
3. Tremors, shuffling gait, and masklike face
4. Extremity and neck spasms, facial grimacing, and jerky movements

27. For several years, a client with chronic schizophrenia has received 10 mg of fluphenazine hydrochloride (Prolixin) by mouth four times per day. Now the client has a temperature of 102° F (38.9° C), a heart rate of 120 beats/minute, a respiratory rate of 20 breaths/minute, and a blood pressure of 210/140 mm Hg. Because the client also is confused and incontinent, the nurse suspects malignant neuroleptic syndrome. What steps should the nurse take?

1. Give the next dose of fluphenazine, call the physician, and monitor vital signs.
2. Withhold the next dose of fluphenazine, call the physician, and monitor vital signs.
3. Give the next dose of fluphenazine and restrict the client to the room to decrease stimulation.
4. Withhold the next dose of fluphenazine, administer an antipyretic agent, and increase the client’s fluid intake.

28. A schizophrenic client with delusions tells the nurse, “There is a man wearing a red coat who’s out to get me.” The client exhibits increasing anxiety when focusing on the delusions. Which of the following would be the best response?

1. “This subject seems to be troubling you. Let’s walk to the activity room.”
2. “Describe the man who’s out to get you. What does he look like?”
3. “There is no reason to be afraid of that man. This hospital is very secure.”
4. “There is no need to be concerned with a man who isn’t even real.”

29. Important teaching for women in their childbearing years who are receiving antipsychotic medications includes which of the following?

1. Occurrence of increased libido due to medication adverse effects
2. Increased incidence of dysmenorrhea while taking the drug
3. Continuing previous use of contraception during periods of amenorrhea
4. Instruction that amenorrhea is irreversible

30. A client is admitted to a psychiatric facility with a diagnosis of chronic schizophrenia. The history indicates that the client has been taking neuroleptic medication for many years. Assessment reveals unusual movements of the tongue, neck, and arms. Which condition should the nurse suspect?

1. Tardive dyskinesia
2. Dystonia
3. Neuroleptic malignant syndrome
4. Akathisia

1. chlorpromazine (Thorazine)
2. haloperidol (Haldol)
3. lithium carbonate (Lithonate)
4. amitriptyline (Elavil)

1. Aggressive behavior
2. Paranoid thoughts
3. Emotional affect
4. Independence needs

1. “When people are under stress, they may see things or hear things that others don’t. Is that what just happened?”
2. “I’m having a difficult time hearing you. Please look at me when you talk.”
3. “There is no one else in the room. What are you doing?”
4. “Who are you talking to? Are you hallucinating?”

1. a false belief about the functioning of the body.
2. belief that the body is deformed or defective in a specific way.
3. false ideas about the self, others, or the world
4. the inability to carry out motor activities.

1. Agranulocytosis
2. Extrapyramidal effects
3. Anticholinergic effects
4. Neuroleptic malignant syndrome (NMS)

1. Helping the client to participate in social interactions
2. Establishing a one-on-one relationship with the client
3. Exploring the effects of the client’s behavior on social interactions
4. Developing a schedule for the client’s participation in social interactions

1. a delusion.
2. flight of ideas.
3. ideas of reference.
4. a hallucination.

1. Telling the client that she may become sick and die unless she eats
2. Paying special attention to the client’s rituals and emotions associated with meals
3. Restricting the client’s access to food except at specified meal and snack times
4. Encouraging the client to express her feelings at meal times

1. Loose associations, grandiose delusions, and auditory hallucinations
2. Periods of hyperactivity and irritability alternating with depression
3. Delusions of jealousy and persecution, paranoia, and mistrust
4. Sadness, apathy, feelings of worthlessness, anorexia, and weight loss

1. Benztropine (Cogentin).
2. diphenhydramine (Benadryl).
3. propranolol (Inderal).
4. haloperidol (Haldol).

1. Ask the client to sit still or leave the room because he is distracting the other clients.
2. Ask the client if he is nervous or anxious about something.
3. Give an as needed dose of a prescribed anticholinergic agent to control akathisia.
4. Administer an as needed dose of haloperidol to decrease agitation.

1. disturbed relationships related to an inability to communicate and think clearly.
2. severe mood swings and periods of low to high activity.
3. multiple personalities, one of which is more destructive than the others.
4. auditory and tactile hallucinations.

1. Asking the physician for droperidol (Inapsine) to control any extrapyramidal symptoms that occur
2. Sitting up for a few minutes before standing to minimize orthostatic hypotension
3. Notifying the physician if her thoughts don’t normalize within 1 week
4. Expecting symptoms of tardive dyskinesia to occur and to be transient

1. tardive dyskinesia.
2. dystonia.
3. neuroleptic malignant syndrome.
4. akathisia.

1. Anxiety attack
2. Projection
3. Hallucination
4. Delusion

1. delusion of persecution.
2. delusion of grandeur.
3. somatic delusion.
4. jealous delusion.

1. somatic delusions.
2. waxy flexibility.
3. neologisms.
4. nihilistic delusions.

1. tell him that she’ll leave for now but will return soon.
2. ask him if it’s okay if she sits quietly with him.
3. ask him why he wants to be left alone.
4. tell him that she won’t let anything happen to him

1. clearly identified with boundaries and specifically defined roles.
2. warm and nonthreatening.
3. centered on clearly defined limits and expression of empathy.
4. flexible enough for the nurse to adjust the plan of care as the situation warrants.

1. Results of treatment are rapid and dramatic but may not last.
2. Although uncomfortable, this reaction isn’t serious.
3. The client shouldn’t buy drugs on the street.
4. The client must take benztropine (Cogentin) as prescribed to prevent a return of symptoms.

Answers and Rationales

1. C. focusing on emotional content. The nurse should help the client focus on the emotional content rather than delusional material. Presenting reality isn’t helpful because it can lead to confrontation and disengagement. Agreeing with the client and supporting his beliefs are reinforcing delusions. Mind reading isn’t therapeutic.
   
2. B. “I find it hard to believe that a foreign government or anyone else is trying to hurt you. You must feel frightened by this.” Responses should focus on reality while acknowledging the client’s feelings. Arguing with the client or denying his belief isn’t therapeutic. Arguing can also inhibit development of a trusting relationship. Continuing to talk about delusions may aggravate the psychosis. Asking the client if a foreign government is trying to kill him may increase his anxiety level and can reinforce his delusions.
   
3. A. Antipsychotic-induced akathisia and anxiety. Propranolol is a potent beta-adrenergic blocker and produces a sedating effect; therefore, it’s used to treat antipsychotic induced akathisia and anxiety. Lithium (Lithobid) is used to stabilize clients with bipolar illness. Antipsychotics are used to treat delusions. Some antidepressants have been effective in treating OCD.
   
4. C. “You had to wait. Can we talk about how this is making you feel right now?”  This response may diffuse the client’s anger by helping to maintain a therapeutic relationship and addressing the client’s feelings. Option A wouldn’t address the client’s anger. Option B is incorrect because the client with a borderline personality disorder blames others for things that happen, so apologizing reinforces the client’s misconceptions. The nurse can’t promise that a delay will never occur again, as in option D, because such matters are outside the nurse’s control.
   
5. D. Several weeks. Although most phenothiazines produce some effects within minutes to hours, their antipsychotic effects may take several weeks to appear.
   
6. B. administer as needed dose of benztropine (Cogentin) I.M. as ordered. The client is most likely suffering from muscle rigidity due to haloperidol. I.M. benztropine should be administered to prevent asphyxia or aspiration. Lorazepam treats anxiety, not extrapyramidal effects. Another dose of haloperidol would increase the severity of the reaction.
   
7. B. Allow him to open the individual wrappers of the medication. Option B is correct because allowing a paranoid client to open his medication can help reduce suspiciousness. Option A is incorrect because the client doesn’t know that it’s his medication and he’s obviously suspicious. Telling the client not to worry or ignoring the comment isn’t supportive and doesn’t offer reassurance.
   
8. C. Acknowledge that the client is hearing voices but make it clear that the nurse doesn’t hear these voices. By acknowledging that the client hears voices, the nurse conveys acceptance of the client. By letting the client know that the nurse doesn’t hear the voices, the nurse avoids reinforcing the hallucination. The nurse shouldn’t touch the client with schizophrenia without advance warning. The hallucinating client may believe that the touch is a threat or act of aggression and respond violently. Being alone in his room encourages the client to withdraw and may promote more hallucinations. The nurse should provide an activity to distract the client. By asking the client what the voices are saying, the nurse is reinforcing the hallucination. The nurse should focus on the client’s feelings, rather than the content of the hallucination.
   
9. C. Evaluate the client for adverse reactions to haloperidol. An antipsychotic agent, such as haloperidol, can cause muscle spasms in the neck, face, tongue, back, and sometimes legs as well as torticollis (twisted neck position). The nurse should be aware of these adverse reactions and assess for related reactions promptly. Although posturing may occur in clients with schizophrenia, it isn’t the same as neck and jaw spasms. Having the client relax can reduce tension-induced muscle stiffness but not drug-induced muscle spasms. When a client develops a new sign or symptom, the nurse should consider an adverse drug reaction as the possible cause and obtain treatment immediately, rather than have the client wait.
   
10. B. practice saying “Go away” or “Stop” when they hear voices. Researchers have found that some clients can learn to control bothersome hallucinations by telling the voices to go away or stop. Taking an as needed dose of psychotropic medication whenever the voices arise may lead to overmedication and put the client at risk for adverse effects. Because the voices aren’t likely to go away permanently, the client must learn to deal with the hallucinations without relying on drugs. Although distraction is helpful, singing loudly may upset other clients and would be socially unacceptable after the client is discharged. Hallucinations are most bothersome in a quiet environment when the client is alone, so sending the client to his room would increase, rather than decrease, the hallucinations.
    
11. A. Assist the client with feeding. According to Maslow’s hierarchy of needs, the need for food is among the most important. Other needs, in order of decreasing importance, include hygiene, safety, and a sense of belonging.
    
12. C. ideas of reference. Ideas of reference refers to the mistaken belief that neutral stimuli have special meaning to the individual such as the television newscaster sending a message directly to the individual. A delusion is a false belief. Flight of ideas is a speech pattern in which the client skips from one unrelated subject to another. A hallucination is a sensory perception, such as hearing voices and seeing objects, that only the client experiences.
    
13. A. has a more predictable onset of action.A liquid phenothiazine preparation will produce effects in 2 to 4 hours. The onset with tablets is unpredictable.
    
14. C. “Client will be able to complete ADLs with assistance in organizing grooming items and clothing within 1 month.” The client’s disorganized personality and history of hospitalization have affected the ability to perform self-care activities. Interventions should be directed at helping the client complete ADLs with the assistance of staff members, who can provide needed structure by helping the client select grooming items and clothing. This goal promotes realistic independence. As the client improves and achieves the established goal, the nurse can set new goals that focus on the client completing ADLs with only verbal encouragement and, ultimately, completing them independently. The client’s condition doesn’t indicate a need for complete assistance, which would only foster dependence.
    
15. A. Risk for violence toward self or others. Because of such factors as suspiciousness, anxiety, and hallucinations, the client with paranoid schizophrenia is at risk for violence toward himself or others. The other options are also appropriate nursing diagnoses but should be addressed after the safety of the client and those around him is established.
    
16. C. his wife can be given a long-acting medication that is administered every 1 to 4 weeks. Long-acting psychotropic drugs can be administered by depot injection every 1 to 4 weeks. These agents are useful for noncompliant clients because the client receives the injection at the outpatient clinic. A client has the right to refuse medication, but this issue isn’t the focus of discussion at this time. Medication should never be hidden in food or drink to trick the client into taking it; besides destroying the client’s trust, doing so would place the client at risk for overmedication or undermedication because the amount administered is hard to determine. Assuming the client knows she must take the medication to avoid future hospitalizations would be unrealistic.
    
17. B. blocking the cholinergic activity in the central nervous system (CNS). Option B is the action of Cogentin. Anxiety doesn’t cause extrapyramidal effects. Overactivity of acetylcholine and lower levels of dopamine are the causes of extrapyramidal effects. Benztropine doesn’t increase norepinephrine in the CNS.
    
18. B. “I find it hard to believe that a foreign government or anyone else is trying to hurt you. You must feel frightened by this.” Responses should focus on reality while acknowledging the client’s feelings. Arguing with the client or denying his belief isn’t therapeutic. Arguing can also inhibit development of a trusting relationship. Continuing to talk about delusions may aggravate the psychosis. Asking the client if a foreign government is trying to kill him may increase his anxiety level and can reinforce his delusions.
    
19. D. activating dopamine receptors in the CNS. Extrapyramidal effects and the muscle rigidity induced by antipsychotic medications are caused by a low level of dopamine. Dopamine receptor agonists stimulate dopamine receptors and thereby reduce rigidity. They don’t affect norepinephrine or acetylcholine.
    
20. C. Depress the CNS by blocking the postsynaptic transmission of dopamine, serotonin, and norepinephrine. The exact mechanism of antipsychotic medication action is unknown, but appear to depress the CNS by blocking the transmission of three neurotransmitters: dopamine, serotonin, and norepinephrine. They don’t sedate the CNS by stimulating serotonin, and they don’t stimulate neurotransmitter action or acetylcholine release.
    
21. D. hallucination. Auditory hallucination, in which one hears voices when no external stimuli exist, is common in schizophrenic clients. Such behaviors as laughing, yelling, and talking to oneself suggest such a hallucination. Delusions, also common in schizophrenia, are false beliefs or ideas that arise without external stimuli. Clients with schizophrenia may exhibit looseness of association, a pattern of thinking and communicating in which ideas aren’t clearly linked to one another. Illusion is a less severe perceptual disturbance in which the client misinterprets actual external stimuli. Illusions are rarely associated with schizophrenia.
    
22. B. diphenhydramine (Benadryl). Diphenhydramine, 25 to 50 mg I.M. or I.V., would quickly reverse this condition. Prochlorperazine and haloperidol are both capable of causing dystonia, not reversing it. Midazolam would make this client drowsy.
    
23. A. “I don’t hear the voice, but I know you hear what sounds like a voice.” This response states reality about the client’s hallucination. The other options are judgmental, flippant, or dismissive.
    
24. C. focusing on emotional content.The nurse should help the client focus on the emotional content rather than delusional material. Presenting reality isn’t helpful because it can lead to confrontation and disengagement. Agreeing with the client and supporting his beliefs are reinforcing delusions. Mind reading isn’t therapeutic.
    
25. C. Acknowledge that the client is hearing voices but make it clear that the nurse doesn’t hear these voices. By acknowledging that the client hears voices, the nurse conveys acceptance of the client. By letting the client know that the nurse doesn’t hear the voices, the nurse avoids reinforcing the hallucination. The nurse shouldn’t touch the client with schizophrenia without advance warning. The hallucinating client may believe that the touch is a threat or act of aggression and respond violently. Being alone in his room encourages the client to withdraw and may promote more hallucinations. The nurse should provide an activity to distract the client. By asking the client what the voices are saying, the nurse is reinforcing the hallucination. The nurse should focus on the client’s feelings, rather than the content of the hallucination.
    
26. C. Tremors, shuffling gait, and masklike face. Pseudoparkinsonism may appear 1 to 5 days after starting an antipsychotic and may also include drooling, rigidity, and “pill rolling.” Akathisia may occur several weeks after starting antipsychotic therapy and consists of restlessness, difficulty sitting still, and fidgeting. An oculogyric crisis is recognized by uncontrollable rolling back of the eyes and, along with dystonia, should be considered an emergency. Dystonia may occur minutes to hours after receiving an antipsychotic and may include extremity and neck spasms, jerky muscle movements, and facial grimacing.
    
27. B. Withhold the next dose of fluphenazine, call the physician, and monitor vital signs. Malignant neuroleptic syndrome is a dangerous adverse effect of neuroleptic drugs such as fluphenazine. The nurse should withhold the next dose, notify the physician, and continue to monitor vital signs. Although an antipyretic agent may be used to reduce fever, increased fluid intake is contraindicated because it may increase the client’s fluid volume further, raising blood pressure even higher.
    
28. A. “This subject seems to be troubling you. Let’s walk to the activity room.” This remark distracts the client from the delusion by engaging the client in a less threatening or more comforting activity at the first sign of anxiety. The nurse should reinforce reality and discourage the false belief. The other options focus on the content of the delusion rather than the meaning, feeling, or intent that it provokes.
    
29. C. Continuing previous use of contraception during periods of amenorrhea. Women may experience amenorrhea, which is reversible, while taking antipsychotics. Amenorrhea doesn’t indicate cessation of ovulation; therefore, the client can still become pregnant. The client should be instructed to continue contraceptive use even when experiencing amenorrhea. Dysmenorrhea isn’t an adverse effect of antipsychotics, and libido generally decreases because of the depressant effect.
    
30. A. Tardive dyskinesia. Unusual movements of the tongue, neck, and arms suggest tardive dyskinesia, an adverse reaction to neuroleptic medication. Dystonia is characterized by cramps and rigidity of the tongue, face, neck, and back muscles. Neuroleptic malignant syndrome causes rigidity, fever, hypertension, and diaphoresis. Akathisia causes restlessness, anxiety, and jitteriness.
31. B. haloperidol (Haldol). Haloperidol administered I.M. or I.V. is the drug of choice for acute aggressive psychotic behavior. Chlorpromazine is also an antipsychotic drug; however, it causes more pronounced sedation than haloperidol. Lithium carbonate is useful in bipolar or manic disorder, and amitriptyline is used for depression.
    
32. B. Paranoid thoughts. Clients with schizotypal personality disorder experience excessive social anxiety that can lead to paranoid thoughts. Aggressive behavior is uncommon, although these clients may experience agitation with anxiety. Their behavior is emotionally cold with a flattened affect, regardless of the situation. These clients demonstrate a reduced capacity for close or dependent relationships.
    
33. A. “When people are under stress, they may see things or hear things that others don’t. Is that what just happened?” This response makes the client feel that experiencing hallucinations is acceptable and promotes an open, therapeutic relationship. Directing the client to look at the nurse wouldn’t address the obvious issue of the hallucination. Confrontational approaches, such as in options C and D, are likely to elicit an uninformative or negative response.
    
34. C. false ideas about the self, others, or the world. Nihilistic delusions are false ideas about the self, others, or the world. Somatic delusions involve a false belief about the functioning of the body. Body dysmorphic disorder is characterized by a belief that the body is deformed or defective in a specific way. Apraxia is the inability to carry out motor activities.
    
35. D. Neuroleptic malignant syndrome (NMS). A rare but potentially fatal condition of antipsychotic medication is called NMS. It generally starts with an elevated temperature and severe extrapyramidal effects. Agranulocytosis is a blood disorder. Anticholinergic effects include blurred vision, drowsiness, and dry mouth. Symptoms of extrapyramidal effects include tremors, restlessness, muscle spasms, and pseudoparkinsonism.
    
36. B. Establishing a one-on-one relationship with the client. 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.
    
37. D. a hallucination. A hallucination is a sensory perception, such as hearing voices and seeing objects, that only the client experiences. A delusion is a false belief. Flight of ideas refers to a speech pattern in which the client skips from one unrelated subject to another. Ideas of reference refers to the mistaken belief that someone or something outside the client is controlling the client’s ideas or behavior.
    
38. C. Restricting the client’s access to food except at specified meal and snack times. Restricting access to food except at specified times prevents the client from eating when she feels anxious, guilty, or depressed; this, in turn, decreases the association between these emotions and food. Telling the client she may become sick or die may reinforce her behavior because illness or death may be her goal. Paying special attention to rituals and emotions associated with meals also would reinforce undesirable behavior. Encouraging the client to express feelings at meal times would increase the association between emotions and food; instead, the nurse should encourage her to express feelings at other times.
39. A. Loose associations, grandiose delusions, and auditory hallucinations. Loose associations, grandiose delusions, and auditory hallucinations are all characteristic of the classic schizophrenic client. These clients aren’t able to care for their physical appearance. They frequently hear voices telling them to do something either to themselves or to others. Additionally, they verbally ramble from one topic to the next. Periods of hyperactivity and irritability alternating with depression are characteristic of bipolar or manic disease. Delusions of jealousy and persecution, paranoia, and mistrust are characteristics of paranoid disorders. Sadness, apathy, feelings of worthlessness, anorexia, and weight loss are characteristics of depression.
    
40. A. Benztropine (Cogentin).Benztropine, trihexyphenidyl, or amantadine are prescribed for a client with Parkinson-type symptoms. Diphenhydramine provides rapid relief for dystonia. Propranolol relieves akathisia. Haloperidol can cause Parkinson-type symptoms.
    
41. C. Give an as needed dose of a prescribed anticholinergic agent to control akathisia. Akathisia, characterized by restlessness, is a common but often overlooked adverse reaction to haloperidol and other antipsychotic agents; it may be confused with psychotic agitation. To control akathisia, the nurse should give an as needed dose of a prescribed anticholinergic agent. The client can’t control the movements, so asking him to sit still would be pointless. Asking him to leave the room wouldn’t address the underlying cause of the problem. Encouraging him to talk about the symptoms wouldn’t stop them from occurring. Giving more antipsychotic medication would worsen akathisia.
    
42. A. disturbed relationships related to an inability to communicate and think clearly. Schizophrenia is best described as one of a group of psychotic reactions characterized by disturbed relationships with others and an inability to communicate and think clearly. Schizophrenic thoughts, feelings, and behavior commonly are evidenced by withdrawal, fluctuating moods, disordered thinking, and regressive tendencies. Severe mood swings and periods of low to high activity are typical of bipolar disorder. Multiple personality, sometimes confused with schizophrenia, is a dissociative personality disorder, not a psychotic illness. Many schizophrenic clients have auditory hallucinations; tactile hallucinations are more common in organic or toxic disorders
    
43. B. Sitting up for a few minutes before standing to minimize orthostatic hypotension. The nurse should teach the client how to manage common adverse reactions, such as orthostatic hypotension and anticholinergic effects. Antipsychotic effects of the drug may take several weeks to appear. Droperidol increases the risk of extrapyramidal effects when given in conjunction with phenothiazines such as fluphenazine. Tardive dyskinesia is a possible adverse reaction and should be reported immediately
    
44. C. neuroleptic malignant syndrome. The client’s signs and symptoms suggest neuroleptic malignant syndrome, a life-threatening reaction to neuroleptic medication that requires immediate treatment. Tardive dyskinesia causes involuntary movements of the tongue, mouth, facial muscles, and arm and leg muscles. Dystonia is characterized by cramps and rigidity of the tongue, face, neck, and back muscles. Akathisia causes restlessness, anxiety, and jitteriness.
45. D. Delusion. A delusion is a false belief based on a misrepresentation of a real event or experience. Although anxiety can increase delusional responses, it isn’t considered the primary symptom. Projection is falsely attributing to another person one’s own unacceptable feelings. Hallucinations, which characterize most psychoses, are perceptual disorders of the five senses; the client may see, taste, feel, smell, or hear something in the absence of external stimulation
    
46. C. somatic delusion.Somatic delusions focus on bodily functions or systems and commonly include delusions about foul odor emissions, insect infestations, internal parasites, and misshapen parts. Delusions of persecution are morbid beliefs that one is being mistreated and harassed by unidentified enemies. Delusions of grandeur are gross exaggerations of one’s importance, wealth, power, or talents. Jealous delusions are delusions that one’s spouse or lover is unfaithful.
    
47. B. waxy flexibility. The correct answer is waxy flexibility, which is defined as retaining any position that the body has been placed in. Somatic delusions involve a false belief about the functioning of the body. Neologisms are invented meaningless words. Nihilistic delusions are false ideas about self, others, or the world.
    
48. A. tell him that she’ll leave for now but will return soon. If the client tells the nurse to leave, the nurse should leave but let the client know that she’ll return so that he doesn’t feel abandoned. Not heeding the client’s request can agitate him further. Also, challenging the client isn’t therapeutic and may increase his anger. False reassurance isn’t warranted in this situation
    
49. D. flexible enough for the nurse to adjust the plan of care as the situation warrants. A flexible plan of care is needed for any client who behaves in a suspicious, withdrawn, or regressed manner or who has a thought disorder. Because such a client communicates at different levels and is in control of himself at various times, the nurse must be able to adjust nursing care as the situation warrants. The nurse’s role should be clear; however, the boundaries or limits of this role should be flexible enough to meet client needs. Because a client with schizophrenia fears closeness and affection, a warm approach may be too threatening. Expressing empathy is important, but centering interventions on clearly defined limits is impossible because the client’s situation may change without warning.
    
50. D. The client must take benztropine (Cogentin) as prescribed to prevent a return of symptoms. An oral anticholinergic agent such as benztropine (Cogentin) is commonly prescribed to control and prevent the return of symptoms. Dystonic reactions are typically acute and reversible. Dystonic reactions can be life-threatening when airway patency is compromised. Lecturing the client about buying drugs on the street isn’t appropriate.