Nokea
When assessing a client with delusional disorder, the nurse would most likely expect to find impairment in which of the following? Select all that apply.
- A. Social functioning
- B. Marital functioning
- C. Intellectual functioning
- D. Occupational functioning
- E. Mental status functioning
Correct Answer: A,B,D
Rationale: Delusional disorder often impairs social (A), marital (B), and occupational functioning (D) due to the impact of delusions on relationships and work. Intellectual (C) and mental status functioning (E) typically remain intact, as the disorder is focal.
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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.
While interviewing a client diagnosed with a delusional disorder, the client states, I have this really strange odor coming out of my mouth. I stop to brush my teeth almost every hour and then rinse with mouthwash every half hour to get rid of this smell. I?ve seen so many doctors, and they can?t tell me what?s wrong. The nurse interprets the client?s statement as reflecting which type of delusion?
- A. Erotomanic
- B. Grandiose
- C. Somatic
- D. Jealous
Correct Answer: C
Rationale: The client?s belief in a persistent, unexplained mouth odor reflects a somatic delusion (C), focusing on bodily concerns. Erotomanic (A) involves romantic beliefs, grandiose (B) involves inflated self-worth, and jealous (D) involves infidelity, none of which apply.
The nurse is caring for a client in an inpatient mental health setting. The nurse notices that when the client is conversing with other clients, he repeats what they are saying word for word. The nurse interprets this finding and documents it as which of the following?
- A. Echopraxia
- B. Neologisms
- C. Tangentiality
- D. Echolalia
Correct Answer: D
Rationale: Echolalia (D) is the correct term for the client?s behavior of repeating others? words verbatim, a common symptom in schizophrenia or other psychotic disorders, reflecting impaired communication processing. Echopraxia (A) involves mimicking movements, not speech. Neologisms (B) are made-up words, and tangentiality (C) refers to responses that veer off-topic, neither of which apply here.
The nurse is caring for a client who was just admitted with a diagnosis of schizoaffective disorder with depression. Which agent would the nurse anticipate as being prescribed for this client?
- A. Lithium
- B. Haloperidol
- C. Chlorpromazine
- D. Clozapine
Correct Answer: D
Rationale: Clozapine (D) is effective for schizoaffective disorder, addressing both psychotic and mood symptoms, especially in treatment-resistant cases. Lithium (A) is primarily for bipolar disorder, and haloperidol (B) and chlorpromazine (C) are less effective for mood components.
The nurse is caring for a client who has been taking clozapine (Clozaril) for 2 weeks. The client tells the nurse, My throat is sore, and I feel weak. The nurse assesses the client?s vital signs and finds that the client has a fever. The nurse notifies the physician, expecting an order to obtain which laboratory test?
- A. A white blood cell count
- B. Liver function studies
- C. Serum potassium level
- D. Serum sodium level
Correct Answer: A
Rationale: Clozapine (A) carries a risk of agranulocytosis, a potentially life-threatening drop in white blood cells, presenting with symptoms like sore throat, weakness, and fever. Monitoring white blood cell counts is critical. Liver function (B), potassium (C), and sodium (D) levels are less relevant to these symptoms.