During lunch, a patient cuts herself with a plastic eating utensil. The patient refuses redirection and continues to attempt to cut herself. The patient is safely secured in a restraint chair. What is the next priority action for the nurse?

Notify the provider for a restraint order and assessment.

Advise the cafeteria staff of plastic utensils that can be used as weapons.

Ask staff members how the patient was able to acquire the utensil.

Notify the house supervisor for further direction.

Answer and Explanation

The Correct Answer is A

Choice A reason: Notifying the provider ensures legal and medical oversight for restraints, addressing self-harm risk driven by serotonin deficits and amygdala hyperactivity. This prioritizes patient safety and evaluates underlying psychiatric causes, ensuring appropriate intervention to stabilize neural dysregulation.

Choice B reason: Advising cafeteria staff is a preventive measure but not the priority during acute self-harm. Serotonin-driven impulsivity requires immediate medical assessment, and addressing utensil access is secondary to stabilizing the patient’s acute neurochemical crisis.

Choice C reason: Investigating utensil acquisition is important for future prevention but not urgent. The patient’s self-harm, driven by serotonin deficits and amygdala hyperactivity, requires immediate medical intervention to ensure safety and address acute psychiatric needs first.

Choice D reason: Notifying the house supervisor is administrative, not clinical, and delays direct intervention. Self-harm reflects serotonin dysregulation and amygdala-driven impulsivity, requiring immediate provider assessment for restraints and psychiatric evaluation, making this less urgent.

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Correct Answer is B

Explanation

Choice A reason: Olanzapine does not primarily increase serotonin or norepinephrine. It blocks dopamine D2 and serotonin 5-HT2 receptors, reducing hallucinations driven by mesolimbic dopamine excess in schizophrenia. Increasing monoamines would exacerbate psychosis, not alleviate it, making this mechanism incorrect.

Choice B reason: Olanzapine, an atypical antipsychotic, blocks dopamine D2 receptors in the mesolimbic pathway, reducing excessive dopamine signaling that causes hallucinations in schizophrenia. It also modulates serotonin 5-HT2 receptors, balancing limbic activity, making this the primary mechanism for controlling psychotic symptoms.

Choice C reason: Decreasing neurotransmitter breakdown enzymes is the mechanism of MAOIs, not olanzapine. Olanzapine’s dopamine and serotonin receptor blockade reduces psychotic symptoms, not enzyme activity, making this choice irrelevant to its antipsychotic action in schizophrenia.

Choice D reason: Olanzapine does not normalize serotonin, norepinephrine, and dopamine levels but blocks their receptors, particularly dopamine D2, to reduce hallucinations. Normalizing levels is not its mechanism, as schizophrenia involves dopamine hyperactivity, not deficiency, making this choice inaccurate.

A. Attachment-Based Therapy and Mirtazapine (Remeron). B. Dialectical Behavior Therapy and Lorazepam (Ativan). C. Cognitive Processing Therapy and Sertraline (Zoloft). D. Applied Behavior Analysis and Atomoxetine (Strattera).

Correct Answer is C

Explanation

Choice A reason: Attachment-Based Therapy focuses on interpersonal relationships, not trauma-specific processing, and is less effective for PTSD’s amygdala-driven fear memories. Mirtazapine enhances serotonin and norepinephrine but lacks strong evidence for PTSD, as it primarily addresses depression by modulating alpha-2 adrenergic receptors, not trauma-specific neural hyperactivity.

Choice B reason: Dialectical Behavior Therapy targets emotional regulation for personality disorders, not PTSD’s trauma-specific memories. Lorazepam, a benzodiazepine, enhances GABA activity but is not recommended for PTSD, as it may suppress rather than process trauma-related amygdala hyperactivity, risking dependency and impairing long-term recovery.

Choice C reason: Cognitive Processing Therapy restructures trauma-related cognitive distortions, reducing amygdala hyperactivity and enhancing prefrontal control in PTSD. Sertraline, an SSRI, increases serotonin levels, stabilizing mood and reducing hyperarousal by modulating amygdala-prefrontal circuits, making it a first-line treatment for PTSD’s neurochemical and cognitive symptoms.

Choice D reason: Applied Behavior Analysis is used for autism, not PTSD, and does not address trauma-related neural changes. Atomoxetine, a norepinephrine reuptake inhibitor, targets ADHD by enhancing prefrontal norepinephrine but lacks efficacy for PTSD’s amygdala-driven fear responses, making it unsuitable for trauma treatment.

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During lunch, a patient cuts herself with a plastic eating utensil. The patient refuses redirection and continues to attempt to cut herself. The patient is safely secured in a restraint chair. What is the next priority action for the nurse?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client with schizophrenia is being treated with olanzapine (Zyprexa) 10 mg daily. The client asks the nurse how this medicine minimizes hallucinations. The nurse explains that the mechanism by which olanzapine controls the client's psychotic symptoms is believed to be what?

Correct Answer is B

Explanation

The nurse preparing to teach a patient diagnosed with post-traumatic stress disorder (PTSD) about recommended psychotherapy and psychopharmacology will discuss:

Correct Answer is C

Explanation

A troubled adolescent pulled out a gun in a school cafeteria, fatally shot three people, and injured many others. Hundreds of parents come to the school after hearing news reports. After police arrest the shooter, which action should occur next?

Which finding indicates the successful completion of an individual’s grieving process?

A patient diagnosed with bipolar disorder has rapidly changing mood cycles. The health care provider prescribes an anticonvulsant medication. Which drug should the nurse anticipate will be prescribed?

Positive symptoms seen in schizophrenia are believed to be a result of which type of neurological dysfunction?

A primary intervention strategy for coping with a maturational crisis includes:

A depressed older adult client is being treated with a tricyclic antidepressant (TCA). Which side effects are important to assess for?

The plan of care for a patient in the manic state of bipolar disorder should include which intervention?

A client on an inpatient psychiatric unit yells "My roommate is Satan's crafty minion" and attempts to strangle him. The patient is refusing redirection. What medication should the nurse expect the on-call provider to order?