Jun 30, 2009

IELTS Test: General Training Reading sample

General Training Reading sample

The General Training Reading test is 60 minutes long. It has three sections with 40 questions to answer. Below is a sample of one section. (Note that candidates for the General Training module do a different Reading test to the Academic module.)

Read the passage below and answer Questions 1-10.

Daybreak Trips by Coach

SPRING IS IN THE AIR!
Welcome to our Spring Daybreak programme which continues the tradition of offering daytrips and tours at unbeatable value for money. All the excursions in this brochure will be operated by Premier Travel Services Limited or Millers Coaches; both companies are part of the CHL Group, which owns Cambridge's Cambus fleet.

WE'RE PROUD OF OUR TRADITION

Premier was established in 1936; the Company now offers the highest standards of coach travel in today's competitive operating environment. Millers has an enviable reputation stretching back over the past 20 years, offering value for money coach services at realistic prices. We've travelled a long way since our early days of pre-war seaside trips. Now our fleet of 50 modern coaches (few are more than five years old) operate throughout Britain and Europe but we're pleased to maintain the high standards of quality and service that were the trademark of our founders nearly sixty years ago.

EXCLUSIVE FEATURES

All Daybreak fares (unless specifically stated otherwise) include admission charges to the attractions, shows and exhibits we visit. Many full day scenic tours are accompanied by a fully trained English Tourist Board 'Blue Badge' guide or local experienced driver/guide. Some Daybreaks include lunch or afternoon tea. Compare our admission inclusive fares and see how much you save. The cheapest is not necessarily the best and value for money is guaranteed with Daybreaks. If you compare our bargain Daybreak fares beware - most of our competitors do not offer an all inclusive fare.

SEAT RESERVATIONS

We value the freedom of choice, so you can choose your seat when you book. The seat reservation is guaranteed and remains yours at all times when aboard the coach.

NO SMOKING COMFORT

With the comfort of our passengers in mind, coaches on all our Daybreaks are no smoking throughout. In the interests of fellow passengers' comfort, we kindly ask that smokers observe our 'no smoking' policy. On scenic tours and longer journeys, ample refreshment stops are provided when, of course, smoking is permitted.

YOUR QUESTIONS ANSWERED

Do I need to book?

Booking in advance is strongly recommended as all Daybreak tours are subject to demand. Subject to availability, stand-by tickets can be purchased from the driver. What time does the coach leave?

The coach departs from Cambridge Drummer Street (Bay 12) at the time shown. There are many additional joining points indicated by departure codes in the brochure. If you are joining at one of our less popular joining points, you will be advised of your pick up time (normally by telephone) not less than 48 hours before departure. In this way, we can minimise the length of pick-up routes and reduce journey times for the majority of passengers.

What time do we get back?

An approximate return time is shown for each excursion. The times shown serve as a guide, but road conditions can sometimes cause delay. If your arrival will be later than advertised, your driver will try to allow for a telephone call during the return journey. Where can I board the coach?

All the Daybreaks in the brochure leave from Cambridge Drummer Street (Bay 12) at the time shown. Many Daybreaks offer additional pick-ups for pre-booked passengers within Cambridge and the surrounding area. This facility must be requested at the time of booking.

Questions 1-10

Do the following statements agree with the information given in the passage above?

In boxes 1-10 on your answer sheet write

TRUE if the statement agrees with the information
FALSE if the statement contradicts the information
NOT GIVEN if there is no information on this

1. Millers Coaches owns Cambridge's Cambus fleet.
2. Premier is an older company than Millers.
3. Most of the Daybreak coaches are less than 5 years old.
4. Daybreak fares are more expensive than most of their competitors.
5. Soft drinks and refreshments are served on most longer journeys.
6. Smoking is permitted at the rear of the coach on longer journeys.
7. Tickets must be bought in advance from an authorised Daybreak agent.
8. Tickets and seats can be reserved by phoning the Daybreak Hotline.
9. Daybreak passengers must join their coach at Cambridge Drummer Street.
10. Daybreak cannot guarantee return times.

Jun 28, 2009

PRESS RELEASE: DEADLINE IN FILING OF APPLICATIONS FOR THE NOV. 29-30, 2009 NURSES LICENSURE EXAM.

The PROFESSIONAL REGULATION COMMISSION announces that the filing of applications for the November 29-30, 2009 (Sunday-Monday) Nurses Licensure Examinations is now on-going in the Central Office and in the Regional Offices of PRC.

The following are the deadlines of filing of applications:

1. NEW / FIRST TIMERS - SEPTEMBER 16, 2009

2. REPEATERS - OCTOBER 16, 2009

Applications shall no longer be accepted after these deadlines.




-- NICOLAS P. LAPEÑA, JR.
Chairman

source: http://www.prc.gov.ph/articles.asp?sid=4&aid=3153

IELTS Test: Academic Writing sample

Academic Writing sample

The Academic Writing test is 60 minutes long. It has two writing tasks of 150 words and 250 words. Below are samples of Task 1 and Task 2. (Note that candidates for the Academic module do a different Writing test to the General Training module.)

Writing Task 1
You should spend about 20 minutes on this task

The graph below shows the different modes of transport used to travel to and from work in one European city in 1960, 1980 and 2000.

Graph Example





Summarise the information by selecting and reporting the main features, and make comparisons where relevant.

Write at least 150 words.

Writing Task 2
You should spend about 40 minutes on this task.

Write about the following topic:

It is inevitable that as technology develops so traditional cultures must be lost. Technology and tradition are incompatible - you cannot have both together.

To what extent do you agree or disagree?

Give reasons for your answer and include any relevant examples from your own knowledge or experience.

Write at least 250 words.

Jun 26, 2009

IELTS Test: Academic Reading Sample

Academic Reading sample

The Academic Reading test is 60 minutes long. It has three sections with 40 questions to answer. Below is a sample of one section. (Note that candidates for the Academic module do a different Reading test to the General Training module.)

Wind Power in the US

Prompted by the oil crises of the 1970s, a wind-power industry flourished briefly in the United States. But then world oil prices dropped, and funding for research into renewable energy was cut. By the mid 1980s US interest in wind energy as a large-scale source of energy had almost disappeared. The development of wind power at this time suffered not only from badly designed equipment, but also from poor long-term planning, economic projections that were too optimistic and the difficulty of finding suitable locations for the wind turbines.

Only now are technological advances beginning to offer hope that wind power will come to be accepted as a reliable and important source of electricity. There have been significant successes in California, in particular, where wind farms now have a capacity of 1500 megawatts, comparable to a large nuclear or fossil-fuelled power station, and produce 1.5 per cent of the state's electricity.

Nevertheless, in the U.S., the image of wind power is still distorted by early failures. One of the most persistent criticisms is that wind power is not a significant energy resource. Researchers at the Battelle Northwest Laboratory, however, estimate that today wind turbine technology could supply 20 per cent of the electrical power the country needs. As a local resource, wind power has even greater potential. Minnesota's energy commission calculates that a wind farm on one of the state's south western ridges could supply almost all that state's electricity. North Dakota alone has enough sites suitable for wind farms to supply more than a third of all electricity consumed in the continental US.

The prevailing notion that wind power is too costly results largely from early research which focused on turbines with huge blades that stood hundreds of metres tall. These machines were not designed for ease of production or maintenance, and they were enormously expensive. Because the major factors influencing the overall cost of wind power are the cost of the turbine and its supporting systems, including land, as well as operating and maintenance costs, it is hardly surprising that it was thought at the time that wind energy could not be supplied at a commercially competitive price. More recent developments such as those seen on California wind farms have dramatically changed the economic picture for wind energy. These systems, like installations in Hawaii and several European countries, have benefited from the economies of scale that come through standardised manufacturing and purchasing. The result has been a dramatic drop in capital costs: the installed cost of new wind turbines stood at $1000 per kilowatt in 1993, down from about $4000 per kilowatt in 1980, and continues to fall. Design improvements and more efficient maintenance programs for large numbers of turbines have reduced operating costs as well. The cost of electricity delivered by wind farm turbines has decreased from about 30 cents per kilowatt-hour to between 7 and 9 cents, which is generally less than the cost of electricity from conventional power stations. Reliability has also improved dramatically. The latest turbines run more than 95 per cent of the time, compared with around 60 per cent in the early 1980s. Another misconception is that improved designs are needed to make wind power feasible. Out of the numerous wind turbine designs proposed or built by inventors or developers, the propeller-blade type, which is based on detailed analytical models as well as extensive experimental data, has emerged as predominant among the more than 20,000 machines now in commercial operation world-wide. Like the gas-driven turbines that power jet aircraft, these are sophisticated pieces of rotating machinery. They are already highly efficient, and there is no reason to believe that other configurations will produce major benefits. Like other ways of generating electricity, wind power does not leave the environment entirely unharmed. There are many potential problems, ranging from interference with telecommunications to impact on wildlife and natural habitats. But these effects must be balanced against those associated with other forms of electricity generation. Conventional power stations impose hidden costs on society, such as the control of air pollution, the management of nuclear waste and global warming. As wind power has been ignored in the US over the past few years, expertise and commercial exploitation in the field have shifted to Europe. The European Union spends 10 times as much as the US government on research and development of wind energy. It estimates that at least 10 per cent of Europe's electrical power could be supplied by land-based wind-turbines using current technology. Indeed, according to the American Wind Energy Association, an independent organisation based in Washington, Denmark, Britain, Spain and the Netherlands will each surpass the US in the generating capacity of wind turbines installed during the rest of the decade.

Glossary

fossil fuel: coal, oil and natural gas kilowatt: 1,000 watts; a watt is a unit of power kilowatt-hour: one kilowatt for a period of one hour megawatt: one million watts wind farm: a group of wind turbines in one location producing a large amount of electricity wind turbine: a machine which produces energy when the wind turns its blades

Questions 1 - 5

Complete the summary below using words from the box. Write your answers in boxes 1-5 on your answer sheet.

NB There are more words or phrases than you will need to fill the gaps. You may use any word or phrase more than once.

The failure during the late 1970s and early 1980s of an attempt to establish a widespread wind power industry in the United States resulted largely from the ...(1)... in oil prices during this period. The industry is now experiencing a steady ...(2)... due to improvements in technology and an increased awareness of the potential in the power of wind. The wind turbines that are now being made, based in part on the ...(3)... of wide-ranging research in Europe, are easier to manufacture and maintain than their predecessors. This has led wind-turbine makers to be able to standardise and thus minimise ...(4)... . There has been growing ...(5)... of the importance of wind power as an energy source.

criticism success design costs decisions
stability operating costs fall effects failure
growth recognition scepticism decline results production costs

Questions 6 - 10

Look at the following issues (Questions 6-10) and the list of implications below (A-C). Match each issue with the correct implication. Write the correct letter A-C in boxes 6-10 on your answer sheet. N.B. You may use any letter more than once.

Implications
A provides evidence against claims that electricity produced from wind power is relatively expensive. B supports claims that wind power is an important source of energy. C opposes the view that wind power technology requires further development.

Example
The current price of one wind-generated kilowatt... Answer A

Issues

6. The recent installation of systems taking advantage of economies of scale ...
7. The potential of meeting one fifth of current US energy requirements by wind power ...
8. The level of acceptance of current wind turbine technology ...
9. A comparison of costs between conventional and wind power sources ...
10. The view of wind power in the European Union ...

Jun 24, 2009

Frequently asked Questions about International English Language Testing System (IELTS)

Content Outline:
1. About IELTS test
2. Registering for IELTS test
3. Sitting for the IELTS test
4. Taking the IELTS test
5. IELTS Test results

About the test

1. What is IELTS?
2. Which organisations accept IELTS?
3. Who owns IELTS and who writes the test?
4. Why are there two versions of the test?
5. Which version should I do?
6. What is the test format and how long will it take?
7. What help is available for disabled candidates?

1. What is IELTS?
IELTS is the International English Language Testing System which tests English proficiency across the globe. Conducting one million tests globally, IELTS is the world’s most popular English testing system.

2. Which organisations accept IELTS?
IELTS is accepted by more than 6000 organisations worldwide. These include universities, immigration departments, government agencies, professional bodies and multinational companies. To search for a recognising institution, use the IELTS Global Recognition System.

3. Who owns IELTS and who writes the test?
IELTS is jointly owned by British Council, IDP: IELTS Australia and the University of Cambridge ESOL Examinations (Cambridge ESOL) and offered through more than 500 locations in 120 countries. International teams of writers contribute to IELTS test materials. Ongoing research ensures that IELTS remains fair and unbiased. Test writers from different English-speaking countries develop IELTS content so it reflects real-life situations.

4. Why are there two versions of the test?
IELTS has two versions – Academic and General Training. The Academic test is for those who want to study at a tertiary level in an English-speaking country. The General Training test is for those who want to do work experience or training programs, secondary school or migrate to an English-speaking country. All candidates take the same Listening and Speaking tests but different Reading and Writing tests.

5. Which version should I do?
Read the explanation of the Academic and General Training tests, then contact the organisation or institution to which you are applying to find out what it requires. Note that you must know which version to take when you complete the IELTS Application Form.

6. What is the test format and how long will it take?
IELTS has four parts – Listening (30 minutes), Reading (60 minutes), Writing (60 minutes) and Speaking (11–14 minutes). The total test time is 2 hours and 45 minutes. The Listening, Reading and Writing tests are done in one sitting. The Speaking test may be on the same day or up to seven days before or after the other tests. Find out more and see a test sample.
The IELTS Official Practice Materials 2007 explains the test format in detail and gives you practice tests and answers. Order a copy online or through your local test centre.

7. What help is available for disabled candidates?
Test centres make every effort to cater for the special needs of disabled candidates. It is our aim for all candidates to be assessed fairly and objectively. If you have a special need, talk to your local test centre when registering. Centres may need three months to organise arrangements.

Registering for the test

1. Where can I take IELTS?
2. When can I take IELTS?
3. How much does it cost?
4. What if I need to postpone or cancel my application?
5. What if I am absent or sick on the test day?

1. Where can I take IELTS?
You can take IELTS in over 500 locations worldwide. Search for your nearest test centre on the IELTS Worldwide Search. IELTS centres have friendly, helpful staff who will help you with the registration process.

2. When can I take IELTS?
IELTS is available on 48 fixed dates a year – up to four times a month, depending on local demand. Check all the test dates for the year or go to your nearest centre to see its next test date.

3. How much does it cost?
IELTS has a set fee for its test. The Academic and General Training tests are the same cost. To find out the test fee in your local currency, check the IELTS Worldwide Search for your nearest centre.

4. What if I need to postpone or cancel my application?
If you postpone or cancel your application more than 5 weeks before the test date, you will receive a refund minus an administration charge.

If you postpone or cancel within 5 weeks of the test date, you will be charged the full fee unless you have a medical reason. If you provide a medical certificate within 5 days of the test date, you will receive a refund minus the local administrative cost.

5. What if I am absent or sick on the test day?
If you are away on the test day with no prior notice, you will lose your full fee. However, if you provide a medical certificate within 5 days of the test date, you will receive a refund minus the local administrative cost.

Sitting the test

1. Is the IELTS test completed in one day?
The Listening, Reading and Writing components of the test are always completed immediately after each other and with no break. Depending on the test centre, the Speaking test may be taken up to 7 days either before or after the test date.

2. What if I am delayed by circumstances beyond my control (eg a transport strike)?
The test centre may offer you a test on the next available test date.

3. What can I bring into the examination room?
Only pens, pencils and erasers. You must bring the passport/national identity card you used on the IELTS Application Form to the test.
You must leave everything else outside the examination room. Mobile phones and pagers must be switched off and placed with personal belongings in the area designated by the supervisor. If you do not switch off your phone/pager or keep it on you, you will be disqualified. Find out more.

4. Which part do I take first?
You do the Listening test first following by the Reading and Writing components of the test. Depending on the test centre, the Speaking test may be taken up to 7 days either before or after the test date.

5. What kinds of accents can be heard in the Listening and Speaking tests?
As IELTS is an international test, a variety of English accents are used in both of these tests.

6. Does the Listening tape provide instructions and pauses?
Yes. At the beginning, you hear instructions and a sample question. Then you read section 1 questions, listen to section 1 and answer the questions.
The same procedure follows for sections 2, 3 and 4.
In the final 10 minutes, you transfer your answers onto the answer sheet.

7. Is there a similar period of 10 minutes in the Reading test to transfer answer?
No. The Reading test is one hour, and you must write all your answers on the answer sheet in this time.

8. Can I use a pen for the Listening and Reading tests?
No. You must do it in pencil. The answer sheet is scanned by a computer which cannot read pen.

9. Can I make notes on the Listening and Reading question papers?
Yes. The IELTS Examiner will not see your question paper.

10. What is the Speaking test?
The Speaking test is a conversation with a certified IELTS Examiner. The Speaking test is made up of three sections. It is recorded on an audiocassette or a digital recorder. Find out more.

11. What do I need for the Speaking test?
You must bring the same identification documents you supplied on your IELTS Application Form and used for the rest of the test. Your ID will be checked before you enter the interview room.

Test results

1. How are the tests marked?
IELTS uses a 9-band scoring system to measure and report test scores in a consistent manner. You receive individual band scores for Listening, Reading, Writing and Speaking and an Overall Band Score on a band scale from one to nine. Find out more.

2. Who sets the ‘pass’ mark for the IELTS test?
There is no pass or fail in IELTS. Scores are graded on the 9-band system. Each educational institution or organisation sets its own level of IELTS scores to meet its individual requirements. To find out more, search the IELTS Global Recognition System for specific organisations and scores.

3. When will I receive my test results?
You will receive your Test Report Form in the mail 13 days after your test date. Some test centres also provide SMS alerts and an Online Results Service. Keep your Test Report Form in a secure place as you only receive one copy. Find out more.

4. What if I lose my Test Report Form?
Test Report Forms are valid for two years. Copies cannot be sent to candidates but IELTS will forward a Test Report Form to your relevant institution or embassy. Up to five copies will be sent free of charge. Additional copies will incur a small administration charge. Talk to your test centre for further details.

5. How soon can I re-sit the test?
There is no limit on sitting the test. However, IELTS recommends you do additional study before taking the test again. Some test centres offer preparatory courses and language classes. You can also improve your skills by using the IELTS Official Practice Materials.

6. What if I feel my test result is wrong?
You can apply for an ‘enquiry on results’ procedure at your test centre within four weeks of receiving your results. You must pay an enquiry fee, which is fully refunded if your band score changes. Note that IELTS Examiners and markers follow strict assessment guidelines and are regularly monitored. The IELTS testing process has the highest quality control procedures.

Taking the test


On the test day, your IELTS centre will be helpful and friendly. But they have to follow strict procedures to ensure the quality and security of the test. Below are some guidelines for taking the test.

Arrive on time and try to stay relaxed and calm so you can do your best in the test. Read the Information for candidates booklet and Notice to candidates before coming to your test.

1. Bring your passport / national identity card with you:

You must have the same identification that you provided on your IELTS Application Form. If you do not have the correct identification document, you will not be able to take the test.

Pens, pencils and erasers which you need for the test.

2. During the test:

Follow the supervisor’s instructions. If you are in doubt, raise your hand and the supervisor will assist you.

Tell the supervisor if you think you have not been given the right question paper, or if the question paper is incomplete or illegible.

You may not ask for any explanation of the questions.

You may not lend or borrow anything from another person.

If you feel that your work may be affected by illness or any other reason, you must tell the supervisor at the time.

3. You must not:

Try to cheat, copy the work of another candidate or disrupt the test.

Use, or try to use, a dictionary, pager, spell-checker, electronic recorder or mobile phone. You will be disqualified.

Talk to, or disturb, other candidates once the test has started. Smoke, eat or drink in the examination room.

Reproduce any part of the test. You will have your test results disqualified and be liable to prosecution.

Take any materials from the examination room. This includes, but is not limited to, test papers, answer papers and working paper.

Leave the examination room without permission.

If you are caught infringing any of the candidate rules, your test result will be disqualified and your receiving institution or professional body will be notified.
Tips for the test
Here are some quick tips for practicing your English and taking the test. Good luck!

1. Practice for confidence

Practice your English language skills with the IELTS Official Practice Materials or through other books or courses.

Download the Information for candidates booklet to understand more about the test.

Read, speak and listen to English as much as you can.

Practice speaking English with your friends.

Use radio, television and the web to read and hear different English texts.

2. Arrive on time to the test

Double check the time and date of your test and allow plenty of time to travel to the test centre.

If you are late, you may not be allowed to take the test.

Make sure you drink water and eat healthy food on the day of your test.

3. Try to be calm and relaxed

Get a good night’s sleep before your test. Don‘t cram your study.

Try to remain calm at the test centre. The centre staff will be friendly and assist you.

Read the IELTS regulations before the test so you understand the rules. (A copy is on your IELTS Application Form.)

4. Understand the test format

To do your best, you need to know what to expect. Make sure you understand the test format.

Look at the free sample test pages to see the types of texts and questions.

5. Follow the instructions

Listen to the supervisor carefully and follow the instructions on how to sit the test.

When you open your test papers, read the instructions first before writing anything.

Don’t lose points for careless mistakes because you haven’t read the question properly.

6. Stay aware of the time

Every test room will have a clock on the wall. Stay aware of the time so you can complete all of your questions.

Each part has a number of sections. Allow enough time for each section. Some questions have suggested time limits for you to follow.

7. Do your best

If you feel yourself becoming worried, take some deep breaths to calm down.

Work calmly, focus on the questions, don’t rush your answers and you will do your best!
Find my nearest test centre
You can sit for an IELTS test in over 500 centres across the world. Find your nearest test centre by using the IELTS Worldwide Search.

Through IELTS Worldwide Search, you can also see the test dates, the deadline for registration and the test fee in your local currency.

The IELTS staff in your local centre are friendly and helpful. They can answer any of your queries.

Our test centres are managed by the British Council, IDP:IELTS Australia or by independent organisations that meet strict standards of quality, security and customer service.

Jun 22, 2009

How do I prepare for International English Language Testing System (IELTS)?

Content Outline:
1. How do I prepare?
2. Who accepts IELTS?


How do I prepare?

To help you prepare for the test, IELTS has a range of materials.

IELTS has Official Practice Materials 2007 to help you understand the format of the test and the types of questions. The book has sample questions for each part of the test, including a CD for Listening. You can practice your skills and then use the answers and Examiner comments to help you further improve.

The IELTS Official Practice Materials 2007 is the only IELTS training book endorsed by the IELTS partners. You can buy a copy from your nearest test centre or order online. It will ensure you do the test to the best of your ability.

Some IELTS centres have workshops to help you prepare for the test. Talk to your local centre for details. IELTS preparation courses may also be offered by language schools in your country.

Who accepts IELTS?

IELTS is the world’s proven test. Due to its high quality controls, IELTS is accepted by thousands of organisations in more than 120 countries.

1. Universities, schools, training colleges, tertiary institutes
2. Government departments and agencies
3. Professional and industry bodies
4. Multinational companies and employers


The IELTS Global Recognition System can tell you exactly which organisations accept IELTS and the scores they require.

Start your journey to international study or employment with an IELTS score.

Jun 21, 2009

Saudi needs 1,000 Filipina nurses—POEA

MANILA, Philippines—The Ministry of Health of the Kingdom of Saudi Arabia is in urgent need of female nurses to fill up some 1,000 positions in its government hospitals, the Philippine Overseas Employment Administrator said.

In a statement sent to media outfits, POEA Administrator Jennifer Jardin-Manalili said qualified nurses may personally submit their documents, including a detailed resume with job description, school credentials, employment certificates, copy of passport, and two pieces of 2x2 recent photo at the Manpower Registry Division, Window M at the ground floor lobby of the POEA building on Ortigas Avenue corner Edsa in Mandaluyong City.

The Ministry of Health offers benefits that include annual paid vacation, free economy round trip ticket, housing and transportation allowance, and yearly renewal of contract.

Applicants should be licensed nurses with at least one year hospital experience, and should not be more than 45 years old.

Manalili added that the Saudi Ministry of Finance is also looking for three communication engineers, three architects, and three electrical engineers. Applicants must be male, not more than 50 years old, with 8 to 10 years work experience, and have valid licenses in their fields of work.

Benefits include housing and transportation allowance equivalent to 2 months salary, yearly renewal of contract, and free economy round trip ticket.

Applicants for engineer and architect positions have until June 26, 2009 to submit the same documents as the ones required of nurses to the POEA.-- INQUIRER.net

Jun 20, 2009

Six (6) steps to register for IELTS test

How do I register?

1. Find your nearest IELTS centre and check the test dates to find two options that suit you. Note the deadline for registering for each test date. (You can also see the cost of the test at your centre in local currency on the IELTS Worldwide Search.)

2. Check with your organisation or on the Global Recognition System whether you need to sit an Academic or General Training test.

3. Print out the IELTS Application Form or ask your test centre for a copy. Read the information for candidates, terms and conditions, complete the form and sign it. Please make sure you have a valid postal address and use the same name as on your passport.

4. Organise two passport-sized photographs, less than six months old, and sign the back of each. Take a photocopy of your current passport – this must be valid and not expired. (Some centres will accept a national identity card.)

5. If you want your results to be sent automatically to a university or educational institution, include the correct details in the section on the IELTS Application Form.

6. Take your application into your IELTS test centre with your money. If you send it by mail, please talk to your centre about the method of payment.

Once you have registered, the test centre will confirm your IELTS test date, time and venue. Please note the Speaking test can be up to 7 days before or after the test date.

On the test day, you must bring the same passport or national identity card that you entered on the Application Form.

Test dates

IELTS has 48 fixed test dates each year to ensure high levels of quality and security.

Test fees

IELTS has a set fee for its test. The Academic and General Training tests are the same cost. You must pay your fee when you put in your Application Form.

To find out the test fee in your local currency, check the IELTS Worldwide Search for your nearest centre. It also has information on terms and conditions for payment and cancellations.

IELTS test fees are used to ensure the quality and security of the test process.

Jun 18, 2009

What is International English Language Testing System (IELTS)?


Content outline
1.What is IELTS?
2.Why choose IELTS?
3.Test Format - Academic and General Training
4.A reliable, secure test
5.Special needs


What is IELTS?

IELTS tests are held in over 500 centres with tests up to four times a month. IELTS respects international diversity and is fair to anyone who sits the test, regardless of nationality

You can choose from two types of IELTS test: Academic or General Training, depending on whether you want to study, work or migrate. Both modules are made up of four parts – Listening, Reading, Writing and Speaking. IELTS results are graded on the unique IELTS 9-band scale.

To help you prepare, IELTS provides samples and practice tests. The test covers the full range of ability from non-user to expert user. You are not limited in how many times you can sit the test.

You can trust the quality and security of IELTS because it is managed by three reputable, international organisations: British Council, IDP: IELTS Australia and the University of Cambridge ESOL Examinations (Cambridge ESOL).

British Council: Please contact ielts@britishcouncil.org for further information.
IELTS Australia: Please contact ielts@idp.com for further information.

Why choose IELTS?

IELTS tests all four language skills – Listening, Reading, Writing and Speaking. The Speaking test is a face-to-face interview with a certified Examiner. It is interactive and as close to a real-life situation as a test can get.

Research shows that IELTS motivates test-takers to develop real and well-rounded English rather than learning by rote. This means your understanding of English is improved and valid for real life in an English-speaking country.

IELTS is owned by three reputable, international organisations. It has the highest quality control and security procedures. More than 6000 organisations, including many government departments and universities, rely on IELTS. The IELTS scoring system is recognised globally, giving you a truly international result.

Test format

IELTS is available in two test formats:
Academic or General Training. All candidates take the same Listening and Speaking modules but different Reading and Writing modules.

Listening, Reading and Writing must be completed in one day. Depending on your test centre, the Speaking test may be offered on the same day or up to a week before or after the other parts. See below for a diagram of the test format.

Academic or General Training

1. Academic – Institutions of Higher and Further Education
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Jun 16, 2009

109 Questions and Rationale on Psychotic Disorders

109 Questions and Rationale on Psychotic Disorders


1. A psychotic client reports to the evening nurse that the day nurse put something suspicious in his water with his medication. The nurse replies, "You're worried about your medication?" The nurse's communication is:

A. an example of presenting reality.
B. reinforcing the client's delusions.
C. focusing on emotional content.
D. a nontherapeutic technique called mind reading.

Rationale: The nurse should help the client focus on the emotional content rather than delusional material. Presenting reality isn't helpful because it can lead to confrontation and disengagement. Agreeing with the client and supporting his beliefs are reinforcing delusions. Mind reading isn't therapeutic.

2. A client is admitted to the inpatient unit of the mental health center with a diagnosis of paranoid schizophrenia. He's shouting that the government of France is trying to assassinate him. Which of the following responses is most appropriate?

A. "I think you're wrong. France is a friendly country and an ally of the United States. Their government wouldn't try to kill you."
B. "I find it hard to believe that a foreign government or anyone else is trying to hurt you. You must feel frightened by this."
C. "You're wrong. Nobody is trying to kill you."
D. "A foreign government is trying to kill you? Please tell me more about it."

Rationale: Responses should focus on reality while acknowledging the client's feelings. Arguing with the client or denying his belief isn't therapeutic. Arguing can also inhibit development of a trusting relationship. Continuing to talk about delusions may aggravate the psychosis. Asking the client if a foreign government is trying to kill him may increase his anxiety level and can reinforce his delusions.

3. Propranolol (Inderal) is used in the mental health setting to manage which of the following conditions?

A. Antipsychotic-induced akathisia and anxiety
B. The manic phase of bipolar illness as a mood stabilizer
C. Delusions for clients suffering from schizophrenia
D. Obsessive-compulsive disorder (OCD) to reduce ritualistic behavior

Rationale: Propranolol is a potent beta-adrenergic blocker and produces a sedating effect; therefore, it's used to treat antipsychotic induced akathisia and anxiety. Lithium (Lithobid) is used to stabilize clients with bipolar illness. Antipsychotics are used to treat delusions. Some antidepressants have been effective in treating OCD.

4. A client with borderline personality disorder becomes angry when he is told that today's psychotherapy session with the nurse will be delayed 30 minutes because of an emergency. When the session finally begins, the client expresses anger. Which response by the nurse would be most helpful in dealing with the client's anger?

A. "If it had been your emergency, I would have made the other client wait."
B. "I know it's frustrating to wait. I'm sorry this happened."
C. "You had to wait. Can we talk about how this is making you feel right now?"
D. "I really care about you and I'll never let this happen again."

Rationale: This response may diffuse the client's anger by helping to maintain a therapeutic relationship and addressing the client's feelings. Option A wouldn't address the client's anger. Option B is incorrect because the client with a borderline personality disorder blames others for things that happen, so apologizing reinforces the client's misconceptions. The nurse can't promise that a delay will never occur again, as in option D, because such matters are outside the nurse's control.

5. How soon after chlorpromazine (Thorazine) administration should the nurse expect to see a client's delusional thoughts and hallucinations eliminated

A. Several minutes
B. Several hours
C. Several days
D. Several weeks

Rationale: Although most phenothiazines produce some effects within minutes to hours, their antipsychotic effects may take several weeks to appear.

6. A client receiving haloperidol (Haldol) complains of a stiff jaw and difficulty swallowing. The nurse's first action is to:

A. reassure the client and administer as needed lorazepam (Ativan) I.M.
B. administer as needed dose of benztropine (Cogentin) I.M. as ordered.
C. administer as needed dose of benztropine (Cogentin) by mouth as ordered.
D. administer as needed dose of haloperidol (Haldol) by mouth.

Rationale: The client is most likely suffering from muscle rigidity due to haloperidol. I.M. benztropine should be administered to prevent asphyxia or aspiration. Lorazepam treats anxiety, not extrapyramidal effects. Another dose of haloperidol would increase the severity of the reaction.

7. A client with a diagnosis of paranoid schizophrenia comments to the nurse, "How do I know what is really in those pills?" Which of the following is the best response?

A. Say, "You know it's your medicine."
B. Allow him to open the individual wrappers of the medication.
C. Say, "Don't worry about what is in the pills. It's what is ordered."
D. Ignore the comment because it's probably a joke.

Rationale: Option B is correct because allowing a paranoid client to open his medication can help reduce suspiciousness. Option A is incorrect because the client doesn't know that it's his medication and he's obviously suspicious. Telling the client not to worry or ignoring the comment isn't supportive and doesn't offer reassurance.

8. The nurse is caring for a client with schizophrenia who experiences auditory hallucinations. The client appears to be listening to someone who isn't visible. He gestures, shouts angrily, and stops shouting in mid-sentence. Which nursing intervention is the most appropriate?

A. Approach the client and touch him to get his attention.
B. Encourage the client to go to his room where he'll experience fewer distractions.
C. Acknowledge that the client is hearing voices but make it clear that the nurse doesn't hear these voices.
D. Ask the client to describe what the voices are saying.

Rationale: By acknowledging that the client hears voices, the nurse conveys acceptance of the client. By letting the client know that the nurse doesn't hear the voices, the nurse avoids reinforcing the hallucination. The nurse shouldn't touch the client with schizophrenia without advance warning. The hallucinating client may believe that the touch is a threat or act of aggression and respond violently. Being alone in his room encourages the client to withdraw and may promote more hallucinations. The nurse should provide an activity to distract the client. By asking the client what the voices are saying, the nurse is reinforcing the hallucination. The nurse should focus on the client's feelings, rather than the content of the hallucination.

9. Yesterday, a client with schizophrenia began treatment with haloperidol (Haldol). Today, the nurse notices that the client is holding his head to one side and complaining of neck and jaw spasms. What should the nurse do?

A. Assume that the client is posturing.
B. Tell the client to lie down and relax.
C. Evaluate the client for adverse reactions to haloperidol.
D. Put the client on the list for the physician to see tomorrow

Rationale: An antipsychotic agent, such as haloperidol, can cause muscle spasms in the neck, face, tongue, back, and sometimes legs as well as torticollis (twisted neck position). The nurse should be aware of these adverse reactions and assess for related reactions promptly. Although posturing may occur in clients with schizophrenia, it isn't the same as neck and jaw spasms. Having the client relax can reduce tension-induced muscle stiffness but not drug-induced muscle spasms. When a client develops a new sign or symptom, the nurse should consider an adverse drug reaction as the possible cause and obtain treatment immediately, rather than have the client wait.

10. A client with paranoid schizophrenia has been experiencing auditory hallucinations for many years. One approach that has proven to be effective for hallucinating clients is to:


A. take an as-needed dose of psychotropic medication whenever they hear voices.
B. practice saying "Go away" or "Stop" when they hear voices.
C. sing loudly to drown out the voices and provide a distraction.
D. go to their room until the voices go away.

Rationale: Researchers have found that some clients can learn to control bothersome hallucinations by telling the voices to go away or stop. Taking an as needed dose of psychotropic medication whenever the voices arise may lead to overmedication and put the client at risk for adverse effects. Because the voices aren't likely to go away permanently, the client must learn to deal with the hallucinations without relying on drugs. Although distraction is helpful, singing loudly may upset other clients and would be socially unacceptable after the client is discharged. Hallucinations are most bothersome in a quiet environment when the client is alone, so sending the client to his room would increase, rather than decrease, the hallucinations.

11. A client with catatonic schizophrenia is mute, can't perform activities of daily living, and stares out the window for hours. What is the nurse's first priority?

A. Assist the client with feeding.
B. Assist the client with showering.
C. Reassure the client about safety.
D. Encourage socialization with peers.

Rationale: According to Maslow's hierarchy of needs, the need for food is among the most important. Other needs, in order of decreasing importance, include hygiene, safety, and a sense of belonging.

12. A client tells the nurse that the television newscaster is sending a secret message to her. The nurse suspects the client is experiencing:

A. a delusion.
B. flight of ideas.
C. ideas of reference.
D. a hallucination.

Rationale: Ideas of reference refers to the mistaken belief that neutral stimuli have special meaning to the individual such as the television newscaster sending a message directly to the individual. A delusion is a false belief. Flight of ideas is a speech pattern in which the client skips from one unrelated subject to another. A hallucination is a sensory perception, such as hearing voices and seeing objects, that only the client experiences.

13. The nurse knows that the physician has ordered the liquid form of the drug chlorpromazine (Thorazine) rather than the tablet form because the liquid:

A. has a more predictable onset of action.
B. produces fewer anticholinergic effects.
C. produces fewer drug interactions.
D. has a longer duration of action.

Rationale: A liquid phenothiazine preparation will produce effects in 2 to 4 hours. The onset with tablets is unpredictable.

14. A client who has been hospitalized with disorganized type schizophrenia for 8 years can't complete activities of daily living (ADLs) without staff direction and assistance. The nurse formulates a nursing diagnosis of Self-care deficient: Dressing/grooming related to inability to function without assistance. What is an appropriate goal for this client?

A. "Client will be able to complete ADLs independently within 1 month."
B. "Client will be able to complete ADLs with only verbal encouragement within 1 month."
C. "Client will be able to complete ADLs with assistance in organizing grooming items and clothing within 1 month."
D. "Client will be able to complete ADLs with complete assistance within 1 month."

Rationale: The client's disorganized personality and history of hospitalization have affected the ability to perform self-care activities. Interventions should be directed at helping the client complete ADLs with the assistance of staff members, who can provide needed structure by helping the client select grooming items and clothing. This goal promotes realistic independence. As the client improves and achieves the established goal, the nurse can set new goals that focus on the client completing ADLs with only verbal encouragement and, ultimately, completing them independently. The client's condition doesn't indicate a need for complete assistance, which would only foster dependence.

15. The nurse is planning care for a client admitted to the psychiatric unit with a diagnosis of paranoid schizophrenia. Which nursing diagnosis should receive the highest priority?

A. Risk for violence toward self or others
B. Imbalanced nutrition: Less than body requirements
C. Ineffective family coping
D. Impaired verbal communication

Rationale: Because of such factors as suspiciousness, anxiety, and hallucinations, the client with paranoid schizophrenia is at risk for violence toward himself or others. The other options are also appropriate nursing diagnoses but should be addressed after the safety of the client and those around him is established.

16. The nurse is preparing for the discharge of a client who has been hospitalized for paranoid schizophrenia. The client's husband expresses concern over whether his wife will continue to take her daily prescribed medication. The nurse should inform him that:

A. his concern is valid but his wife is an adult and has the right to make her own decisions.
B. he can easily mix the medication in his wife's food if she stops taking it.
C. his wife can be given a long-acting medication that is administered every 1 to 4 weeks.
D. his wife knows she must take her medication as prescribed to avoid future hospitalizations.

Rationale: Long-acting psychotropic drugs can be administered by depot injection every 1 to 4 weeks. These agents are useful for noncompliant clients because the client receives the injection at the outpatient clinic. A client has the right to refuse medication, but this issue isn't the focus of discussion at this time. Medication should never be hidden in food or drink to trick the client into taking it; besides destroying the client's trust, doing so would place the client at risk for overmedication or undermedication because the amount administered is hard to determine. Assuming the client knows she must take the medication to avoid future hospitalizations would be unrealistic.

17. Benztropine (Cogentin) is used to treat the extrapyramidal effects induced by antipsychotics. This drug exerts its effect by:

A. decreasing the anxiety causing muscle rigidity.
B. blocking the cholinergic activity in the central nervous system (CNS).
C. increasing the level of acetylcholine in the CNS.
D. increasing norepinephrine in the CNS.

Rationale: Option B is the action of Cogentin. Anxiety doesn't cause extrapyramidal effects. Overactivity of acetylcholine and lower levels of dopamine are the causes of extrapyramidal effects. Benztropine doesn't increase norepinephrine in the CNS.

18. A client is admitted to the inpatient unit of the mental health center with a diagnosis of paranoid schizophrenia. He's shouting that the government of France is trying to assassinate him. Which of the following responses is most appropriate?

A. "I think you're wrong. France is a friendly country and an ally of the United States. Their government wouldn't try to kill you."
B. "I find it hard to believe that a foreign government or anyone else is trying to hurt you. You must feel frightened by this."
C. "You're wrong. Nobody is trying to kill you."
D. "A foreign government is trying to kill you? Please tell me more about it."

Rationale: Responses should focus on reality while acknowledging the client's feelings. Arguing with the client or denying his belief isn't therapeutic. Arguing can also inhibit development of a trusting relationship. Continuing to talk about delusions may aggravate the psychosis. Asking the client if a foreign government is trying to kill him may increase his anxiety level and can reinforce his delusions.

19. A dopamine receptor agonist such as bromocriptine (Parlodel) relieves muscle rigidity caused by antipsychotic medication by:

A. blocking dopamine receptors in the central nervous system (CNS).
B. blocking acetylcholine in the CNS.
C. activating norepinephrine in the CNS.
D. activating dopamine receptors in the CNS.

Rationale: Extrapyramidal effects and the muscle rigidity induced by antipsychotic medications are caused by a low level of dopamine. Dopamine receptor agonists stimulate dopamine receptors and thereby reduce rigidity. They don't affect norepinephrine or acetylcholine.

20. Most antipsychotic medications exert which of following effects on the central nervous system (CNS)?

A. Stimulate the CNS by blocking postsynaptic dopamine, norepinephrine, and serotonin receptors.
B. Sedate the CNS by stimulating serotonin at the synaptic cleft.
C. Depress the CNS by blocking the postsynaptic transmission of dopamine, serotonin, and norepinephrine.
D. Depress the CNS by stimulating the release of acetylcholine.

Rationale: The exact mechanism of antipsychotic medication action is unknown, but appear to depress the CNS by blocking the transmission of three neurotransmitters: dopamine, serotonin, and norepinephrine. They don't sedate the CNS by stimulating serotonin, and they don't stimulate neurotransmitter action or acetylcholine release.

21. A client is admitted to the psychiatric unit of a local hospital with chronic undifferentiated schizophrenia. During the next several days, the client is seen laughing, yelling, and talking to herself. This behavior is characteristic of:

A. delusion.
B. looseness of association.
C. illusion.
D. hallucination.

Rationale: Auditory hallucination, in which one hears voices when no external stimuli exist, is common in schizophrenic clients. Such behaviors as laughing, yelling, and talking to oneself suggest such a hallucination. Delusions, also common in schizophrenia, are false beliefs or ideas that arise without external stimuli. Clients with schizophrenia may exhibit looseness of association, a pattern of thinking and communicating in which ideas aren't clearly linked to one another. Illusion is a less severe perceptual disturbance in which the client misinterprets actual external stimuli. Illusions are rarely associated with schizophrenia.

22. Which of the following medications would the nurse expect the physician to order to reverse a dystonic reaction?

A. prochlorperazine (Compazine)
B. diphenhydramine (Benadryl)
C. haloperidol (Haldol)
D. midazolam (Versed)

Rationale: Diphenhydramine, 25 to 50 mg I.M. or I.V., would quickly reverse this condition. Prochlorperazine and haloperidol are both capable of causing dystonia, not reversing it. Midazolam would make this client drowsy.

23. A schizophrenic client states, "I hear the voice of King Tut." Which response by the nurse would be most therapeutic?

A. "I don't hear the voice, but I know you hear what sounds like a voice."
B. "You shouldn't focus on that voice."
C. "Don't worry about the voice as long as it doesn't belong to anyone real."
D. "King Tut has been dead for years."

Rationale: This response states reality about the client's hallucination. The other options are judgmental, flippant, or dismissive.

24. A psychotic client reports to the evening nurse that the day nurse put something suspicious in his water with his medication. The nurse replies, "You're worried about your medication?" The nurse's communication is:

A. an example of presenting reality.
B. reinforcing the client's delusions.
C. focusing on emotional content.
D. a nontherapeutic technique called mind reading.

Rationale: The nurse should help the client focus on the emotional content rather than delusional material. Presenting reality isn't helpful because it can lead to confrontation and disengagement. Agreeing with the client and supporting his beliefs are reinforcing delusions. Mind reading isn't therapeutic.

25. The nurse is caring for a client with schizophrenia who experiences auditory hallucinations. The client appears to be listening to someone who isn't visible. He gestures, shouts angrily, and stops shouting in mid-sentence. Which nursing intervention is the most appropriate?

A. Approach the client and touch him to get his attention.
B. Encourage the client to go to his room where he'll experience fewer distractions.
C. Acknowledge that the client is hearing voices but make it clear that the nurse doesn't hear these voices.
D. Ask the client to describe what the voices are saying

Rationale: By acknowledging that the client hears voices, the nurse conveys acceptance of the client. By letting the client know that the nurse doesn't hear the voices, the nurse avoids reinforcing the hallucination. The nurse shouldn't touch the client with schizophrenia without advance warning. The hallucinating client may believe that the touch is a threat or act of aggression and respond violently. Being alone in his room encourages the client to withdraw and may promote more hallucinations. The nurse should provide an activity to distract the client. By asking the client what the voices are saying, the nurse is reinforcing the hallucination. The nurse should focus on the client's feelings, rather than the content of the hallucination.

26. A client has been receiving chlorpromazine (Thorazine), an antipsychotic, to treat his psychosis. Which findings should alert the nurse that the client is experiencing pseudoparkinsonism?

A. Restlessness, difficulty sitting still, and pacing
B. Involuntary rolling of the eyes
C. Tremors, shuffling gait, and masklike face
D. Extremity and neck spasms, facial grimacing, and jerky movements

Rationale: Pseudoparkinsonism may appear 1 to 5 days after starting an antipsychotic and may also include drooling, rigidity, and "pill rolling." Akathisia may occur several weeks after starting antipsychotic therapy and consists of restlessness, difficulty sitting still, and fidgeting. An oculogyric crisis is recognized by uncontrollable rolling back of the eyes and, along with dystonia, should be considered an emergency. Dystonia may occur minutes to hours after receiving an antipsychotic and may include extremity and neck spasms, jerky muscle movements, and facial grimacing.

27. For several years, a client with chronic schizophrenia has received 10 mg of fluphenazine hydrochloride (Prolixin) by mouth four times per day. Now the client has a temperature of 102° F (38.9° C), a heart rate of 120 beats/minute, a respiratory rate of 20 breaths/minute, and a blood pressure of 210/140 mm Hg. Because the client also is confused and incontinent, the nurse suspects malignant neuroleptic syndrome. What steps should the nurse take?

A. Give the next dose of fluphenazine, call the physician, and monitor vital signs.
B. Withhold the next dose of fluphenazine, call the physician, and monitor vital signs.
C. Give the next dose of fluphenazine and restrict the client to the room to decrease stimulation.
D. Withhold the next dose of fluphenazine, administer an antipyretic agent, and increase the client's fluid intake.

Rationale: Malignant neuroleptic syndrome is a dangerous adverse effect of neuroleptic drugs such as fluphenazine. The nurse should withhold the next dose, notify the physician, and continue to monitor vital signs. Although an antipyretic agent may be used to reduce fever, increased fluid intake is contraindicated because it may increase the client's fluid volume further, raising blood pressure even higher.

28. A schizophrenic client with delusions tells the nurse, "There is a man wearing a red coat who's out to get me." The client exhibits increasing anxiety when focusing on the delusions. Which of the following would be the best response?

A. "This subject seems to be troubling you. Let's walk to the activity room."
B. "Describe the man who's out to get you. What does he look like?"
C. "There is no reason to be afraid of that man. This hospital is very secure."
D. "There is no need to be concerned with a man who isn't even real."

Rationale: This remark distracts the client from the delusion by engaging the client in a less threatening or more comforting activity at the first sign of anxiety. The nurse should reinforce reality and discourage the false belief. The other options focus on the content of the delusion rather than the meaning, feeling, or intent that it provokes.

29. Important teaching for women in their childbearing years who are receiving antipsychotic medications includes which of the following?

A. Occurrence of increased libido due to medication adverse effects
B. Increased incidence of dysmenorrhea while taking the drug
C. Continuing previous use of contraception during periods of amenorrhea
D. Instruction that amenorrhea is irreversible

Rationale: Women may experience amenorrhea, which is reversible, while taking antipsychotics. Amenorrhea doesn't indicate cessation of ovulation; therefore, the client can still become pregnant. The client should be instructed to continue contraceptive use even when experiencing amenorrhea. Dysmenorrhea isn't an adverse effect of antipsychotics, and libido generally decreases because of the depressant effect.

30. A client is admitted to a psychiatric facility with a diagnosis of chronic schizophrenia. The history indicates that the client has been taking neuroleptic medication for many years. Assessment reveals unusual movements of the tongue, neck, and arms. Which condition should the nurse suspect?

A. Tardive dyskinesia
B. Dystonia
C. Neuroleptic malignant syndrome
D. Akathisia

Rationale: Unusual movements of the tongue, neck, and arms suggest tardive dyskinesia, an adverse reaction to neuroleptic medication. Dystonia is characterized by cramps and rigidity of the tongue, face, neck, and back muscles. Neuroleptic malignant syndrome causes rigidity, fever, hypertension, and diaphoresis. Akathisia causes restlessness, anxiety, and jitteriness.

31. What medication would probably be ordered for the acutely aggressive schizophrenic client?

A. chlorpromazine (Thorazine)
B. haloperidol (Haldol)
C. lithium carbonate (Lithonate)
D. amitriptyline (Elavil)

Rationale: Haloperidol administered I.M. or I.V. is the drug of choice for acute aggressive psychotic behavior. Chlorpromazine is also an antipsychotic drug; however, it causes more pronounced sedation than haloperidol. Lithium carbonate is useful in bipolar or manic disorder, and amitriptyline is used for depression.

32. A client is admitted with a diagnosis of schizotypal personality disorder. Which signs would this client exhibit during social situations?

A. Aggressive behavior
B. Paranoid thoughts
C. Emotional affect
D. Independence needs

Rationale: Clients with schizotypal personality disorder experience excessive social anxiety that can lead to paranoid thoughts. Aggressive behavior is uncommon, although these clients may experience agitation with anxiety. Their behavior is emotionally cold with a flattened affect, regardless of the situation. These clients demonstrate a reduced capacity for close or dependent relationships.

33. During the initial interview, a client with schizophrenia suddenly turns to the empty chair beside him and whispers, "Now just leave. I told you to stay home. There isn't enough work here for both of us!" What is the nurse's best initial response?

A. "When people are under stress, they may see things or hear things that others don't. Is that what just happened?"
B. "I'm having a difficult time hearing you. Please look at me when you talk."
C. "There is no one else in the room. What are you doing?"
D. "Who are you talking to? Are you hallucinating?"

Rationale: This response makes the client feel that experiencing hallucinations is acceptable and promotes an open, therapeutic relationship. Directing the client to look at the nurse wouldn't address the obvious issue of the hallucination. Confrontational approaches, such as in options C and D, are likely to elicit an uninformative or negative response.

34. The definition of nihilistic delusions is:

A. a false belief about the functioning of the body.
B. belief that the body is deformed or defective in a specific way.
C. false ideas about the self, others, or the world

D. the inability to carry out motor activities.

Rationale: Nihilistic delusions are false ideas about the self, others, or the world. Somatic delusions involve a false belief about the functioning of the body. Body dysmorphic disorder is characterized by a belief that the body is deformed or defective in a specific way. Apraxia is the inability to carry out motor activities.

35. A client who's taking antipsychotic medication develops a very high temperature, severe muscle rigidity, tachycardia, and rapid deterioration in mental status. The nurse suspects what complication of antipsychotic therapy?

A. Agranulocytosis
B. Extrapyramidal effects
C. Anticholinergic effects
D. Neuroleptic malignant syndrome (NMS)

Rationale: A rare but potentially fatal condition of antipsychotic medication is called NMS. It generally starts with an elevated temperature and severe extrapyramidal effects. Agranulocytosis is a blood disorder. Anticholinergic effects include blurred vision, drowsiness, and dry mouth. Symptoms of extrapyramidal effects include tremors, restlessness, muscle spasms, and pseudoparkinsonism.

36. The nurse formulates a nursing diagnosis of Impaired social interaction related to disorganized thinking for a client with schizotypal personality disorder. Based on this nursing diagnosis, which nursing intervention takes highest priority?

A. Helping the client to participate in social interactions
B. Establishing a one-on-one relationship with the client
C. Exploring the effects of the client's behavior on social interactions
D. Developing a schedule for the client's participation in social interactions

Rationale: By establishing a one-on-one relationship, the nurse helps the client learn how to interact with people in new situations. The other options are appropriate but should take place only after the nurse-client relationship is established.

37. A client with schizophrenia hears a voice telling him he is evil and must die. The nurse understands that the client is experiencing:

A. a delusion.
B. flight of ideas.
C. ideas of reference.
D. a hallucination.

Rationale: A hallucination is a sensory perception, such as hearing voices and seeing objects, that only the client experiences. A delusion is a false belief. Flight of ideas refers to a speech pattern in which the client skips from one unrelated subject to another. Ideas of reference refers to the mistaken belief that someone or something outside the client is controlling the client's ideas or behavior.

38. A client with delusional thinking shows a lack of interest in eating at meal times. She states that she is unworthy of eating and that her children will die if she eats. Which nursing action would be most appropriate for this client?

A. Telling the client that she may become sick and die unless she eats
B. Paying special attention to the client's rituals and emotions associated with meals
C. Restricting the client's access to food except at specified meal and snack times
D. Encouraging the client to express her feelings at meal times

Rationale: Restricting access to food except at specified times prevents the client from eating when she feels anxious, guilty, or depressed; this, in turn, decreases the association between these emotions and food. Telling the client she may become sick or die may reinforce her behavior because illness or death may be her goal. Paying special attention to rituals and emotions associated with meals also would reinforce undesirable behavior. Encouraging the client to express feelings at meal times would increase the association between emotions and food; instead, the nurse should encourage her to express feelings at other times.

39. Which of the following groups of characteristics would the nurse expect to see in the client with schizophrenia?

A. Loose associations, grandiose delusions, and auditory hallucinations
B. Periods of hyperactivity and irritability alternating with depression
C. Delusions of jealousy and persecution, paranoia, and mistrust
D. Sadness, apathy, feelings of worthlessness, anorexia, and weight loss

Rationale: Loose associations, grandiose delusions, and auditory hallucinations are all characteristic of the classic schizophrenic client. These clients aren't able to care for their physical appearance. They frequently hear voices telling them to do something either to themselves or to others. Additionally, they verbally ramble from one topic to the next. Periods of hyperactivity and irritability alternating with depression are characteristic of bipolar or manic disease. Delusions of jealousy and persecution, paranoia, and mistrust are characteristics of paranoid disorders. Sadness, apathy, feelings of worthlessness, anorexia, and weight loss are characteristics of depression.

40. The nurse must administer a medication to reverse or prevent Parkinson-type symptoms in a client receiving an antipsychotic. The medication the client will likely receive is:

A. Benztropine (Cogentin).

B. diphenhydramine (Benadryl).
C. propranolol (Inderal).
D. haloperidol (Haldol).

Rationale: Benztropine, trihexyphenidyl, or amantadine are prescribed for a client with Parkinson-type symptoms. Diphenhydramine provides rapid relief for dystonia. Propranolol relieves akathisia. Haloperidol can cause Parkinson-type symptoms.

41. A client is receiving haloperidol (Haldol) to reduce psychotic symptoms. As he watches television with other clients, the nurse notes that he has trouble sitting still. He seems restless, constantly moving his hands and feet and changing position. When the nurse asks what is wrong, he says he feels jittery. How should the nurse manage this situation?

A. Ask the client to sit still or leave the room because he is distracting the other clients.
B. Ask the client if he is nervous or anxious about something.
C. Give an as needed dose of a prescribed anticholinergic agent to control akathisia.
D. Administer an as needed dose of haloperidol to decrease agitation.

Rationale: Akathisia, characterized by restlessness, is a common but often overlooked adverse reaction to haloperidol and other antipsychotic agents; it may be confused with psychotic agitation. To control akathisia, the nurse should give an as needed dose of a prescribed anticholinergic agent. The client can't control the movements, so asking him to sit still would be pointless. Asking him to leave the room wouldn't address the underlying cause of the problem. Encouraging him to talk about the symptoms wouldn't stop them from occurring. Giving more antipsychotic medication would worsen akathisia.

42. A man is brought to the hospital by his wife, who states that for the past week her husband has refused all meals and accused her of trying to poison him. During the initial interview, the client's speech, only partly comprehensible, reveals that his thoughts are controlled by delusions that he is possessed by the devil. The physician diagnoses paranoid schizophrenia. Schizophrenia is best described as a disorder characterized by:

A. disturbed relationships related to an inability to communicate and think clearly.
B. severe mood swings and periods of low to high activity.
C. multiple personalities, one of which is more destructive than the others.
D. auditory and tactile hallucinations.

Rationale: Schizophrenia is best described as one of a group of psychotic reactions characterized by disturbed relationships with others and an inability to communicate and think clearly. Schizophrenic thoughts, feelings, and behavior commonly are evidenced by withdrawal, fluctuating moods, disordered thinking, and regressive tendencies. Severe mood swings and periods of low to high activity are typical of bipolar disorder. Multiple personality, sometimes confused with schizophrenia, is a dissociative personality disorder, not a psychotic illness. Many schizophrenic clients have auditory hallucinations; tactile hallucinations are more common in organic or toxic disorders

43. A client has a history of chronic undifferentiated schizophrenia. Because she has a history of noncompliance with antipsychotic therapy, she'll receive fluphenazine decanoate (Prolixin Decanoate) injections every 4 weeks. Before discharge, what should the nurse include in her teaching plan?

A. Asking the physician for droperidol (Inapsine) to control any extrapyramidal symptoms that occur
B. Sitting up for a few minutes before standing to minimize orthostatic hypotension
C. Notifying the physician if her thoughts don't normalize within 1 week
D. Expecting symptoms of tardive dyskinesia to occur and to be transient

Rationale: The nurse should teach the client how to manage common adverse reactions, such as orthostatic hypotension and anticholinergic effects. Antipsychotic effects of the drug may take several weeks to appear. Droperidol increases the risk of extrapyramidal effects when given in conjunction with phenothiazines such as fluphenazine. Tardive dyskinesia is a possible adverse reaction and should be reported immediately

44. A client with chronic schizophrenia who takes neuroleptic medication is admitted to the psychiatric unit. Nursing assessment reveals rigidity, fever, hypertension, and diaphoresis. These findings suggest which life-threatening reaction:

A. tardive dyskinesia.
B. dystonia.
C. neuroleptic malignant syndrome.
D. akathisia.

Rationale: The client's signs and symptoms suggest neuroleptic malignant syndrome, a life-threatening reaction to neuroleptic medication that requires immediate treatment. Tardive dyskinesia causes involuntary movements of the tongue, mouth, facial muscles, and arm and leg muscles. Dystonia is characterized by cramps and rigidity of the tongue, face, neck, and back muscles. Akathisia causes restlessness, anxiety, and jitteriness.

45. While looking out the window, a client with schizophrenia remarks, "That school across the street has creatures in it that are waiting for me." Which of the following terms best describes what the creatures represent?

A. Anxiety attack
B. Projection
C. Hallucination
D. Delusion

Rationale: A delusion is a false belief based on a misrepresentation of a real event or experience. Although anxiety can increase delusional responses, it isn't considered the primary symptom. Projection is falsely attributing to another person one's own unacceptable feelings. Hallucinations, which characterize most psychoses, are perceptual disorders of the five senses; the client may see, taste, feel, smell, or hear something in the absence of external stimulation

46. A client with schizophrenia tells the nurse, "My intestines are rotted from the worms chewing on them." This statement indicates a:

A. delusion of persecution.
B. delusion of grandeur.
C. somatic delusion.
D. jealous delusion.

Rationale: Somatic delusions focus on bodily functions or systems and commonly include delusions about foul odor emissions, insect infestations, internal parasites, and misshapen parts. Delusions of persecution are morbid beliefs that one is being mistreated and harassed by unidentified enemies. Delusions of grandeur are gross exaggerations of one's importance, wealth, power, or talents. Jealous delusions are delusions that one's spouse or lover is unfaithful.

47. During the assessment stage, a client with schizophrenia leaves his arm in the air after the nurse has taken his blood pressure. His action shows evidence of:

A. somatic delusions.
B. waxy flexibility.
C. neologisms.
D. nihilistic delusions.

Rationale: The correct answer is waxy flexibility, which is defined as retaining any position that the body has been placed in. Somatic delusions involve a false belief about the functioning of the body. Neologisms are invented meaningless words. Nihilistic delusions are false ideas about self, others, or the world.

48. A client with paranoid type schizophrenia becomes angry and tells the nurse to leave him alone. The nurse should

A. tell him that she'll leave for now but will return soon.
B. ask him if it's okay if she sits quietly with him.
C. ask him why he wants to be left alone.
D. tell him that she won't let anything happen to him

Rationale: If the client tells the nurse to leave, the nurse should leave but let the client know that she'll return so that he doesn't feel abandoned. Not heeding the client's request can agitate him further. Also, challenging the client isn't therapeutic and may increase his anger. False reassurance isn't warranted in this situation

49. Nursing care for a client with schizophrenia must be based on valid psychiatric and nursing theories. The nurse's interpersonal communication with the client and specific nursing interventions must be:

A. clearly identified with boundaries and specifically defined roles.
B. warm and nonthreatening.
C. centered on clearly defined limits and expression of empathy.
D. flexible enough for the nurse to adjust the plan of care as the situation warrants.

Rationale: A flexible plan of care is needed for any client who behaves in a suspicious, withdrawn, or regressed manner or who has a thought disorder. Because such a client communicates at different levels and is in control of himself at various times, the nurse must be able to adjust nursing care as the situation warrants. The nurse's role should be clear; however, the boundaries or limits of this role should be flexible enough to meet client needs. Because a client with schizophrenia fears closeness and affection, a warm approach may be too threatening. Expressing empathy is important, but centering interventions on clearly defined limits is impossible because the client's situation may change without warning.

50. When discharging a client after treatment for a dystonic reaction, the emergency department nurse must ensure that the client understands which of the following?

A. Results of treatment are rapid and dramatic but may not last.
B. Although uncomfortable, this reaction isn't serious.
C. The client shouldn't buy drugs on the street.
D. The client must take benztropine (Cogentin) as prescribed to prevent a return of symptoms.

Rationale: An oral anticholinergic agent such as benztropine (Cogentin) is commonly prescribed to control and prevent the return of symptoms. Dystonic reactions are typically acute and reversible. Dystonic reactions can be life-threatening when airway patency is compromised. Lecturing the client about buying drugs on the street isn't appropriate

51. The nurse is caring for a client with schizophrenia. Which of the following outcomes is the least desirable?

A. The client spends more time by himself.
B. The client doesn't engage in delusional thinking.
C. The client doesn't harm himself or others.
D. The client demonstrates the ability to meet his own self-care needs.

Rationale: The client with schizophrenia is commonly socially isolated and withdrawn; therefore, having the client spend more time by himself wouldn't be a desirable outcome. Rather, a desirable outcome would specify that the client spend more time with other clients and staff on the unit. Delusions are false personal beliefs. Reducing or eliminating delusional thinking using talking therapy and antipsychotic medications would be a desirable outcome. Protecting the client and others from harm is a desirable client outcome achieved by close observation, removing any dangerous objects, and administering medications. Because the client with schizophrenia may have difficulty meeting his or her own self-care needs, fostering the ability to perform self-care independently is a desirable client outcome.

52. The nurse formulates a nursing diagnosis of Impaired verbal communication for a client with schizotypal personality disorder. Based on this nursing diagnosis, which nursing intervention is most appropriate?

A. Helping the client to participate in social interactions
B. Establishing a one-on-one relationship with the client
C. Establishing alternative forms of communication
D. Allowing the client to decide when he wants to participate in verbal communication with the nurse
Rationale: By establishing a one-on-one relationship, the nurse helps the client learn how to interact with people in new situations. The other options are appropriate but should take place only after the nurse-client relationship is established.

53. Since admission 4 days ago, a client has refused to take a shower, stating, "There are poison crystals hidden in the showerhead. They'll kill me if I take a shower." Which nursing action is most appropriate?

A. Dismantling the showerhead and showing the client that there is nothing in it
B. Explaining that other clients are complaining about the client's body odor
C. Asking a security officer to assist in giving the client a shower
D. Accepting these fears and allowing the client to take a sponge bath

Rationale: By acknowledging the client's fears, the nurse can arrange to meet the client's hygiene needs in another way. Because these fears are real to the client, providing a demonstration of reality (as in option A) wouldn't be effective at this time. Options B and C would violate the client's rights by shaming or embarrassing the client.

54. Drug therapy with thioridazine (Mellaril) shouldn't exceed a daily dose of 800 mg to prevent which adverse reaction?

A. Hypertension
B. Respiratory arrest
C. Tourette syndrome
D. Retinal pigmentation

Rationale: Retinal pigmentation may occur if the thioridazine dosage exceeds 800 mg per day. The other options don't occur as a result of exceeding this dose.


55. A client with paranoid personality disorder is admitted to a psychiatric facility. Which remark by the nurse would best establish rapport and encourage the client to confide in the nurse?

A. "I get upset once in a while, too."
B. "I know just how you feel. I'd feel the same way in your situation."
C. "I worry, too, when I think people are talking about me."
D. "At times, it's normal not to trust anyone."

Rationale: Sharing a benign, nonthreatening, personal fact or feeling helps the nurse establish rapport and encourages the client to confide in the nurse. The nurse can't know how the client feels. Telling the client otherwise, as in option B, would justify the suspicions of a paranoid client; furthermore, the client relies on the nurse to interpret reality. Option C is incorrect because it focuses on the nurse's feelings, not the client's. Option D wouldn't help establish rapport or encourage the client to confide in the nurse

56. How soon after chlorpromazine (Thorazine) administration should the nurse expect to see a client's delusional thoughts and hallucinations eliminated?

A. Several minutes
B. Several hours
C. Several days
D. Several weeks

Rationale: Although most phenothiazines produce some effects within minutes to hours, their antipsychotic effects may take several weeks to appear.

57. A client is about to be discharged with a prescription for the antipsychotic agent haloperidol (Haldol), 10 mg by mouth twice per day. During a discharge teaching session, the nurse should provide which instruction to the client?

A. Take the medication 1 hour before a meal.
B. Decrease the dosage if signs of illness decrease.
C. Apply a sunscreen before being exposed to the sun.
D. Increase the dosage up to 50 mg twice per day if signs of illness don't decrease.

Rationale: Because haloperidol can cause photosensitivity and precipitate severe sunburn, the nurse should instruct the client to apply a sunscreen before exposure to the sun. The nurse also should teach the client to take haloperidol with meals — not 1 hour before — and should instruct the client not to decrease or increase the dosage unless the physician orders it

58. A client with paranoid schizophrenia repeatedly uses profanity during an activity therapy session. Which response by the nurse would be most appropriate?

A. "Your behavior won't be tolerated. Go to your room immediately."
B. "You're just doing this to get back at me for making you come to therapy."
C. "Your cursing is interrupting the activity. Take time out in your room for 10 minutes."
D. "I'm disappointed in you. You can't control yourself even for a few minutes."

Rationale: The nurse should set limits on client behavior to ensure a comfortable environment for all clients. The nurse should accept hostile or quarrelsome client outbursts within limits without becoming personally offended, as in option A. Option B is incorrect because it implies that the client's actions reflect feelings toward the staff instead of the client's own misery. Judgmental remarks, such as option D, may decrease the client's self-esteem.

59. Which of the following is one of the advantages of the newer antipsychotic medication risperidone (Risperdal)?

A. The absence of anticholinergic effects
B. A lower incidence of extrapyramidal effects
C. Photosensitivity and sedation
D. No incidence of neuroleptic malignant syndrome

Rationale: Risperdal has a lower incidence of extrapyramidal effects than the typical antipsychotics. Risperdal does produce anticholinergic effects and neuroleptic malignant syndrome can occur. Photosensitivity isn't an advantage.

60. The etiology of schizophrenia is best described by:

A. genetics due to a faulty dopamine receptor.
B. environmental factors and poor parenting.
C. structural and neurobiological factors.
D. a combination of biological, psychological, and environmental factors.

Rationale: A reliable genetic marker hasn't been determined for schizophrenia. However, studies of twins and adopted siblings have strongly implicated a genetic predisposition. Since the mid-19th century, excessive dopamine activity in the brain has also been suggested as a causal factor. Communication and the family system have been studied as contributing factors in the development of schizophrenia. Therefore, a combination of biological, psychological, and environmental factors are thought to cause schizophrenia.

61. A client with schizophrenia who receives fluphenazine (Prolixin) develops pseudoparkinsonism and akinesia. What drug would the nurse administer to minimize extrapyramidal symptoms?

A. benztropine (Cogentin)
B. dantrolene (Dantrium)
C. clonazepam (Klonopin)
D. diazepam (Valium)

Rationale: Benztropine is an anticholinergic drug administered to reduce extrapyramidal adverse effects in the client taking antipsychotic drugs. It works by restoring the equilibrium between the neurotransmitters acetylcholine and dopamine in the central nervous system (CNS). Dantrolene, a hydantoin drug that reduces the catabolic processes, is administered to alleviate the symptoms of neuroleptic malignant syndrome, a potentially fatal adverse effect of antipsychotic drugs. Clonazepam, a benzodiazepine drug that depresses the CNS, is administered to control seizure activity. Diazepam, a benzodiazepine drug, is administered to reduce anxiety.

62. A client with a diagnosis of paranoid schizophrenia comments to the nurse, "How do I know what is really in those pills?" Which of the following is the best response?

A. Say, "You know it's your medicine."
B. Allow him to open the individual wrappers of the medication.
C. Say, "Don't worry about what is in the pills. It's what is ordered."
D. Ignore the comment because it's probably a joke.

Rationale: Option B is correct because allowing a paranoid client to open his medication can help reduce suspiciousness. Option A is incorrect because the client doesn't know that it's his medication and he's obviously suspicious. Telling the client not to worry or ignoring the comment isn't supportive and doesn't offer reassurance.

63. A client tells the nurse that people from Mars are going to invade the earth. Which response by the nurse would be most therapeutic?

A. "That must be frightening to you. Can you tell me how you feel about it?"
B. "There are no people living on Mars."
C. "What do you mean when you say they're going to invade the earth?"
D. "I know you believe the earth is going to be invaded, but I don't believe that."

Rationale: This response addresses the client's underlying fears without feeding the delusion. Refuting the client's delusion, as in option B, would increase anxiety and reinforce the delusion. Asking the client to elaborate on the delusion, as in option C, would also reinforce it. Voicing disbelief about the delusion, as in option D, wouldn't help the client deal with underlying fears

64. A client with schizophrenia tells the nurse he hears the voices of his dead parents. To help the client ignore the voices, the nurse should recommend that he:

A. sit in a quiet, dark room and concentrate on the voices.
B. listen to a personal stereo through headphones and sing along with the music.
C. call a friend and discuss the voices and his feelings about them.
D. engage in strenuous exercise.

Rationale: Increasing the amount of auditory stimulation, such as by listening to music through headphones, may make it easier for the client to focus on external sounds and ignore internal sounds from auditory hallucinations. Option A would make it harder for the client to ignore the hallucinations. Talking about the voices, as in option C, would encourage the client to focus on them. Option D is incorrect because exercise alone wouldn't provide enough auditory stimulation to drown out the voices.

65. A client with schizophrenia is receiving antipsychotic medication. Which nursing diagnosis may be appropriate for this client?

A. Ineffective protection related to blood dyscrasias
B. Urinary frequency related to adverse effects of antipsychotic medication
C. Risk for injury related to a severely decreased level of consciousness
D. Risk for injury related to electrolyte disturbances

Rationale: Antipsychotic medications may cause neutropenia and granulocytopenia, life-threatening blood dyscrasias, that warrant a nursing diagnosis of Ineffective protection related to blood dyscrasias. These medications also have anticholinergic effects, such as urine retention, dry mouth, and constipation. Urinary frequency isn't an approved nursing diagnosis. Although antipsychotic medications may cause sedation, they don't severely decrease the level of consciousness, eliminating option C. These drugs don't cause electrolyte disturbances, eliminating option D.

66. A client with persistent, severe schizophrenia has been treated with phenothiazines for the past 17 years. Now the client's speech is garbled as a result of drug-induced rhythmic tongue protrusion. What is another name for this extrapyramidal symptom?

A. Dystonia
B. Akathisia
C. Pseudoparkinsonism
D. Tardive dyskinesia

Rationale: An adverse reaction to phenothiazines, tardive dyskinesia refers to choreiform tongue movements that commonly are irreversible and may interfere with speech. Dystonia refers to involuntary contraction of a muscle group. Akathisia is restlessness or inability to sit still. Pseudoparkinsonism describes a group of symptoms that mimic those of Parkinson's disease.

67. The nurse is assigned to a client with catatonic schizophrenia. Which intervention should the nurse include in the client's plan of care?

A. Meeting all of the client's physical needs
B. Giving the client an opportunity to express concerns
C. Administering lithium carbonate (Lithonate) as prescribed
D. Providing a quiet environment where the client can be alone

Rationale: Because a client with catatonic schizophrenia can't meet physical needs independently, the nurse must provide for all of these needs, including adequate food and fluid intake, exercise, and elimination. This client is incapable of expressing concerns; however, the nurse should try to verbalize the message conveyed by the client's nonverbal behavior. Lithium is used to treat mania, not catatonic schizophrenia. Despite the client's mute, unresponsive state, the nurse should provide nonthreatening stimulation and should spend time with the client, not leave the client alone all the time. Although aware of the environment, the client doesn't interact with it actively; the nurse's support and presence can be reassuring.

68. A client with a history of medication noncompliance is receiving outpatient treatment for chronic undifferentiated schizophrenia. The physician is most likely to prescribe which medication for this client?

A. chlorpromazine (Thorazine)
B. imipramine (Tofranil)
C. lithium carbonate (Lithane)
D. fluphenazine decanoate (Prolixin Decanoate)

Rationale: Fluphenazine decanoate is a long-acting antipsychotic agent given by injection. Because it has a 4-week duration of action, it's commonly prescribed for outpatients with a history of medication noncompliance. Chlorpromazine, also an antipsychotic agent, must be administered daily to maintain adequate plasma levels, which necessitates compliance with the dosage schedule. Imipramine, a tricyclic antidepressant, and lithium carbonate, a mood stabilizer, are rarely used to treat clients with chronic schizophrenia.

69. Propranolol (Inderal) is used in the mental health setting to manage which of the following conditions?

A. Antipsychotic-induced akathisia and anxiety
B. The manic phase of bipolar illness as a mood stabilizer
C. Delusions for clients suffering from schizophrenia
D. Obsessive-compulsive disorder (OCD) to reduce ritualistic behavior

Rationale: Propranolol is a potent beta-adrenergic blocker and produces a sedating effect; therefore, it's used to treat antipsychotic induced akathisia and anxiety. Lithium (Lithobid) is used to stabilize clients with bipolar illness. Antipsychotics are used to treat delusions. Some antidepressants have been effective in treating OCD.

70. Every day for the past 2 weeks, a client with schizophrenia stands up during group therapy and screams, "Get out of here right now! The elevator bombs are going to explode in 3 minutes!" The next time this happens, how should the nurse respond?

A. "Why do you think there is a bomb in the elevator?"
B. "That is the same thing you said in yesterday's session."
C. "I know you think there are bombs in the elevator, but there aren't."
D. "If you have something to say, you must do it according to our group rules."

Rationale: Option C is the most therapeutic response because it orients the client to reality. Options A and B are condescending. Option D sounds punitive and could embarrass the client.

71. A 26-year-old client is admitted to the psychiatric unit with acute onset of schizophrenia. His physician prescribes the phenothiazine chlorpromazine (Thorazine), 100 mg by mouth four times per day. Before administering the drug, the nurse reviews the client's medication history. Concomitant use of which drug is likely to increase the risk of extrapyramidal effects?

A. guanethidine (Ismelin)
B. droperidol (Inapsine)
C. lithium carbonate (Lithonate)
D. alcohol

Rationale: When administered with any phenothiazine, droperidol may increase the risk of extrapyramidal effects. The other options are incorrect

72. A client, age 36, with paranoid schizophrenia believes the room is bugged by the Central Intelligence Agency and that his roommate is a foreign spy. The client has never had a romantic relationship, has no contact with family members, and hasn't been employed in the last 14 years. Based on Erikson's theories, the nurse should recognize that this client is in which stage of psychosocial development?

A. Autonomy versus shame and doubt
B. Generativity versus stagnation
C. Integrity versus despair
D. Trust versus mistrust

Rationale: This client's paranoid ideation indicates difficulty trusting others. The stage of autonomy versus shame and doubt deals with separation, cooperation, and self-control. Generativity versus stagnation is the normal stage for this client's chronologic age. Integrity versus despair is the stage for accepting the positive and negative aspects of one's life, which would be difficult or impossible for this client.

73. During a group therapy session in the psychiatric unit, a client constantly interrupts with impulsive behavior and exaggerated stories that cast her as a hero or princess. She also manipulates the group with attention-seeking behaviors, such as sexual comments and angry outbursts. The nurse realizes that these behaviors are typical of:

A. paranoid personality disorder.
B. avoidant personality disorder.
C. histrionic personality disorder.
D. borderline personality disorder.

Rationale: This client's behaviors are typical of histrionic personality disorder, which is marked by excessive emotionality and attention seeking. The client constantly seeks and demands attention, approval, or praise; may be seductive in behavior, appearance, or conversation; and is uncomfortable except when she is the center of attention. Typically, a client with paranoid personality disorder is suspicious, cold, hostile, and argumentative. Avoidant personality disorder is characterized by anxiety, fear, and social isolation. Borderline personality disorder is characterized by impulsive, unpredictable behavior and unstable, intense interpersonal relationships.

74. The nurse is teaching a psychiatric client about her prescribed drugs, chlorpromazine and benztropine. Why is benztropine administered?
A. To reduce psychotic symptoms
B. To reduce extrapyramidal symptoms
C. To control nausea and vomiting
D. To relieve anxiety

Rationale: Benztropine is an anticholinergic medication, administered to reduce the extrapyramidal adverse effects of chlorpromazine and other antipsychotic medications. Benztropine doesn't reduce psychotic symptoms, relieve anxiety, or control nausea and vomiting.

75. A client is admitted to the psychiatric unit with a tentative diagnosis of psychosis. Her physician prescribes the phenothiazine thioridazine (Mellaril) 50 mg by mouth three times per day. Phenothiazines differ from central nervous system (CNS) depressants in their sedative effects by producing:

A. deeper sleep than CNS depressants.
B. greater sedation than CNS depressants.
C. a calming effect from which the client is easily aroused.
D. more prolonged sedative effects, making the client more difficult to arouse.

Rationale: Shortly after phenothiazine administration, a quieting and calming effect occurs, but the client is easily aroused, alert, and responsive and has good motor coordination.


76. A woman is admitted to the psychiatric emergency department. Her significant other reports that she has difficulty sleeping, has poor judgment, and is incoherent at times. The client's speech is rapid and loose. She reports being a special messenger from the Messiah. She has a history of depressed mood for which she has been taking an antidepressant. The nurse suspects which diagnosis?

A. Schizophrenia
B. Paranoid personality
C. Bipolar illness
D. Obsessive-compulsive disorder (OCD)

Rationale: Bipolar illness is characterized by mood swings from profound depression to elation and euphoria. Delusions of grandeur along with pressured speech are common symptoms of mania. Schizophrenia doesn't exhibit mood swings from depression to euphoria. Paranoia is characterized by unrealistic suspiciousness and is often accompanied by grandiosity. OCD is a preoccupation with rituals and rules.

77. A client with paranoid schizophrenia is admitted to the psychiatric unit of a hospital. Nursing assessment should include careful observation of the client's:

A. thinking, perceiving, and decision-making skills.
B. verbal and nonverbal communication processes.
C. affect and behavior.
D. psychomotor activity.

Rationale: Nursing assessment of a psychotic client should include careful inquiry about and observation of the client's thinking, perceiving, symbolizing, and decision-making skills and abilities. Assessment of such a client typically reveals alterations in thought content and process, perception, affect, and psychomotor behavior; changes in personality, coping, and sense of self; lack of self-motivation; presence of psychosocial stressors; and degeneration of adaptive functioning. Although assessing communication processes, affect, behavior, and psychomotor activity would reveal important information about the client's condition, the nurse should concentrate on determining whether the client is hallucinating by assessing thought processes and decision-making ability.

78. Which information is most important for the nurse to include in a teaching plan for a schizophrenic client taking clozapine (Clozaril)?

A. Monthly blood tests will be necessary.
B. Report a sore throat or fever to the physician immediately.
C. Blood pressure must be monitored for hypertension.
D. Stop the medication when symptoms subside.

Rationale: A sore throat and fever are indications of an infection caused by agranulocytosis, a potentially life-threatening complication of clozapine. Because of the risk of agranulocytosis, white blood cell (WBC) counts are necessary weekly, not monthly. If the WBC count drops below 3,000/μl, the medication must be stopped. Hypotension may occur in clients taking this medication. Warn the client to stand up slowly to avoid dizziness from orthostatic hypotension. The medication should be continued, even when symptoms have been controlled. If the medication must be stopped, it should be slowly tapered over 1 to 2 weeks and only under the supervision of a physician.

79. Important teaching for clients receiving antipsychotic medication such as haloperidol (Haldol) includes which of the following instructions?

A. Use sunscreen because of photosensitivity.
B. Take the antipsychotic medication with food.

C. Have routine blood tests to determine levels of the medication.
D. Abstain from eating aged cheese.

* A and B are both correct in taking HALDOL.

80. Positive symptoms of schizophrenia include which of the following?

A. Hallucinations, delusions, and disorganized thinking
B. Somatic delusions, echolalia, and a flat affect
C. Waxy flexibility, alogia, and apathy
D. Flat affect, avolition, and anhedonia

Rationale: The positive symptoms of schizophrenia are distortions of normal functioning. Option A lists the positive symptoms of schizophrenia. A flat affect, alogia, apathy, avolition, and anhedonia refer to the negative symptoms. Negative symptoms list the diminution or loss of normal function

81. A client with chronic schizophrenia receives 20 mg of fluphenazine decanoate (Prolixin Decanoate) by I.M. injection. Three days later, the client has muscle contractions that contort the neck. This client is exhibiting which extrapyramidal reaction?

A. Dystonia
B. Akinesia
C. Akathisia
D. Tardive dyskinesia

Rationale: Dystonia, a common extrapyramidal reaction to fluphenazine decanoate, manifests as muscle spasms in the tongue, face, neck, back, and sometimes the legs. Akinesia refers to decreased or absent movement; akathisia, to restlessness or inability to sit still; and tardive dyskinesia, to abnormal muscle movements, particularly around the mouth.

82. Hormonal effects of the antipsychotic medications include which of the following?

A. Retrograde ejaculation and gynecomastia
B. Dysmenorrhea and increased vaginal bleeding
C. Polydipsia and dysmenorrhea
D. Akinesia and dysphasia

Rationale: Decreased libido, retrograde ejaculation, and gynecomastia are all hormonal effects that can occur with antipsychotic medications. Reassure the client that the effects can be reversed or that changing medication may be possible. Polydipsia, akinesia, and dysphasia aren't hormonal effects.

83. A client is unable to get out of bed and get dressed unless the nurse prompts every step. This is an example of which behavior?


A. Word salad
B. Tangential
C. Perseveration
D. Avolition

Rationale: Avolition refers to impairment in the ability to initiate goal-directed activity. Word salad is when a group of words are put together in a random fashion without logical connection. Tangential is where a person never gets to the point of the communication. Perseveration is when a person repeats the same word or idea in response to different questions.

84. An agitated and incoherent client, age 29, comes to the emergency department with complaints of visual and auditory hallucinations. The history reveals that the client was hospitalized for paranoid schizophrenia from ages 20 to 21. The physician prescribes haloperidol (Haldol), 5 mg I.M. The nurse understands that this drug is used in this client to treat:

A. dyskinesia.
B. dementia.
C. psychosis.
D. tardive dyskinesia.

Rationale: By treating psychosis, haloperidol, an antipsychotic drug, decreases agitation. Haloperidol is used to treat dyskinesia in clients with Tourette syndrome and to treat dementia in elderly clients. Tardive dyskinesia may occur after prolonged haloperidol use; the client should be monitored for this adverse reaction.

85. Yesterday, a client with schizophrenia began treatment with haloperidol (Haldol). Today, the nurse notices that the client is holding his head to one side and complaining of neck and jaw spasms. What should the nurse do?

A. Assume that the client is posturing.
B. Tell the client to lie down and relax.
C. Evaluate the client for adverse reactions to haloperidol.
D. Put the client on the list for the physician to see tomorrow.

Rationale: An antipsychotic agent, such as haloperidol, can cause muscle spasms in the neck, face, tongue, back, and sometimes legs as well as torticollis (twisted neck position). The nurse should be aware of these adverse reactions and assess for related reactions promptly. Although posturing may occur in clients with schizophrenia, it isn't the same as neck and jaw spasms. Having the client relax can reduce tension-induced muscle stiffness but not drug-induced muscle spasms. When a client develops a new sign or symptom, the nurse should consider an adverse drug reaction as the possible cause and obtain treatment immediately, rather than have the client wait.

86. A client receiving fluphenazine decanoate (Prolixin Decanoate) therapy develops pseudoparkinsonism. The physician is likely to prescribe which drug to control this extrapyramidal effect?

A. phenytoin (Dilantin)
B. amantadine (Symmetrel)
C. benztropine (Cogentin)
D. diphenhydramine (Benadryl)

Rationale: An antiparkinsonian agent, such as amantadine, may be used to control pseudoparkinsonism; diphenhydramine or benztropine may be used to control other extrapyramidal effects. Phenytoin is used to treat seizure activity.

87. Important teaching for a client receiving risperidone (Risperdal) would include advising the client to:

A. double the dose if missed to maintain a therapeutic level.
B. be sure to take the drug with a meal because it's very irritating to the stomach.
C. discontinue the drug if the client reports weight gain.
D. notify the physician if the client notices an increase in bruising.

Rationale: Bruising may indicate blood dyscrasias, so notifying the physician about increased bruising is very important. Don't double the dose. This drug doesn't irritate the stomach, and weight gain isn't a problem.


88. A client is admitted to the psychiatric hospital with a diagnosis of catatonic schizophrenia. During the physical examination, the client's arm remains outstretched after the nurse obtains the pulse and blood pressure, and the nurse must reposition the arm. This client is exhibiting:

A. suggestibility.
B. negativity.
C. waxy flexibility.
D. retardation.

Rationale: Waxy flexibility, the ability to assume and maintain awkward or uncomfortable positions for long periods, is characteristic of catatonic schizophrenia. Clients commonly remain in these awkward positions until someone repositions them. Clients with dependency problems may demonstrate suggestibility, a response pattern in which one easily agrees to the ideas and suggestions of others rather than making independent judgments. Negativity (for example, resistance to being moved or being asked to cooperate) and retardation (slowed movement) also occur in catatonic clients.

89. A client with borderline personality disorder becomes angry when he is told that today's psychotherapy session with the nurse will be delayed 30 minutes because of an emergency. When the session finally begins, the client expresses anger. Which response by the nurse would be most helpful in dealing with the client's anger?

A. "If it had been your emergency, I would have made the other client wait."
B. "I know it's frustrating to wait. I'm sorry this happened."
C. "You had to wait. Can we talk about how this is making you feel right now?"
D. "I really care about you and I'll never let this happen again."

Rationale: This response may diffuse the client's anger by helping to maintain a therapeutic relationship and addressing the client's feelings. Option A wouldn't address the client's anger. Option B is incorrect because the client with a borderline personality disorder blames others for things that happen, so apologizing reinforces the client's misconceptions. The nurse can't promise that a delay will never occur again, as in option D, because such matters are outside the nurse's control.

90. A client begins clozapine (Clozaril) therapy after several other antipsychotic agents fail to relieve her psychotic symptoms. The nurse instructs her to return for weekly white blood cell (WBC) counts to assess for which adverse reaction?

A. Hepatitis
B. Infection
C. Granulocytopenia
D. Systemic dermatitis

Rationale: Clozapine can cause life-threatening neutropenia or granulocytopenia. To detect this adverse reaction, a WBC count should be performed weekly. Hepatitis, infection, and systemic dermatitis aren't adverse reactions of clozapine therapy.

91. Which nonantipsychotic medication is used to treat some clients with schizoaffective disorder?

A. phenelzine (Nardil)
B. chlordiazepoxide (Librium)
C. lithium carbonate (Lithane)
D. imipramine (Tofranil)

Rationale: Lithium carbonate, an antimania drug, is used to treat clients with cyclical schizoaffective disorder, a psychotic disorder once classified under schizophrenia that causes affective symptoms, including maniclike activity. Lithium helps control the affective component of this disorder. Phenelzine is a monoamine oxidase inhibitor prescribed for clients who don't respond to other antidepressant drugs such as imipramine. Chlordiazepoxide, an antianxiety agent, generally is contraindicated in psychotic clients. Imipramine, primarily considered an antidepressant agent, is also used to treat clients with agoraphobia and those undergoing cocaine detoxification.

92. A client diagnosed with schizoaffective disorder is suffering from schizophrenia with elements of which of the following disorders?

A. Personality disorder
B. Mood disorder
C. Thought disorder
D. Amnestic disorder

Rationale: According to the DSM-IV, schizoaffective disorder refers to clients suffering from schizophrenia with elements of a mood disorder, either mania or depression. The prognosis is generally better than for the other types of schizophrenia, but it's worse than the prognosis for a mood disorder alone. Option A is incorrect because personality disorders and psychotic illness aren't listed together on the same axis. Option C is incorrect because schizophrenia is a major thought disorder and the question asks for elements of another disorder. Clients with schizoaffective disorder aren't suffering from schizophrenia and an amnestic disorder.

93. When teaching the family of a client with schizophrenia, the nurse should provide which information?

A. Relapse can be prevented if the client takes the medication.
B. Support is available to help family members meet their own needs.
C. Improvement should occur if the client has a stimulating environment.
D. Stressful family situations can precipitate a relapse in the client.

Rationale: Because family members of a client with schizophrenia face difficult situations and great stress, the nurse should inform them of support services that can help them cope with such problems. The nurse should also teach them that medication can't prevent relapses and that environmental stimuli may precipitate symptoms. Although stress can trigger symptoms, the nurse shouldn't make the family feel responsible for relapses (as in option D).

94. A client is admitted to the psychiatric unit with active psychosis. The physician diagnoses schizophrenia after ruling out several other conditions. Schizophrenia is characterized by:

A. loss of identity and self-esteem.
B. multiple personalities and decreased self-esteem.
C. disturbances in affect, perception, and thought content and form.
D. persistent memory impairment and confusion.

Rationale: The Diagnostic and Statistic Manual of Mental Disorders, 4th edition, defines schizophrenia as a disturbance in multiple psychological processes that affects thought content and form, perception, affect, sense of self, volition, relationship to the external world, and psychomotor behavior. Loss of identity sometimes occurs but is only one characteristic of the disorder. Multiple personalities typify multiple personality disorder, a dissociative personality disorder. Mood disorders are commonly accompanied by increased or decreased self-esteem. Schizophrenia doesn't cause a disturbance in sensorium, although the client may exhibit confusion, disorientation, and memory impairment during the acute phase.

95. The nurse is providing care to a client with a catatonic type of schizophrenia who exhibits extreme negativism. To help the client meet his basic needs, the nurse should:

A. ask the client which activity he would prefer to do first.
B. negotiate a time when the client will perform activities.
C. tell the client specifically and concisely what needs to be done.
D. prepare the client ahead of time for the activity.

Rationale: The client needs to be informed of the activity and when it will be done. Giving the client choices isn't desirable because he can be manipulative or refuse to do anything. Negotiating and preparing the client ahead of time also isn't therapeutic with this type of client because he may not want to perform the activity.

96. The nurse is caring for a client who experiences false sensory perceptions with no basis in reality. These perceptions are known as:

A. delusions.
B. hallucinations.
C. loose associations.
D. neologisms.

Rationale: Hallucinations are visual, auditory, gustatory, tactile, or olfactory perceptions that have no basis in reality. Delusions are false beliefs, rather than perceptions, that the client accepts as real. Loose associations are rapid shifts among unrelated ideas. Neologisms are bizarre words that have meaning only to the client.

97. The nurse is aware that antipsychotic medications may cause which of the following adverse effects?

A. Increased production of insulin
B. Lower seizure threshold
C. Increased coagulation time
D. Increased risk of heart failure

Rationale: Antipsychotic medications exert an effect on brain neurotransmitters that lowers the seizure threshold and can, therefore, increase the risk of seizure activity. Antipsychotics don't affect insulin production or coagulation time. Heart failure isn't an adverse effect of antipsychotic agents

98. A client is admitted with a diagnosis of delusions of grandeur. This diagnosis reflects a belief that one is:

A. highly important or famous.
B. being persecuted.
C. connected to events unrelated to oneself.
D. responsible for the evil in the world.

Rationale: A delusion of grandeur is a false belief that one is highly important or famous. A delusion of persecution is a false belief that one is being persecuted. A delusion of reference is a false belief that one is connected to events unrelated to oneself or a belief that one is responsible for the evil in the world.

99. A man with a 5-year history of multiple psychiatric admissions is brought to the emergency department by the police. He was found wandering the streets disheveled, shoeless, and confused. Based on his previous medical records and current behavior, he is diagnosed with chronic undifferentiated schizophrenia. The nurse should assign highest priority to which nursing diagnosis?

A. Anxiety
B. Impaired verbal communication
C. Disturbed thought processes
D. Self-care deficient: Dressing/grooming

Rationale: For this client, the highest-priority nursing diagnosis is Anxiety (severe to panic-level), manifested by the client's extreme withdrawal and attempt to protect himself from the environment. The nurse must act immediately to reduce anxiety and protect the client and others from possible injury. Impaired verbal communication, manifested by noncommunicativeness; Disturbed thought processes, evidenced by inability to understand the situation; and Self-care deficient: Dressing/grooming, evidenced by a disheveled appearance, are appropriate nursing diagnoses but aren't the highest priority

100. A client's medication order reads, "Thioridazine (Mellaril) 200 mg P.O. q.i.d. and 100 mg P.O. p.r.n." The nurse should:

A. administer the medication as prescribed.
B. question the physician about the order.
C. administer the order for 200 mg P.O. q.i.d. but not for 100 mg P.O. p.r.n.
D. administer the medication as prescribed but observe the client closely for adverse effects.

Rationale: The nurse must question this order immediately. Thioridazine (Mellaril) has an absolute dosage ceiling of 800 mg/day. Any dosage above this level places the client at high risk for toxic pigmentary retinopathy, which can't be reversed. As written, the order allows for administering more than the maximum 800 mg/day; it should be corrected immediately, before the client's health is jeopardized.

101. A client is admitted to the psychiatric unit with a diagnosis of borderline personality disorder. The nurse expects the assessment to reveal:

A. unpredictable behavior and intense interpersonal relationships.
B. inability to function as a responsible parent.
C. somatic symptoms.
D. coldness, detachment, and lack of tender feelings.

Rationale: A client with borderline personality disorder displays a pervasive pattern of unpredictable behavior, mood, and self-image. Interpersonal relationships may be intense and unstable and behavior may be inappropriate and impulsive. Although the client's impaired ability to form relationships may affect parenting skills, inability to function as a responsible parent is more typical of antisocial personality disorder. Somatic symptoms characterize avoidant personality disorder. Coldness, detachment, and lack of tender feelings typify schizoid and schizotypal personality disorders.

102. A client with disorganized type schizophrenia has been hospitalized for the past 2 years on a unit for chronic mentally ill clients. The client's behavior is labile and fluctuates from childishness and incoherence to loud yelling to slow but appropriate interaction. The client needs assistance with all activities of daily living. Which behavior is characteristic of disorganized type schizophrenia?

A. Extreme social impairment
B. Suspicious delusions
C. Waxy flexibility
D. Elevated affect

Rationale: Disorganized type schizophrenia (formerly called hebephrenia) is characterized by extreme social impairment, marked inappropriate affect, silliness, grimacing, posturing, and fragmented delusions and hallucinations. A client with a paranoid disorder typically exhibits suspicious delusions, such as a belief that evil forces are after him. Waxy flexibility, a condition in which the client's limbs remain fixed in uncomfortable positions for long periods, characterizes catatonic schizophrenia. Elevated affect is associated with schizoaffective disorder.

103. The nurse is providing care for a female client with a history of schizophrenia who's experiencing hallucinations. The physician orders 200 mg of haloperidol (Haldol) orally or I.M. every 4 hours as needed. What is the nurse's best action?

A. Administer the haloperidol orally if the client agrees to take it.
B. Call the physician to clarify whether the haloperidol should be given orally or I.M.
C. Call the physician to clarify the order because the dosage is too high.
D. Withhold haloperidol because it may worsen hallucinations.

Rationale: The dosage is too high (normal dosage ranges from 5 to 10 mg daily). Options A and B may lead to an overdose. Option D is incorrect because haloperidol helps with symptoms of hallucinations.

104. A client receiving haloperidol (Haldol) complains of a stiff jaw and difficulty swallowing. The nurse's first action is to:

A. reassure the client and administer as needed lorazepam (Ativan) I.M.
B. administer as needed dose of benztropine (Cogentin) I.M. as ordered.
C. administer as needed dose of benztropine (Cogentin) by mouth as ordered.
D. administer as needed dose of haloperidol (Haldol) by mouth.

Rationale: The client is most likely suffering from muscle rigidity due to haloperidol. I.M. benztropine should be administered to prevent asphyxia or aspiration. Lorazepam treats anxiety, not extrapyramidal effects. Another dose of haloperidol would increase the severity of the reaction.

105. A 24-year-old client is experiencing an acute schizophrenic episode. He has vivid hallucinations that are making him agitated. The nurse's best response at this time would be to:

A. take the client's vital signs.
B. explore the content of the hallucinations.
C. tell him his fear is unrealistic.
D. engage the client in reality-oriented activities.

Rationale: Exploring the content of the hallucinations will help the nurse understand the client's perspective on the situation. The client shouldn't be touched, such as in taking vital signs, without telling him exactly what is going to happen. Debating with the client about his emotions isn't therapeutic. When the client is calm, engage him in reality-based activities.

106. Which medication can control the extrapyramidal effects associated with antipsychotic agents?

A. perphenazine (Trilafon)
B. doxepin (Sinequan)
C. amantadine (Symmetrel)
D. clorazepate (Tranxene)

Rationale: Amantadine is an anticholinergic drug used to relieve drug-induced extrapyramidal adverse effects, such as muscle weakness, involuntary muscle movement, pseudoparkinsonism, and tardive dyskinesia. Other anticholinergic agents used to control extrapyramidal reactions include benztropine mesylate (Cogentin), trihexyphenidyl (Artane), biperiden (Akineton), and diphenhydramine (Benadryl). Perphenazine is an antipsychotic agent; doxepin, an antidepressant; and chlorazepate, an antianxiety agent. Because these medications have no anticholinergic or neurotransmitter effects, they don't alleviate extrapyramidal reactions.

107. A client with paranoid schizophrenia has been experiencing auditory hallucinations for many years. One approach that has proven to be effective for hallucinating clients is to:

A. take an as-needed dose of psychotropic medication whenever they hear voices.
B. practice saying "Go away" or "Stop" when they hear voices.
C. sing loudly to drown out the voices and provide a distraction.
D. go to their room until the voices go away.

Rationale: Researchers have found that some clients can learn to control bothersome hallucinations by telling the voices to go away or stop. Taking an as needed dose of psychotropic medication whenever the voices arise may lead to overmedication and put the client at risk for adverse effects. Because the voices aren't likely to go away permanently, the client must learn to deal with the hallucinations without relying on drugs. Although distraction is helpful, singing loudly may upset other clients and would be socially unacceptable after the client is discharged. Hallucinations are most bothersome in a quiet environment when the client is alone, so sending the client to his room would increase, rather than decrease, the hallucinations.

108. A dystonic reaction can be caused by which of the following medications?

A. diazepam (Valium)
B. haloperidol (Haldol)
C. amitriptyline (Elavil)
D. clonazepam (Klonopin)

Rationale: Haloperidol is a phenothiazine and is capable of causing dystonic reactions. Diazepam and clonazepam are benzodiazepines, and amitriptyline is a tricyclic antidepressant. Benzodiazepines don't cause dystonic reactions; however, they can cause drowsiness, lethargy, and hypotension. Tricyclic antidepressants rarely cause severe dystonic reactions; however, they can cause a decreased level of consciousness, tachycardia, dry mouth, and dilated pupils.

109. While pacing in the hall, a client with paranoid schizophrenia runs to the nurse and says, "Why are you poisoning me? I know you work for central thought control! You can keep my thoughts. Give me back my soul!" How should the nurse respond during the early stage of the therapeutic process?

A. "I'm a nurse. I'm not poisoning you. It's against the nursing code of ethics."
B. "I'm a nurse, and you're a client in the hospital. I'm not going to harm you."
C. "I'm not poisoning you. And how could I possibly steal your soul?"
D. "I sense anger. Are you feeling angry today?"

Rationale: The nurse should directly orient a delusional client to reality, especially to place and person. Options A and C may encourage further delusions by denying poisoning and offering information related to the delusion. Validating the client's feelings, as in option D, occurs during a later stage in the therapeutic process.