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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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While assessing a client with schizophrenia, the client states, Everywhere I turn, the government is watching me because I know too much. They are afraid that I might go public with the information about all those conspiracies. The nurse interprets this statement as indicating which type of delusion?
- A. Grandiose
- B. Nihilistic
- C. Persecutory
- D. Somatic
Correct Answer: C
Rationale: The client?s belief that the government is watching them due to their knowledge reflects a persecutory delusion (C), characterized by fears of harm or surveillance. Grandiose delusions (A) involve inflated self-importance, nihilistic delusions (B) involve beliefs in nonexistence, and somatic delusions (D) focus on bodily concerns.
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.
The nurse is caring for an elderly client who has been taking an antipsychotic medication for 1 week. The nurse notifies the physician when he observes that the client has muscle rigidity that resembles Parkinson?s disease. Which agent would the nurse expect the physician to prescribe?
- A. Anticholinergic
- B. Anxiolytic
- C. Benzodiazepine
- D. Beta-blocker
Correct Answer: A
Rationale: Anticholinergic agents (A), such as benztropine, are used to treat extrapyramidal symptoms (EPS) like parkinsonian muscle rigidity caused by antipsychotics, by balancing acetylcholine and dopamine. Anxiolytics (B) and benzodiazepines (C) address anxiety, not EPS, and beta-blockers (D) treat akathisia or other symptoms, not rigidity.
A hospitalized client with schizophrenia is receiving antipsychotic medications. While assessing the client, the nurse identifies signs and symptoms of a dystonic reaction. Which agent would the nurse expect to administer?
- A. Diphenhydramine (Benadryl)
- B. Propranolol (Inderal)
- C. Risperidone (Risperdal)
- D. Aripiprazole (Abilify)
Correct Answer: A
Rationale: Diphenhydramine (A), an antihistamine with anticholinergic properties, is commonly used to treat acute dystonic reactions caused by antipsychotics, relieving muscle spasms. Propranolol (B) treats akathisia, while risperidone (C) and aripiprazole (D) are antipsychotics that could worsen dystonia.
After teaching a class on antipsychotic agents, the instructor determines that the teaching was successful when the class identifies which of the following as an example of a second-generation antipsychotic agent?
- A. Fluphenazine (Prolixin)
- B. Thiothixene (Navane)
- C. Quetiapine (Seroquel)
- D. Chlorpromazine (Thorazine)
Correct Answer: C
Rationale: Quetiapine (C) is a second-generation (atypical) antipsychotic, effective for schizophrenia with fewer extrapyramidal side effects. Fluphenazine (A), thiothixene (B), and chlorpromazine (D) are first-generation (typical) antipsychotics, associated with higher side effect risks.