Chapter 28 Delusional and Shared Psychotic Disorders

Chapter 28  Delusional and Shared Psychotic Disorders

Complete Chapter Questions And Answers
 

Sample Questions

A client insists that his wife is having an affair despite repeated confirmation from her that she is faithful. These beliefs began abruptly about a month ago, after the couple returned from a vacation. The client shows no other signs of any personality or functional disturbances except for his firm belief about his wife’s infidelity. When the client is found spying on his wife’s boss at her office, a judge orders him to undergo a 10-day psychiatric evaluation. What is the most likely psychiatric diagnosis for James?
A)
Delusional disorder or NOS
B)
Induced psychotic disorder
C)
Delusional disorder, erotomanic type
D)
Conjugal paranoia
Ans:
D

Feedback:

In delusional disorder of the erotomanic type, the client has an erotic delusion of being loved by another person and tries to contact the object of the delusion through such behaviors as sending gifts, calling, and stalking. The object of the undesired attention may be a complete stranger and usually is of higher status. In a psychotic disorder, a delusion of suspicion occurs within the context of a close relationship. The individual may believe that someone has an inappropriate or sexual interest in him. Schizophreniform disorder involves bizarre delusions and hallucinations of less than 6 months duration. Conjugal paranoia is a delusion that the spouse is being unfaithful.

2.
A client with delusional thinking shows a lack of interest in eating at mealtimes. 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 mealtimes and snack times
D)
Encouraging the client to express her feelings at mealtimes
Ans:
C

Feedback:

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 that 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 mealtimes would increase the association between emotions and food; instead, the nurse should encourage her to express feelings at other times.

3.
A client has been prescribed quetiapine (Seroquel) for delusional disorder. In teaching the client about this medication, the nurse must be certain to include which of the following information?
A)
Quetiapine can cause breast milk production.
B)
One of the common side effects is dry mouth.
C)
If dizziness is experienced, the client must call the doctor immediately.
D)
Quetiapine can cause you to crave sugar.
Ans:
B

Feedback:

Dry mouth is a common, sometimes bothersome, side effect. Quetiapine does not cause breast milk production. Dizziness may occur due to orthostatic hypotension but will decrease as the body becomes accustomed to the medication. It is not an emergency. Quetiapine can cause changes in blood sugar but will not induce sugar cravings.

4.
Which of the following data support a nursing diagnosis of impaired verbal communication?
A)
As evidenced by ambivalence, delusional thinking, and avolition
B)
As evidenced by the presence of neologism, echolalia, and clanging
C)
As evidenced by the presence of neologism, delusions, and anergia
D)
As evidenced by rapid pacing and running
Ans:
B

Feedback:

Although the client may be indecisive, have false beliefs, and lack motivation, these do not support a diagnosis of impaired verbal communication. Invented words, repetition of words heard, and rhyming do get in the way of the ability to use or understand language in the human interaction. Fixed false beliefs and an absence of energy do not support a diagnosis of impaired verbal communication, nor do pacing and running.

5.
A married couple arrives at the outpatient clinic. Upon assessment, the nurse finds that the couple believes that the police have been following them and tapping their phones for 2 months. This couple most likely suffers from which of the following disorders?
A)
Folie à deux
B)
Psychotic disorder NOS
C)
Delusional disorder, paranoid type
D)
Conjugal delusion
Ans:
A

Feedback:

Shared psychotic disorder, or folie à deux, involves two individuals who have a close relationship and share the same delusion. This occurrence is attributed to the strong influence of the more dominant person. It is seen more frequently in women who are isolated by language, culture, or geography. Such persons are often related by blood or marriage and have lived together for an extended period of time. Contributing factors include old age, low intelligence, sensory impairment, cerebrovascular disease, and alcohol abuse. This disorder has been diagnosed in twins and individuals, both of whom had a chronic psychotic disorder. This disorder also has occurred in a group of individuals or in families in which the parent is the primary case (inducer).