PTC Observation and Patient Monitoring 2 — Questions and Answers
Question 1: A psychiatric technician observes a patient exhibiting pressured speech, decreased need for sleep, and grandiose statements over the past 24 hours. This cluster of symptoms MOST likely indicates:
- Worsening depressive episode
- Emerging manic episode (Correct answer)
- Onset of psychotic break unrelated to mood
- Anticholinergic side effects
Correct answer: Emerging manic episode
Pressured speech, decreased need for sleep, and grandiosity are hallmark signs of a manic episode and should be reported promptly so the treatment plan can be adjusted.
Question 2: Which vital sign change in a patient taking clozapine (Clozaril) should be reported to the nurse IMMEDIATELY?
- Blood pressure of 118/76 mmHg
- Heart rate of 105 beats per minute with fever and sore throat (Correct answer)
- Respiratory rate of 16 breaths per minute
- Temperature of 98.9°F (37.2°C)
Correct answer: Heart rate of 105 beats per minute with fever and sore throat
Tachycardia with fever and sore throat in a patient on clozapine may indicate agranulocytosis, a life-threatening reduction in white blood cells requiring emergency intervention.
Question 3: A psychiatric technician is monitoring a patient in seclusion. The minimum frequency for checking on the patient per Joint Commission standards is:
- Every 60 minutes
- Every 30 minutes
- Every 15 minutes (Correct answer)
- Every 5 minutes
Correct answer: Every 15 minutes
The Joint Commission requires that patients in seclusion or restraints be monitored at least every 15 minutes for signs of distress, injury, and readiness for discontinuation.
Question 4: When observing a patient for extrapyramidal symptoms (EPS), a psychiatric technician should monitor for all of the following EXCEPT:
- Shuffling gait and mask-like facial expression
- Muscle spasms or abnormal posturing
- Sudden onset of polyuria and polydipsia (Correct answer)
- Inability to sit still and internal sense of restlessness
Correct answer: Sudden onset of polyuria and polydipsia
Polyuria and polydipsia (excessive urination and thirst) are not extrapyramidal symptoms; they may indicate diabetes insipidus or lithium toxicity rather than EPS.
Question 5: A patient on elopement precautions is missing from the unit. The FIRST action the psychiatric technician should take is:
- Search the unit and common areas immediately without notifying anyone
- Notify the charge nurse and initiate the facility's elopement protocol (Correct answer)
- Call the patient's family to ask if they have been contacted
- Document the disappearance and wait 30 minutes before escalating
Correct answer: Notify the charge nurse and initiate the facility's elopement protocol
Immediate notification of the charge nurse and activation of the elopement protocol ensures a coordinated response that prioritizes patient safety and meets regulatory requirements.
Question 6: A psychiatric technician documents 'Patient appears sad' in the observation record. This documentation is BEST described as:
- Objective because it describes observable behavior
- Subjective because 'sad' is an interpretation, not a behavioral observation (Correct answer)
- Appropriate clinical language for psychiatric settings
- Complete and sufficient for medicolegal documentation
Correct answer: Subjective because 'sad' is an interpretation, not a behavioral observation
The word 'sad' is an interpretive label; objective documentation should describe observable behaviors such as 'patient sitting alone, eyes downcast, not responding to greetings.'
Question 7: Which patient behavior during monitoring should a psychiatric technician recognize as a potential precursor to aggressive behavior?
- Quietly reading a book in the dayroom
- Pacing, clenching fists, and making verbal threats (Correct answer)
- Sleeping more than usual during the day
- Requesting extra snacks from the staff
Correct answer: Pacing, clenching fists, and making verbal threats
Pacing, clenching fists, and making verbal threats are escalating behavioral cues that signal increasing agitation and potential for physical aggression.
PTC Observation and Patient Monitoring 2
A psychiatric technician observes a patient exhibiting pressured speech, decreased need for sleep, and grandiose statements over the past 24 hours.
This cluster of symptoms MOST likely indicates: