Schizophrenia
A 22-year-old male presents with hallucinations and delusions that began gradually over the past year. Which finding supports a diagnosis of schizophrenia?
A. Sudden onset of symptoms
B. Symptoms lasting less than 1 month
C. Onset during adolescence or early adulthood
D. Full return to baseline functioning
Correct Answer: C
Rationale: Schizophrenia develops insidiously, usually between ages 15–25 for men and 25–35 for women.
Which finding is a positive symptom of schizophrenia?
A. Flat affect
B. Alogia
C. Hallucinations
D. Avolition
Correct Answer: C
Rationale: Positive symptoms are added behaviors such as hallucinations and delusions.
A patient interprets a coat on a rack as a bear. This is:
A. Hallucination
B. Illusion
C. Delusion
D. Magical thinking
Correct Answer: B
Rationale: Illusions are misinterpretations of real stimuli.
Which medication is a first-generation antipsychotic?
A. Risperidone
B. Quetiapine
C. Haloperidol
D. Olanzapine
Correct Answer: C
Rationale: Haloperidol is a typical (first-generation) antipsychotic.
A patient says, “You’re part of the FBI trying to hurt me.” What is the nurse’s best response?
A. “That’s not true.”
B. “Why do you believe that?”
C. “That must feel frightening. I will not hurt you.”
D. “You’re imagining things.”
Correct Answer: C
Rationale: Focuses on feelings without reinforcing or challenging the delusion.
Which symptom must be present for a schizophrenia diagnosis according to DSM-5?
A. Negative symptoms
B. Mood disturbance
C. Hallucinations, delusions, or disorganized speech
D. Cognitive impairment
Correct Answer: C
Rationale: At least one core symptom (hallucinations, delusions, or disorganized speech) must be present.
A patient shows little motivation to perform ADLs. This symptom is best described as:
A. Anhedonia
B. Avolition
C. Alogia
D. Affective blunting
Correct Answer: B
Rationale: Avolition is reduced motivation for goal-directed behavior.
A patient states, “The TV is sending me messages meant only for me.” This is:
A. Auditory hallucination
B. Referential delusion
C. Paranoia
D. Thought blocking
Correct Answer: B
Rationale: Referential delusions involve belief that events are directed at the patient.
A patient on haloperidol develops pacing and inability to sit still. This side effect is:
A. Acute dystonia
B. Akathisia
C. Tardive dyskinesia
D. NMS
Correct Answer: B
Rationale: Akathisia causes motor restlessness and is often mistaken for anxiety.
Which communication technique is non-therapeutic?
A. Clarifying
B. Reflecting
C. Giving advice
D. Summarizing
Correct Answer: C
Rationale: Giving advice interferes with patient autonomy.
A patient has symptoms identical to schizophrenia but lasting 4 months. The nurse anticipates which diagnosis?
A. Schizoaffective disorder
B. Brief psychotic disorder
C. Delusional disorder
D. Schizophreniform disorder
Correct Answer: D
Rationale: Schizophreniform disorder mirrors schizophrenia but lasts less than 6 months.
A patient cannot think abstractly and answers questions literally. This reflects which cognitive symptom?
A. Impaired executive functioning
B. Anosognosia
C. Concrete thinking
D. Impaired memory
Correct Answer: C
Rationale: Concrete thinking limits abstract reasoning.
A patient makes up words that only have meaning to them. This speech pattern is:
A. Clang association
B. Echolalia
C. Neologism
D. Circumstantiality
Correct Answer: C
Rationale: Neologisms are invented words with personal meaning.
Which medication treats tardive dyskinesia?
A. Benztropine
B. Diphenhydramine
C. Valbenazine
D. Lorazepam
Correct Answer: C
Rationale: Valbenazine and deutetrabenazine are approved for tardive dyskinesia.
Which nursing intervention is most appropriate for hallucinations?
A. Agree with the hallucination
B. Ignore the patient
C. Ask about the content and assess safety
D. Tell the patient it is not real
Correct Answer: C
Rationale: Assessing content, especially for command hallucinations, is critical.
Which phase of schizophrenia includes social withdrawal, odd thinking, and declining school performance?
A. Acute
B. Maintenance
C. Prodromal
D. Stabilization
Correct Answer: C
Rationale: The prodromal phase occurs before overt psychosis and includes subtle behavioral changes.
A patient does not believe they have a mental illness and refuses medication. This is known as:
A. Delusion
B. Insight
C. Anosognosia
D. Paranoia
Correct Answer: C
Rationale: Anosognosia is lack of awareness of illness, common in schizophrenia.
Which hallucination type is most dangerous and requires immediate assessment?
A. Visual
B. Olfactory
C. Tactile
D. Command auditory
Correct Answer: D
Rationale: Command hallucinations may direct harm to self or others.
A patient on antipsychotics develops fever, muscle rigidity, altered LOC, and autonomic instability. What is the priority action?
A. Administer benztropine
B. Continue medication at lower dose
C. Discontinue antipsychotic immediately
D. Encourage oral fluids
Correct Answer: C
Rationale: These are signs of neuroleptic malignant syndrome, a medical emergency.
Which nursing action best promotes safety for a patient at risk for violence?
A. Increase stimulation
B. Provide unpredictable rounding
C. Encourage isolation
D. Debate delusions
Correct Answer: B
Rationale: Frequent, unpredictable monitoring enhances safety without escalating behavior.
A patient is newly diagnosed with schizophrenia. Which information should the nurse include when teaching the family about prognosis?
A. Most patients experience full recovery after the first episode
B. Earlier onset is associated with a poorer prognosis
C. Medication is only needed during acute episodes
D. Symptoms typically resolve within one year
Correct Answer: B
Rationale: Earlier onset, especially in males, is linked to more severe disease and poorer long-term outcomes.
Which assessment finding is most consistent with a negative symptom of schizophrenia?
A. Responding to voices
B. Belief that others are plotting against them
C. Limited eye contact and minimal speech
D. Disorganized thought process
Correct Answer: C
Rationale: Negative symptoms reflect absence of normal behaviors such as speech and emotional expression.
A patient states, “Blue glue shoe zoo,” while smiling inappropriately. This speech pattern is best described as:
A. Word salad
B. Clang association
C. Neologism
D. Perseveration
Correct Answer: B
Rationale: Clang associations link words by sound rather than meaning.
Which assessment finding indicates a patient taking clozapine requires immediate provider notification?
A. Weight gain of 5 lb in 1 month
B. Excessive salivation
C. Absolute neutrophil count of 900/mm³
D. Drowsiness
Correct Answer: C
Rationale: Clozapine can cause agranulocytosis. ANC below 1,500 requires intervention; below 1,000 is critical.
A patient with schizophrenia states, “The government put a chip in my brain.” What is the nurse’s best response?
A. “That’s impossible.”
B. “Why would they do that?”
C. “I don’t see any evidence of that, but I know this feels real to you.”
D. “You need to stop thinking about that.”
Correct Answer: C
Rationale: Acknowledges the patient’s feelings without validating the delusion, which is key therapeutic communication.