Psychiatric care technicians (PCTs) are unlicensed assistive personnel that are an integral part of the acute care mental healthcare team. Which of the following choices would be an example(s) of overdelegation by the nurse to a PCT? The nurse directs the PCT to (Select All that Apply):

Perform a neurological assessment on a patient in seclusion to compare the nurse’s findings.

Play cards with 3 patients during unstructured time.

Review follow-up care with a patient about to be discharged.

Set a goal for the day for a patient with a borderline personality disorder.

Obtain a weight on a patient with bipolar disorder in a hypomanic state.

Answer and Explanation

Correct Answer : A,C,D

Choice A Reason: Perform a neurological assessment on a patient in seclusion to compare the nurse’s findings

This task is an example of overdelegation. Performing a neurological assessment requires specialized knowledge and skills that are beyond the scope of practice for unlicensed assistive personnel. Such assessments should be conducted by a licensed nurse or healthcare provider to ensure accuracy and appropriate clinical judgment.

Choice B Reason: Play cards with 3 patients during unstructured time

This task is appropriate for a PCT. Engaging patients in recreational activities like playing cards does not require specialized clinical skills and falls within the scope of practice for unlicensed assistive personnel. It helps in providing social interaction and can be beneficial for the patients’ mental health.

Choice C Reason: Review follow-up care with a patient about to be discharged

This task is an example of overdelegation. Reviewing follow-up care involves providing important information about the patient’s ongoing treatment and care plan, which requires clinical knowledge and the ability to answer any questions the patient may have. This responsibility should be handled by a licensed nurse or healthcare provider.

Choice D Reason: Set a goal for the day for a patient with a borderline personality disorder

This task is also an example of overdelegation. Setting therapeutic goals for patients, especially those with complex mental health conditions like borderline personality disorder, requires clinical expertise and an understanding of the patient’s treatment plan. This should be done by a licensed nurse or mental health professional.

Choice E Reason: Obtain a weight on a patient with bipolar disorder in a hypomanic state

This task is appropriate for a PCT. Obtaining a patient’s weight is a routine task that does not require specialized clinical skills and falls within the scope of practice for unlicensed assistive personnel. It is a straightforward task that can be safely delegated.

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Correct Answer is A

Explanation

a. Charming, dramatic, seductive, and seeks admiration.

Explanation of Choices

Choice A Reason: Charming, Dramatic, Seductive, and Seeks Admiration

Clients with histrionic personality disorder often exhibit behaviors that are charming, dramatic, and seductive. They seek constant attention and admiration from others. These individuals may use their appearance and behavior to draw attention to themselves and can be very expressive and theatrical. Their need for approval and validation is a core feature of the disorder, and they may go to great lengths to ensure they are the center of attention.

Choice B Reason: Preoccupied with Minute Details and Is a Perfectionist

This description is more characteristic of obsessive-compulsive personality disorder (OCPD), not histrionic personality disorder. Individuals with OCPD are often preoccupied with orderliness, perfectionism, and control. They may focus excessively on details, rules, and schedules, often at the expense of flexibility and efficiency. This behavior is not typically seen in those with histrionic personality disorder.

Choice C Reason: Grandiose, Self-Important, and Has a Sense of Entitlement

These traits are more indicative of narcissistic personality disorder. Individuals with narcissistic personality disorder often have an inflated sense of their own importance, a deep need for excessive attention and admiration, and a lack of empathy for others. They may believe they are superior to others and expect special treatment. While there can be some overlap in behaviors, these traits are not the primary characteristics of histrionic personality disorder.

Choice D Reason: Describes Difficulty Being Alone and Shows Indecisiveness and Submissiveness

This description aligns more closely with dependent personality disorder. Individuals with dependent personality disorder often have difficulty making decisions without excessive advice and reassurance from others. They may feel uncomfortable or helpless when alone and may go to great lengths to avoid being alone. They often exhibit submissive and clingy behavior, seeking others to take care of them.

A. Limit fluid intake to 1,000 mL of fluid per day. B. Adjust the dose if you feel out of control. C. Have serum lithium levels checked every 6 months. D. Do not reduce normal dietary sodium intake.

Correct Answer is D

Explanation

d. Do not reduce normal dietary sodium intake.

Explanation of Choices

Choice A Reason: Limit Fluid Intake to 1,000 mL of Fluid per Day

Limiting fluid intake to 1,000 mL per day is not recommended for clients taking lithium carbonate. Adequate hydration is crucial because lithium can affect kidney function and fluid balance. Dehydration can increase lithium levels in the blood, leading to toxicity. Therefore, clients should maintain normal fluid intake to ensure proper hydration and avoid complications.

Choice B Reason: Adjust the Dose if You Feel Out of Control

Clients should never adjust their lithium dose on their own. Lithium has a narrow therapeutic range, meaning the difference between an effective dose and a toxic dose is small. Any changes in dosage should be made under the supervision of a healthcare provider to avoid the risk of lithium toxicity or subtherapeutic levels. Self-adjusting the dose can lead to serious health risks.

Choice C Reason: Have Serum Lithium Levels Checked Every 6 Months

While regular monitoring of serum lithium levels is essential, checking levels every 6 months may not be sufficient. Initially, serum lithium levels should be checked more frequently, such as every 1 to 2 weeks, until stable therapeutic levels are achieved. After stabilization, levels are typically monitored every 3 to 6 months, depending on the patient’s clinical status and any changes in medication or health condition. Regular monitoring helps ensure the medication remains within the therapeutic range and prevents toxicity.

Choice D Reason: Do Not Reduce Normal Dietary Sodium Intake

Maintaining normal dietary sodium intake is crucial for clients taking lithium. Sodium levels in the body can affect lithium levels; a decrease in sodium intake can lead to higher lithium levels and increase the risk of toxicity. Conversely, an increase in sodium intake can lower lithium levels, reducing its effectiveness. Therefore, clients should be advised to maintain a consistent sodium intake to help stabilize lithium levels in the blood.

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Psychiatric care technicians (PCTs) are unlicensed assistive personnel that are an integral part of the acute care mental healthcare team. Which of the following choices would be an example(s) of overdelegation by the nurse to a PCT? The nurse directs the PCT to (Select All that Apply):

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is scheduled to interview a client with histrionic personality disorder. The nurse can anticipate that the assessment findings will include the following. The client:

Correct Answer is A

Explanation

A client who is prescribed lithium carbonate is being discharged from inpatient care. Which medication information should the nurse teach this client?

Correct Answer is D

Explanation

A client who has just been raped arrives at the Emergency Room. The client is crying, pacing, and cursing their attacker. Which is the priority therapeutic statement for the nurse to make?

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The intervention appropriate for a client who has been manipulating others and has a diagnosis of antisocial personality disorder is to:

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A nurse is preparing to administer fluoxetine 40 mg PO daily. The amount available is fluoxetine 20 mg/mL. How many mL should the nurse administer? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)