Chapter 01: Med, Meds, Milieu
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Keltner: Psychiatric Nursing, 8th Edition
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1. A newly licensed asks a nursing recruiter for a description of nursing practice in
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the psychiatric setting. What is the nurse recruiter‘s best response?
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a. —The nurse primarily serves in a supportive role to members of the health care Y.F
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delivery team.‖ L
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b. —The multidisciplinary approach eliminates the need to clearly define the L
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responsibilities of nursing in such a setting.‖ Y.F,T L Y.F
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c. —Nursing actions are identified by the institution that distinguishes nursing from L
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other mental health professions.‖ L
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d. —Nursing offers unique contributions to the psychotherapeutic management of Y.F,T L L
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psychiatric patients.‖ Y,F
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Professional role overlap cannot be denied; however, nursing is unique in its focus on Y. F,T L Y.F,T L Y.F, T L Y.F,T L L
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and application of psychotherapeutic management. Neither the facility nor the
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multidisciplinary team define the professional responsibilities of its members but rather
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utilizes their unique skills to provide holistic care. Ideally, all team members support
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each other and have functions within the team.
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2. Which component of the nursing process will the nurse focus upon to address
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the responsibility to match individual patient needs with appropriate
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services?
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a. Planning
b. Evaluation
c. Assessment
d. Implementation
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Proper assessment is critical for being able to determine the appropriate level of services
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that will provide optimal care while considering patient input and at the lowest cost.
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Planning and implementation utilizes the assessment data to identify and execute actions
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(treatment plan) that will provide appropriate care. Evaluation validates the effectiveness of
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the treatment plan.
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3. An adult diagnosed with paranoid schizophrenia frequent experiences auditory hallucinations
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and walks about the unit, muttering. Which nursing action demonstrates the nurse‘s
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understanding of effective psychotherapeutic management of this client?
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a. Discussing the disease process of schizophrenia with the client and their L
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,b. Minimizing contact between this patient and other patients to assure a stress
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free
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milieu
c. Administering PRN medication when first observing the evidence that the client
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, may be hallucinating Y.F,TL Y.F,T L
d. Independently determining that behavior modification is appropriate to ,T
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decrease
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the client‘s paranoid thoughts YF
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An understanding of psychopathology is the foundation on which the three components
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of psychotherapeutic management rest; it facilitates therapeutic communication and provides
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a basis for understanding psychopharmacology and milieu management. Minimizing
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contact between the patient and others and administering PRN medication
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indiscriminately are nontherapeutic interventions. Using behavior modification to
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decrease the frequency of hallucinations would need to be incorporated into the plan of
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care by the care team.
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4. An adult diagnosed with chronic depression is hospitalized after a suicide attempt.
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Which intervention is critical in assuring long-term, effective client care as described
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by psychotherapeutic management?
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a. Involvement in group therapies Y . F, T L YFL
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b. Focus of close supervision by the unit staff Y.F,T L L
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c. Maintaining effective communication with support system L
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d. Frequently scheduled one-on-one time with nursing staff L
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A critical element of psychotherapeutic management is the presence of a therapeutic
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nurse-patient relationship. One-on-one time with nursing staff will help in establishing this Y.F,T L Y.F,TL L
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connection. While the other options are appropriate and client centered, the nurse-client
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relation is critical in the long-term delivery of quality effective care to this client.
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5. A patient‘s haloperidol dosage was reduced 2 weeks ago to decrease side effects.
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What assessment question demonstrates the nurse‘s understanding of the resulting
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needs of the client?
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a. —Will you have any difficulty getting your prescription refilled?‖ Y.F,TL Y.F,T L Y.F,T L YFL
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b. —Have you begun experiencing any forms of hallucinations?‖ Y.F,TL YF L
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c. —What do you expect will occur since the dosage has been reduced?‖ L
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d. —What can I do to help you manage this reduction in haloperidol therapy?‖ L
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It will be necessary for the nurse to assess for exacerbation of the patient‘s symptoms of
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psychosis as well as for a lessening of side effects. Dosage decrease might lead to the
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return or worsening of positive symptoms such as hallucinations and delusions, and
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negative symptoms such as blunted affect, social withdrawal, and poor grooming. While
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the other options may be appropriate assessment questions, they are not directed at the
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current needs of the client; the identification of emerging psychotic behaviors.
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6. Which statement forms the foundation upon which a nurse should base the implementation
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of psychotherapeutic management to the care of a patient with mental illness?
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b. Omitting any one component will compromise the effectiveness of the treatment. L
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, c. The most important element of psychotherapeutic management is drug therapy.
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d. A therapeutic nurse-patient relationship is the most important aspect of
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. treatment.
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When one element is missing, treatment is usually compromised. No single element is
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more important than the others; however, patients‘ needs govern the application of the
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components and permit judicious use. The remaining options identify components of the
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psychotherapeutic management process.
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7. Which statement most accurately describes a nurse‘s role regarding psychopharmacology?
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a. —You will need to frequently make decisions regarding the administration of PRN L
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medications to help the client manage anger.‖ YF
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c. —Nurses administers medications while evaluating drug effectiveness is a medical L
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responsibility.‖
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d. —To best assure appropriate response, a patient‘s questions about drug therapy should
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be referred to the psychiatrist.‖
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ANS: Y . F , T L A
Nursing assessment and analysis of data might suggest the need for PRN medication as
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patient anxiety increases or psychotic symptoms become more acute. The nurse is the
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health team member who makes this determination. Nurses are responsible for
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monitoring drug effectiveness as well as administering medication. Nurses should assume
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responsibility for teaching patients about the side effects of medications. Nurses cannot alter
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8. When considering environmental aspects of milieu management, which intervention has
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belongings
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dimensions of the milieu. Initiation of suicide precautions are the priority for this client. All
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the remaining options are appropriate but none protect the client from the risk of another
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attempt to self-harm as effectively as one-on-one observation as part of suicide precautions.
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Keltner: Psychiatric Nursing, 8th Edition
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the psychiatric setting. What is the nurse recruiter‘s best response?
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c. —Nursing actions are identified by the institution that distinguishes nursing from L
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d. —Nursing offers unique contributions to the psychotherapeutic management of Y.F,T L L
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psychiatric patients.‖ Y,F
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and application of psychotherapeutic management. Neither the facility nor the
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multidisciplinary team define the professional responsibilities of its members but rather
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utilizes their unique skills to provide holistic care. Ideally, all team members support
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each other and have functions within the team.
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2. Which component of the nursing process will the nurse focus upon to address
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the responsibility to match individual patient needs with appropriate
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services?
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a. Planning
b. Evaluation
c. Assessment
d. Implementation
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that will provide optimal care while considering patient input and at the lowest cost.
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Planning and implementation utilizes the assessment data to identify and execute actions
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(treatment plan) that will provide appropriate care. Evaluation validates the effectiveness of
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the treatment plan.
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3. An adult diagnosed with paranoid schizophrenia frequent experiences auditory hallucinations
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and walks about the unit, muttering. Which nursing action demonstrates the nurse‘s
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understanding of effective psychotherapeutic management of this client?
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a. Discussing the disease process of schizophrenia with the client and their L
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,b. Minimizing contact between this patient and other patients to assure a stress
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free
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milieu
c. Administering PRN medication when first observing the evidence that the client
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decrease
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An understanding of psychopathology is the foundation on which the three components
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of psychotherapeutic management rest; it facilitates therapeutic communication and provides
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a basis for understanding psychopharmacology and milieu management. Minimizing
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contact between the patient and others and administering PRN medication
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indiscriminately are nontherapeutic interventions. Using behavior modification to
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decrease the frequency of hallucinations would need to be incorporated into the plan of
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care by the care team.
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4. An adult diagnosed with chronic depression is hospitalized after a suicide attempt.
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Which intervention is critical in assuring long-term, effective client care as described
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by psychotherapeutic management?
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a. Involvement in group therapies Y . F, T L YFL
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b. Focus of close supervision by the unit staff Y.F,T L L
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c. Maintaining effective communication with support system L
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d. Frequently scheduled one-on-one time with nursing staff L
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A critical element of psychotherapeutic management is the presence of a therapeutic
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connection. While the other options are appropriate and client centered, the nurse-client
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relation is critical in the long-term delivery of quality effective care to this client.
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5. A patient‘s haloperidol dosage was reduced 2 weeks ago to decrease side effects.
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What assessment question demonstrates the nurse‘s understanding of the resulting
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needs of the client?
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a. —Will you have any difficulty getting your prescription refilled?‖ Y.F,TL Y.F,T L Y.F,T L YFL
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c. —What do you expect will occur since the dosage has been reduced?‖ L
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psychosis as well as for a lessening of side effects. Dosage decrease might lead to the
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return or worsening of positive symptoms such as hallucinations and delusions, and
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negative symptoms such as blunted affect, social withdrawal, and poor grooming. While
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the other options may be appropriate assessment questions, they are not directed at the
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current needs of the client; the identification of emerging psychotic behaviors.
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6. Which statement forms the foundation upon which a nurse should base the implementation
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of psychotherapeutic management to the care of a patient with mental illness?
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, c. The most important element of psychotherapeutic management is drug therapy.
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d. A therapeutic nurse-patient relationship is the most important aspect of
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. treatment.
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When one element is missing, treatment is usually compromised. No single element is
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more important than the others; however, patients‘ needs govern the application of the
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components and permit judicious use. The remaining options identify components of the
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psychotherapeutic management process.
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7. Which statement most accurately describes a nurse‘s role regarding psychopharmacology?
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be referred to the psychiatrist.‖
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patient anxiety increases or psychotic symptoms become more acute. The nurse is the
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health team member who makes this determination. Nurses are responsible for
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monitoring drug effectiveness as well as administering medication. Nurses should assume
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responsibility for teaching patients about the side effects of medications. Nurses cannot alter
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prescribed dosages of medications unless they have prescriptive privileges.
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belongings
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dimensions of the milieu. Initiation of suicide precautions are the priority for this client. All
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attempt to self-harm as effectively as one-on-one observation as part of suicide precautions.
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