Question 1

Inability to carry out daily responsibilities typically occurs during the prodromal phase of schizophrenia. Which symptom may also occur during this phase?

Accepted Answer

Answer reason: Typical findings include social withdrawal, reduced motivation, deterioration in school/work performance, and decreased self-care. Neglect of hygiene and impaired role functioning fit this early negative-symptom/functional-deterioration pattern. Options describing increased energy, increased social interaction, or heightened work performance conflict with the usual prodromal trajectory of worsening functioning and self-neglect.

Question 2

The daughter of a client with schizophrenia states, “I’m afraid I may develop this disease, too.” The nurse explains that schizophrenia is associated with which of the following?

Accepted Answer

Answer reason: This aligns with family studies showing increased risk in first-degree relatives, but not determinism, meaning a child can have elevated risk without inevitably developing the disorder. The trauma-only options are not established as primary causes and are better viewed as possible stressors that may affect onset or course rather than etiology. The “both parents” statement is overly narrow and implies a single necessary condition, whereas risk can be increased with one affected relative and still depends on additional factors.

Question 3

A nurse teaches a class of caregivers about the positive and negative behaviors of schizophrenia. The nurse explains positive behaviors as?

Accepted Answer

Answer reason: Positive symptoms in schizophrenia are added experiences or distortions of normal functioning, such as hallucinations, delusions, and disorganized perception/thought. This option describes altered sensory processing and misinterpretation of experiences, which aligns with hallucinations/perceptual disturbances. The other options reflect negative symptoms (diminished or absent normal functions), including alogia (limited speech), avolition (inability to initiate/persist), and reduced verbal output. Therefore, this is the best description of a positive behavior.

Question 4

A nurse is assisting with morning care when a client suddenly throws off the covers and starts shouting, “My body is changing and disintegrating because I’m not of this world.” The nurse describes this behavior as which of the following?

Accepted Answer

Answer reason: The statement about the body “changing and disintegrating” with an alien-like quality indicates an ego boundary disturbance commonly seen in psychotic states. Ideas of reference would involve attributing special meaning to neutral external events, not an internal bodily unreality. Paranoid ideation centers on suspicion and threat from others, which is not the focus of the client’s experience here.

Question 5

The teenage son of a father with schizophrenia is worried that he might have schizophrenia as well. Which behavior would be an indication that he should be evaluated for signs of the disorder?

Accepted Answer

Answer reason: Increasingly staying away from home can reflect emerging isolation from family and disruption of usual roles, which warrants assessment for broader changes (school performance, peer relationships, affect, and thought content). By contrast, moodiness and sleep changes are common and nonspecific in teenagers and do not uniquely point toward a psychotic disorder. Preoccupation with the body more strongly suggests anxiety or somatic/appearance-related concerns rather than an early psychosis picture.

Question 6

The nurse is teaching the family of a client with schizophrenia about symptoms of remission. Which of the following responses would be the most accurate?

Accepted Answer

Answer reason: Remission in schizophrenia means a sustained reduction in the intensity and prominence of core psychotic symptoms (e.g., delusions, hallucinations, disorganized thinking), not a guaranteed absence of all symptoms. This option matches the clinical definition families need: symptoms are controlled to a point that they are not prominent or functionally impairing. The prodromal phase is an early phase before full psychosis and is not the definition of remission. Statements implying being completely symptom-free and off medication are inaccurate and can increase relapse risk because maintenance treatment is commonly needed.

Question 7

A client has started taking haloperidol (Haldol). What is the most important instruction for the nurse to give the client?

Accepted Answer

Answer reason:  Haloperidol is a high-potency typical antipsychotic with a significant risk for extrapyramidal symptoms, including akathisia, which often presents as inner restlessness, pacing, and agitation. Early recognition matters because untreated akathisia is highly distressing and is associated with medication nonadherence and increased risk of impulsivity or suicidality. Prompt reporting allows the prescriber to adjust the dose or add treatments (e.g., beta-blocker, anticholinergic, or benzodiazepine) to reduce symptoms and improve safety. Sunscreen advice can be relevant for photosensitivity with some antipsychotics but is not the most critical initial safety instruction compared with identifying early EPS.

Question 8

A client is admitted after being found on a highway, hitting at cars and yelling at motorists. When approached by the nurse, the client shouts, “You’re the one who stole my husband from me!” The nurse interprets the behavior as?

Accepted Answer

Answer reason: A delusion is a fixed, false belief that is not consistent with reality and is maintained despite evidence to the contrary. The client’s accusation reflects a persecutory/jealous belief about the nurse having “stolen” the husband, without any supporting basis, which is characteristic of psychosis. Hallucinations involve sensory perceptions (e.g., hearing voices) rather than an organized false belief about events or relationships. Disorientation would present as confusion about person/place/time, and a phobia is an excessive fear response to a specific object or situation, neither of which best fits this presentation.

Question 9

A client diagnosed with schizophrenia has been taking haloperidol (Haldol) for 1 week when a nurse observes that the client’s eyeball is fixated on the ceiling. Which specific condition is the client exhibiting?

Accepted Answer

Answer reason: This presentation fits an oculogyric crisis, an emergency EPS manifestation requiring prompt treatment (e.g., IM/IV anticholinergic such as benztropine or diphenhydramine) and monitoring for airway/neck involvement. Akathisia instead presents as inner restlessness and inability to sit still, not fixed gaze. Tardive dyskinesia is a late-onset syndrome (months to years) with choreoathetoid movements, and neuroleptic malignant syndrome would include fever, rigidity, autonomic instability, and altered mental status.

Question 10

A client with schizophrenia reports that her hallucinations have decreased in frequency. What is the most appropriate nursing intervention to address the client's problem with social isolation?

Accepted Answer

Answer reason: As hallucinations decrease, the priority shifts to gradually increasing reality-based social interaction to reduce isolation without overwhelming the client. Structured, low-pressure group activities provide predictable rules and brief, goal-directed contact that supports socialization and reduces anxiety. Making the client a group leader is too demanding and may worsen stress and withdrawal. Solitaire reinforces isolation, and a sing-along can be overly stimulating and cognitively demanding for someone still recovering from psychotic symptoms.

Question 11

A client with schizophrenia is huddled on the floor and appears to be interacting with someone underneath the bed. The nurse notes that the client appears afraid. Which assessment by the nurse is most likely correct?

Accepted Answer

Answer reason: Interacting with an unseen person strongly indicates a perceptual disturbance, where the client experiences sensory input without an external stimulus. Schizophrenia commonly presents with auditory (and sometimes visual) hallucinations that can be frightening and lead to fearful, protective behavior such as hiding or huddling. A delusion is a fixed false belief, not a direct sensory experience, and would more typically be assessed through the client’s stated beliefs rather than observed “interaction” with an unseen entity. Nightmares occur during sleep and would not explain the client’s awake behavior, and suicidal ideation requires direct assessment but is not the most likely explanation for this specific presentation.

Question 12

A nurse on an inpatient unit is having a discussion with a client diagnosed with schizophrenia about his schedule for the day. The client comments that he was highly active at home and then explains the volunteer job he held. The nurse interprets the client’s response as reflecting which of the following?

Accepted Answer

Answer reason: Here, when asked about the day’s schedule, the client diverts into being highly active at home and discussing a past volunteer job rather than addressing the schedule. This differs from circumstantiality, where excessive detail is given but the person eventually gets back to the question. Loose associations would be a more severe derailment with little logical connection between ideas, which is not the best fit for the described response.

Question 13

A client is brought to the crisis response center by his family. During evaluation, he reports being depressed for the last month and complains about voices constantly whispering to him. Which diagnosis is the most likely?

Accepted Answer

Answer reason: The combination of persistent auditory hallucinations (voices whispering) plus a month of depressive symptoms most strongly supports a mood disorder with psychosis rather than a schizophrenia subtype alone. Catatonic and disorganized schizophrenia require prominent motor/catatonic features or disorganized speech/behavior and flat/inappropriate affect, which are not described. Paranoid schizophrenia can include auditory hallucinations, but the stem emphasizes a sustained depressive episode alongside psychosis, pointing to schizoaffective disorder as the best fit.

Question 14

The nurse is providing care for the client diagnosed with paranoid hallucination. The nurse determines that the client is experiencing a stage IV reaction to hallucinations. Which client behavior supports this assessment?

Accepted Answer

Answer reason: Striking objects in a public area reflects escalating psychomotor agitation and impaired behavioral control, which aligns with a severe stage. Earlier stages more often show anxiety and increased scanning/listening behaviors without overt aggression. Autonomic symptoms like palpitations can occur with anxiety but are less specific for the severe, potentially dangerous stage than aggressive motor behavior.

Question 15

A client admitted to an inpatient unit approaches a nursing student saying he descended from a long line of people of a “superrace.” What is the most appropriate response by the nursing student?

Accepted Answer

Answer reason: Delusions are fixed false beliefs, and therapeutic communication focuses on understanding the meaning and feelings behind them rather than validating or directly arguing. Exploring themes can reveal underlying needs (e.g., desire for power, safety, or self-worth) and helps build rapport while keeping the interaction reality-based. Directly challenging the belief often increases defensiveness, distrust, and escalation, making engagement harder. Avoidant behavior (walking away) misses an opportunity for assessment and therapeutic connection, while simply socializing without addressing content is less clinically purposeful than assessing the delusional theme.

Question 16

The nurse is reviewing the discharge plan with the father of the adolescent recently diagnosed with paranoid schizophrenia. Which statement made by the father indicates understanding of the client’s diagnosis?

Accepted Answer

Answer reason:  Schizophrenia is a chronic psychotic disorder with significant comorbidity and elevated suicide risk, especially early in the illness and during/after hospitalization. Recognizing the need to monitor mood symptoms reflects understanding of major safety concerns that accompany psychotic disorders, including depression and suicidality. Medication adherence reduces relapse risk but does not guarantee the client will not worsen, so an absolute statement is inaccurate. Promising a single hospitalization is unrealistic given the typical relapsing course, and keeping the client home solely for monitoring is not a core diagnostic understanding and may impede appropriate follow-up care.

Question 17

A disorganized schizophrenic’s symptoms include the distressing triad of extreme social withdrawal, odd mannerisms, and other regressive behaviors. What is the most appropriate intervention by the nurse?

Accepted Answer

Answer reason: Schizophrenia with severe social withdrawal is managed initially by building trust and reducing stimulation while promoting reality-based contact. Short, frequent, non-demanding interactions decrease anxiety, support orientation, and gradually increase social engagement without overwhelming the client. Forcing group activities can worsen withdrawal or agitation due to overstimulation and impaired social processing. Simply waiting for the client to “be ready” reinforces isolation and misses the nursing role of structured, supportive engagement.

Question 18

A 34-year-old male client is referred to a mental health clinic by the court. The client harassed a couple next door to him with charges that the wife was in love with him. He wrote love notes and called her on the telephone throughout the night. The client is employed and has had no problems in his job. Which disorder is suspected?

Accepted Answer

Answer reason: The erotomanic theme (belief that another person is in love with him) explains the persistent harassment behaviors. The absence of broader psychotic features such as disorganized speech/behavior, prominent negative symptoms, or marked functional decline makes schizophrenia less likely. Major depression and bipolar disorder would require prominent mood symptoms driving the presentation, which are not described here.

Question 19

A 40-year-old client with a diagnosis of chronic, undifferentiated schizophrenia lives in a rooming house that has a weekly nursing clinic. He scratches while he tells the nurse he feels creatures eating away at his skin. Which intervention should be done first?

Accepted Answer

Answer reason: Safety and nursing process principles require ruling out physiologic causes and actual injury before attributing symptoms to psychosis. Scratching can cause excoriations and may be driven or worsened by dermatologic conditions (e.g., scabies, dermatitis), substance use, or medication side effects, so immediate assessment of skin integrity and objective findings is the priority. Addressing hallucinations therapeutically can follow, but it does not mitigate immediate risk of infection or self-injury. Changing antipsychotic dosing is a provider decision and should come after assessment data support uncontrolled psychosis rather than a physical etiology.

Question 20

A nurse is talking with the family of a client diagnosed with schizophrenia. The mother asks, “What causes this disorder?” What is the best response by the nurse?

Accepted Answer

Answer reason: This response is accurate, nonblaming, and aligns with current understanding that no single parenting behavior or simple perinatal event fully accounts for the disorder. The other choices incorrectly imply a direct, single-cause etiology (e.g., specific maternal bacterial infection or CNS damage) that is not the standard explanation given to families. Attributing illness to poor bonding is outdated and stigmatizing, and it mischaracterizes both schizophrenia and the development of depression.

Question 21

A single 24-year-old client is admitted with acute schizophrenic reaction. The nurse anticipates that which of the following is the most appropriate therapy for the client?

Accepted Answer

Answer reason: g., hallucinations, delusions, severe agitation) and lower risk to self/others. In the acute phase, reality-based psychotherapy aimed at insight is typically ineffective because thought processes are disorganized and reality testing is impaired. Biofeedback is not a standard first-line treatment for schizophrenia and would not address core psychotic symptoms. ECT is generally reserved for severe, treatment-resistant mood disorders or catatonia, not as routine therapy for an acute schizophrenic reaction.

Question 22

A client who is taking antipsychotic medications becomes agitated, fearful, and panicky that people are staring at him. He paces with his neck twisted to one side, and his eyes forcefully drawn upward toward the ceiling. The nurse recognizes the need for intervention. What is the most appropriate medication for the nurse to administer?

Accepted Answer

Answer reason: I.M. benztropine (Cogentin) The presentation is an acute dystonic reaction (extrapyramidal symptom) from antipsychotics, characterized by torticollis and oculogyric crisis. Immediate treatment is an anticholinergic to restore dopamine–acetylcholine balance in the nigrostriatal pathway, and the IM route provides rapid relief. Giving additional antipsychotic medication can worsen extrapyramidal toxicity rather than resolve it. A benzodiazepine may reduce anxiety or provide adjunctive muscle relaxation but is not first-line for reversing dystonia.

Question 23

The client is admitted to the psychiatric unit with a diagnosis of paranoid schizophrenia. Two days after admission, the client’s mother tells the nurse, “He’s still talking about how the government is controlling his thoughts.” What is the most accurate nursing assessment of the mother’s statement?

Accepted Answer

Answer reason: Psychotic symptoms such as delusions (including thought control) commonly persist early in hospitalization and typically improve gradually with antipsychotic treatment and a therapeutic milieu over days to weeks. Expecting complete resolution within 48 hours reflects misunderstanding of the course of schizophrenia and the expected timeline for symptom response. Nursing assessment should focus on identifying knowledge deficits and providing teaching about illness features, treatment goals, and realistic expectations. Requesting a medication change based solely on ongoing delusional content at day 2 is premature without assessing adherence, dosing, side effects, and overall clinical response.

Question 24

The nurse is discussing the importance of taking medication as prescribed with the client diagnosed with paranoid schizophrenia. Which response demonstrates that the nurse understands the importance of relapse prevention?

Accepted Answer

Answer reason: " Relapse prevention in schizophrenia is crucial because repeated psychotic episodes are associated with functional decline, poorer long-term prognosis, and increased difficulty returning to baseline. This statement correctly links adherence to preventing relapses that can worsen overall mental health over time, which is the central teaching point. Option A is inaccurate because adherence lowers relapse risk but does not eliminate it, making it misleading and potentially damaging to trust if relapse occurs. Options C and D address side-effect counseling and safety, but they do not directly communicate the long-term importance of preventing relapse episodes.

Question 25

A homebound client taking clozapine (Clozaril) tells the nurse he has been feeling tired for 5 days. His temperature is 99.6° F; pulse, 110 beats/minute; and respirations, 20 breaths/minute. What is the best information for the nurse to tell the client?

Accepted Answer

Answer reason: Clozapine can cause potentially life-threatening agranulocytosis, so new fatigue with even low-grade fever or infection-like signs warrants urgent evaluation and immediate provider notification. The mild temperature elevation plus tachycardia can be an early warning of infection in an immunocompromised client, and delaying care increases risk of sepsis. Nursing priority is safety: instruct the client to stop taking the drug and be assessed promptly with CBC/ANC and clinical evaluation. Reassuring the client or postponing follow-up is unsafe, and taking it with milk does not address the potentially serious adverse effect.

Question 26

A 20-year-old client has been diagnosed with schizophrenia. He presently lives by himself; doesn’t bathe or dress himself; and is erratic with eating, drinking, and taking prescribed medications. Which nursing diagnosis for this client has priority?

Accepted Answer

Answer reason: The stem highlights erratic eating and drinking in a client living alone, creating immediate risk for weight loss, electrolyte imbalance, and impaired functioning that can worsen psychiatric symptoms and medication tolerance. A nursing diagnosis focused on nutrition directly targets this imminent safety threat and guides urgent interventions (monitor intake/weight, ensure access to food/fluids, evaluate need for support/supervision). Problems like ineffective coping or role performance are important but are lower priority when basic survival needs and medical risk are present.

Question 27

A client is admitted to a psychiatric unit for a delusional disorder. He explains to a nurse that he made a contract with God to be the best minister on earth. Now that he has achieved the goal, most of his friends have stopped seeing him out of envy. On mental status examination, there is little impairment in psychosocial functioning. Which condition is expected?

Accepted Answer

Answer reason: The expected delusion type is typically nonbizarre—plausible-sounding beliefs that could occur in real life (e.g., being treated unfairly, jealousy, grandiose religious mission) even though the belief is fixed and false. The stem emphasizes little impairment in psychosocial functioning, which aligns with delusional disorder rather than schizophrenia-spectrum conditions where thought/behavior disorganization is more common. Fragmentary delusions are more consistent with disorganized, poorly systematized psychosis, and regression is not a defining feature of delusional disorder.

Question 28

The nurse is conducting an admission history on the client being hospitalized with symptoms characteristic of schizophrenia. Which interview question demonstrates that the nurse can identify the most prevalent comorbid substance abuse issue for the client with schizophrenia?

Accepted Answer

Answer reason:  Clients with schizophrenia have high rates of comorbid substance use, and cannabis use is among the most common and clinically relevant because it can precipitate or worsen psychosis and impair treatment response. Asking specifically and neutrally about recent marijuana use targets a highly prevalent comorbidity that directly affects symptom severity, relapse risk, and medication adherence. A broad question about “street drugs” is less focused and can reduce disclosure compared with naming a specific substance. While alcohol and nicotine are also common, the question is asking for the most prevalent comorbid substance abuse issue linked to psychotic symptom exacerbation, making cannabis-focused screening the best match.

Question 29

The nurse has been discussing the medication therapy prescribed for the client newly diagnosed with Alzheimer’s disease. Which statement by the client’s wife best demonstrates an understanding of the treatment goals of anticholinesterase medications?

Accepted Answer

Answer reason: " Anticholinesterase drugs in Alzheimer’s increase available acetylcholine in the CNS to temporarily support cognition and function. The realistic goal is modest symptom stabilization or slowed decline, not cure or guaranteed arrest of progression. This statement reflects appropriate expectations by emphasizing slowing deterioration rather than stopping it completely. A common misunderstanding is expecting memory to remain unchanged or return to normal, which these agents typically cannot achieve. Early initiation can be beneficial, but the key treatment goal is delaying worsening of cognitive symptoms.

Question 30

The client admitted to a behavioral medicine unit with a diagnosis of catatonic schizophrenia is constantly rearranging furniture and appears to be responding to internal stimuli. In addition to being flee of physical injury during phases of hyperactivity, which short-term goal is appropriate for this client?

Accepted Answer

Answer reason: In acute psychosis with hyperactivity and response to internal stimuli, physiologic stability is a priority because patients may neglect basic needs and rapidly become dehydrated or malnourished. A short-term goal should be immediate, observable, and safety-focused; monitoring and promoting intake can be evaluated each shift and directly reduces medical risk. Sleep and social interaction are desirable but are less realistic in the short term when agitation and hallucinations dominate behavior. Decreased activity within 24 hours depends heavily on treatment response and is less directly nurse-controlled than ensuring hydration and nutrition.

Question 31

A client begins to display some bothersome and dismaying new symptoms from his antipsychotic medicine. He is concerned because he has noted improvement of his psychotic symptoms but is now experiencing uncontrollable restlessness of his limbs and head. The client calls the clinic to ask what is happening and how he can stop it. What is the best response by the nurse?

Accepted Answer

Answer reason: New involuntary movements/restlessness after starting antipsychotics can indicate an extrapyramidal reaction, and nurses must screen for red-flag symptoms that signal a potentially life-threatening adverse effect requiring urgent evaluation. Fever with antipsychotic use raises concern for neuroleptic malignant syndrome, where immediate emergency assessment is critical to prevent complications such as rhabdomyolysis and autonomic instability. Blurred vision can also suggest serious medication-related toxicity or acute complications that should not be managed at home without prompt medical evaluation. In contrast, advising the client to ignore symptoms or self-adjust dosing is unsafe, and labeling the presentation as tardive dyskinesia is not the best fit for the described acute restlessness.

Question 32

A client with schizophrenia says, “I hear the devil telling me to hurt people.” What is the nurse’s priority action?

Accepted Answer

Answer reason: The priority is assessment of command hallucinations to determine content, intent, and potential risk of harm. Asking what the voices are saying helps evaluate immediate safety. Telling the client the voices aren’t real is non-therapeutic, seclusion is premature without full assessment, and medication may be needed later but does not replace initial safety-focused assessment.

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Psychotic Disorders Practice Test 2

Psychotic Disorders NCLEX Practice Test

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