A client who has attempted suicide has an underlying diagnosis of depression. Based on the biochemical function that is most associated with suicidal behavior, the nurse anticipates which medication classification will be ordered for the client?

Choice A reason: Cerebral atrophy is associated with neurodegenerative diseases, not schizophrenia’s positive symptoms. Hallucinations and delusions stem from dopamine hyperactivity in the mesolimbic pathway, not structural brain loss, making atrophy irrelevant to the acute psychotic symptoms described.

Choice B reason: Organic functional changes are vague and not specific to schizophrenia’s positive symptoms. Dopamine excess in the mesolimbic pathway drives hallucinations and delusions, not unspecified functional changes, making this choice too broad and inaccurate for the mechanism.

Choice C reason: Inadequate dopamine is linked to negative symptoms like apathy, due to prefrontal cortex hypofunction. Positive symptoms like hallucinations result from excessive dopamine in the mesolimbic pathway, making low dopamine an incorrect mechanism for these symptoms.

Choice D reason: Positive symptoms like hallucinations and delusions in schizophrenia result from increased dopamine in the mesolimbic pathway, causing hyperactive neural signaling. This dopamine excess overstimulates D2 receptors, leading to psychotic perceptions and beliefs, accurately explaining the neurological dysfunction.

Choice A reason: Asking why may escalate agitation, as anger involves amygdala-driven norepinephrine surges. In a crowded area, this risks further overstimulation, not addressing the immediate need to reduce environmental triggers and stabilize neural hyperactivity for safety.

Choice B reason: Escorting to a quiet area reduces sensory input, calming amygdala-driven anger and norepinephrine release. This de-escalates the situation, engaging prefrontal cortex regulation to prevent further aggression, prioritizing safety in a crowded, stimulating environment.

Choice C reason: Discussing feelings is therapeutic but not the priority in a crowded area. Anger’s amygdala hyperactivity requires immediate de-escalation to reduce norepinephrine-driven impulsivity, making a quiet environment the first step before verbal processing.

Choice D reason: Demanding the patient pick up the table is confrontational, risking escalation of amygdala-driven aggression and norepinephrine surges. It does not address immediate safety or de-escalation needs, making it inappropriate in a volatile, crowded situation.