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A client who has a major depressive episode tells the nurse that for the past 2 weeks, he has been hearing voices and at times thinks that someone is following him. History reveals that he had these alternating symptoms before along with times when he has experienced neither of these symptoms and has been able to function adequately. The nurse interprets these findings as suggesting which of the following?
- A. Paranoid schizophrenia
- B. Undifferentiated schizophrenia
- C. Brief psychotic disorder
- D. Schizoaffective disorder
Correct Answer: D
Rationale: Schizoaffective disorder (D) combines mood episodes (depression) with psychotic symptoms (hallucinations, paranoia) that persist but allow periods of adequate functioning, matching the client?s history. Paranoid (A) and undifferentiated schizophrenia (B) lack prominent mood components, and brief psychotic disorder (C) is shorter in duration.
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A client is being released from the inpatient psychiatric unit with a diagnosis of schizophrenia and treatment with antipsychotic medications. After teaching the client and family about managing the disorder, the nurse determines that the teaching was effective when they state which of the following should be reported immediately?
- A. Elevated temperature
- B. Tremor
- C. Decreased blood pressure
- D. Weight gain
Correct Answer: A
Rationale: Elevated temperature (A) could indicate a serious side effect like neuroleptic malignant syndrome or infection (e.g., agranulocytosis with clozapine), requiring immediate reporting. Tremor (B), decreased blood pressure (C), and weight gain (D) are less urgent, though they warrant monitoring.
While caring for a hospitalized client with schizophrenia, the nurse observes that the client is listening to the radio. The client tells the nurse that the radio commentator is speaking directly to him. The nurse interprets this finding as which of the following?
- A. Autistic thinking
- B. Concrete thinking
- C. Referential thinking
- D. Illusional thinking
Correct Answer: C
Rationale: Referential thinking (C) describes the client?s belief that neutral events, like a radio broadcast, are personally directed at them, a common delusion in schizophrenia. Autistic thinking (A) involves private, illogical thoughts, concrete thinking (B) is overly literal interpretation, and illusional thinking (D) is not a standard term, making them incorrect.
A nursing instructor is developing a class lecture that compares and contrasts schizoaffective disorder with schizophrenia. When describing one of the differences between these two diagnoses, which of the following would the instructor include as reflecting schizoaffective disorder?
- A. It is episodic in nature.
- B. It involves difficulties with self-care.
- C. It has less severe hallucinations.
- D. It is associated with a lower suicide risk.
Correct Answer: A
Rationale: Schizoaffective disorder (A) is characterized by episodic mood disturbances (depressive or manic) alongside psychotic symptoms, unlike the more persistent psychotic symptoms in schizophrenia. Self-care difficulties (B) and hallucination severity (C) are not distinguishing features, and suicide risk (D) is not necessarily lower.
A nurse is working with a group of clients diagnosed with schizophrenia in a community setting. Which of the following would least likely be a priority?
- A. Improving the quality of life
- B. Instilling hope
- C. Managing psychosis
- D. Preventing relapse
Correct Answer: A
Rationale: While improving quality of life (A) is important, managing psychosis (C), preventing relapse (D), and instilling hope (B) are more immediate priorities in schizophrenia care to stabilize symptoms and maintain recovery. Quality of life is a longer-term goal.
Which of the following would be most important for the nurse to keep in mind when establishing the nurse-patient relationship with a client with schizophrenia to promote recovery?
- A. The relationship typically develops over a short period of time.
- B. Decisions about care are the responsibility of interdisciplinary team.
- C. Short, time-limited interactions are best for the client experiencing psychosis.
- D. Typically, clients with schizophrenia readily engage in a therapeutic relationship.
Correct Answer: C
Rationale: Short, time-limited interactions (C) are most effective for clients with schizophrenia experiencing psychosis, as they reduce overstimulation and build trust gradually. Relationships take time (A), interdisciplinary teams share decisions (B), and engagement is often challenging (D), not readily achieved.