The nurse is performing the admission assessment for a client with schizophrenia in an acute care inpatient facility. The nurse should identify which observed behavior is characteristic of schizophrenia?

Exhibits compulsive, ritualistic behaviors.

Responds with illogical answers to questions.

Admits to frequently thinking about committing suicide.

Describes times of depression followed by feelings of euphoria.

None

Answer and Explanation

The Correct Answer is B

Choice A reason: Compulsive, ritualistic behaviors are characteristic of obsessive-compulsive disorder, not schizophrenia. Schizophrenia involves disorganized thinking, often manifesting as illogical responses. Ritualistic behaviors are less typical, making this incorrect for identifying a behavior characteristic of schizophrenia in an acute care setting.

Choice B reason: Illogical answers reflect disorganized thinking, a core symptom of schizophrenia, particularly in acute phases. This is due to impaired thought processes, a hallmark of the disorder, aligning with psychiatric diagnostic criteria. This behavior is characteristic and observable during admission assessment, making it the correct choice.

Choice C reason: Suicidal thoughts may occur in schizophrenia but are not specific to it, as they appear in many psychiatric conditions. Illogical responses are more characteristic of schizophrenia’s cognitive disorganization. This choice is less precise, making it incorrect for a defining schizophrenia behavior.

Choice D reason: Depression followed by euphoria suggests bipolar disorder, not schizophrenia. Schizophrenia involves persistent psychotic symptoms like disorganized thinking, not mood swings. Illogical answers better represent schizophrenia’s thought disorder, making this incorrect for a characteristic behavior in an acute care schizophrenia admission.

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Correct Answer is C

Explanation

Choice A reason: Administering a PRN sedative is inappropriate for echolalia, a non-emergent symptom of schizophrenia. Sedation does not address the behavior and may cause oversedation. Escorting to a private area reduces disruption without medication, aligning with least restrictive interventions, making this incorrect.

Choice B reason: Avoiding recognition of echolalia may ignore the client’s needs and fail to address unit disruption. Escorting to a private area de-escalates the situation while maintaining engagement, offering a therapeutic response. Ignoring the behavior is less effective, making this incorrect for managing echolalia.

Choice C reason: Escorting the client to a private area minimizes disruption to others while providing a calm environment to address echolalia. This intervention reduces stimuli and supports the client therapeutically, aligning with psychiatric nursing principles for managing schizophrenia symptoms, making it the best choice for this scenario.

Choice D reason: Isolating the client is overly restrictive and may exacerbate schizophrenia symptoms like paranoia. Escorting to a private area is less isolating, maintaining therapeutic engagement while addressing unit dynamics. Isolation is not patient-centered, making this incorrect compared to a supportive, de-escalating intervention.

A. Current weight. B. Medication history. C. Any history of heart disease. D. Familial history of mental illness.

Correct Answer is B

Explanation

Choice A reason: Current weight is relevant for monitoring but not critical before starting sertraline. Medication history is more important to avoid drug interactions, as sertraline affects serotonin levels. Weight changes may occur during treatment, but they are not a primary concern for initiation, making this incorrect.

Choice B reason: Medication history is critical before starting sertraline to identify potential drug interactions, especially with MAOIs, SSRIs, or other serotonergic drugs, which can cause serotonin syndrome. This ensures safe prescribing, aligning with psychopharmacology guidelines, making it the most important information to obtain prior to initiation.

Choice C reason: Heart disease history is relevant but less critical than medication history for sertraline, which has minimal cardiac effects. Drug interactions pose a greater immediate risk, particularly with serotonergic agents. This choice is secondary, as cardiac concerns are not the primary consideration for sertraline initiation.

Choice D reason: Familial history of mental illness may guide diagnosis but is not essential for starting sertraline. Medication history directly impacts safety due to interaction risks. Family history is less urgent, making this incorrect compared to the immediate need to assess current medications for safe antidepressant use.

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The nurse is performing the admission assessment for a client with schizophrenia in an acute care inpatient facility. The nurse should identify which observed behavior is characteristic of schizophrenia?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client with schizophrenia is demonstrating echolalia, which is becoming annoying to other clients on the unit. Which intervention is best for the nurse to implement?

Correct Answer is C

Explanation

Prior to initiating a treatment regimen with the antidepressant sertraline, it is most important for the nurse to obtain which information?

Correct Answer is B

Explanation

The mental health unit nurse completes the admission assessment for a depressed adolescent client with suicidal ideation. The client reports becoming angry with a sibling, so the client took a handful of pills. Which goal is most important for the nurse to establish with this client?

A preschool-aged girl tells the school nurse that her hair hurts. The nurse finds that the child's hair has been arranged to cover several small bald spots. Which finding indicates to the nurse that the hair loss is not disease related?

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The charge nurse of the psychiatric unit observes clients in the day area. Which client is exhibiting symptoms of a conversion disorder?

The nurse is planning the care for a client who is hospitalized with a bipolar disorder. The client wanders the hallways, talks excessively, and makes sexual comments about the staff. Which intervention(s) should the nurse include in the plan of care? (Select all that apply)

The nurse is performing the admission assessment for a client with schizophrenia in an acute care inpatient facility. The nurse should identify which observed behavior is characteristic of schizophrenia?