The patients below were evaluated in the emergency department The psychiatric unit has a bed available. which patient should be admitted?
The patient who is feeling anxiety and a sad mood after separation from a spouse of 10 years.
The patient experiencing dry mouth and tremor related to taking haloperidol (Haldol
The patient who is a new parent and hears voices saying. "Smother your baby"
The patient who self-inflicted a superficial cut on the forearm after a family argument.
The Correct Answer is C
Choice A reason: This patient is experiencing a normal grief reaction or adjustment disorder following a significant life stressor. While the patient feels sadness and anxiety, there is no indication of a loss of reality testing, inability to care for self, or immediate risk of harm to self or others.
Choice B reason: These are common extrapyramidal side effects of first-generation antipsychotics. Dry mouth and tremors are manageable in an outpatient setting by adjusting the medication dosage or adding an anticholinergic agent like benztropine. These symptoms do not constitute a psychiatric emergency requiring acute inpatient hospitalization for stabilization.
Choice C reason: Command hallucinations directed toward harming a vulnerable infant represent a high-risk psychiatric emergency. This patient requires immediate admission to ensure the safety of the child and to begin intensive pharmacological and therapeutic intervention for postpartum psychosis or a similar severe psychotic disorder.
Choice D reason: While self-harm is serious, a superficial cut following a specific argument may indicate a maladaptive coping mechanism rather than an acute suicidal intent. This patient might be stabilized in the emergency department and referred to intensive outpatient therapy unless further assessment reveals active suicidal ideation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Reasoning:
Choice A reason: Zyprexa, or olanzapine, is a second-generation atypical antipsychotic. Unlike first-generation drugs, it antagonizes both dopamine D2 and serotonin 5-HT2A receptors. This dual mechanism allows it to effectively treat positive symptoms like hallucinations while also significantly improving negative symptoms such as social withdrawal, alogia, and flattened affect.
Choice B reason: Haldol, or haloperidol, is a first-generation typical antipsychotic that primarily targets D2 receptors. While it is highly effective at reducing positive symptoms like delusions and agitation, it is generally ineffective for negative symptoms. In some cases, it may even exacerbate negative symptoms due to its potent dopamine blockade.
Choice C reason: Lorazepam is a benzodiazepine used primarily to manage acute anxiety, agitation, or catatonic features in psychiatric patients. It is not classified as an antipsychotic and does not treat the underlying pathophysiology of schizophrenia. It has no efficacy in reducing the chronic positive or negative symptoms of the disorder.
Choice D reason: Loxapine is a first-generation or "typical" antipsychotic, although it sometimes displays properties similar to atypicals. Its primary clinical use is focused on treating positive symptoms of psychosis. It lacks the robust serotonergic activity required to be the expected choice for specifically addressing the negative symptoms of schizophrenia.
Correct Answer is B
Explanation
Reasoning:
Choice A reason: While talking normally is helpful, playing music or maintaining constant chatter can contribute to sensory overload in a patient with delirium. An agitated, delirious patient often lacks the cognitive ability to filter environmental stimuli, and excessive noise can worsen their confusion, fear, and combative behaviors during the acute phase.
Choice B reason: Delirium management requires a "low-stimulus" environment to prevent exacerbating agitation. Limiting visitors to one at a time and encouraging quiet, tactile comfort like hand-holding provides a sense of security without overwhelming the patient's compromised neurological processing. This approach helps the brain recover by reducing unnecessary cognitive demands.
Choice C reason: Allowing a large group of visitors is highly detrimental for a patient with post-operative delirium. The presence of many people, multiple voices, and varied movements creates a chaotic environment that increases the patient's disorientation and risk of injury, such as attempting to climb over side-rails to escape the perceived chaos.
Choice D reason: Providing stimulation through activities is counterproductive during the acute phase of delirium. The brain is currently in a state of metabolic or physiological crisis and needs rest and clear, simple orientation cues rather than "enjoyable" activities that require complex cognitive engagement or physical effort that the patient cannot currently sustain.
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