SCHIZOPHENIS

Rational Only

1. (C): Requesting a client who is disoriented and psychotic to interact with

peers, participate in unit programs, or encourage involvement in the milieu
would agitate the client. Reality orientation would orient the client to the
surroundings.
2. (A, B & D): Interventions for a client in the treatment of delusions include
orienting the client to date, time, place, and situation. Decrease the client's
anxiety by avoiding whispering or laughing in front of the client, and avoid
touching the client without permission. In hallucination management, an
intervention is to decrease environmental stimulation with low lighting, low
noise level, and decreased activity surrounding the client. Interventions for
environmental management are to initiate cognitively motivating activities
and provide animal-assisted recreation.
3. (D): negative clinical manifestations of schizophrenia are much harder to
detect and describe than are positive clinical manifestations. The negative
clinical manifestations, such as flattened affect, slowed thinking, and lack of
motivation, are observed and in many ways are more debilitating. Unlike
positive clinical manifestations, negative clinical manifestations are
behaviors not fundamentally different from behaviors exhibited by many
people. They are more common and severe in schizophrenia. They are
particularly obvious when contrasted to how the client was before the
onset of the disorder. Delusions and hallucinations are positive clinical
manifestations because they must be self-reported by the client.
4. (B): although the etiology of schizophrenia remains unknown, there is
research suggesting the validity of the dopamine hypothesis—that the
functional abnormalities in schizophrenia are the result of excessive
amounts of the dopamine in the brain. Normally dopamine is produced in
the brain and functions as a neurotransmitter.
5. (D): computerized tomography scanning may be used to evaluate brain
structure in schizophrenic clients. The results have shown that clients with
schizophrenia have larger lateral ventricles than nonschizophrenic
individuals. This is a well-documented fact, but the meaning behind this
finding remains unclear. it remains unknown as to whether the
enlargement is the cause or a consequence of the schizophrenia. it also has
no bearing on the severity of the clinical manifestations. Some data
 demonstrate that the ventricular enlargement is related to cerebral
atrophy. Although speculative, there is some research suggesting that
schizophrenia may be a degenerative neurological disorder.
6. (C): Schizophrenia is a disorder that has a large genetic component. This
conclusion has been reached based on the close incidence of schizophrenia
in twins and particularly monozygotic twins, which have a higher
concordance rate than any other biological relationship. Although genetics
plays a role in the development of schizophrenia, the relationship remains
unclear. Some studies indicate that this relationship may be as high as 50%,
but other studies indicate that a monozygotic twin has less than a 10%
chance of developing schizophrenia when the other twin is affected.
7. (D): Catatonic schizophrenia is a type of schizophrenia in which there is a
marked decrease in reactivity to the environment. The client will not likely
be able to socialize or adequately communicate secondary to the catatonia.
Although administering prescribed drugs may be appropriate, it is not the
priority. Decreasing the stimuli in the client's environment is the priority.
The client with catatonia will be less stimulated in the client's room.
8. (C): a function of case management is to coordinate the client's health care
needs. The priority goal for a client with paranoid schizophrenia is to
encourage the client to regularly attend all the scheduled appointments
with health care providers. Although taking public transportation,
maintaining a steady job, or socializing with the neighbors may be
appropriate interventions, they are not the priority. Clients with paranoid
schizophrenia are likely to be socially isolated and have few trusting
relationships.
9. (A, B & E): Anhedonia, alogia, and a failure to socialize are all negative
clinical manifestations seen in schizophrenia. Anhedonia is the inability to
find enjoyment in daily activities. Alogia is a tendency to speak very little or
use short, empty phrases.
10. (A): Catatonia is a state in which there is a large decrease in reactivity to
the environment. An extreme degree of immobility and unawareness may
result.
11. (A, C, & D): chronic clinical manifestations of the medical complications of
schizophrenia include weight gain, generalized edema, and hyponatremia.
Catatonic schizophrenia clinical manifestations include immobility. Clinical
manifestations of agitated motor activity are purposeless movements and
activity that is unrelated to external stimuli.
12. (A):  An idea of influence is a client's false impression that outside activities
have a unique meaning for the client. It is an internal thought regarding
some content in which the client's thoughts are controlled by an external
entity. The client's inability to identify person, place, and time, as well as
the client's confusion to the point of delirium, is related to the client's
orientation. Interpreting a shadow as a person is an illusion that is an
incorrect perception of a sensory stimulus.
13. (B): Dopamine has been specifically identified as having an influence on
both the positive and negative clinical manifestations of schizophrenia.
Selective serotonin reuptake inhibitors treat depression. Anxiolytics treat
anxiety, and sedatives are calming agents.
14. (C): The mother's genetics at the time of diagnosis of schizophrenia is the
major risk factor for the
client diagnosed with schizophrenia. Being recently divorced, from a lower
socioeconomic status, and a recent search for employment are all
environmental influences.
15. (C): elusions are false ideas that an individual believes to be real despite
evidence to the contrary. They are disturbed thought processes, so a
nursing diagnosis of disturbed thought processes would be appropriate.
nursing diagnosis of disturbed role performance would be appropriate with
a loss of function. Impaired verbal communication would be an appropriate
nursing diagnosis for a clinical manifestation of incomprehensible language.
Hallucinations are a sensory perception for which there is no reality, and
disturbed sensory perception would be an appropriate nursing diagnosis.
16. (D): Paranoid delusions are disturbances in thought processes that
generally affect only an individual's social relationships. They do not
predominantly impact the work environment or daily functioning.
17. (A): methamphetamine causes psychosis and is the most recent drug that
was abused by the client, so it would be the most plausible explanation for
the behavior. Current use of alcohol may cause psychosis but not alcohol
taken a week ago. Marijuana used 2 days ago and use of tranquilizers are
both unlikely to cause psychosis.
18. (A): about 30% of the homeless suffer from schizophrenia. The woman is
showing signs of responding to internal stimuli. Auditory and visual
hallucinations are precipitated by internal stimuli. Speaking on a cell phone
and calling to a friend down the street are both external stimuli.
19. (B): although monitoring the intake and output may be an appropriate
intervention, it is not the priority intervention, because the client is a new
admission and the electrolyte levels need to be monitored first to
determine if any other nursing interventions are necessary. Educating the
client about a low-sodium diet may also be an appropriate intervention but
is not the priority. The client's oral intake should not be restricted unless
there is a medical reason to do so.
20. (C): Psychogenic polydipsia is a major cause of death among clients who
have schizophrenia. polyuria, polydipsia, nausea, and muscle cramps are
classic features of psychogenic polydipsia
21. (C): Culture variations that exist among spiritual beliefs in family and
friends are the most plausible explanation for a lack of concern over seeing
"visions."
22. (C):  Telling a client who is experiencing delusionshreatening approach to
initiate conversation. The client is most likely experiencing some paranoia
along with the delusional content. Asking a client what happened to cause
the visit to the hospital has an accusatory tone. Asking what is bothering
the client is too intrusive for an initial stage of establishing trust. Telling the
client that the other clients want to meet the client is perceived as a
socially uncomfortable situation for someone who is experiencing paranoia.
23. (C):  a licensed practical nurse may document the hallucinations a client is
experiencing. Planning a medication schedule, instructing a client on a drug,
and discussing a treatment plan with a client's family are all activities that
should be performed by a registered nurse.
24. (A): a physical examination is a necessary part of the initial assessment for
a client diagnosed to be a psychiatric client, because many clinical
manifestations that appear to be
psychiatric in nature may in actuality have a medical etiology. Any medical
cause must be ruled out before making a definitive psychiatric diagnosis. A
physical exam cannot determine functional status. A physical exam cannot
replace the mental status exam. Testing the client's perception of what is
happening is not the primary reason for conducting a physical exam.
25. (D): An infection may contribute to a client's distortion of perceptual
reality. Dementia does not have an acute onset. There is no evidence that
the client had a seizure. it is unlikely that an infection would make someone
psychotic