Which action would a nurse take when documenting a patient's affect that appears discordant with the rest of their mood?
Exclusively document verbal behavior
Document both affect and mood and any discrepancies
Separate the documentation into two different entries
Only describe the patient's current affect
The Correct Answer is B
Choice A reason: Exclusively documenting verbal behavior provides an incomplete clinical picture. Nonverbal cues, such as affect (the outward expression of emotion), often provide more honest data than the patient's verbal reports. Ignoring these cues can lead to a missed diagnosis of depression, mania, or other psychological conditions where verbal and nonverbal signals conflict.
Choice B reason: Comprehensive psychiatric and physical assessment requires the documentation of both mood (the patient's internal emotional state as reported by them) and affect (the nurse's objective observation of the patient's emotional expression). Noting a discrepancy—such as a patient reporting deep sadness while laughing (incongruent affect)—is a critical diagnostic finding for mental health evaluation.
Choice C reason: Separating the documentation into different entries is inefficient and makes it difficult for other members of the healthcare team to see the relationship between the findings. To identify patterns of behavior, the mood, affect, and any observed incongruence should be documented together within the same narrative or flow sheet entry.
Choice D reason: Only describing the current affect ignores the patient's subjective experience (their mood). A nurse must assess the "whole" person. Without the context of the reported mood, an observation of affect alone is less meaningful. For example, a "flat affect" is significantly more concerning when the patient also reports feeling hopeless or suicidal.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: Attempting multiple home remedies simultaneously can lead to severe skin irritation, contact dermatitis, and unpredictable chemical interactions. This approach lacks scientific evidence and may exacerbate the inflammatory response of acne vulgaris, potentially leading to permanent scarring or post-inflammatory hyperpigmentation without addressing the underlying hormonal or bacterial causes.
Choice B reason: Increasing the frequency of over-the-counter medicated creams, which often contain benzoyl peroxide or salicylic acid, can excessively dry the stratum corneum. This can damage the skin's moisture barrier, causing redness and peeling, and may trigger compensatory seborrhea, where the skin produces even more oil.
Choice C reason: Washing the face more than 2 times a day can strip the skin of its natural acid mantle and essential lipids. Over-cleansing leads to mechanical irritation of the pilosebaceous units, which can worsen acne lesions. It does not address the deeper cystic or inflammatory components of the condition.
Choice D reason: When conservative management fails, a referral to a dermatologist is necessary for advanced pharmacological intervention. Dermatologists can prescribe systemic retinoids, hormonal therapies, or oral antibiotics to target Propionibacterium acnes and follicular hyperkeratosis. This specialized care is essential to prevent long-term physical scarring and the psychological distress associated with refractory acne.
Correct Answer is D
Explanation
Choice A reason: Beneficence refers to the ethical obligation of healthcare providers to act in the best interest of the patient. While the nurse aims to provide good care, this specific scenario focuses on the patient's right to choose their own path rather than the nurse's duty to provide a benefit.
Choice B reason: Justice involves the fair and equitable distribution of healthcare resources and treatments among all individuals. In this context, the patient's request for non-traditional therapy does not directly involve the allocation of resources or fairness compared to other patients, making this principle less relevant to the individual choice.
Choice C reason: Confidentiality is the ethical and legal duty to protect a patient's private information from unauthorized disclosure. Requesting a specific treatment plan is a matter of decision-making and self-determination rather than a matter of keeping medical records or personal discussions private from third parties or the public.
Choice D reason: Autonomy is the fundamental ethical principle that recognizes a patient's right to self-determination and independent decision-making regarding their own medical care. By respecting a patient's request for non-traditional therapies, the nurse acknowledges the patient's sovereignty over their body and their personal healthcare values and preferences.
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