The psychiatric unit has one bed available.
Which client should be admitted from the emergency department?
The client who is a new parent and hears voices saying, "Smother your baby.”.
The client who self-inflicted a superficial cut on the forearm after a family argument.
The client feeling anxiety and a sad mood after separation from a spouse of 10 years.
The client experiencing dry mouth and tremor related to taking antipsychotic medication.
The Correct Answer is A
Choice A rationale
This client poses an immediate and severe risk of harm to others due to command hallucinations. Command hallucinations are auditory hallucinations that instruct the individual to perform an action. These are considered a psychiatric emergency due to the high potential for violence. The client requires immediate inpatient admission for safety and stabilization to protect both the baby and the client.
Choice B rationale
A superficial cut is a self-inflicted injury that is not life-threatening. While this client is in distress and requires evaluation, the risk of immediate, lethal harm is not as high as the client with command hallucinations to harm someone else. This client could likely be managed on an outpatient basis or with a less restrictive intervention than immediate inpatient admission.
Choice C rationale
This client is experiencing an adjustment disorder with depressed mood and anxiety. While the client is in psychological distress, they do not present with a high risk of harm to self or others. This condition can often be treated effectively in an outpatient setting with therapy and possibly medication, without the need for an inpatient psychiatric bed.
Choice D rationale
The client is experiencing side effects from their antipsychotic medication, specifically dry mouth and tremors. This is not a psychiatric emergency but rather a pharmacological issue. These symptoms can be managed by adjusting the medication dosage or switching to a different medication. This can be done in an outpatient setting and does not require an inpatient bed.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Assertive community treatment (ACT) is an intensive, non-traditional community-based mental health service for individuals with severe mental illness who have not responded to traditional outpatient care. A phobic fear of crowded places, while distressing, is typically manageable with exposure therapy or other psychotherapeutic interventions and does not meet the criteria for ACT.
Choice B rationale
A client diagnosed with schizophrenia with multiple hospitalizations in the past year is an ideal candidate for ACT. This service is designed for individuals with severe and persistent mental illness, such as schizophrenia, who have a history of repeated hospitalizations or are at high risk for them. ACT helps them achieve stability and live successfully in the community.
Choice C rationale
An episode of severe anxiety due to a tornado is an acute stress reaction. This is not a chronic mental illness and can often be addressed with crisis intervention and short-term therapy. The client does not meet the criteria for a severe and persistent mental illness that would necessitate the long-term, intensive support provided by an ACT team.
Choice D rationale
A single episode of major depressive disorder is treatable with standard outpatient interventions, including psychotherapy and medication. While depression is a serious illness, a single episode does not typically indicate the need for the intensive, long-term support of an ACT team, which is reserved for the most challenging and persistent cases.
Correct Answer is B
Explanation
Choice A rationale
Noncompliance with medication at home, while a concern, does not necessarily warrant hospitalization on its own unless it leads to a clear and present danger to self or others. The standard of care often involves less restrictive interventions, such as outpatient care, medication management support, or case management, to address noncompliance before resorting to inpatient treatment.
Choice B rationale
Hospitalization for mental illness is generally reserved for clients who pose a clear and present danger to themselves or others. This is due to the principle of least restrictive environment, which mandates that individuals be treated in the least restrictive setting possible. When an individual's behavior escalates to the point of imminent harm, inpatient care is necessary to ensure safety.
Choice C rationale
Limited support systems in the community can increase the risk of relapse and poor outcomes, but it is not a primary criterion for psychiatric hospitalization. Community-based services, such as assertive community treatment (ACT) teams, case managers, or partial hospitalization programs, are typically employed to address inadequate support without the need for inpatient admission.
Choice D rationale
The development of new symptoms during the course of an illness, unless they signify an immediate risk of harm, is usually managed in an outpatient setting. A healthcare provider would likely adjust the treatment plan, such as changing medication or therapy, and monitor the client's response. Hospitalization is not the initial or default response for symptom fluctuation.
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