A client presents to the Emergency Department (ED) after ingesting phencyclidine (PCP). Characteristic behaviors of an individual who has ingested PCP include:

Sedated, heightened senses, withdrawn.

Heightened sensory perceptions, nystagmus, hypotension.

Grandiose delusions, hypotension, quiet.

Violence, psychomotor agitation, hypertension.

Answer and Explanation

The Correct Answer is D

Choice A Reason:

Sedated, heightened senses, withdrawn. This statement is incorrect. While PCP can cause a range of sensory and psychological effects, sedation and withdrawal are not typical primary symptoms. PCP is more likely to cause agitation and aggressive behavior rather than sedation.

Choice B Reason:

Heightened sensory perceptions, nystagmus, hypotension. This statement is partially correct. PCP can cause heightened sensory perceptions and nystagmus (rapid, involuntary eye movements), but hypotension is not a common symptom. Instead, PCP often leads to hypertension (high blood pressure) due to its stimulant effects.

Choice C Reason:

Grandiose delusions, hypotension, quiet. This statement is incorrect. While PCP can cause grandiose delusions, it is more likely to result in agitation and aggressive behavior rather than a quiet demeanor. Hypotension is also not a typical symptom of PCP intoxication.

Choice D Reason:

Violence, psychomotor agitation, hypertension. This statement is correct. PCP intoxication is commonly associated with violent behavior, psychomotor agitation, and hypertension. These symptoms are due to the drug’s stimulant and dissociative effects, which can lead to severe agitation and aggressive behavior.

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Correct Answer is B

Explanation

The correct answer is b.

Choice A Reason:

Expect hyperactivity as a common adverse effect. This statement is incorrect. Atomoxetine is a non-stimulant medication used to treat ADHD and does not typically cause hyperactivity. Instead, it helps improve attention and reduce hyperactivity and impulsiveness. Common side effects of atomoxetine include nausea, vomiting, upset stomach, constipation, dry mouth, loss of appetite, mood changes, feeling tired, dizziness, urination problems, or impotence.

Choice B Reason:

Give the dose in the morning to help prevent insomnia. This statement is correct. Atomoxetine should be taken in the morning to help prevent insomnia, as taking it later in the day can interfere with sleep. The medication can be taken with or without food, and if a second dose is prescribed, it is typically taken in the late afternoon or early evening.

Choice C Reason:

Avoid crowds due to the increased risk for infection. This statement is incorrect. Atomoxetine does not increase the risk of infection, and there is no need to avoid crowds while taking this medication3. Common side effects do not include an increased risk of infection.

Choice D Reason:

Limit caloric intake to prevent excessive weight gain. This statement is incorrect. Atomoxetine is more likely to cause weight loss rather than weight gain. It can decrease appetite, which may lead to weight loss in some patients. Therefore, limiting caloric intake is not necessary while taking atomoxetine.

A. Perform a neurological assessment on a patient in seclusion to compare the nurse’s findings. B. Play cards with 3 patients during unstructured time. C. Review follow-up care with a patient about to be discharged. D. Set a goal for the day for a patient with a borderline personality disorder. E. Obtain a weight on a patient with bipolar disorder in a hypomanic state.

Correct Answer is ["A","C","D"]

Explanation

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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A client presents to the Emergency Department (ED) after ingesting phencyclidine (PCP). Characteristic behaviors of an individual who has ingested PCP include:

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Naxlex Comprehensive Predictor Exams

A nurse is teaching the parents of a school-age child who has ADHD about atomoxetine. Which of the following instructions should the nurse include in the teaching?

Correct Answer is B

Explanation

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):

Correct Answer is ["A","C","D"]

Explanation

The rationale for the nurse needing to be aware of their own feelings while working with the family experiencing domestic violence is best explained as:

In assessing a client diagnosed with borderline personality disorder, which characteristic would the nurse expect to observe?

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.)

A client with major depressive disorder has been taking fluoxetine, an SSRI, for 5 weeks. During the first outpatient visit, the client smiles and states, “I feel like a great weight is off my chest.” How should the nurse interpret this behavior change?

Which of the following assessment findings would lead the nurse to suspect the client has a venous ulcer to the right lower extremity? (SELECT ALL THAT APPLY)

When assessing a client diagnosed with narcissistic personality disorder, the nurse expects to identify which characteristic behavior?

The nurse understands that which factors are central to the dynamic of intimate partner violence?

The nurse is providing discharge instructions to the client taking disulfiram. Which of the following items should the nurse teach the client to avoid?