MH TEST 3 CH 13 part 1

wipimebe's version from 2015-10-06 21:44


1. Schizophrenia is classified as which of the following types of disorders in the DSM-IV-TR manual?


a. mood
b. thought
c. personality
d. anxiety


According to the DSM-IV-TR, schizophrenia is classified as a thought disorder. It is characterized by disordered thoughts, hallucinations, and delusions.


2. The client who has schizophrenia and exhibits the symptom of alogia will display which of the following behaviors?


a. inability to use common sense and logic
b. rapid speech
c. sparse (little) speech with brief, empty phrases
d. argumentativeness


Alogia refers to the tendency of individuals with schizophrenia to speak very little and, even when speaking openly, to use brief and often seemingly empty phrases.


PTS: 1 DIF: Comprehension REF: Symptoms


3. You are assigned to work with a client who has psychosis. In your assessment of this client, you would assess for one or more of three phenomena that are characteristic of psychosis. These three phenomena of psychosis include disordered thought and which of the following phenomena?


a. delusions and hallucinations
b. illusions and confusions
c. tangentiality and circumstantiality
d. bizarreness and aggression


Psychosis is characterized by disordered thoughts, hallucinations, and delusions. Hallucinations are the misinterpretation of the environment without sensory input, and delusions are false fixed ideas or beliefs.


4. Incomprehensible language is characteristic of persons with schizophrenia. A client is telling you about his hallucinations of Indians on the wind calling out to him Òipeechee.Ó You offer the client a drink of water, and the client says, ÒEmanah.Ó You wonder about these words, which seem created by the client. If in your assessment you discover that the client makes up these words, they are good examples of which of the following?


a. incoherence
b. neologisms
c. tangentiality
d. word salad


The clientÕs use of the words ipeechee and Emanah are examples of neologisms. Neologistic words are words invented by the individual with schizophrenia.


5. You are working with a client who has a diagnosis of schizophrenia. This client is usually dressed in two overcoats, three scarves, and a pair of dress gloves that do not match, even on days when the temperature is over 60 degrees Fahrenheit. Assessing the dress of this client, you know that symptoms of schizophrenia usually lead to which of the following behaviors?


a. oppositional behavior
b. mimicking behaviors
c. bizarre social behaviors
d. fixation on being warm


The clientÕs inappropriate dress is an example of the bizarre social behavior characteristic of clients with schizophrenia. These individuals frequently display eccentric language, appearance, and behavior.


6. A client was admitted to the unit with a diagnosis of schizophrenia. In a report, you learn that this client was admitted after the client smashed the television in a group home. This client is said to have been isolated in his room and rocking in the corner. This client refuses to go into the community room where the television set is located, because he believes it can see him and record his thoughts. This client also believes the news commentators are always talking about him and his family. Which type of delusions does this client have?


a. grandiose
b. persecutory
c. referential
d. telecommunication


The belief that the television set can see him and record his thoughts is an example of a referential delusion. Persons with referential delusions believe that common events such as passages in songs, patterns of clouds in the sky, or comments of others on the radio or television refer specifically to them.


7. Which of the following types of delusions is the MOST common in schizophrenia?


a. defensive
b. persecutory
c. referential
d. grandiose


The most common delusions seen in schizophrenia are persecutory delusions. Persons with persecutory delusions are paranoid; they believe that others intend to do them harm.


8. You are having a one-on-one communication with a client with a diagnosis of schizophrenia. You notice that when this client speaks, there is less order in the ideas and topics than you have found in clients without a diagnosis of schizophrenia. Some ideas do not make sense together, but make sense alone. You decide to chart this speech pattern as which of the following patterns?


a. tangential
b. circumstantial
c. loose
d. irrational


A characteristic of schizophrenia is the use of language that demonstrates loose association of the clientÕs thoughts. The connection between thoughts and ideas seems lost. Without coherent language, the individual loses ability to communicate verbally.


9. You are assigned to a client with schizophrenia. You find that this client has lessened reactivity to the environment, rigid posture, resistance to being moved, and even bizarre posturing. Which of the following words is used in psychiatric nursing and the psychiatric field to describe these behaviors of your client?


a. catatonia
b. posture fixation
c. neuroleptic malignant syndrome
d. postsynaptic paralytic condition


Catatonia is a marked decrease in reactivity to the environment, sometimes reaching an extreme degree of complete unawareness. The catatonic individual maintains a rigid posture and resists efforts to be moved. Catatonia is among the most striking psychotic manifestations.


10. You are working with a client who has been admitted to the unit for medication adjustment. She reports that she hears voices that tell her she is evil. The nurse knows that auditory hallucinations are:


a. sensory experiences perceptible to other individuals
b. usually voices that follow the clientÕs own thoughts
c. often specific in content with a threatening nature
d. the most uncommon type of hallucination


The voices heard in auditory hallucinations generally contain specific content. The content is frequently of a threatening or negative nature. Auditory hallucinations are often seen as evil and will sometimes prompt the individual to harm him- or herself or others.


11. While the cause of schizophrenia is unknown, it is commonly believed to be caused by which of the following factors?


a. dysfunctional family interaction
b. trauma at birth or in utero
c. sin or an evil nature
d. biological and genetic factors


Schizophrenia is believed to be caused by biological and genetic factors. The neurotransmitter dopamine has been identified as being involved with schizophrenia. Studies have also documented the relationship between genetics and the development of schizophrenia.


12. You are working with a client who has a diagnosis of schizophrenia. This client is giving away belongings and telling people good-bye. In your assessment, planning, and interventions, you would MOST keep in mind which of the following ideas?


a. People with schizophrenia have little use for belongings.
b. Persons with a diagnosis of schizophrenia never hurt themselves, only others.
c. 10% of persons with schizophrenia eventually commit suicide.
d. As high as 50% of persons with schizophrenia commit suicide.


Overall, at least 10% of individuals with schizophrenia eventually commit suicide. Suicide may occur at any time in the course of the disorder and occurs with equal frequency in men and women. A variety of factors may stimulate an individual to commit suicide. These include low self-esteem, the individualÕs perception of the diagnosis and prognosis, auditory hallucinations that prompt the individual to harm him- or herself, and so on.


13. Based on the writings of Sigmund Freud, during the 20th century, many professionals were taught that schizophrenia was caused by:


a. biological factors
b. inadequate maternal nurturing
c. both environmental and biological factors
d. stresses of urban life


Psychoanalytic theory portrayed schizophrenia as arising out of inadequate maternal nurturance in early infancy. According to Freud, the child does not develop normally because of ineffective mothering.


14. The use of a computed tomography (CT) scanner to evaluate brain structure in individuals with schizophrenia during the 1970s found that lateral ventricles were:


a. larger in males with schizophrenia than in nonschizophrenic persons
b. the cause of schizophrenia in older adults after 65 years of age
c. larger in females with schizophrenia than in nonschizophrenic persons
d. the same in both males and females with schizophrenia and were of little importance


The computed tomography (CT) scanner was used to evaluate brain structure in individuals with schizophrenia. It found that the ventricles in males with schizophrenia were larger than those of nonschizophrenic males. No one knows if the ventricular enlargement is a cause or consequence of schizophrenia.


15. The dopamine hypothesis postulates that functional abnormalities in schizophrenia are due to which of the following situations?


a. diminished activity of brain dopamine
b. the interaction of dopamine and metabolic activity
c. excessive activity of brain dopamine
d. the reduced effects of dopamine on the basal ganglia


The dopamine hypothesis postulates that functional abnormalities in schizophrenia are due to excessive activity of brain dopamine. Dopamine is normally produced in the brain, and it serves as a signaling molecule or neurotransmitter. Dopamine seems to have the most important effects in the basal ganglia of the brain.


16. Recent research into the neurophysiology of schizophrenia has explored the role of neurotransmitters (NTs) other than dopamine. Findings include:


a. expression of the signaling neuropeptide cholecystokinin is increased in schizophrenia
b. decreased number of inhibitory neurons for which gamma-aminobutyric acid (GABA) is the predominant NT
c. decreased brain activity in the hippocampus
d. effects of the excitatory NT glutamine


Recent research shows that in schizophrenia there is a decrease in the number of inhibitory neurons, particularly those in which GABA is the predominant neurotransmitter. Expression of the signaling neuropeptides cholecystokinin and somatostatin is also decreased in schizophrenia. Loss of inhibitory function may account for the increased brain activity seen in some specific brain sites, notably the hippocampus and parts of the prefrontal cortex.


17. Intervention for schizophrenia can be divided into three categories: clinical and family support services, rehabilitative services, and humanitarian aid and public safety. Which of the following choices is an example of rehabilitative services?


a. reducing positive and negative symptoms of schizophrenia
b. providing social controls to prevent harm to others in the community
c. improving quality of life for clients by enhancing their independence
d. providing productive activity and occupational therapy


An example of rehabilitative services for the client with schizophrenia would include providing productive activity and occupational therapy. Rehabilitation involves increasing the clientÕs capacity, both for social interactions and for productive activity (including gainful employment when feasible).


18. You are working with the parents of a young adult with a diagnosis of schizophrenia. You would teach the parents of the adult with schizophrenia that their adult child will:


a. have little awareness of what goes on around him or her
b. benefit by the parents feeling and appearing in control of themselves
c. be in need of lifelong hospitalization in a locked psychiatric facility
d. get worse as time goes on, since psychiatry has little to offer such a client


People who suffer from schizophrenia are usually sensitive to stress in others. Therefore, the nurse would teach the parents of an adult child with schizophrenia to indicate that the parent is in control of him- or herself. This will inevitably help the adult child.


19. One of the primary goals in providing rehabilitation services to clients with schizophrenia is to:


a. obtain good paying employment for them
b. eliminate the presence of negative symptoms
c. help them problem solve in everyday social challenges
d. reduce psychotic relapse rates significantly to save money


A primary goal in providing rehabilitation services to clients with schizophrenia


20. Although humane care is defined as the individualÕs right to the least restrictive care needed, this policy often does NOT protect the client from which of the following?


a. lack of support, lack of monetary funds, and lack of treatment
b. overly caring individuals who want to give the client everything
c. prolonged mandatory treatments and prolonged care in a treatment facility
d. homeless agencies wanting to put the clients in sheltered care


A goal of deinstitutionalization was to address the individualÕs right to least restrictive care. However, this practice did not ensure individuals would receive the support, monetary funds, and treatment needed to function adequately outside of the institutions. Many persons with schizophrenia are currently homeless, starving, and lacking appropriate treatment.