Types of Psychotic Disorders
T/F: Schizophrenia involves psychotic thinking or behavior present for at least 3 months.
Schizophrenia involves psychotic thinking or behavior present for at least 6 months.
A nurse is caring for an 11-year-old child who has oppositional definant disorder (ODD) and begins shouting at the nurse about the rules at a residential treatment program. Which of the following actions is the priority for the nurse to take to defuse the situation?
a. Take the child swimming at the facility's pool.
b. Ask the child, "How are you feeling right now?"
c. Establish a behavioral contract with the child.
d. Administer an anxiolytic medication.
a. Take the child swimming at the facility's pool.
Redirecting the expression of feelings to nondestructive, age-appropriate behaviors such as a physical activity helps the child learn how to modulate the expression of feelings and exert self-control. This is the least restrictive alternative and should be tried before resorting to measures that are more restrictive.
A nurse is planning care for a client who has borderline personality disorder and has been engaging in self-mutilation. Which of the following groups should the nurse encourage the client to participate in?
Correct Answer: C) Dialectical behavior treatment group
Rationale: Dialectical behavior therapy (DBT) is specifically designed to help clients with borderline personality disorder regulate emotions and reduce self-destructive behaviors.
A nurse is caring for a client who is experiencing a panic attack. Which of the following actions should the nurse take?
Correct Answer: C) Ask the client to focus on deep breathing exercises
Rationale: Deep breathing exercises help reduce the physical symptoms of a panic attack by slowing the heart rate and reducing hyperventilation.
A nurse is caring for a pediatric client who has conduct disorder (CD).
Exhibit 1:
History
Admitted at 1400:
• ADHD
• CD
Pediatric client is being admitted for inpatient evaluation and therapy by court order following arrest for vandalism and attempting to start a fire.
Client was expelled from school last year for possession of a gun on school property.
Client has been arrested previously for vandalism and shoplifting. History of animal cruelty and aggressiveness.
Client is being raised by grandparents. According to history given by grandparent, one of the client's guardians is in prison and their other guardian has alcohol use disorder. Grandparent states, "The child was basically raising themselves before we took them in. We love them, but we don't know how to handle them. They are just so angry all the time."
Exhibit 2:
Vital Signs
1430:
Temperature 36.1° C (97° F)
Blood pressure 128/66 mm Hg
Heart rate 74/min
Respiratory rate 12/min
Pulse oximetry 96% on room air (95% to 100%)
Exhibit 3:
Nurses' Notes
1500:
Client escorted and oriented to room.
Client refuses to answer questions or converse, states "Just leave me alone. You don't need to know anything about me. I'll be breaking out of this place soon."
Select the 4 provider prescriptions the nurse should anticipate receiving for this child. (Select all that apply.)
a. Educate grandparents on coping strategies
b. Provide high-protein, high-calorie finger food
c. Mechanical restraints PRN
d. Encourage aerobic exercise
e. Group therapy daily
f. Assist client in developing tools to manage anger
A,D,E,F
When recognizing cues, the nurse should identify that educate grandparents on coping strategies, encourage aerobic exercise, group therapy daily, and assist client in developing tools to manage anger are correct. Provide high-protein, high-calorie finger food is incorrect because this prescription is provided for a client who is experiencing mania. Also, mechanical restraints PRN is incorrect because it cannot be prescribed on a PRN basis.
A nurse is assessing a client with schizophrenia. Which of the following findings should the nurse identify as positive symptoms of psychotic disorders? (Select all that apply.)
Correct Answers:
Rationale: Positive symptoms of psychotic disorders reflect an excess or distortion of normal functions. These include hallucinations, delusions, alterations in speech, and bizarre behaviors. Negative symptoms, such as anhedonia, avolition, blunted/flat affect, alogia, and anergia, involve a decrease or absence of normal functions and are not part of the positive symptom category.
A nurse is caring for a 15-year-old client who has run away from home six times and was recently arrested for shoplifting. The client's guardians tell the nurse that ther child is physically abusive toward them. Based on the client's behavior, which of the following diagnoses should the nurse anticiapate?
a. Attention deficit hyperactivity disorder (ADHD)
b. Posttraumatic stress disorder (PTSD)
c. Intermittent explosive disorder (IED)
d. Conduct disorder (CD)
d. Conduct disorder (CD)
CD is manifested by a persistent pattern of behavior in which the rights of others and age-appropriate societal norms are violated.
A nurse is planning care for a client who has antisocial personality disorder. Which of the following outcomes should the nurse include in the plan of care?
Correct Answer: C) The client will treat others with respect
Rationale: Respectful behavior is a realistic and essential goal for clients with antisocial personality disorder, who often have difficulty with interpersonal relationships.
A nurse is caring for a client who reports feeling sad, worthless, and hopeless 9 months after the death of her son. Which of the following actions should the nurse take first?
Correct Answer: B) Ask the client if she has thoughts about harming herself
Rationale: Assessing for suicidal ideation is the priority in clients expressing feelings of worthlessness and hopelessness.
Nurse's Notes:
The client was admitted to the psychiatric unit for an acute manic episode. The client is pacing rapidly, speaking loudly, and attempting to engage multiple people in conversation. The client reports not sleeping for 3 nights. The client is resistant to sitting down for meals and states, "I don't have time to eat." The client also makes impulsive decisions, including giving away personal belongings to staff members.
Vital Signs:
Labs:
Case Study Question: Which of the following interventions should the nurse implement? (Select all that apply.)
Answers:
A nurse is assessing a client who is diagnosed with schizophrenia and is displaying signs of paranoia. Which of the following is the most appropriate action for the nurse to take?
Correct Answer: B) Give the client personal space
Rationale: Clients with paranoia may feel threatened by close proximity or forced interactions. Giving the client personal space helps reduce anxiety.
A nurse is preparing an in-service on impulse-control disorder (ICD). Which of the following information should the nurse include? (SATA)
a. The client is not at risk for causing injury to others.
b. The client will display a diminished control over their behavior no matter how problematic.
c. The client illustrates an ongoing pattern of defiance and extreme negativity.
d. The client feels a sense of pleasure and excitement following the behavior.
e. The client has intense feelings of anxiety and tension preceding the behavior.
f. The client will perform compulsive and repetitive behaviors in spite of the adverse
B-A client who has ICD is often not able to control their impulses, which can pose harm to themselves and others. Their lack of control is often characterized by heightened feelings of anxiety and tension preceding the impulsive behavior and feelings of gratification of reward following the impulsive behavior.
D- A client who has ICD is often not able to control their impulses, which can pose harm to themselves and others. Their lack of control is often characterized by heightened feelings of anxiety and tension preceding the impulsive behavior and feelings of gratification of reward following the impulsive behavior.
E-A client who has ICD is often not able to control their impulses, which can pose harm to themselves and others. Their lack of control is often characterized by heightened feelings of anxiety and tension preceding the impulsive behavior and feelings of gratification of reward following the impulsive behavior.
F - A client who has ICD is often not able to control their impulses, which can pose harm to themselves and others. Their lack of control is often characterized by heightened feelings of anxiety and tension preceding the impulsive behavior and feelings of gratification of reward following the impulsive behavior.
A nurse is caring for a client who has borderline personality disorder. Which of the following strategies should the nurse use to prevent self-inflicted injury?
Correct Answer: B) Implement measures to prevent intentional self-inflicted injury
Rationale: Preventing self-harm behaviors is a priority in clients with borderline personality disorder due to the impulsive and destructive nature of their condition.
A nurse is teaching a client who has generalized anxiety disorder about relaxation techniques. Which of the following techniques should the nurse recommend to help the client manage anxiety?
Correct Answer: A) Yoga and meditation
Rationale: Yoga and meditation are relaxation techniques that can help reduce physical and emotional stress in clients with anxiety.
Nurse's Notes:
The client was admitted following multiple superficial cuts to the forearms and reports ongoing suicidal ideation. The client presents with mood lability, alternating between cooperative and hostile. The client has a history of previous hospitalizations for self-harm and unstable relationships. The client currently denies any desire to harm others but states, "I feel like hurting myself again."
Vital Signs:
Labs:
Case Study Question: Which of the following interventions should the nurse include in the plan of care? (Select all that apply.)
Answers:
2. A nurse is assessing a young adult female for schizophrenia. Which of the following findings should the nurse identify as a risk factor for this condition?
Correct Answer: A) A history of depression
Rationale: A history of depression and other mood disorders is a known risk factor for the development of schizophrenia.
A nurse is caring for an adolescent client who has intermittent explosive disorder (IED). The nurse should identify that the child can experience which of the following affective manifestations (SATA)
A. Racing thoughts
B. Extreme anger
C. Extreme sadness
D. Increasing sense of tension
E. Temper tantrums
F. General remorse
A- Explosive episodes can be associated with affective manifestations which can include increased energy, an increased sense of tension, temper tantrums, shouting, being argumentative, getting into fights, threatening others, assaulting people or animals, damaging property, irritability, extreme anger, racing thoughts during the aggressive act, and a rapid onset of a depressed mood and fatigue after the act.
B- Explosive episodes can be associated with affective manifestations which can include increased energy, an increased sense of tension, temper tantrums, shouting, being argumentative, getting into fights, threatening others, assaulting people or animals, damaging property, irritability, extreme anger, racing thoughts during the aggressive act, and a rapid onset of a depressed mood and fatigue after the act.
D- Explosive episodes can be associated with affective manifestations which can include increased energy, an increased sense of tension, temper tantrums, shouting, being argumentative, getting into fights, threatening others, assaulting people or animals, damaging property, irritability, extreme anger, racing thoughts during the aggressive act, and a rapid onset of a depressed mood and fatigue after the act.
E- Explosive episodes can be associated with affective manifestations which can include increased energy, an increased sense of tension, temper tantrums, shouting, being argumentative, getting into fights, threatening others, assaulting people or animals, damaging property, irritability, extreme anger, racing thoughts during the aggressive act, and a rapid onset of a depressed mood and fatigue after the act.
A nurse is assessing a client who has been diagnosed with narcissistic personality disorder. Which of the following behaviors should the nurse expect the client to exhibit?
Correct Answer: A) Overconfidence in their abilities
Rationale: Clients with narcissistic personality disorder often exhibit an inflated sense of self-importance and overestimate their abilities.
A nurse is caring for a client who has been diagnosed with post-traumatic stress disorder (PTSD). Which of the following statements should the nurse include in the client’s teaching?
Correct Answer: D) "Exposure to triggers can help you reduce your response to them."
Rationale: Controlled exposure to triggers in a therapeutic setting can help clients reduce the intensity of their response to trauma-related stimuli.
Nurse's Notes:
The client presents with a flat affect, reporting feelings of hopelessness and decreased interest in daily activities. The client reports difficulty sleeping, fatigue, and a weight loss of 5 kg (11 lbs) over the past month. The client expresses vague thoughts of self-harm but denies any active plans. The client is currently on fluoxetine (Prozac) and reports taking the medication inconsistently.
Vital Signs:
Labs:
Case Study Question: Which of the following instructions should the nurse include in the discharge teaching for this client? (Select all that apply.)
Answers:
A nurse is reviewing the medical record of a client who is taking Haloperidol. The nurse should plan to initiate the AIMS assessment to monitor for adverse effects of which of the following conditions?
Correct Answer: B) Tardive dyskinesia
A nurse is teaching a group of students about oppositional defieant disorder (ODD) and conduct disorder (CD). Which of the following factors should the nurse suggest using when distinguishing between the behavior of the clinet who has ODD and a client who has CD (SATA).
a. Clients who have CD experience extreme sadness.
b. Clients who have ODD test limits and disobey authority figures.
c. Clients who have CD often violate the rights of others.
d. Clients who have CD violate societal norms.
e. Clients who have ODD disregard moral boundaries.
b. Clients who have ODD test limits and disobey authority figures.
Clients who have ODD are negativistic, disobedient, and defiant toward authority figures without seriously violating the basic rights of others, whereas clients who have CD frequently behave in ways that do violate the rights of others and age-appropriate societal norms.
c. Clients who have CD often violate the rights of others.
Clients who have ODD are negativistic, disobedient, and defiant toward authority figures without seriously violating the basic rights of others, whereas clients who have CD frequently behave in ways that do violate the rights of others and age-appropriate societal norms.
d. Clients who have CD violate societal norms.
These are findings associated with CD.
A charge nurse is discussing the care of a client who has a substance use disorder with a staff nurse. Which of the following statements by the staff nurse should the charge nurse identify as countertransference?
Correct Answer: A) "The client is just like my brother who finally overcame his drug habit."
Rationale: Countertransference occurs when a healthcare provider unconsciously projects personal feelings about someone onto a client, which can affect the quality of care provided.
A nurse is caring for a client who has panic disorder. Which of the following nursing interventions is most effective in helping the client manage acute panic attacks?
Correct Answer: C) Teach the client about progressive muscle relaxation
Rationale: Progressive muscle relaxation helps reduce physical tension and anxiety, making it an effective strategy for managing panic attacks.
Nurse's Notes:
The client was brought to the emergency department by family members, who report that the client has been increasingly withdrawn, talking to themselves, and refusing to eat. The client believes that "the government is trying to poison me." The client has a flat affect and appears disheveled. The client is currently prescribed haloperidol but has been noncompliant with medications for the past two weeks.
Vital Signs:
Labs:
Case Study Question: Which of the following interventions should the nurse implement? (Select all that apply.)
Answers: