Question 1

The nurse assesses a client who has been readmitted to the psychiatric inpatient unit for schizophrenia. His symptoms have been managed for several months with fluphenazine (Prolixin). Which of the following should be the FIRST assessment?

Accepted Answer

Answer reason: During a schizophrenia relapse, the highest-priority initial assessment is whether the client has been taking prescribed antipsychotics; nonadherence is a common cause of decompensation.

Question 2

A patient expresses the belief that someone is about to shoot him; this is an example of which type of delusion?

Accepted Answer

Answer reason: Belief that others intend to harm or are plotting against the person is a persecutory (persecution) delusion. Grandiosity involves exaggerated self-importance, ideas of reference misinterpret neutral events as personal, and nihilism denies existence of self/world.

Question 3

A client expresses the belief that the armed forces are out to kill him; this is an example of what?

Accepted Answer

Answer reason: A fixed false belief that others intend to harm the person is a persecutory delusion. Hallucinations involve false sensory perceptions; self-accusatory delusions center on guilt; error in judgment is not a psychotic delusion.

Question 4

A person hears noises such as somebody knocking at the door in the absence of an actual stimulus; what mental disorder is the person suffering from?

Accepted Answer

Answer reason: Perception of sound without any external stimulus is a hallucination; since the modality is hearing, it is an auditory hallucination. Illusions require a real stimulus.

Question 5

What is the name of the mental disorder in which a patient becomes self-critical and believes that he is a criminal?

Accepted Answer

Answer reason: Self-accusatory, excessive guilt with beliefs of being a criminal is characteristic of guilt delusion, seen in psychotic depression.

Question 6

Disturbances of orientation, memory, and intelligence are present in which of the following conditions?

Accepted Answer

Answer reason: Global cognitive deficits—disorientation, memory loss, and impaired intellect—characterize organic psychoses (e.g., delirium/dementia). Functional psychoses usually preserve orientation; hallucination and phobia are single symptoms, not global impairments.

Question 7

Which of the following is NOT a good prognostic factor in schizophrenia?

Accepted Answer

Answer reason: Poor premorbid adjustment is associated with worse outcomes in schizophrenia. Acute onset, being in a first episode, and having good social support are associated with better prognosis.

Question 8

What is the name of the disorder of thought content in which the patient does not accept the existence of the world around him?

Accepted Answer

Answer reason: Nihilistic delusions involve beliefs that the self, others, or the world does not exist or has been destroyed, matching the stem. Persecution, grandeur, and guilt are other delusional themes that do not deny existence.

Question 9

Loss of insight and judgement is seen in patients with which condition?

Accepted Answer

Answer reason: Psychosis commonly presents with poor insight and impaired judgement due to loss of reality testing. Clients with phobic or dissociative disorders usually retain insight, and alcoholism may affect judgement acutely but does not classically cause persistent loss of insight.

Question 10

A client is brought to the emergency room by the police. He is combative and yells, "I have to get out of here. They are trying to kill me." Which assessment is most likely correct in relation to this statement?

Accepted Answer

Answer reason: The belief that others are trying to kill him indicates a persecutory (paranoid) delusion, not an auditory hallucination or delusion of grandeur; intoxication is not the most specific explanation for the stated belief.

Question 11

The chart of a client with schizophrenia states that the client has echolalia. The nurse can expect the client to?

Accepted Answer

Answer reason: Echolalia is the pathological repetition of another person's words or phrases. Clang associations involve rhyming words, circumstantiality adds excessive irrelevant detail, and neologisms are made-up words.

Question 12

A client admitted to the psychiatric unit claims to be the Pope and insists that he will not be kept away from his subjects. The most likely explanation for the client's delusion is?

Accepted Answer

Answer reason: Grandiose delusions often function as a defense to bolster a fragile sense of self-worth; clients may adopt powerful identities to compensate for low self-esteem. Reaction formation is not consistent, and while stress/anxiety may precipitate symptoms, they do not best explain the content of a grandiose delusion.

Question 13

Which of the following is NOT included in the 4 A’s of schizophrenia?

Accepted Answer

Answer reason: Bleuler’s classic four A’s of schizophrenia are Affect (blunted), Autism, Ambivalence, and Association disturbance. Anxiety is not one of the four A’s.

Question 14

A client continually repeats phrases that others have just said. The nurse recognizes this behavior as?

Accepted Answer

Answer reason: Repeating words or phrases spoken by others is echolalia. Echopraxia involves imitating movements, catatonia is a motor syndrome, and 'autistic' is a diagnosis not the specific behavior.

Question 15

What does the management of schizophrenia include?

Accepted Answer

Answer reason: Best practice for schizophrenia combines antipsychotic medication with psychosocial interventions/psychotherapy for symptom control and functional recovery.

Question 16

A schizophrenic client talks animatedly but the staff are unable to understand what the client is communicating. The client is observed mumbling to herself and speaking to the radio. A desirable outcome for this client's care will be?

Accepted Answer

Answer reason: Findings indicate impaired verbal communication with disorganized, unintelligible speech; the most appropriate outcome is achieving meaningful, understandable verbal communication. Other options are not supported by the data provided.

Question 17

Which of the following statements made by a female client indicate to the nurse that she may have a thought disorder?

Accepted Answer

Answer reason: Using a newly invented word ("mesmer") is a neologism, which reflects disorganized thought content characteristic of a thought disorder/psychosis.

Question 18

A client is admitted to a psychiatric unit with delusions. The nurse can expect which of the following signs and symptoms?

Accepted Answer

Answer reason: Delusional disorders commonly present with fixed false beliefs, marked suspiciousness/paranoia, and poor insight leading to resistance to therapy. The other options describe mania (flight of ideas, hyperactivity), major depression (anorexia, hopelessness), or panic/somatic symptoms.

Question 19

A nurse is assessing a patient diagnosed with schizophrenia. Which finding is considered a positive symptom?

Accepted Answer

Answer reason: Positive symptoms represent an excess of normal functioning. Disorganized speech reflects abnormalities in thought processes, a hallmark positive symptom of schizophrenia.

Question 20

Schizophrenia is best defined as?

Accepted Answer

Answer reason: Schizophrenia is a primary psychotic disorder characterized by disturbances in thought processes and content, such as delusions, hallucinations, disorganized thinking/speech, and impaired reality testing. While cognitive deficits can occur, they are not the defining feature in standard classifications. It is distinct from mood disorders and personality disorders, which have different core diagnostic patterns and symptom clusters.

Question 21

Mental disorder means split of mind ....?

Accepted Answer

Answer reason: In nursing/mental health exam contexts, the phrase "split of mind" is commonly (though imprecisely) used to refer to schizophrenia. Schizophrenia is a psychotic disorder characterized by disturbances in thought processes, perception, and reality testing (e.g., delusions, hallucinations, disorganized thinking). Autism is a neurodevelopmental disorder, anorexia nervosa is an eating disorder, and obsession is a symptom class typically associated with OCD rather than a psychotic disorder.

Question 22

In following which is not a good prognostic factors in schizophrenia-?

Accepted Answer

Answer reason: Good prognostic factors in schizophrenia include acute onset, a first (or short) episode, and strong social support, all of which are associated with better functional recovery. Poor premorbid adjustment reflects longstanding social/occupational dysfunction prior to illness onset and is linked with greater negative symptoms and worse long-term outcomes. Therefore, it is not a good prognostic factor compared with the other options.

Question 23

A female client is admitted with a diagnosis of delusions of GRANDEUR. This diagnosis reflects a belief that one is?

Accepted Answer

Answer reason:  Delusions of grandeur are fixed false beliefs involving exaggerated self-importance, power, knowledge, identity, or special relationship (e.g., believing one is famous, exceptionally important, or has unique abilities). This is characteristic of psychotic disorders (and may also be seen in manic episodes) and differs from persecutory delusions (being harmed) or somatic/guilt-related delusions. The other options describe different delusional themes rather than grandiosity.

Question 24

A patient with schizophrenia tells the nurse that she hears a voice in her head telling her to run into traffic. Which type of a symptom is this?

Accepted Answer

Answer reason: A voice giving an instruction to perform an act (especially a dangerous one) is an auditory hallucination with a command component. This differs from delusions, which are fixed false beliefs, and echolalia, which is repetition of another’s speech. Anergia refers to decreased energy/motivation, a negative symptom, not a perceptual disturbance. Because the command involves self-harm risk, it also signals an urgent safety concern requiring immediate assessment and protection.

Question 25

A client is telling the nurse about his perception of his thought patterns. Which of the following statements by the client would validate the diagnosis of schizophrenia?

Accepted Answer

Answer reason: " This reflects a fixed, false belief that is bizarre and not based in reality, consistent with a delusion, which is a core positive symptom seen in schizophrenia and other psychotic disorders. The other statements are more consistent with obsessive thinking, mood lability suggestive of a mood disorder, or transient disorientation/dissociation rather than psychosis. Delusional content with grandiose and paranoid themes strongly supports a psychotic disorder diagnosis when persistent and impairing.

Question 26

A male client in the mental health unit is guarded and vaguely answers the nurse's questions. He isolates in his room and sometimes opens the door to peek into the hall. Which problem can the nurse anticipate?

Accepted Answer

Answer reason: Guardedness, vague responses, social isolation, and peeking out the door suggest suspiciousness and fear of being watched or harmed. These behaviors are commonly associated with paranoid thinking and persecutory beliefs seen in psychotic disorders. Hallucinations are not directly evidenced because no reports of hearing or seeing things are described. Excessive motor activity would present as agitation, pacing, or hyperactivity rather than avoidance and surveillance behaviors.

Question 27

Which type hallucination is mostcommon in schizophrenia?

Accepted Answer

Answer reason: Hearing voices commenting, conversing, or giving commands is the most typical hallucination pattern and is a key clinical clue in psychotic disorders. Visual hallucinations can occur but are less characteristic and often prompt consideration of substance intoxication/withdrawal, neurologic disease, or delirium. Tactile and gustatory hallucinations are comparatively uncommon in schizophrenia and more often associated with intoxication (e.g., stimulants) or other medical etiologies.

Question 28

The nurse is aware that a schizophrenic client who is experiencing prolonged isolation is at risk for developing?

Accepted Answer

Answer reason: Prolonged social isolation and reduced external stimulation increase the likelihood that a client with schizophrenia will misinterpret internal thoughts or sensory perceptions as real, contributing to perceptual disturbances. Hallucinations are a classic positive symptom and can be exacerbated when reality testing is weakened by minimal interpersonal contact. Delusions are also positive symptoms, but isolation more directly heightens risk for sensory-perceptual distortions rather than fixed false beliefs. Waxy flexibility is associated with catatonia, and lack of volition is a negative symptom not specifically driven by isolation in the same way as perceptual disturbances.

Question 29

A client who is delusional approaches the nurse and states, “You are my aunt and you live with my family.” What is the most appropriate response by the nurse?

Accepted Answer

Answer reason: “This is my name. What is your aunt’s name?” A core principle in caring for clients with delusions is to provide reality-based information while avoiding arguing, confronting, or validating the delusional belief. This response calmly states the nurse’s real identity and then redirects the client to provide information, which supports orientation and can reduce escalation. Options that directly contradict the delusion can increase defensiveness and mistrust, while a response that expresses agreement or approval risks reinforcing the delusion. Redirecting with a neutral question maintains therapeutic communication and preserves rapport and safety.

Question 30

A client is preoccupied with his belief that the CIA has been planning to take him away to save the agency from his influence. These delusions are a defense against which underlying feeling?

Accepted Answer

Answer reason: Believing a powerful agency is targeting him because of his “influence” inflates self-importance and reduces conscious awareness of low self-worth. This pattern reflects an attempt to manage vulnerability by externalizing threats and enhancing perceived significance. In contrast, guilt would more typically drive themes of punishment or deserved harm rather than exaggerated personal power and importance.

Question 31

The nurse is interviewing a client with a delusional disorder. Which of the following conditions would the nurse expect from this client?

Accepted Answer

Answer reason: Because the delusion is often circumscribed, many clients can appear organized and maintain work and relationships except where the delusional content interferes. Marked bizarre behavior and prominent disorganization are more typical of schizophrenia spectrum disorders with disorganized features. Cognitive deficits like impaired short-term memory are not defining features and would prompt assessment for neurocognitive disorder, delirium, or substance/medication effects.

Question 32

A nurse is facilitating a group of schizophrenic clients when one client says, “I like to drive my car, bar, tar, far.” This pattern of speech is known as which disorder?

Accepted Answer

Answer reason: The client’s string of rhyming words (“car, bar, tar, far”) reflects this sound-based association despite poor semantic coherence. Echolalia would be repeating another person’s words, and echopraxia is mimicking another person’s movements, so neither fits a rhyme-driven speech pattern. Neologisms refer to invented words with idiosyncratic meaning, which is not demonstrated here.

Question 33

Which nursing diagnosis is most appropriate for a client diagnosed with schizophrenia, disorganized type?

Accepted Answer

Answer reason: A nursing diagnosis should target the most defining, high-impact impairment that guides immediate therapeutic interventions such as structured, simple communication and reality-based cues. While sleep disturbance and social isolation can occur in schizophrenia, they are not as specifically tied to the disorganized subtype as formal thought disorder affecting speech. Self-care deficits may be present, but they are secondary to the core cognitive/communication disorganization driving overall functioning and engagement in care.

Question 34

The nurse is assessing a client with schizophrenia who exhibits negativism, rigidity, excitement, stupor, and posturing. The nurse suspects that the client has which type of schizophrenia?

Accepted Answer

Answer reason: The cluster of stupor, negativism, rigidity, excitement, and posturing is classic for catatonic features and is far more specific than the other subtypes listed. Paranoid presentations center on delusions/hallucinations with relatively preserved affect and motor behavior, which does not match the stem. Disorganized schizophrenia emphasizes disorganized speech/behavior and flat or inappropriate affect, rather than the severe motor syndrome described.

Question 35

Which symptom indicates that schizophrenia is a thought disorder?

Accepted Answer

Answer reason: Faulty logic reflects formal thought disorder, where conclusions don’t follow from premises and associations become illogical or loose. The other options either imply thinking is largely organized or focus more on behavioral/social response rather than the core disturbance in thought processes. In clinical terms, this symptom aligns with classic findings like illogicality, tangentiality, and loose associations that define a thought disorder.

Question 36

While talking to a client with schizophrenia, a nurse notes the client frequently uses unrecognizable words with no common meaning. The nurse identifies this as which of the following?

Accepted Answer

Answer reason: The stem specifically describes unrecognizable words with no common meaning, which directly matches this definition. Echolalia is the repetition of another person’s words, not invented language. Word salad refers to a jumbled, incoherent mixture of words/phrases, whereas the key feature here is creation of new words.

Question 37

A 45-year-old client experiencing delusions has been admitted to the crisis center. When assessing the content of the delusions, the nurse should look for which aspect of the delusions?

Accepted Answer

Answer reason: g., persecutory, grandiose, somatic, erotomanic) to understand risk, triggers, and needed interventions. Recognizing the theme helps the nurse anticipate safety concerns such as fear-driven aggression in persecutory delusions or impaired judgment in grandiose delusions. Evaluating “logic” is less useful because delusions are typically internally consistent to the client but not reality-based. Focusing on “true experiences” can inadvertently validate the delusion and distract from assessing impact on functioning and safety.

Question 38

Which statement made by a client taking fluphenazine tells the nurse that the client understands his discharge instructions?

Accepted Answer

Answer reason: ” First-generation antipsychotics such as fluphenazine can cause photosensitivity and increase the risk of sunburn, so teaching includes limiting sun exposure and using protective clothing/sunscreen. This statement demonstrates the client understands a key safety instruction aimed at preventing an adverse effect. Avoiding cheese is relevant to MAO inhibitors due to tyramine interactions, not typical antipsychotics. While adequate fluids and planning rest may be helpful general health measures, they are not the most specific, high-yield discharge teaching point for this medication compared with photosensitivity precautions.

Question 39

The nurse is caring for the client prescribed the traditional antipsychotic drug haloperidol for the treatment of schizophrenia. Which medication should the nurse expect to administer if extra pyramidal side effects develop?

Accepted Answer

Answer reason: An anticholinergic agent can restore the dopamine–acetylcholine balance and rapidly reduce acute dystonia, parkinsonism, and akathisia. This medication is a standard PRN/adjunct treatment when EPS emerge with haloperidol. Switching to another antipsychotic (including atypicals) may be considered longer term, but it does not provide immediate symptomatic reversal of EPS, and an SSRI does not treat EPS.

Question 40

A client diagnosed with schizophrenia several years ago tells a nurse that he feels “very sad.” The nurse observes that he’s smiling when he says it. The nurse interprets the behavior as which of the following?

Accepted Answer

Answer reason: Smiling while reporting feeling “very sad” reflects a mismatch between reported internal mood state and displayed emotional expression. This is a classic example of inappropriate (incongruent) affect seen in psychotic disorders. Extrapyramidal symptoms relate to antipsychotic side effects (e.g., rigidity, tremor) and do not explain an emotional-expression mismatch. Insight refers to awareness of illness, which is not being assessed here.

Question 41

A client tells the nurse that he can only drink bottled water since the water from his sink has been poisoned. The nurse understands that the client is exhibiting which of the following?

Accepted Answer

Answer reason: Believing the sink water has been poisoned reflects suspiciousness and fear of being harmed, which aligns with paranoid thinking. Auditory hallucinations would involve hearing voices or sounds without an external stimulus, which is not described. Delusions of grandeur involve exaggerated self-importance, and perseveration is repetitive speech/behavior, neither of which match the client’s statement.

Question 42

A client tells a nurse voices are telling him to do “terrible things.” What is the best response by the nurse?

Accepted Answer

Answer reason: Command hallucinations create an immediate safety risk, so the priority nursing action is to assess content, intent, and the client’s ability/willingness to resist the commands. Clarifying what the voices say helps determine imminence of harm to self/others and guides urgent interventions (e.g., increased observation, removal of means, notifying provider). Redirecting or sending the client away can delay recognition of a dangerous command and reduce supervision. Directly arguing that the voices aren’t real often escalates defensiveness and is less effective than acknowledging the experience and assessing risk while maintaining reality-based communication.

Question 43

Which action by a client with stable schizophrenia is most important for preventing relapse?

Accepted Answer

Answer reason: Ongoing medication reduces positive-symptom re-emergence and helps maintain functional stability over time. Psychosocial supports like therapy, family support, and skills training improve coping and functioning, but they do not substitute for antipsychotic maintenance in preventing symptom return. Nonadherence is a leading cause of relapse and rehospitalization, so consistent use is the highest-impact action.

Question 44

During the initial interview, a schizophrenic client states to the nurse, “I don’t enjoy things anymore. I used to love to read mystery books but even that isn’t enjoyable now.” The nurse determines the client is experiencing which of the following?

Accepted Answer

Answer reason: The client explicitly reports no longer enjoying reading, which directly reflects reduced capacity for pleasure rather than a primary problem with motivation, speech, or emotional expression. Avolition refers to decreased goal-directed activity/initiative, which is not the main complaint here. Flat affect would be observed as reduced emotional expression, but the stem describes subjective loss of enjoyment rather than blunted outward affect.

Question 45

A client with paranoid schizophrenia tells the nurse that two people talking in the hall are planning to kidnap and kill him. The client’s thought pattern reflects which of the following?

Accepted Answer

Answer reason: The client is attributing a private, threatening message/intent to an unrelated conversation in the hallway. This differs from hallucinations, which are perception-like experiences without an external stimulus (e.g., hearing voices). It also is not grandiosity (inflated self-importance) or echolalia (pathologic repetition of another’s words).

Question 46

Which nursing diagnosis is most appropriate for a client with acute schizophrenic reaction?

Accepted Answer

Answer reason: Perceptual distortions increase the risk of the patient responding to internal stimuli (e.g., command hallucinations) or paranoid beliefs, making potential harm to others a high-stakes, time-sensitive concern. This diagnosis aligns with the acute phase where reality testing is impaired and behavioral control may be compromised. Social withdrawal and sleep disruption can occur, but they are typically secondary to immediate risk management. Focusing on violence risk supports urgent interventions such as close observation, de-escalation, and milieu safety planning.

Question 47

A client on the psychiatric unit is copying and imitating the movements of his primary nurse. During recovery, he says, "I thought the nurse was my mirror. I felt connected only when I saw my nurse." The nurse identifies this behavior as which of the following?

Accepted Answer

Answer reason: The client’s description of the nurse as a “mirror” and the observed copying of movements directly match this phenomenon. Modeling is a purposeful, goal-directed learning process rather than an automatic mimicry seen in psychosis. Ego-syntonicity refers to behaviors experienced as consistent with one’s self-image, and ritualism refers to repetitive acts (often linked with anxiety/OCD), neither of which primarily describes motor imitation of another person.

Question 48

The nurse is teaching the family of a client with a psychiatric disorder about traditional antipsychotic drugs and their effect on symptoms. Which of the following symptoms would be most responsive to these types of drugs?

Accepted Answer

Answer reason: Positive symptoms include hallucinations, delusions, and disorganized thought/behavior, and these tend to improve most with typical antipsychotics. In contrast, negative symptoms such as apathy and social withdrawal and cognitive deficits like attention impairment are generally less responsive to first-generation agents and may persist despite treatment. Therefore, the symptom most likely to respond is a positive symptom—delusions.

Question 49

The nurse is providing information to a client who is taking chlorpromazine. What is the most important information for the nurse to provide?

Accepted Answer

Answer reason: Antipsychotics like chlorpromazine require ongoing monitoring because clinically significant adverse effects (e.g., extrapyramidal symptoms, anticholinergic effects, orthostatic hypotension, sedation, and rare but life-threatening reactions) may emerge over time and need dose adjustment or provider-directed changes. Routine follow-up supports early detection of complications, evaluation of therapeutic response, and reinforcement of adherence and safety teaching. Telling a client to self-reduce the dose risks relapse and rebound psychosis. Advising alcohol is safe is incorrect due to additive CNS depression and increased fall risk, and instructing the client to stop the medication on their own can cause abrupt discontinuation problems and delays in appropriate medical evaluation.

Question 50

While caring for a hospitalized client diagnosed with schizophrenia, a nurse observes the client watching television. The client tells the nurse the television is speaking directly to him. Which term describes this belief?

Accepted Answer

Answer reason: g., TV content) are interpreted as having special personal meaning. Believing the television is speaking directly to the client reflects misinterpretation of an external stimulus as directed specifically at them, which is common in schizophrenia. Paranoid thinking is centered on persecutory themes (harm, threat, conspiracy), which is not required by this belief. Concrete thinking refers to literal interpretation and difficulty with abstraction, and autistic thinking refers to inward-focused, fantasy-based thought processes rather than a misattribution of external messages.

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