During an interview with a non-English-speaking middle-aged woman recently diagnosed with major depressive disorder, the patient's husband states, "She is happy now and doing very well.”. The patient, however, sits motionless looking at the floor and wringing her hands.

A professional interpreter would provide better information due to the fact that a family member in the interpreter role may (Select all that apply.)

Choice A rationale

While a "no self-harm" contract can be a useful tool for enhancing patient accountability and commitment to safety, it is a secondary intervention. Given the immediate, high-risk behaviors associated with poor judgment and impulsivity in ADHD, a contract alone does not provide the necessary physical protection or immediate external control required to prevent potential harm, which necessitates continuous direct observation.

Choice B rationale

Assigning a staff member to one-to-one observation is the highest priority intervention for an individual with poor judgment, high risk-taking behaviors, and impulsivity, as it provides constant, direct visual monitoring. This crucial measure prevents the adolescent from acting on sudden, uncontrolled urges to self-harm or engage in dangerous behaviors, ensuring immediate physical safety until the risk level is professionally reassessed by the multidisciplinary treatment team.

Choice C rationale

Frequent discussions are valuable for building therapeutic rapport and exploring underlying psychological factors, coping mechanisms, and alternative behaviors. However, this is a longer-term, insight-oriented strategy that is secondary to the immediate need for physical safety. It does not, by itself, mitigate the acute risk posed by severe impulsivity and poor judgment.

Choice D rationale

Locked seclusion is a form of physical restraint and is a last-resort intervention used only when a patient presents an imminent, extreme danger to self or others and less restrictive measures have failed. Given the scenario, continuous observation (Choice B) is a more therapeutic, less restrictive, and highly effective safety measure, making seclusion an inappropriate initial priority.

Choice A rationale

Covert data refers to hidden or non-observable information, often related to internal thoughts, feelings, or unconscious processes. While the MSE may infer aspects of covert data (e.g., through speech patterns), the data collected is primarily based on direct observation and the patient's immediate behavioral and cognitive presentation, making it objective.

Choice B rationale

Subjective data is information provided by the client, such as their feelings, perceptions, or history. While the MSE relies on client reports (e.g., mood, thought content), the final collected data is the examiner's objective description of the client's appearance, motor behavior, speech, and responses observed during the examination.

Choice C rationale

Physical data typically refers to physiological measurements (e.g., blood pressure, heart rate, lab results) or somatic findings. Although general appearance is noted in the MSE, its primary focus is on mental and behavioral status, making "physical" too broad or potentially misleading for the core data collected.

Choice D rationale

The Mental Status Examination (MSE) is a systematic, structured observation and assessment designed to collect objective data about a client's current mental state. This includes observable behaviors like appearance, motor activity, speech, and the examiner's objective description of the client's affect, thought process, and cognitive function.