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

Choice A Reason: Their full therapeutic potential may not be reached until 4 weeks

This statement is correct. Tricyclic antidepressants (TCAs) often take several weeks to reach their full therapeutic effect. Patients may start to notice some improvement within one to two weeks, but it can take up to four weeks or longer for the full benefits to be realized1. This delayed onset is due to the time it takes for the medication to build up in the system and exert its effects on neurotransmitter levels.

Choice B Reason: Aged cheese should not be eaten while taking them

This statement is incorrect. The dietary restriction of avoiding aged cheese is associated with monoamine oxidase inhibitors (MAOIs), not tricyclic antidepressants. MAOIs can cause dangerous interactions with tyramine, a substance found in aged cheese and other foods, leading to hypertensive crises. TCAs do not have this dietary restriction.

Choice C Reason: They should not be given with antianxiety agents

This statement is incorrect. Tricyclic antidepressants can be used in conjunction with antianxiety agents under medical supervision. However, it is important to monitor for potential interactions and side effects. The combination can be beneficial for patients with comorbid depression and anxiety disorders.

Choice D Reason: They may cause hypomania or recent memory impairment

This statement is partially correct but not the best indicator of understanding. While TCAs can cause side effects such as memory impairment and, in rare cases, hypomania, these are not the primary concerns when teaching about the medication. The focus should be on understanding the therapeutic timeline and common side effects.

A. Food is rapidly ingested without proper chewing B. Poor dental and oral hygiene leads to dental caries C. Purging causes the depletion of dietary calcium D. Emesis from purging corrodes the tooth enamel

Correct Answer is D

Explanation

d. Emesis from purging corrodes the tooth enamel

Explanation of Choices

Choice A Reason: Food is Rapidly Ingested Without Proper Chewing

While individuals with bulimia nervosa may engage in rapid eating during binge episodes, this behavior alone does not directly cause dental deterioration. Rapid ingestion of food can lead to other gastrointestinal issues, but it is not the primary cause of dental problems seen in bulimia nervosa. The main dental issues arise from the purging behavior that follows binge eating.

Choice B Reason: Poor Dental and Oral Hygiene Leads to Dental Caries

Poor dental and oral hygiene can indeed lead to dental caries (cavities), but this is not the primary issue in bulimia nervosa. The dental deterioration observed in bulimia nervosa is more specifically related to the effects of repeated vomiting, which introduces stomach acid into the mouth. While maintaining good oral hygiene is important, it does not fully address the unique dental challenges posed by bulimia.

Choice C Reason: Purging Causes the Depletion of Dietary Calcium

Purging can lead to various nutritional deficiencies, including calcium, but the depletion of dietary calcium is not the main cause of dental deterioration in bulimia nervosa. The primary issue is the direct effect of stomach acid on the teeth. Calcium depletion can contribute to overall bone health issues, but it is not the specific cause of the dental erosion seen in bulimia.

Choice D Reason: Emesis from Purging Corrodes the Tooth Enamel

Emesis (vomiting) from purging is the primary cause of dental deterioration in bulimia nervosa. When individuals with bulimia vomit, stomach acid comes into contact with the teeth, leading to enamel erosion. This acid is highly corrosive and can wear away the protective enamel layer, resulting in increased tooth sensitivity, cavities, and other dental issues. This repeated exposure to stomach acid is the most significant factor in the dental deterioration observed in bulimia nervosa.

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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):

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Naxlex Comprehensive Predictor Exams

The nurse assesses that medication teaching about tricyclic antidepressants was understood when the client states:

Correct Answer is A

Explanation

The nurse observes dental deterioration when assessing a client diagnosed with Bulimia Nervosa. Which best explains this assessment finding?

Correct Answer is D

Explanation

The nurse is caring for a client who has been placed on hospice care. Which statement by the client indicates a need for further education?

A nurse is caring for a client who reports that they have been eliminating specific foods from their diet in order to “eat clean.” The nurse should identify that this is an indication of which of the following conditions?

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)

A nurse is providing care for a client who is malnourished and appears exhausted. What data would cause the nurse to suspect the client is a victim of human trafficking? The client:

What is the most important factor for the nurse to assess when doing an admission assessment of a client with a history of alcoholism?

Several children come to the Emergency Department for treatment. The situation that would cause the nurse to have the highest suspicion of child abuse would be:

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

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