A 44 year old man has severe pain following surgical fixation of a comminuted ankle fracture. Which is the most appropriate additional analgesic?

Correct Answer: D

Rationale: In this scenario, the most appropriate additional analgesic for a 44-year-old man experiencing severe pain following surgical fixation of a comminuted ankle fracture is option D, patient-controlled intravenous morphine. Patient-controlled intravenous morphine is the most suitable choice due to its ability to provide immediate and effective pain relief for acute and severe pain, which is often experienced post-surgery. The patient-controlled aspect allows the patient to self-administer the medication within preset limits, ensuring pain management is tailored to individual needs without the risk of overmedication. Option A, intramuscular diclofenac, is not the best choice in this situation as it is a nonsteroidal anti-inflammatory drug (NSAID) and may not provide adequate relief for severe acute pain. Option B, oral codeine phosphate, may not be potent enough to manage the intense pain experienced post-surgery, especially in a comminuted fracture scenario where pain can be more severe. Option C, oral oxycodone, while a strong opioid analgesic, may not be the most appropriate initial choice for severe acute pain following surgery when compared to the faster onset and titratable nature of patient-controlled intravenous morphine. In an educational context, it is crucial for healthcare professionals, especially those in psychiatric emergency nursing, to understand the appropriate selection of analgesics based on the severity of pain, individual patient needs, and the nature of the condition. Proper pain management is essential to ensure patient comfort, improve outcomes, and prevent complications associated with uncontrolled pain.

Correct Answer: B

Rationale: The correct answer is B) Disorder of Thought. In this scenario, the patient's belief that people are talking about him and spying on him despite evidence to the contrary is indicative of a disorder of thought, specifically a delusion of persecution. Delusions are fixed false beliefs that are not in line with the person's cultural or religious background. This type of delusion is common in psychiatric disorders such as schizophrenia. Option A) Delusion of persecution is incorrect because it is not a standalone diagnosis but a specific type of delusion that falls under the broader category of disorder of thought. Option C) Hallucination is incorrect because hallucinations involve sensory perceptions without external stimuli, such as hearing voices or seeing things that are not there. The scenario described does not involve hallucinations. Option D) Seen in anxiety disorder is incorrect because the symptoms described are more indicative of a psychotic disorder rather than an anxiety disorder. Educationally, understanding the differences between various psychiatric symptoms is crucial for nurses working in psychiatric emergency settings. Recognizing and correctly identifying symptoms like delusions of persecution can help in providing appropriate care and interventions for patients experiencing psychiatric crises. Nurses must be able to differentiate between different types of symptoms to provide effective care and support for individuals in distress.

Correct Answer: B

Rationale: The correct answer is B) Neuroleptic malignant syndrome (NMS). In this scenario, the patient's presentation of fever, sweating, disorientation, and rigidity after being on haloperidol is indicative of NMS, a rare but potentially life-threatening side effect of antipsychotic medications like haloperidol. NMS is characterized by altered mental status, autonomic dysfunction, hyperthermia, and muscle rigidity. Option A) Acute dystonia presents with sudden-onset muscle spasms and abnormal postures, usually in the head and neck region, which is not consistent with the patient's symptoms. Option C) Viral encephalitis typically presents with symptoms like headache, altered consciousness, and neurological deficits, which do not align with the patient's symptoms and medication history. Option D) Tardive dyskinesia is a movement disorder characterized by repetitive, involuntary movements of the face and body, usually occurring after prolonged use of antipsychotic medications. The acute onset of symptoms in this case is not suggestive of tardive dyskinesia. Understanding the differentiation between these conditions is crucial for nurses working in psychiatric emergency settings to promptly identify and manage potentially life-threatening complications like NMS. Nurses need to be vigilant about monitoring patients on antipsychotic medications for such side effects and take immediate action to ensure patient safety and well-being.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Echolalia. Echolalia is a phenomenon where a person repeats the words or phrases spoken by others, often without fully understanding or engaging in meaningful communication. In psychiatric emergencies, echolalia can be a symptom of various conditions such as autism, schizophrenia, or other neurological disorders. It can indicate cognitive or communication difficulties and may require specific interventions or communication strategies to address the underlying issues. Option A) Coprolalia refers to the involuntary use of obscene or inappropriate language, typically associated with Tourette syndrome, and is not applicable in this case. Option B) Echopraxia is the imitation or repetition of another person's actions or movements, not words, making it an incorrect choice in this context. Option C) Copropraxia is the involuntary performance of obscene or inappropriate gestures, which is not the behavior exhibited in the scenario described. Understanding the difference between these terms is crucial for nurses working in psychiatric settings to accurately assess and provide appropriate care for patients. Recognizing and interpreting behaviors like echolalia can lead to better communication and understanding of the patient's needs, ultimately improving the quality of care provided in psychiatric emergencies.

Correct Answer: C

Rationale: Premature ejaculation is a disorder characterized by the inability to delay ejaculation during sexual activity, leading to distress or interpersonal difficulties. The correct answer is C) Orgasm because premature ejaculation occurs during the orgasm phase of the normal sexual cycle. Option A) Desire is incorrect because it refers to the initial phase when sexual interest or arousal is first triggered. Option B) Arousal is incorrect as it involves physiological changes preparing the body for sexual activity. Option D) Pain is incorrect as it is not a phase of the normal sexual cycle and is unrelated to premature ejaculation. In an educational context, understanding the phases of the normal sexual cycle is crucial for healthcare professionals, especially in psychiatric emergency nursing where issues like premature ejaculation may present. This knowledge helps in accurate assessment, diagnosis, and management of sexual disorders, ensuring comprehensive care for patients experiencing such conditions.