A nurse is assessing a client diagnosed with schizophrenia who is exhibiting positive symptoms. Which of the following findings should the nurse expect? (Select all that apply.)
Social withdrawal
Delusional thinking
Bizarre or disorganized behavior
Flat affect
Auditory hallucinations
Correct Answer : B,C,E
Choice A reason: Social withdrawal is a negative symptom of schizophrenia, reflecting reduced engagement rather than an excess or distortion of normal function.
Choice B reason: Delusional thinking is a hallmark positive symptom, representing a distortion of reality through fixed false beliefs.
Choice C reason: Bizarre or disorganized behavior, such as unusual movements or incoherent actions, is a positive symptom reflecting disruption in normal functioning.
Choice D reason: Flat affect is a negative symptom, reflecting diminished emotional expression rather than an added or distorted behavior.
Choice E reason: Auditory hallucinations are classic positive symptoms, involving perception of voices or sounds that are not present in reality.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: While silence may sometimes convey understanding, its primary therapeutic purpose in communication is to allow the patient time to think or reflect, not simply to indicate understanding.
Choice B reason: Prolonged silence may cause withdrawal in some patients, but this is not the guiding principle in therapeutic communication. The focus should be on the value of reflection.
Choice C reason: Silence provides the patient with opportunities for reflection and processing of thoughts and emotions. It encourages deeper expression and supports therapeutic dialogue.
Choice D reason: The nurse is not always responsible for breaking silence. Sometimes allowing the patient to break the silence themselves is more therapeutic and empowering.
Correct Answer is A
Explanation
Choice A reason: The nurse’s role is to advocate for the client by collaborating with the healthcare team and ensuring the guardian respects the client’s best interests and personal preferences. This balances autonomy and protection.
Choice B reason: While explaining changes in decision-making is part of education, focusing only on the loss of control without emphasizing advocacy may increase fear and distress.
Choice C reason: Avoiding communication violates therapeutic principles and disregards the client’s dignity. Even if incapable of informed consent, clients should remain included in discussions.
Choice D reason: Treatment cannot proceed without proper consent unless there is an emergency. Acting before guardianship is finalized would violate legal and ethical standards.
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