A registered nurse has accepted a position as staff nurse on a psychiatric unit.
Which statement made by the nurse requires additional instructions regarding the therapies provided on the unit?
You will attend a psychotherapy group that I lead that will help you care for yourself.
You will see your provider daily in a one-to-one session.
You will be given a schedule daily of the groups we would like you to attend.
You will participate in unit activities and groups daily.
The Correct Answer is A
Choice A rationale
The ethical and therapeutic principle of professional boundaries strictly prohibits a nurse from leading a psychotherapy group that a patient in their care attends. The nurse-patient relationship must remain professional; leading a psychotherapy group constitutes a dual relationship, which compromises therapeutic objectivity, introduces conflicts of interest, and violates the ethical standards of professional nursing practice. Such an action requires immediate correction and additional instruction.
Choice B rationale
Daily one-to-one sessions with a psychiatric provider (physician, nurse practitioner) are a common and appropriate component of inpatient psychiatric care. This frequency facilitates daily assessment of mental status, medication effectiveness, and treatment planning adjustments, especially in acute phases. It ensures the provider maintains close oversight of the patient's condition, which is critical for safety and timely intervention in a psychiatric setting.
Choice C rationale
Providing a daily schedule of groups is an expected and therapeutic standard on a psychiatric unit. The structure and predictability of a schedule reduce anxiety and encourage adherence to the therapeutic milieu, which is the purposeful manipulation of the environment to be therapeutic. Group participation is central to learning coping skills and receiving psychoeducation.
Choice D rationale
Active participation in unit activities and groups is a core expectation and a vital aspect of inpatient psychiatric treatment. These activities are designed to facilitate social interaction, improve coping skills, reinforce psychoeducation, and structure the patient's day, aligning with the principles of milieu therapy and recovery-oriented care.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Anticholinergic medications primarily block acetylcholine receptors, commonly leading to side effects like dry mouth, blurred vision, constipation, and urinary retention. They do not typically cause hyperprolactinemia-related effects such as gynecomastia (male breast enlargement), amenorrhea (absence of menstruation), or galactorrhea (milky discharge).
Choice B rationale
First-generation (conventional) antipsychotics, like haloperidol, exert a potent Dopamine-2 receptor antagonism in the tuberoinfundibular pathway. This blockade lifts the dopaminergic inhibition on prolactin release from the anterior pituitary, resulting in hyperprolactinemia, which is the direct cause of gynecomastia, amenorrhea, and galactorrhea.
Choice C rationale
Second-generation (atypical) antipsychotics also block D2 receptors but often have a broader receptor profile. While some (like risperidone) can cause hyperprolactinemia, others are prolactin-sparing or cause it less frequently or severely than the first-generation agents.
Choice D rationale
Third-generation antipsychotics, such as aripiprazole, are often dopamine system stabilizers (partial agonists). They are less likely to cause significant D2 blockade and often have a lower risk of inducing hyperprolactinemia and the associated endocrine side effects compared to both first- and some second-generation agents.
Correct Answer is C
Explanation
Choice A rationale
Rapid, pressured speech, or tachylalia, is a common behavioral manifestation of mania, indicating an accelerated thought process known as a flight of ideas. While it affects communication and social interaction, it is a safety or security need concern (difficulty following rules, potential for anger) or a psychological need, ranking lower than physiological needs in Maslow's Hierarchy.
Choice B rationale
Hyperactive behavior reflects a state of psychomotor agitation and increased energy characteristic of mania, often leading to impulsive or non-goal-directed actions. This is primarily a safety and security need concern due to the risk of accidental injury or harm to self or others, placing it below the fundamental physiological needs in Maslow's hierarchy.
Choice C rationale
Lack of sleep, or insomnia, is a disruption of a fundamental physiological need essential for maintaining homeostasis, physical health, and cognitive function. According to Maslow's Hierarchy of Needs, physiological needs (like sleep, food, water, and breathing) must be met first, making this symptom the highest priority for intervention.
Choice D rationale
Grandiose thoughts are an alteration in thought content, reflecting an inflated sense of self-worth, power, or identity common in mania. This symptom relates to the need for self-esteem or self-actualization in Maslow's model, which are higher-level psychological needs, thus having a lower priority than the client's basic physiological needs.
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