A 35-year-old patient has been admitted following a mass disaster event. Which nursing actions should be prioritized in this situation? (Select all that apply)

Choice A reason: Three tablets (30 mg) exceed the prescribed 20 mg, risking Paroxetine overdose. This SSRI increases serotonin levels, and excessive dosing may cause serotonin syndrome, with symptoms like agitation or seizures. Scientifically, precise dosing is critical to avoid disrupting neurotransmitter balance, ensuring safe treatment for depression or anxiety.

Choice B reason: Four tablets (40 mg) significantly exceed the prescribed dose, increasing toxicity risk. Paroxetine’s serotonin-enhancing effects can lead to severe side effects, like serotonin syndrome or cardiovascular issues, if overdosed. Scientifically, maintaining therapeutic levels prevents adverse neurological effects, ensuring safe and effective management of mental health conditions.

Choice C reason: One tablet (10 mg) underdoses the patient, providing half the required 20 mg. Subtherapeutic Paroxetine levels fail to adequately increase serotonin, reducing efficacy for depression or anxiety. Scientifically, insufficient dosing may leave neural imbalances unaddressed, risking persistent symptoms and poor mental health outcomes.

Choice D reason: Two tablets (20 mg) match the prescribed dose, ensuring therapeutic serotonin levels for depression or anxiety management. Scientifically, accurate SSRI dosing optimizes neurotransmitter balance, stabilizing mood without risking toxicity. This supports effective treatment, reducing symptoms like low mood or anxiety through targeted neurochemical modulation.

Choice A reason: Reassuring and scheduling follow-up delays action on potential abuse. Unexplained bruises suggest trauma, potentially elevating cortisol and stress responses. Scientifically, delaying intervention risks ongoing harm, as unaddressed abuse can lead to psychological disorders like PTSD, compromising the child’s safety and mental health.

Choice B reason: Documenting and discharging ignores immediate safety concerns. Bruises and discomfort may indicate abuse, triggering stress-related physiological changes. Scientifically, failing to investigate risks further trauma, as unaddressed abuse can exacerbate anxiety or depression, leaving the child vulnerable to ongoing harm without protective intervention.

Choice C reason: Contacting child protective services and further assessing ensures immediate safety. Bruises and discomfort suggest abuse, impacting stress hormones like cortisol. Scientifically, prompt reporting and evaluation protect the child from further trauma, addressing neurobiological stress responses and preventing long-term psychological harm, prioritizing child welfare.

Choice D reason: Confronting the child risks re-traumatization, as children may fear disclosure. Scientifically, direct confrontation can elevate stress responses, increasing cortisol and amygdala activity, potentially worsening trauma-related symptoms. A sensitive, professional assessment is needed to confirm abuse without causing psychological harm or deterring honest communication.