Nokea
A nurse is providing care to a client just recently diagnosed with schizophrenia during an inpatient hospital stay. Throughout the day, the nurse observes the client drinking from the water fountain quite frequently as well as carrying cans of soda and bottles of water with him wherever he goes. Upon entering the client?s room, the nurse sees numerous empty cups that had been filled with fluids on his table and in the trash can. The room has an odor of urine. The nurse suspects which of the following?
- A. Diabetes mellitus
- B. Disordered water balance
- C. Tardive dyskinesia
- D. Orthostatic hypotension
Correct Answer: B
Rationale: Excessive fluid intake and urine odor suggest disordered water balance (B), such as psychogenic polydipsia, common in schizophrenia, leading to excessive drinking and urination. Diabetes mellitus (A) may cause thirst but not typically urine odor in this context. Tardive dyskinesia (C) and orthostatic hypotension (D) are unrelated to these symptoms.
You may also like to solve these questions
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.
The nurse is interviewing a client with schizophrenia when the client begins to say, Kite, night, right, height, fright. The nurse documents this as which of the following?
- A. Clang association
- B. Stilted language
- C. Verbigeration
- D. Neologisms
Correct Answer: A
Rationale: Clang association (A) describes speech patterns where words are chosen for their sound (e.g., rhyming), as seen in the client?s list, common in schizophrenia. Stilted language (B) is overly formal, verbigeration (C) is repetitive phrases, and neologisms (D) are invented words, none of which fit.
The nurse is caring for a client diagnosed with a delusional disorder. While assessing this client, which of the following would the nurse expect to find?
- A. History of chronic major depression
- B. Consistently disrupting behavior patterns
- C. Verbalization of bizarre delusions
- D. Living with one or more delusions for a period of time
Correct Answer: D
Rationale: Delusional disorder (D) is characterized by persistent, non-bizarre delusions lasting at least one month without prominent mood or psychotic symptoms. Depression (A) is not typical, disruptive behavior (B) is uncommon, and delusions are not bizarre (C) but plausible.
The nurse is caring for a client who was diagnosed with schizoaffective disorder. Based on the nurse?s understanding of this disorder, the nurse develops a plan of care to address which issue as the top priority?
- A. Suicide
- B. Aggression
- C. Substance abuse
- D. Eating disorder
Correct Answer: A
Rationale: Suicide (A) is the top priority in schizoaffective disorder due to the combined risk of mood disturbances (e.g., depression) and psychosis, both of which elevate suicide risk. Aggression (B), substance abuse (C), and eating disorders (D) are concerns but less immediate unless actively present.
A nursing instructor is preparing a class lecture about schizophrenia and outcomes focusing on recovery. Which of the following would the instructor include as a major goal?
- A. Continuity of care
- B. Shorter in-patient stays
- C. Immediate crisis stabilization
- D. Social engagement
Correct Answer: D
Rationale: Social engagement (D) is a major recovery goal in schizophrenia, promoting reintegration and quality of life. Continuity of care (A) and crisis stabilization (C) are means to achieve recovery, and shorter stays (B) are logistical, not primary goals.