Psych NCLEX Exam for Schizophrenia

1. Nurse Dorothy is evaluating care of a client with schizophrenia, the nurse should keep which point in mind?

  1. Frequent reassessment is needed and is based on the client’s response to treatment.
  2. The family does not need to be included in the care because the client is an adult.
  3. The client is too ill to learn about his illness.
  4. Relapse is not an issue for a client with schizophrenia.

2. Gio told his nurse that the FBI is monitoring and recording his every movement and that microphones have been plated in the unit walls. Which action would be the most therapeutic response?

  1. Confront the delusional material directly by telling Gio that this simply is not so.
  2. Tell Gio that this must seem frightening to him but that you believe he is safe here.
  3. Tell Gio to wait and talk about these beliefs in his one-on-one counselling sessions.
  4. Isolate Gio when he begins to talk about these beliefs.

3. Which of the following client behaviors documented in Gio’s chart would validate the nursing diagnosis of Risk for other-directed violence?

  1. Gio’s description of being endowed with superpowers
  2. Frequent angry outburst noted toward peers and staff
  3. Refusal to eat cafeteria food
  4. Refusal to join in group activities

4. Nurse Winona educates the family about symptom management for when the schizophrenic client becomes upset or anxious. Which of the following would Nurse Winona state is helpful?

  1. Call the therapist to request a medication change.
  2. Encourage the use of learned relaxation techniques.
  3. Request that the client be hospitalized until the crisis is over.
  4. Wait before the anxiety worsens before intervening.

5. Drogo who has had auditory hallucinations for many years tells Nurse Khally that the voices prevents his participation in a social skills training program at the community health center. Which intervention is most appropriate?

  1. Let Drogo analyze the content of the voices.
  2. Advise Drogo to participate in the program when the voices cease.
  3. Advise Drogo to take his medications as prescribed.
  4. Teach Drogo to use thought stopping techniques.

6. Cersei is diagnosed as having disorganized schizophrenia. Which behaviors would Nurse Sansa most likely assess in the client?

  1. Absence of acute symptoms, impaired role function
  2. Extreme social withdrawal, odd mannerisms and behavior
  3. Psychomotor immobility; presence of waxy flexibility
  4. Suspiciousness toward others, increased hostility

7. Jaime has a diagnosis of schizophrenia with negative symptoms. In planning care for the client, Nurse Brienne would anticipate a problem with:

  1. auditory hallucinations.
  2. bizarre behaviors.
  3. ideas of reference.
  4. motivation for activities.

8. The family of a schizophrenic client asks the nurse if there is a genetic cause of this disorder. To answer the family, which fact would the nurse cite?

  1. Conclusive evidence indicates a specific gene transmits the disorder.
  2. Incidence of this disorder is variable in all families.
  3. There is a little evidence that genes play a role in transmission.
  4. Genetic factors can increase the vulnerability for this disorder.

9. Ramsay is diagnosed with schizophrenia paranoid type and is admitted in the psychiatric unit of Medical Center. Which of the following nursing interventions would be most appropriate?

  1. Establishing a non demanding relationship
  2. Encouraging involvement in group activities
  3. Spending more time with Ramsay
  4. Waiting until Ramsay initiates interaction

10. A client tells the nurse that psychotropic medicines are dangerous and refuses to take them. Which intervention should the nurse use first?

  1. Ask the client about any previous problems with psychotropic medications.
  2. Ask the client if an injection is preferable.
  3. Insist that the client take medication as prescribed.
  4. Withhold the medication until client is less suspicious.

11. Upon Sam’s admission for acute psychiatric hospitalization, Nurse Jona documents the following: Client refuses to bathe or dress, remains in room most of the day, speaks infrequently to peers or staff. Which nursing diagnosis would be the priority at this time?

  1. Anxiety
  2. Decisional conflict
  3. Self-care deficit
  4. Social isolation

12. Which statement is correct about a 25-year-old client with newly diagnosed schizophrenia?

  1. Age of onset is typical for schizophrenia.
  2. Age of onset is later than usual for schizophrenia.
  3. Age of onset is earlier than usual for schizophrenia.
  4. Age of onset follows no predictable pattern in schizophrenia.

13. Which factor is associated with increased risk for schizophrenia?

  1. Alcoholism
  2. Adolescent pregnancy
  3. Overcrowded schools
  4. Poverty

14. Nurse Arya assesses for evidence of positive symptoms of schizophrenia in a newly admitted client. Which of the following symptoms are considered positive evidence? Select all that apply.

  1. Anhedonia
  2. Delusions
  3. Flat affect
  4. Hallucinations
  5. Loose associations
  6. Social withdrawal

15. A client with schizophrenia is referred for psychosocial rehabilitation. Which of the following are typical of this type of program? Select all that apply.

  1. Analyzing family issues and past problems
  2. Developing social skills and supports
  3. Learning how to live independently in a community
  4. Learning job skills for employment
  5. Treating family members affected by the illness
  6. Participating in in-depth psychoanalytical counselling
Answers and Rationales
  1. Answer: A. Frequent reassessment is needed and is based on the client’s response to treatment. Because client respond to treatment in different ways, the nurse must constantly evaluate the client and his potential. Premorbid adjustment must also be considered. Most clients with such condition go home, so the family should be involved. The client can learn about the illness if information is provided gradually. Relapse is  common in schizophrenia.
  2. Answer: B. Tell Gio that this must seem frightening to him but that you believe he is safe here. The nurse must realize that these perceptions are very real to the client. Acknowledging the client’s feelings provides support; explaining how the nurse sees the situation in a different way provides reality orientation. Confronting the delusional material directly will not work with this client and may diminish trust. Telling the client to wait and talk about these beliefs in his one-on-one counselling session will reinforce the delusion. Isolation will increase anxiety. Distraction with a radio or activities would be a better approach.
  3. Answer: B. Frequent angry outburst noted toward peers and staff. Anger is an important factor that indicated the potential for acting out. Because the client is angry with both peers and staff, any acting out would probably be directed toward others. The client’s description of being endowed with superpowers and his refusal to eat cafeteria food indicate that he may have delusional beliefs, but not necessarily a risk for violence. Refusal to join in group activities indicates discomfort with a group, however, no threat of violence is apparent.
  4. Answer: B. Encourage the use of learned relaxation techniques. The client with schizophrenia can learn relaxation techniques, which help reduce anxiety. The family can be supportive and helpful by encouraging the client to use these techniques. Anxiety is a common experience for everyone, and is no reason to change medication. Handling anxiety is a learned skill that is important to reinforce. There is no indication that the client is in crisis. It is much easier to intervene early in anxiety rather than waiting until escalation occurs.
  5. Answer: D. Teach Drogo to use thought stopping techniques. Clients with long-lasting auditory hallucinations can learn to use thought stopping measures to accomplish tasks. Analyzing the content of the voices may be indicated when hallucinations first occur to establish whether the voices are threatening to the client or instructing him to harm others. However, focusing on their content at this point would reinforce this symptom. The voices have lasted many years; the client should participate despite the voices. There is no indication that the client is not taking medication as prescribed.
  6. Answer: B. Extreme social withdrawal, odd mannerisms and behavior. Disorganized schizophrenia is characterized by regressive behavior with extreme social withdrawal and frequently odd mannerisms. The absence of acute symptoms and impaired role function are more characteristic of residual-type schizophrenia. Psychomotor immobility and presence of waxy flexibility are more indicative of catatonic schizophrenia. Suspiciousness toward others and increased hostility is more characteristic of paranoid schizophrenia.
  7. Answer: D. motivation for activities. In a client demonstrating negative symptoms of schizophrenia, avolition, or the lack of motivation for activities, is a common problem. All of the other symptoms listed are the positive symptoms of schizophrenia.
  8. Answer: D. Genetic factors can increase the vulnerability for this disorder. Research shows that family history statistically increases the risk for development of schizophrenia. However, no single gene has yet been identified. Options B and and C are both incorrect because genetics plays a role in the etiology of schizophrenia.
  9. Answer: A. Establishing a non demanding relationship. A nonthreatening, non demanding relationship helps decrease the mistrust that is common in a client with paranoid schizophrenia. Encouraging involvement in group activities and spending more time with the client would be threatening for a client who is suspicious of other people’s motives. This client is unlikely to initiate interaction; the nurse is responsible for initiating a relationship with the client.
  10. Answer: A. Ask the client about any previous problems with psychotropic medications. The nurse needs to clarify the client’s previous experience with psychotropic medication in order to understand the meaning of the client’s statement. Asking the client if an injection is preferable may add to the client;s suspicion and feeling threatened. Withholding medication prescribed to relieve delusional beliefs will likely intensify paranoid thinking. Insisting that the client take medication can be a violation of his right to refuse treatment.
  11. Answer: D. Social isolation. These behaviors indicate the client’s withdrawal from others and possible fear or mistrust of relationships. There is no indication of Anxiety or Decisional conflict in the information provided. Although the client refuses to bathe or dress, Self-care deficit would not be the priority nursing diagnosis in this situation.
  12. Answer: A. Age of onset is typical for schizophrenia. The primary age of onset for schizophrenia is late adolescence through young adulthood (ages 17 to 27). Paranoid schizophrenia may sometimes have a later onset. All of the other options are incorrect.
  13. Answer: D. Poverty. Low socioeconomic status or poverty is an identified environmental factor associated with increased incidence of schizophrenia. Although alcoholism, adolescent pregnancy, and overcrowded schools may be stressful, research does not show they increase the risk of schizophrenia.
  14. Answer: B, D, E. These are considered positive symptoms of schizophrenia. Options A, C, and F are considered negative symptoms.
  15. Answer: B, C, D. The goal of psychosocial rehabilitation as a treatment method is to help the client develop the skills and supports necessary for successful living, learning, and working in the community. Analysis of family issues and past problems and treatment of family members are not commonly part of this type of program. The emphasis of psychosocial rehabilitation is on the client’s development of skills in the here and now; consequently, psychoanalytic counselling is not part of the approach.