A nurse in an emergency department is caring for a client who is experiencing acute alcohol withdrawal. Which of the following actions should the nurse take first?

Choice A reason:The total daily dose of quetiapine is 800 mg, divided into two doses, meaning each dose is 400 mg (800 mg ÷ 2). With 200 mg tablets, each dose requires 400 mg ÷ 200 mg = 2 tablets. This is the correct calculation for the number of tablets per dose.

Choice B reason:Four tablets per dose would result in 800 mg per dose (4 × 200 mg), totaling 1600 mg daily, which doubles the prescribed daily dose of 800 mg. This is incorrect and could lead to an overdose.

Choice C reason:Five tablets per dose would result in 1000 mg per dose (5 × 200 mg), totaling 2000 mg daily, far exceeding the prescribed 800 mg daily dose. This is incorrect and unsafe.

Choice D reason:Three tablets per dose would result in 600 mg per dose (3 × 200 mg), totaling 1200 mg daily, which exceeds the prescribed 800 mg daily dose. This is incorrect and not aligned with the prescription.

Choice A reason: Administering prescribed antipsychotic medication is a priority in acute psychotic episodes to reduce agitation, control hallucinations, and stabilize thought processes. Prompt pharmacologic intervention can prevent escalation of symptoms and potential harm.

Choice B reason: Ensuring a safe environment is essential because patients experiencing psychosis are at increased risk of self-harm or harming others due to delusions and impaired judgment. Safety is always the first priority in emergency psychiatric care.

Choice C reason: Monitoring for side effects of medications is necessary because antipsychotics can cause acute adverse reactions such as dystonia, akathisia, or even neuroleptic malignant syndrome. Early recognition and intervention can prevent complications.

Choice D reason: Leaving the patient alone while highly agitated is unsafe, as the patient may harm themselves or others. Continuous supervision and therapeutic presence are needed.

Choice E reason: Using calm and clear communication builds trust, reduces paranoia, and helps orient the patient. Clear, simple language is effective when the patient’s cognitive processing is impaired.

Choice F reason: Group therapy is inappropriate during acute agitation. The patient must first stabilize before being introduced to therapeutic group settings.

Choice G reason: Ignoring hallucinations and delusions is not therapeutic. While the nurse should not reinforce false beliefs, acknowledging the patient’s feelings and providing reality orientation is best practice.

Choice H reason: Providing detailed explanations about the condition and treatment during acute psychosis is ineffective. The patient is unlikely to process complex information until stabilized.