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WorksheetsSchizophrenia: Risk Factors and Prodromal Phase
Total questions: 118
Worksheet time: 59mins
Which factor best represents a genetic vulnerability for schizophrenia in a diathesis-stress framework?
Single-gene mutation with complete penetrance
Several genes contributing to inherited risk
No heritability, purely learned behavior
A reversible vitamin deficiency only
Which physiological condition is a recognized risk factor for schizophrenia?
High protein intake in late childhood
Childhood obesity without endocrine changes
Prenatal infections and maternal hypoxia
Postnatal hypoxia during adolescence
Chronic exposure to cortisol due to prolonged stress most directly suggests risk through which pathway?
Environmental deprivation without stress hormones
Physiological changes in bone density
Genetic mutation of dopamine receptors
Biochemical dysregulation of endocrine systems
Which environmental factor has been linked to increased schizophrenia risk, especially in adolescence?
Low-stimulation study environments
Cannabis use during teenage years
Moderate exercise with peers
Balanced nutrition and sleep
At what age range is schizophrenia typically diagnosed, considering sex differences?
Males earlier, typical 28–30, late onset around 40
Uniform onset at 25 for all sexes
Females earlier, typical 18–22, no late onset
Early teens for both sexes, peak at 16
Which change most likely signals the prodromal phase as the first sign of an emerging psychotic disorder?
Sudden complete amnesia of personal identity
Immediate catatonia with mutism and rigidity
Gradual disruption of sleep, concentration, and anxiety
Abrupt severe delusions with violent behavior
During the prodromal phase, how do perceptual disturbances and speech typically present?
Perceptions are normal and speech highly articulate
Perceptual disturbances like sensing unseen persons, speech slightly vague
Perceptions profoundly distorted with incoherent word salad
Perceptual clarity increases and speech becomes verbose
Which finding best characterizes the active phase of schizoaffective disorder?
Concurrent mood episode with psychotic features
Only mania without hallucinations or delusions
Only depression resolving before psychosis
Cognition intact with mild anxiety only
Persistent negative symptoms without mood change
During the active phase of schizophrenia, which presentation is most expected?
Severe hallucinations and delusions
Stable mood without psychosis
Organized speech and behavior
Persistent mania across entire phase
Normal perception with mild stress
Which early change can signal impending psychosis in severe mental illness?
Increased isolation from others
Enhanced motivation for tasks
Improved concentration at work
Regular sleep with vivid dreams
Greater social engagement weekly
Which nursing action most directly empowers a client with schizophrenia to engage in care?
Limit access to support groups
Avoid discussing triggers entirely
Discourage questions about therapy
Decide treatment without input
Collaborate on clear limits and safety
In the exploitation phase of the nurse–client relationship, what does the client primarily do?
Explore interventions like meds and therapy
Complete intake and basic assessment
Terminate services and plan discharge
Establish rapport and initial trust
Avoid discussing symptoms or needs
Which approach helps clients recognize and manage worsening symptoms autonomously?
Eliminating all routine supports
Psychiatric advance directive documentation
Withholding information about relapse
Encouraging isolation during stress
Delaying care until crisis emerges
Which self-awareness focus is essential for mental health nurses?
Reflect on personal bias and stigma
Suppress feelings during shifts
Ignore need for nutrition and rest
Avoid mindfulness and breaks
Deny impact of client narratives
Which nursing diagnosis best aligns with active psychosis affecting social behavior?
Risk for fluid volume deficit
Impaired social interaction
Ineffective airway clearance
Acute pain related to injury
Readiness for enhanced learning
Which implementation action fits therapeutic milieu and crisis intervention priorities?
Provide structured environment and support
Limit access to psychotherapy services
Delay safety planning until discharge
Avoid discussing symptom triggers
Encourage withdrawal from activities
During evaluation of a client with schizophrenia, which outcome best indicates improved coping and safety?
Focuses on delusional content when interacting
Refuses medications and denies need for any support
Avoids staff contact and isolates in room frequently
Reports fewer hallucinations and seeks help promptly
Schizophreniform disorder is characterized by symptom duration of
Greater than 1 month but less than 6 months
More than 1 year with chronic decline
Exactly 6 months with full remission
Less than 1 month with rapid resolution
Which nursing communication approach is most therapeutic when a client reports hearing voices?
Offer lengthy explanations of neurobiology
Ignore the report and change the topic
Challenge the client to prove the voices
Use simple words and speak clearly
When a client describes seeing things others do not, which direct question supports assessment without confrontation?
Why do you insist these visions are real?
What are you hearing and what are you seeing?
Are you sure you took your medication today?
Can you stop imagining those pictures now?
Which action helps maintain a therapeutic environment for clients with psychosis?
Stand very close to reduce anxiety
Debate the delusions to show evidence
Avoid arguments during interactions
Provide complex choices to encourage autonomy
Respecting personal space during interactions with psychotic symptoms primarily aims to
Increase stimulation and engagement
Test the client’s reality orientation
Reduce agitation and enhance trust
Demonstrate authority and control
A client is re-admitted due to medication non-adherence. Which long-term goal aligns with relapse prevention?
Identify early relapse signs and use crisis supports
Rely solely on family without professionals
Avoid all social contact to minimize stress
Discontinue therapy after discharge completely
For an inpatient with schizophrenia at risk for self-harm, the priority nursing focus is
Exploring complex family dynamics
Planning community outings daily
Safety and remaining free from injury
Administering multiple new sedatives
Which nurse action strengthens the therapeutic relationship in acute psychosis care?
Provide a safe environment consistently
Use sarcasm to confront delusions
Minimize assessments to avoid distress
Delay interventions until symptoms resolve
Thorough assessment in psychosis care should include
Focusing only on sleep hygiene
Assuming all reports are malingering
Arguing against hallucination content
Evaluating risks and symptom patterns
Which statement reflects appropriate advocacy and support for psychosis?
Discount the client’s experiences entirely
Collaborate on stabilization interventions
Promote restraint use without review
Discourage participation in recovery
Which adverse effect of antipsychotics involves restlessness and an inability to stay still?
Agranulocytosis
Sedation
Sialorrhea
Akathisia
Orthostatic hypotension from antipsychotics is best described as
Slow heart rate at rest
Persistent high blood pressure
Fluid retention with edema
Blood pressure drop on standing
Which life-threatening adverse reaction requires immediate discontinuation and emergency care?
Sialorrhea
Impulse control disorder
Sexual dysfunction
Neuroleptic malignant syndrome
OTC decongestants containing phenylephrine or pseudoephedrine can
Reverse metabolic side effects
Treat tardive dyskinesia effectively
Prevent extrapyramidal symptoms
Exacerbate psychotic symptoms
Which statement about DSM-5 criteria for schizophrenia is accurate?
A single brief hallucination is sufficient
Diagnosis is based solely on brain imaging
Only mood symptoms are required for diagnosis
Diagnosis requires characteristic symptoms and functional impairment
A client adds blood to a urine sample to appear ill. This behavior most aligns with which diagnosis?
Conversion disorder
Factitious disorder imposed on self
Somatic symptom disorder
Illness anxiety disorder
For a client with dissociative identity disorder, what is the immediate nursing priority?
Assess suicidal ideation and self-harm risk
Teach journaling for memory lapses
Explore childhood trauma narratives
Plan long-term psychotherapy referrals
Clients with somatic symptom disorder have increased risk of which outcome requiring assessment?
Suicidal ideation and suicide attempts
Hypertensive emergency during stress
Development of psychotic symptoms
Opioid withdrawal complications
Epidemiologically, somatic symptom disorder is more common in which group?
Adults older than ninety only
Equal rates in men and women
Males in early childhood
Females across adolescence to adulthood
Which description fits somatic symptom disorder presentation?
Single physical symptom without distress or worry
Distressing somatic symptoms with high preoccupation
Fear of disease despite normal function
Neurological deficits explained by imaging
Typical onset pattern for somatic symptom disorder includes which statement?
Diagnosed at any age, common in kids and older adults
Only begins in late adulthood after retirement
Starts in infancy with developmental delay
Restricted to adolescence with abrupt resolution
Population prevalence for somatic symptom disorder is approximately which percentage?
Four to six percent of the general population
One percent of hospitalized adults
Ten to fifteen percent of all children
Twenty percent of primary care patients
Timeline criteria for a new diagnosis of somatic symptom disorder requires what?
Persistent fear of disease without any symptoms
Multiple neurological deficits without medical cause
Two or more symptoms lasting over six months
At least one distressing somatic symptom causing disruption
Clients with somatic symptom disorder often present with which pattern?
Only psychological symptoms without pain
Exclusive gastrointestinal symptoms only
Multiple medical complaints across systems
Single acute complaint resolving quickly
Which type of memory loss is most consistent with localized dissociative amnesia?
Poor short-term memory for new information
Difficulty recalling names of distant relatives
Complete loss of identity and life history
Inability to recall events during a specific period
During recovery from dissociative amnesia, what is a key nursing goal?
Support return of memories and teach self-regulation
Discourage memory recall to avoid distress
Increase exposure to triggering stimuli
Focus solely on medication adherence
Illness anxiety disorder is characterized by which cycle?
Excessive worry and reassurance seeking
Neurological deficits with positive findings
Memory loss after acute stress
Persistent somatic pain without distress
Functional neurological symptom disorder involves which hallmark?
Pain localized to one joint from arthritis
Repeated fainting due to hypotension
Seizures with epileptiform EEG patterns
Altered motor or sensory function without medical cause
Which symptom fits conversion disorder clinical examples?
Fever and rash from autoimmune disease
Paralysis or blindness without organic basis
Dyspnea from pulmonary embolism
Weight gain due to endocrine imbalance
When a client with somatic symptom disorder is distressed by normal test results, the therapeutic response is to
Validate concern and shift focus to coping
Advise stopping all medical appointments
Confront beliefs and challenge directly
Dismiss worry and repeat testing frequently
Which treatments are appropriate for functional neurological symptom disorder?
Electroconvulsive therapy first-line
Long-term benzodiazepines alone
High-dose corticosteroids weekly
Psychotherapy and CBT; PT, OT, ST
Transcranial magnetic stimulation may be used in these comorbidities with somatic symptom presentations:
Depression, anxiety, and pain syndromes
Psychosis, mania, and delirium
Asthma, allergy, and infection
Hypertension, diabetes, and obesity
For DID at the start of care, which nursing action is prioritized?
Communicate with empathetic listening for safety
Perform cognitive testing for executive function
Schedule exposure therapy in first session
Teach advanced mindfulness immediately
In clients with DID and PTSD, a therapeutic environment helps them to
Avoid all social interactions entirely
Eliminate dissociative episodes permanently
Practice coping skills and reduce self-harm risk
Recall all trauma details in one session
Which statement about psychotherapy for DID and related disorders is accurate?
Medications alone resolve dissociation completely
Exposure therapy is contraindicated in all cases
CBT is most effective when paired with medications
Psychoeducation replaces the need for therapy
Which underlying reason best explains why a client may begin using opioids?
Peer pressure during adolescence
Stress from a new job
Genetics increasing vulnerability
Dental pain after a procedure
Which protective factor most reduces the likelihood of developing addiction in adults?
Social isolation
Multiple comorbidities
Chronic unemployment
Positive family support
Regular methamphetamine use places a client at high risk for which physical condition?
Severe dental issues
Stroke syndromes
Cirrhosis of liver
Bradycardia episodes
Which substance effect profile includes delusions, hallucinations, paranoia, and impaired thinking with detachment from environment?
Alcohol withdrawal
Methamphetamine intoxication
Opioid intoxication
Cannabis intoxication
A hallmark sign of gambling addiction is best described as what?
Physical withdrawal symptoms
Tolerance requiring larger bets
Persistent low mood states
Excitement triggering reward pathways
Which nursing action best reflects patient-centered care for substance use disorder?
Setting nurse-driven goals only
Asking the patient’s most important goal
Focusing solely on abstinence
Prioritizing staff convenience
Which consideration should guide planning care for a client with SUD?
Limit family involvement
Include age-specific needs
Emphasize provider beliefs
Ignore cultural preferences
How are stages of alcohol (ETOH) withdrawal categorized by number of manifestations?
Mild 2–3, Moderate 4–5, Severe 6+
Mild 3–5, Moderate 6–7, Severe 8+
Mild 1–2, Moderate 3–4, Severe 5+
Mild 2–4, Moderate 5–6, Severe 7+
Which presentation aligns with a blood alcohol level of 0.15 mg/dL in the ED?
Agitation, tremors, insomnia, vomiting
Bradycardia only, no tremors
Euphoria, normal vitals, mild nausea
Severe hypothermia, clear mentation
Delirium tremens (DTs) is best characterized as what?
A severe, potentially fatal alcohol withdrawal
A mild, self-limited intoxication
A benign sleep disturbance
A chronic nutritional deficiency
If a provider believes addiction is the client’s fault, which negative outcome may occur?
Enhanced patient autonomy
Earlier access to evidence-based care
Delivery of substandard or denied care
Improved therapeutic alliance
Which element belongs in a relapse prevention plan after detox discharge?
Attend meetings, identify triggers, develop coping skills
Rely on willpower without support
Reduce prescribed medications abruptly
Avoid all social contact indefinitely
In an intake interview for a SUD program, which data are subjective?
Observed tremor severity
Collateral police report
Client’s stated pain level
Historic past medical records
Which is an example of secondary data in a SUD intake?
Nurse-observed diaphoresis
Current lab values
Client-reported cravings
Information from a caregiver
Which workplace red flag may suggest a nurse’s substance use disorder?
Volunteering for medication nurse
Taking scheduled breaks
Consistent on-time charting
Requesting peer feedback
What is the nurse’s duty upon witnessing a coworker using substances on the job?
Ignore to avoid conflict
Report the impaired coworker promptly
Wait for manager’s weekly meeting
Confront privately and keep secret
What initial outcome is likely after a nurse is reported for medication diversion to the board?
An investigation and potential hearing
Immediate license revocation
Automatic criminal conviction
No action unless patient harmed
Which AA/NA principle supports sustained recovery?
Sponsor accountability and regular meetings
Solo recovery without support groups
Using substances to manage stress
Avoiding skill development for relapse
Which outcome can occur when a nurse is reported for medication diversion and does not succeed in recovery efforts?
License suspension or restriction becomes public
Private coaching without formal discipline
Immediate reinstatement without monitoring
Anonymous warning with no record
What is a primary reason to enroll a nurse in a substance use disorder rehab program instead of formal discipline?
Eliminates the need for treatment
Ensures public posting of sanctions
Permits independent practice without oversight
Allows continued work under restrictions
Alternative-to-discipline (ATD) programs typically require which condition for participating nurses?
Not practicing for a designated recovery period
Working full-time in any clinical setting
Taking voluntary courses without monitoring
Self-reporting only when relapse occurs
Which pathway component is most directly linked to feelings of euphoria in addiction?
Acetylcholine rise in the brainstem
Dopamine burst within the limbic system
GABA release in the thalamus
Serotonin surge in the cerebellum
A hospital discovers a nurse diverting opioids. Leadership must choose a response that balances safety and recovery. Which plan best demonstrates strategic use of policy and neurobiology knowledge?
Enroll in ATD with practice pause, monitored recovery
Issue private warning, resume unrestricted duties
Transfer units, rely on peer observation only
Suspend publicly, no treatment or monitoring
Which finding is a positive symptom of schizophrenia?
Alogia with reduced spontaneous speech
Hearing voices that others do not
Avolition with decreased motivation
Flat affect with social withdrawal
Which statement best describes a negative symptom of schizophrenia?
Clang speech with frequent rhyming
Anhedonia and inability to feel pleasure
Delusions of FBI stealing thoughts
Visual hallucinations occurring daily
Which risk factor most increases the likelihood of developing schizophrenia?
High income and stable housing
Twin sibling with schizophrenia diagnosis
Late‑life onset after age seventy
Growing up in rural low‑density areas
During the work phase of a schizophrenia care plan, which task reflects orientation?
Assessing home safety determinants
Exploring cultural and religious beliefs
Making and keeping clinic appointments
Practicing stress management techniques
A patient states, “The FBI is stealing my thoughts.” What is the most therapeutic initial response?
Challenge the belief with firm evidence
Acknowledge concern by stating you can see they are worried
Ignore the statement and change topics
Agree the FBI is monitoring them closely
Which medication requires weekly WBC monitoring for the first 6 weeks due to agranulocytosis risk?
Haloperidol depot injection
Risperidone oral tablet
Olanzapine disintegrating tablet
Clozapine maintenance therapy
Which statement differentiates psychosis from schizophrenia?
Schizophrenia occurs only after head trauma
Psychosis requires substance use; schizophrenia does not
Schizophrenia is brief; psychosis is always chronic
Psychosis is the syndrome; schizophrenia shows its manifestations
Which priority intervention supports a client who is lonely and isolating with serious mental illness?
Initiate long‑term seclusion orders
Recommend strict bedrest at home
Encourage support groups for SMI
Schedule daily neuroimaging follow‑ups
Which example illustrates a manifestation of positive psychosis?
Alogia and sparse conversation
Anhedonia and social withdrawal
Avolition and poor self‑care
Clang speech with frequent rhyming
A patient reports seeing figures others cannot. Which education point is accurate regarding medications?
Antipsychotics eliminate all hallucinations
OTC medications never affect perception
Both prescription and OTC medications can cause hallucinations
Only prescription drugs can cause hallucinations
Which statement about diagnosing schizophrenia is correct?
Clinical observation establishes the diagnosis
Blood tests confirm neurotransmitter imbalances
Genetic testing definitively confirms cases
EEG findings are diagnostic on their own
Which description aligns with depersonalization in dissociative disorders?
Forgetting autobiographical memories
Believing others control one’s thoughts
Experiencing repetitive intrusive sounds
Seeing oneself outside the body
Illness anxiety disorder commonly presents with which pattern of care seeking?
Avoidance of medical providers entirely
Frequent visits due to fear of serious illness
Only urgent care use during emergencies
Single annual wellness appointment
Which initial nursing step strengthens the therapeutic relationship for somatic symptom disorder with back pain?
Ask what has helped relieve pain in the past
Redirect all conversation away from pain
Offer immediate diagnostic imaging
Suggest stopping all analgesic medications
Which risk factor is associated with dissociative identity disorder development?
Physical abuse experienced as a child
Prolonged high‑altitude exposure
Late‑life bereavement without trauma
Chronic insomnia starting in adulthood
Which medication is noted for treatment in dissociative disorders?
Haloperidol typical antipsychotic
Fluoxetine selective serotonin reuptake inhibitor
Lithium carbonate mood stabilizer
Buspirone non‑benzodiazepine anxiolytic
When a patient with DID reports wanting to die, what is the priority nursing action?
Provide privacy and leave the room
Stay with the client to ensure safety
Discuss long‑term coping strategies
Schedule routine follow‑up tomorrow
Which care strategy is recommended when dissociative amnesia resolves and memories return?
Promote grounding with relaxation techniques
Confront inconsistencies aggressively
Encourage detailed recollection immediately
Limit psychotherapy to one session
Which nursing communication approach supports clients with DID during trauma discussion?
Strictly written communication only
Empathetic listening in a one‑to‑one setting
Rapid‑fire questioning without pause
Frequent group therapy confrontations
Which social determinant listed improves mental health outcomes in schizophrenia care?
Elimination of primary care visits
Access to healthy foods routinely
Removal of all vocational tasks
Strict isolation from communities
Which statement best indicates possible substance use disorder in a patient?
My provider is mad I missed three appointments
I take my medications exactly as prescribed daily
I rarely drink alcohol and never use drugs
My mood has been stable for the past month
Which developmental factor increases adolescent risk for substance use?
Enhanced long-term planning abilities
Fully matured prefrontal cognition
Immature decision making and self-control
Stable peer relationships and routines
Which nursing action helps decrease risk of relapse after discharge?
Suggest journaling without formal supports
Provide a single counseling session only
Refer to 12-step, CBT, and support groups
Schedule no follow-up or community links
A patient is fidgeting and anxious. Which data category is this?
Diagnostic lab values
Objective assessment findings
Subjective patient reports
Historical risk factors
Which guiding principle should direct care for addiction?
Use punishment rather than empathy
Focus only on abstinence without supports
Assume addiction is purely moral weakness
Recognize addiction as a complex brain disorder
What is a potential consequence when a nurse is impaired at work?
No change in patient safety or outcomes
Clients always receive superior nursing care
Clients could be harmed or die during care
Improved teamwork and communication
Which regulatory response occurs when a nurse has SUD?
State board investigation with program enrollment
Immediate criminal arrest without assessment
No action taken if work continues
Automatic license revocation permanently
Which labs help assess chronic alcohol use?
Liver panel, CMP, BAL, magnesium
Thyroid panel and cortisol level
CBC with differential only
Urinalysis and ketone test
Heavy alcohol use raises risk for which conditions?
Hepatitis, pancreatitis, cirrhosis of liver
Asthma, dermatitis, seasonal allergies
Glaucoma, cataracts, macular degeneration
Hypothyroidism, anemia, renal colic
A staff nurse shows mood swings. Which behavior could also indicate misuse?
Seeking peer feedback on dosing
Refusing overtime due to fatigue
Administering all narcotics on their shift
Documenting pain reassessments promptly
Which neurotransmitter is central to reward pathways?
Dopamine in mesolimbic circuitry
Serotonin in raphe nuclei systems
Acetylcholine in basal forebrain
GABA in cortical interneurons
Which is a risk factor for alcohol use in older adults?
High school peer pressure dynamics
Chronic pain and medical comorbidities
Childhood developmental immaturity
Pregnancy and postpartum changes
When assessing asthma and anxiety as childhood data, which category applies?
Diagnostic imaging results
Subjective present complaints
Objective vitals at current visit
Historical information in health record
Which nursing process phase includes asking about the current problem and screening?
Assessment phase with S/S identification
Diagnosis phase with NANDA labeling
Evaluation phase with outcome review
Planning phase with measurable goals
Which cluster suggests alcohol withdrawal in an agitated patient?
Low temperature, bradycardia, euphoria, clarity
Hypothermia, slow RR, sedation, orientation
Normal vitals, calm mood, organized thoughts
High temperature, increased RR, irritability, confusion
Which symptoms are typical of stimulant use effects?
Depression, fatigue, insomnia, nightmares
Ataxia, nystagmus, blurred vision
Bradykinesia, hypersomnia, weight gain
Euphoria, analgesia, pinpoint pupils
Which CIWA-Ar score threshold indicates high risk and need to reduce severe withdrawal?
Exactly ten signals hallucination certainty
Any score means no clinical action needed
Score under five indicates severe danger
Score over nineteen signifies delirium risk
Which ingestion routes increase addiction risk for SUD?
Smoking and injection pathways
Oral tablets with food intake
Topical creams in low doses
Sublingual vitamins and herbs
Which follow-up priority after suspected child abuse is appropriate?
Assess for family substance abuse patterns
Plan only for routine clinic visit
Ignore psychosocial risk factors
Focus solely on physical injuries
Which risks make healthcare workers vulnerable to addiction?
Strict supervision and limited medications
Remote work flexibility and autonomy
High job satisfaction and recognition
Work stress, burnout, injuries, drug access
Which statement best defines addiction?
Recurring uncontrollable urges despite consequences
Occasional use with no functional impairment
Planned abstinence with strong social supports
Mild curiosity resolved with education
Which substances commonly cause headaches, increased appetite, and sleepiness during use?
Hallucinogens such as cannabis variants
Opioids like morphine derivatives
Inhalants found in household products
Sedative-hypnotics like benzodiazepines
Which heroin-related findings are consistent with withdrawal?
Bradycardia, hypothermia, calm mood
Improved sleep and reduced anxiety
Euphoria, analgesia, pinpoint pupils
Restlessness, bone pain, insomnia, diarrhea
