The patients below were evaluated in the emergency department. The psychiatric unit has one bed available. Which patient should be admitted?
The patient who self-inflicted a superficial cut on the forearm after a family argument.
The patient who is a new parent and hears voices saying, "Kill your baby."
The patient experiencing dry mouth and tremor related to taking haloperidol (Haldol).
The patient who is feeling anxiety and a sad mood after separation from a spouse of 10 years.
The Correct Answer is B
Choice A reason: While self-harm requires assessment, a superficial cut following an argument often represents a maladaptive coping mechanism rather than an imminent threat to life. If the patient is now stable and has a safety plan, they may be managed through outpatient crisis services rather than an inpatient bed.
Choice B reason: This patient is experiencing command hallucinations directed toward infanticide, representing an immediate and high-risk psychiatric emergency (postpartum psychosis). This situation requires immediate inpatient admission to ensure the safety of the infant and the parent, and to initiate intensive antipsychotic stabilization and monitoring.
Choice C reason: Dry mouth and tremors are common side effects of haloperidol (anticholinergic and extrapyramidal symptoms). These can usually be managed by adjusting the medication dosage or administering an anticholinergic like benztropine in the emergency department or an outpatient setting; they do not necessitate an acute psychiatric admission.
Choice D reason: Anxiety and sadness following a significant life event like a divorce are normal grief reactions. Unless the patient expresses active suicidal ideation with a plan or an inability to care for themselves, they are best served by community support groups or outpatient therapy rather than inpatient hospitalization.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: Patients' rights are never fully "suspended." Even during a crisis, patients retain the right to the least restrictive intervention and to be treated with dignity. While some rights (like freedom of movement) may be temporarily limited for safety, the legal and ethical framework of patient rights remains active.
Choice B reason: This is a utilitarian perspective that does not align with psychiatric nursing ethics. Care must be individualized. The nurse's duty is to balance the safety of the collective with the rights and clinical needs of the individual, rather than simply dismissing one for the other without specific justification.
Choice C reason: While "least restrictive" care is a goal, waiting for a patient to "regain control" during a behavioral crisis can be dangerous. If a patient is actively destructive or threatening, delaying intervention increases the risk of escalation, injury, and the destruction of the therapeutic environment (milieu).
Choice D reason: In a behavioral crisis, the priority is the safety of the patient, other patients, and the staff. Swift, organized intervention (such as de-escalation, chemical restraint, or physical restraint) is necessary to prevent injury and maintain the stability of the unit's therapeutic environment, ensuring that the milieu remains safe for all.
Correct Answer is B
Explanation
Choice A reason: While family dynamics and meal planning are relevant to the social context of an eating disorder, this question does not provide specific data regarding the patient’s individual intake or nutritional habits. It fails to address the immediate clinical need to evaluate the patient's actual consumption patterns.
Choice B reason: This open-ended question is the most effective way to elicit a detailed dietary recall. It allows the nurse to assess the quantity, variety, and frequency of food intake, as well as identify restrictive behaviors, food rituals, or avoidant patterns that are central to diagnosing and treating eating disorders.
Choice C reason: Asking the patient if they feel fat assesses body image distortion, which is a diagnostic criterion for anorexia and bulimia. However, "feeling fat" is a psychological perception rather than a "pattern of eating." The nurse must distinguish between cognitive distortions and actual behavioral eating habits.
Choice D reason: This question explores the patient's insight and cognitive appraisal of their current physical state. While important for understanding the patient’s motivation and degree of illness denial, it does not provide objective or descriptive data regarding the mechanical patterns of daily food and fluid ingestion.
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